Long-term Distress Research Articles

Rationale for Early Psychological Intervention Among Disaster Actors in Nairobi County, Kenya

The prevention of long-term psychological distress following traumatic events is a major concern for all. Providing early psychological intervention in disaster management is one of the major attempts in preventing Posttraumatic stress symptoms, which may lead to Posttraumatic Stress Disorder (PTSD). Traumatic events can have a significant impact on individuals’; families and community’s abilities to cope. Intense effect during a traumatic event and its accompanying psychological arousal have been associated with the development of PTSD. The National Disaster Management Policy, 2012 provides an integrated and coordinated disaster Risk management that focuses on preventing the risk of disasters, mitigating their severity, and effective response to disaster recovery. The policy put in place mechanisms to ensure that there is construction and recovery after disaster. However, less emphasis is placed on post-disaster trauma management, counseling services, psychosocial support services, and health services in order to ensure that disaster victims do not suffer from permanent or prolonged disaster-related effects. This study, therefore, sought to evaluate the impact of early psychological intervention in preventing PTSD among disaster actors. Research done in the area has shown very little information if any on psychological aspects in disaster management, yet this is the premises of vulnerability. The specific objective of this study was to assess the rationale for early psychological intervention among disaster actors in Nairobi county, Kenya. The study was guided by two psychological theories; cognitive behavior theory and constructivist self-development theory. Descriptive and correlational survey designs were adopted in the study, and purposive sampling was used to select the disaster actors that comprised of those who provide rescue services, those who provide first aid and those who provide psychosocial support. Directors and deputy directors were also sampled using the same technique. The simple random technique was used to select 400 disaster actors from various disaster response organizations.Purposive sampling was used to select key informants who included directors and deputy directors of disaster operation organizations. Same sampling technique was used in the selection of FGD participants. Data collection employed qualitative and quantitative techniques i.e., questionnaires, interviews, and Focus group discussions. Document analysis guides assisted in gathering secondary data. Reliability of the instruments was done by the test-retest method. The data collected was coded and entered into the computer data sheet using the statistical package for social sciences (SPSS) version 23.0. Descriptive and inferential statistics used in data analysis include frequencies, percentages. A SWOT analysis was also used. Results obtained were presented using tables, graphs, and pie charts. The study then came up with findings which will be significant to the disaster operation organizations in preventing PTSD among disaster actors in the aftermath of disasters in Kenya by giving new insights. The study found out that: the study respondents overwhelmingly favored the need to provide early psychological intervention for disaster management with a percentage of 68 strongly agree and 32 % disagree. SWOT analysis revealed that disaster response organizations were rich with varied strengths and opportunities that were not adequately exploited towards prevention of PTSD among disaster actors. The findings of this study are significant in policymaking and mechanisms pertaining psychological support in recovery after disaster in Kenya emphasis being placed on post-disaster trauma management, counseling and psychosocial support services to ensure that disaster actors do not suffer from permanent or prolonged disaster-related effects. Keywords: Trauma, PTSD, Psychological intervention, Acute stress disorder, disaster actors, SWOT, Vicarious traumatization DOI : 10.7176/JEP/10-36-13 Publication date: December 31 st 2019

Prospective, longitudinal study of risk factors for cancer-related distress in colorectal cancer survivors from prior to surgery until one year after surgery: Results from the ColoCare study.

146 Background: Although cancer-related distress is known to persist long after completion of colorectal cancer (CRC) treatment, factors related to distress are largely unexplored in CRC survivors. We examined changes over time and risk factors for distress in CRC patients over the first year after surgery. Methods: We included 212 CRC patients who consented pre-surgery, with data at 6 and 12 months post-surgery from the ColoCare Study in Heidelberg, Germany. Sociodemographic and lifestyle factors, social support and health-related quality of life (QOL) prior to surgery were evaluated as predictors of cancer-related distress. Distress was measured with the Cancer and Treatment Distress instrument (CTXD). Linear regression analyses examined associations between risk factors and distress. Results: Although overall mean of six distress subscales did not change from 6 to 12 months, distress subscale scores varied over time: health burden subscale score increased ( p < .001), while finances ( p = .004), medical demands ( p < .001), and identity ( p < .001) subscale scores decreased from 6 to 12 months. Uncertainty and family strain subscale scores did not change. Younger age, lower income, advanced cancer stage, poorer social support, and poorer baseline QOL scores predicted worse distress at 6 and 12 months. Conclusions: Cancer-related distress continues unresolved at 6 and 12 months post-surgery in this population of CRC survivors. Although some risk factors are difficult to alter, lack of social support may be modifiable and those at risk can be identified early after diagnosis. Screening for risk factors pre-surgery would allow for targeted interventions including strategies to improve resources for those with low support, thereby reducing long-term distress in CRC survivors.

Medical and socio-occupational predictive factors of psychological distress 5 years after a road accident: a prospective study.

Psychosocial consequences of road accidents are a major clinical problem that incurs significant social, occupational, and economic costs. The purpose of our study was to assess medical and socio-occupational factors of psychological distress in the severely injured 5 years after a road accident. A total of 691 of the 1168 subjects enrolled in a prospective cohort of road accident casualties (ESPARR cohort) responded to both standardized follow-up questionnaires at 1 and 5 years, assessing socio-occupational characteristics, physical and psychological sequelae, pain and perceived quality of life. One quarter of participants exhibited psychological distress 5 years after the road accident; most of whom are women, with low educational level,and suffering from spinal lesions. After adjusting for several factors, psychological distress at 5 years was predicted by female gender and low educational level, and by several other factors observed 1 year after the road accident: poor self-reported quality of life, attention deficit and symptoms of anxiety. Early-stage improvement in the screening and care of mental disorders in road accident casualties should help to reduce long-term psychological distress.

Psychological Distress and Sleep Disturbance Among Female Nurses: Anxiety or Depression?

Introduction: Sleep quality is an important issue in nurses' mental and general health. Long-term psychological distress leads to increased sleep disturbances among nurses. However, which forms of psychological distress are most associated with sleep disturbances is unclear among female nurses. Methodology: To determine which psychological distress factors are associated with sleep disturbances among female nurses. A total of 119 female Taiwanese nurses were recruited and surveyed using the Occupational Stress Indicator-2, Beck Anxiety Inventory, Beck Depression Inventory-II, and Pittsburgh Sleep Quality Index. Results: Overall, 68.9% of the nurses were poor sleepers, and 20.2% and 11.7% of them had more than moderate levels of anxiety and depression, respectively. A logistic regression analysis showed that sleep disturbances were associated with higher levels of depression and poorer general health. Discussion: Compared with anxiety, depression more heavily influences sleep disturbances among female nurses. Depression prevention should thus be a focus of mental health promotion for female nurses.

Long-term psychological distress in breast cancer survivors and their matched controls: A cross-sectional study

IntroductionBreast cancer survivors often experience psychological distress shortly after diagnosis. Long-term psychological effects, however, have not been clearly demonstrated. MethodsThis cross-sectional cohort study included 350 breast cancer survivors and 350 age-matched and general-practitioner-matched women. The median follow-up was 10 years. Using logistic regression we compared breast cancer survivors with controls on having (severe) symptoms of depression and/or anxiety, as measured with the Hospital Anxiety and Depression Scale. In multivariable logistic regression, we adjusted the results for a history of depression or prescription of antidepressants. ResultsLarger proportions of breast cancer survivors experienced symptoms of depression (10.6%) compared with controls (4.9%) and symptoms of anxiety (18.6%) compared with controls (16.3%). The odds of symptoms of depression (OR 2.3, 95%CI 1.3–4.2), severe symptoms of depression (OR 3.3, 95%CI 1.1–10.3) and severe symptoms of anxiety (OR 2.1, 95%CI, 1.1–4.0) were significantly higher for breast cancer survivors than for controls, even after adjusting for history of depression or prescription of antidepressants. No significant difference was seen for mild symptoms of anxiety. ConclusionsBreast cancer survivors have an increased risk of symptoms of depression, including severe symptoms, and severe symptoms of anxiety compared with controls, for up to at least 10 years after diagnosis.

Negative effects associated with internet-delivered cognitive behaviour therapy: An analysis of client emails

Internet-delivered cognitive behaviour therapy (ICBT) is an efficacious form of treatment for anxiety and depression, yet it is still possible for clients to experience negative effects associated with treatment. In the ICBT literature, the term negative effects is broadly used to refer to all potentially adverse or unwanted events or experiences that are perceived as undesirable by the client and may or may not be associated with long-term symptoms or distress. Previous ICBT studies have asked clients to retrospectively describe negative effects at post-treatment; however, no research has examined the content of clients' emails to their therapist to see whether clients are reporting negative effects as they arise. In the current study, 96 clients (80 completers; 16 non-completers) were randomly selected from a published ICBT trial and directed content analysis was used to examine client emails for mention of negative effects. In addition, correlational analyses were used to examine the relationship between negative effects and: 1) demographic characteristics; 2) treatment engagement; 3) treatment satisfaction; 4) working alliance; and 5) symptom outcomes among completers. The results indicated that 61.5% of clients experienced at least one negative effect during treatment, although total number of negative effects was not significantly correlated with client demographic characteristics, lessons completed, working alliance, treatment satisfaction, or symptom outcomes. Among completers, technical difficulties, implementation problems, and negative emotional states were the most commonly reported negative effects, whereas dropout was the most commonly reported negative effect by non-completers. Negative effects that have been identified in previous research, such as symptom deterioration, novel symptoms, and severe adverse events, were not identified in client emails. The high incidence of negative effects in the current study suggests there may be value in systematically monitoring client emails for negative effects throughout treatment as a supplement to retrospective post-treatment reports. This will give therapists the opportunity to intervene as negative effects occur and potentially mitigate any impact they have on treatment outcomes. Future research, both qualitative and quantitative, is needed to gain a more nuanced understanding of negative effects associated with ICBT.

Long-term distress in older patients with cancer: a longitudinal cohort study.

BackgroundReceiving a cancer diagnosis can be a major life event which causes distress even years after primary treatment.AimTo examine the prevalence of distress in older patients with cancer (OPCs) up until 5 years post-diagnosis, and identify predictors present at time of diagnosis. Results are compared with reference groups of middle-aged patients with cancer (MPCs) and older patients without a cancer diagnosis (OPs).Design & settingOPCs, MPCs, and OPs participated in a longitudinal cohort study in Belgium and the Netherlands by filling in questionnaires at designated time points from 2010–2019.MethodData from 541 patients were analysed using multivariable logistic regression analyses.ResultsAt baseline, 40% of OPCs, 37% of MPCs, and 17% of OPs reported distress. After 5 years, 35% of OPCs, 23% of MPCs, and 25% of OPs reported distress. No significant predictors for long-term distress in OPCs and OPs were found. For MPCs, it was found that baseline distress (odds ratio [OR] 2.94; 95% confidence intervals [CI] = 1.40 to 6.19) and baseline fatigue (OR 4.71; 95% CI = 1.81 to 12.31) predicted long-term distress.ConclusionDistress is an important problem for people with cancer, with peaks at different moments after diagnosis. Feelings of distress are present shortly after diagnosis but they decrease quickly for the majority of patients. In the long term, however, OPCs in particular appear to be most at risk for distress. This warrants extra attention from primary healthcare professionals, such as GPs who are often patients’ first medical contact point. More research into risk factors occurring later in an illness trajectory might shed more light on predictors for development of long-term distress.

Multiple session early psychological interventions for the prevention of post-traumatic stress disorder.

Background The prevention of long-term psychological distress following traumatic events is a major concern. Systematic reviews have suggested that individual Psychological Debriefing is not an effective intervention at preventing post traumatic stress disorder (PTSD). Recently other forms of intervention have been developed with the aim of preventing PTSD. Objectives To examine the efficacy of multiple session early psychological interventions commenced within three months of a traumatic event aimed at preventing PTSD. Single session individual/group psychological interventions were excluded. Search methods Computerised databases were searched systematically, the most recent search was conducted in August 2008. The Journal of Traumatic Stress and the Journal of Consulting and Clinical Psychology were handsearched for the last two years. Personal communication was undertaken with key experts in the field. Selection criteria Randomised controlled trials of any multiple session early psychological intervention or treatment (two or more sessions) designed to prevent symptoms of PTSD. Data collection and analysis Data were entered using Review Manager software. The methodological quality of included studies was assessed individually by two review authors. Data were analysed for summary effects using Review Manager 4.2. Mean difference was used for meta-analysis of continuous outcomes and relative risk for dichotomous outcomes. Main results Eleven studies with a total of 941 participants were found to have evaluated brief psychological interventions aimed at preventing PTSD in individuals exposed to a specific traumatic event, examining a heterogeneous range of interventions. Eight studies were entered into meta-analysis. There was no observable difference between treatment and control conditions on primary outcome measures for these interventions at initial outcome (k=5, n=479; RR 0.84; 95% CI 0.60 to 1.17). There was a trend for increased self-report of PTSD symptoms at 3 to 6 month follow-up in those who received an intervention (k=4, n=292; SMD 0.23; 95% CI 0.00 to 0.46). Two studies compared a memory structuring intervention against supportive listening. There was no evidence supporting the efficacy of this intervention. Authors' conclusions The results suggest that no psychological intervention can be recommended for routine use following traumatic events and that multiple session interventions, like single session interventions, may have an adverse effect on some individuals. The clear practice implication of this is that, at present, multiple session interventions aimed at all individuals exposed to traumatic events should not be used. Further, better designed studies that explore new approaches to early intervention are now required.

Rapid Assessment of Needs and Services in Long-Term Care

With the growing number of older population, our society raises the need to organise various forms of care. In contemporary society, this is considered to be a long-term care system. Since Slovenia does not yet have a long-term care system based on long-term care legislation, while the demographic trends show a great need for it, it is essential to investigate the needs of older people and the possible responses to their needs. By using the method of rapid assessment of needs and services in the Municipality of Straža, we have identified the nature and extent of long-term distress, and sought effective responses to the needs of older people following the modern guidelines of care and substitutions for institutional care. We have found that the population of the municipality is old, the young population is moving away, and the middle generation commutes daily to work outside the municipality. There is no one available to take care of the older population and this trend will continue in the future. The solutions may be found in the organisation of community assistance within the municipality and in regional integration. When planning new services, however, the trend of lowering the quality of well-being of older people, overcoming the prevailing taboos about the phenomena of old age and strengthening the autonomy and power of older people, their social network and introducing modern information and communication technology should be taken into account in the context of social policy.

P141 A Mixed Methods Analysis Examining Differential Patterns of Long-Term Distress From Weight Stigma

Background As many as 40% of adults have experienced weight stigma, yet little is known about why some individuals are more distressed by weight stigma than others. Qualitative research is limited in this field but may help inform this understudied question. Objective Using a mixed method design, we compared individuals who described lasting impacts from prior experiences of weight stigma to individuals who expressed no longer being distressed by these experiences. We assessed how these groups differ in weight bias internalization and other health indices. Study Design, Settings, Participants Participants (n = 425) were part of a larger study of adults enrolled in a commercial weight management program. Participants completed online self-report questionnaires and an open-ended question asking them to share their experiences with weight stigma. Study analyses focused on participants whose open-ended responses were coded as having either a lasting impact from weight stigma (n = 247) or no longer feeling distressed by weight stigma (n = 178). Measurable Outcome/Analysis Linear regressions examined the associations between group membership (i.e. belonging to the ‘lasting impact’ group in reference to the ‘no longer distressed’ group) and internalized weight bias, perceived stress, and mental as well as physical health. Results Belonging to the ‘lasting impact’ group was associated with greater internalized weight bias (P Conclusion Weight bias internalization may play a contributing role to the lasting impact that people experience from weight stigma. Longitudinal research is needed to examine these relationships over time. Funding Weight Watchers.

Association between long-term stressors and mental health distress following the 2013 Moore tornado: a pilot study

PurposeStress has considerable impacts on human health, potentially leading to issues such as fatigue, anxiety and depression. Resource loss, a common outcome of disasters, has been found to contribute to stress among disaster survivors. Prior research focuses heavily on clinical mental health impacts of disaster experience, with less research on the effect of cumulative stress during long-term recovery. To address this gap, the purpose of this paper is to examine the influence of stressors including resource loss and debt on mental health in a sample of households in Moore, Oklahoma, impacted by a tornado in 2013.Design/methodology/approachFor this pilot study, questionnaires were mailed to households residing along the track of the May 2013 tornado in Moore, OK. Descriptive statistics were calculated to report sample characteristics and disaster experience. Independent associations between disaster losses and demographic characteristics with the outcome mental health were examined withχ2and unadjusted logistic regression analysis. Adjusted logistic regression models were fit to examine resource loss and mental health.FindingsFindings suggest that the tornado had considerable impacts on respondents: 56.24 percent (n=36) reported that their homes were destroyed or sustained major damage. Greater resource loss and debt were associated with mental health distress during long-term recovery from the Moore, OK, 2013 tornadoes.Research limitations/implicationsThe association between resource loss and mental health point to a need for interventions to mitigate losses such as bolstering social support networks, incentivizing mitigation and reducing financial constraints on households post-disaster.Originality/valueThis study contributes to a better understanding of long-term, accumulated stress post-disaster and the impact on health to a literature heavily focused on clinical outcomes.

Understanding carers\u2019 fall concern and their management of fall risk among older people at home

BackgroundMany older people (care recipients) experience long-term psychological distress due to the fear of falling again. Falls can affect carers due to concerns about their care recipients falling. Understanding carers’ fall concern is crucial to determine if carers are coping with the provision of care or have adequate knowledge and support in preventing their care recipients from falling at home.MethodsA descriptive qualitative study was conducted to explore carers’ concern about their care recipients being at risk of falling and their management of fall risk at home. Twenty-two carers were recruited from two research registers and a large tertiary hospital in a regional centre of Australia. Carers were interviewed face-to-face, or by telephone using a semi-structured interview guide about their fall concern. The data was analysed using an inductive content analysis method.ResultsEight major themes emerged from the interviews. Four themes described key factors influencing carers’ fall concern which include: 1) carers’ perception of fall and fall risk, 2) care recipients’ behaviour and attitude towards fall risk, 3) care recipients’ health and function, and 4) care recipients’ living environment. Another four themes described the management of care recipients’ fall risk which include: 5) fall prevention strategies used, 6) risk of preventing falls, 7) support from family and friends, and 8) support from healthcare professionals.ConclusionsThe findings from this qualitative study provide an insight into the carers’ awareness of fall risk, knowledge, and the availability of support in preventing their care recipients from falling at home. Healthcare professionals are encouraged to include carers and address their fall concern to improve fall prevention programmes for care recipients at risk of falling at home.

Utilization of mental health services among survivors of testicular cancer: A population-based study.

e16062 Background: Testicular cancer survivors may experience long-term psychological distress related to their diagnosis and treatment. Measurement of mental health service use (MHS) is an objective way to quantify the incurred burden of psychological distress. Here we describe patterns of MHS use among survivors of testicular cancer in a single-payer health system. Methods: The Ontario Cancer Registry was linked to electronic treatment records to identify all incident cases of testicular cancer treated with orchiectomy in the Canadian province of Ontario during 2004-2010. Mental health clinical visits were identified from records of hospital admission, emergency room visits and out-patient physician billing records. Results: The study cohort included 1877 patients; mean age was 35 and 61% had pure seminoma. Two thirds of patients (66%, 1230/1877) were initially treated with active surveillance. In the 2-year period prior to orchiectomy, 24% (443/1877) of patients had MHS use. Post-orchiectomy, the prevalence of MHS use was 18% (331/1877), 23% (431/1877) and 30% (572/1877) at 6, 12 and 24 months, respectively. The use of MHS was greatest in the peri-diagnostic/surgical period. Rates of MHS visits, 3 months before, 0-3 months after, 4-6 months after and 2 years after orchiectomy were 11%, 14%, 10%, and 6%, respectively. Post-orchiectomy MHS use was greatest among those with baseline MHS use. The prevalence of MHS use for patients with and without baseline MHS use was 40% (175/443) vs 11% (156/1434, p < 0.001) at 6 months; 51% (225/443) vs 14% (206/1434, p < 0.001) at 12 months; and 61% (271/443) vs 21% (301/1434, p < 0.001) at 24 months post-orchiectomy. Post-orchiectomy MHS use did not vary by initial treatment strategy (active surveillance vs upfront treatment, p = 0.435). Older patients were more likely to have MHS visits at all time periods than younger patients; MHS rates at 6 months were 15% (93/631) vs 18% (112/625) vs 20% (126/621) for ages 16-29, 30-39, and 40+ years respectively (p = 0.035). Conclusions: MHS use among survivors of testicular cancer is common, particularly in the peri-diagnostic and surgical period. The rate of MHS use is highest among those patients with a history of prior MHS use. Clinicians should screen for the presence of psychological distress among survivors of testicular cancer.

A Longitudinal Examination of Heart-Rate and Heart Rate Variability as Risk Markers for Child Posttraumatic Stress Symptoms in an Acute Injury Sample

Heart rate (HR) alterations in the immediate aftermath of trauma-exposure have been proposed to be potentially useful markers for child and adolescent posttraumatic stress disorder (PTSD). However, it is not yet clear if this holds true for measures taken more distal to the trauma, and no studies have investigated the predictive validity of more sensitive HR variability (HRV) indices. We recruited 76 parent-child pairs (child age 6 to 13 years) after the child experienced a traumatic event leading to presentation at a hospital emergency department. At 1-month post trauma (T1), HR recordings were obtained at rest, and while children verbally recounted their traumatic experience, both alone and together with a parent. Child post-traumatic stress symptoms (PTSS) were assessed concurrently (T1), and at 3 (T2) and 6-month (T3) follow-ups. We found that for T1, elevated mean HR during trauma narratives, but not at baseline, was positively associated with PTSS, with some evidence that HRV-indices were negatively cross-sectionally associated with PTSS. Furthermore, T1 HR indices predicted PTSS at T2 and partially at T3, although these effects did not hold when T1 PTSS were added to the model. Findings suggest that, consistent with the adult literature, HR indices in children may be a concurrent marker of higher PTSS and may be predictive of longer term distress. The findings encourage further investigations that track child HR and HRV in relation to PTSS over time after trauma, in order to examine how biological profiles evolve in those with persistent symptoms.

Long-Term Economic Distress, Cultural Backlash, and Support for Brexit

Economic and cultural factors are often presented as alternative explanations of Brexit. Most studies have failed to recognize the interplay between contextual economic factors and individual attitudes such as nativism and Euroscepticism. We argue that both economic and cultural factors matter to explain the outcome of the referendum. Economic factors are critical because they shape cultural attitudes. British citizens who live in economically depressed and declining districts are more likely to develop anti-immigrant and Eurosceptic views. These cultural grievances, in turn, explain support for Brexit. Using both aggregate economic and electoral data at the local level (380 districts) and data from the 7th wave of the British Election Study 2014-2017 panel, we find strong support for our argument that cultural grievances mediate the effect of long-term economic decline on support for Brexit. Our results have important policy implications, and suggest targeted economic policies are necessary to protect the “losers of globalization.”

Impact of post-traumatic stress symptoms on the health-related quality of life in a cohort study with chronically critically ill patients and their partners: age matters

BackgroundSurvivors of an acute critical illness with continuing organ dysfunction and uncontrolled inflammatory responses are prone to become chronically critically ill. As mental sequelae, a post-traumatic stress disorder and an associated decrease in the health-related quality of life (QoL) may occur, not only in the patients but also in their partners. Currently, research on long-term mental distress in chronically critically ill patient-partner dyads, using appropriate dyadic analysis strategies (patients and partners being measured and linked on the same variables) and controlling for contextual factors, is lacking.MethodsThe present study investigates the interdependence of post-traumatic stress symptoms (PTSS) and the health-related QoL in n = 70 dyads of chronically critically ill patients and their partners, using the Actor-Partner-Interdependence Model (APIM) under consideration of contextual factors (age, gender, length of partnership). The Post-traumatic Stress Scale (PTSS-10) and Euro-Quality of Life (EQ-5D-3L) were applied in both the patients and their partners, within up to 6 months after the transfer from acute care ICU to post-acute ICU.ResultsClinically relevant post-traumatic stress symptoms were reported by 17.1% of the patients and 18.6% of the partners. Both the chronically critically ill patients and their partners with more severe post-traumatic stress symptoms also showed a decreased health-related QoL. The latter was more pronounced in male partners compared to female partners or female patients. In younger partners (≤ 57 years), higher values of post-traumatic stress symptoms were associated with a decreased QoL in the patients.ConclusionsMental health screening and psychotherapeutic treatment options should be offered to both the chronically critically ill patients and their partners. Future research is required to address the special needs of younger patient-partner dyads, following protracted ICU treatment.Trial registrationGerman Clinical Trials Register No. DRKS00003386. Registered 13 November 2011

Parental depression and diabetes-specific distress after the onset of type 1 diabetes in children.

To examine trajectories of two types of type 1 diabetes (T1D) specific distress (i.e., daily T1D management and worries about the future and long-term complications) and the moderating role of parental depression in parents of children newly diagnosed with T1D. A total of 126 families of 5- to 9-year-olds with new-onset T1D enrolled in the study. One-hundred twenty-five families completed study measures at baseline, 102 at 6-month follow-up, and 89 at 12-month follow-up. Parents completed measures of depression and T1D-specific distress concerning daily T1D management and worries about the future and long-term complications at baseline and at 6- and 12-month follow-ups. We used multilevel modeling to examine 12-month trajectories of daily and long-term T1D-specific distress and to examine if parental depression modified these trajectories. Results showed a significant reduction in daily T1D-specific distress from baseline to 6-month follow-up and maintenance of daily T1D-specific distress from 6- to 12-month follow-up. The significant interaction of baseline parental depression and time indicated that parents with depressive symptoms had a smaller reduction in daily T1D-specific distress from baseline to 6-month follow-up compared to parents without depressive symptoms. Findings for long-term T1D-specific distress indicated that parents with depressive symptoms reported higher distress across all assessment points, with peak long-term T1D-specific distress for parents with depressive symptoms occurring at 6-month follow-up. Many parents experienced significant T1D-specific distress for a period of time following their child's initial diagnosis and this distress appears to be exacerbated by parental depressive symptoms. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Long-term psychological distress of Bosnian war survivors: an 11-year follow-up of former displaced persons, returnees, and stayers

BackgroundResearch on the long-term mental health consequences of war and displacement among civilians who live in post-conflict countries is rare. The aim of this study was to examine the developmental trajectories and predictors of general psychological distress in three samples of Bosnian war survivors over an 11-year period.MethodsIn 1998/99, about three years after the war in Bosnia and Herzegovina, a representative sample of 299 adult Sarajevo citizens was examined in three subsamples: individuals who had stayed in Sarajevo throughout the siege, individuals who had been internally displaced, and refugees who had returned. Of the 138 study participants who could be located 11 years later, 100 were re-assessed (71%) using the Brief Symptom Inventory.ResultsOver time, psychological symptoms and general psychological distress decreased in those survivors who had stayed and increased in returnees. Former displaced persons did not show any significant changes. After controlling for other factors, cumulative trauma exposure before and during the war predicted general psychological distress at baseline. Eleven years later, higher trauma exposure during and after the war, returnee status, and more current stressors were all associated with higher levels of general psychological distress.ConclusionsLevels of psychological symptoms remained high in three subsamples of Bosnian war survivors. The differential symptom trajectories may correspond to distinct war experiences and contemporary stressors. Still, the cumulative effect of war traumata on mental distress persisted more than a decade after war and displacement, although the influence of current stressors seemed to increase over time.

High-dose-rate brachytherapy for high-grade vaginal intraepithelial neoplasia: a dosimetric analysis.

PurposeDue to the rarity of vaginal intraepithelial neoplasia (VAIN), it is impossible to define the best treatment approach or to assess vaginal morbidity. However, brachytherapy (BT) could be a valuable choice for VAIN grade 3 (VAIN3). The aim of this paper was to report a single-institution study of the application of high-dose-rate BT and to evaluate clinical outcomes as well as to investigate the dose-effect relationship for vaginal stenosis.Material and methodsWe retrospectively collected hospital records and treatment plans of 14 consecutive women treated in our department from August 2010 to August 2016, with HDR-BT delivered using iridium-192 by a remote after-loading system. Doses in 3D-planned treatment based on computed tomography (CT) were prescribed in high-risk clinical target volume (HR-CTV) at the vaginal wall. Vaginal stenosis was defined as vaginal shortening/narrowing according to CTCAE4.1. The International Commission on Radiation Units & Measurements (ICRU) bladder and rectal points were used for dose report analysis. The posterior-inferior border of the symphysis points was used to derive reference points. The median age of the enrolled women was 60 years, and the median total radiation dose delivered was 35 Gy.ResultsDuring a median period of 15 days, the treatment was well tolerated, and no interruption was necessary. Acute toxicity was minimal, whereas late toxicity appeared in 4 patients as G2 and in 3 patients as G3 vaginal stenosis. Patients with stenosis G ≥ 2 received a higher median dose to the rectal point and were mainly over 60 years old.ConclusionsPatients with VAIN3 seemed to benefit from BT. It is generally assumed that the vagina is radio-resistant, and no constraints have yet been set, but sexual dysfunction after BT is an important cause of long-term distress. Finding applicable dose limits to the vagina could improve patients’ quality of life.

재무적 곤경, 한계기업으로의 전이, 그리고 이익조정과의 관련성

재무적 곤경, 한계기업으로의 전이, 그리고 이익조정과의 관련성