Long-term Distress Research Articles

The Accuracy of Financial Distress Prediction During the COVID-19 Pandemic on Health Sub Sector Companies

During the recent COVID-19 pandemic, most countries are in a phase of slowing economic growth that causes long-term financial distress and leads to bankruptcy. This paper describes the accuracy of financial distress prediction of the healthcare sub-sector companies using the Altman Modified Z-Score, Springate, and Zmijewski methods. The level of accuracy is determined based on the suitability of the calculation results of the three models with the company’s bankruptcy data published on the Indonesia Stock Exchange and strengthened by the analysis based on the calculation of the type error I and II. Based on the level of accuracy and error types I and II, the Springate is the most accurate method in analyzing the financial distress prediction of the healthcare sub-sector companies with an accuracy rate of 91.4275. Comparing financial performance before and after the COVID-19 pandemic, the mean difference test shows that there is no significant difference in financial performance before and after the COVID-19 pandemic.

Australian Rural Caregivers’ Experiences in Supporting Patients With Kidney Failure to Access Dialysis and Kidney Transplantation: A Qualitative Study

Caregivers of patients with chronic kidney disease from rural communities play a crucial role in access to dialysis and transplantation, but they face many challenges including geographical distance, financial hardship, and limited support. This study aimed to inform strategies to overcome these challenges by describing the experiences of caregivers of patients with kidney failure from rural Australian communities in accessing kidney replacement therapy. Qualitative study. 18 adult caregivers of Australian rural patients with kidney failure treated with dialysis or kidney transplantation. Semistructured interviews were conducted. Interview transcripts were thematically analyzed. The 18 participants were aged 20 to 78years; 13 (72%) were female, and 13 (72%) were the spouse/partner of the patient. We identified 5 themes: devastating social isolation (difficult periods of separation, exclusion from peers, forced relocation); financial dependency and sacrifice (burgeoning out-of-pocket costs, disruption to work life, foregoing autonomy); ongoing psychological trauma (concern for neglect and stress on children, long-term emotional distress); overwhelmed by multifaceted roles and expectations (patient advocacy, uncertainty in navigating multiple health systems); and persistent burden of responsibility (loss of self-identity, ongoing travel requirements, scarcity of psychosocial support, unpreparedness for treatment regime). The study was conducted in a high-income, English-speaking country with universal health insurance, which may limit the transferability of the findings. Australian rural caregivers of people with kidney failure treated by maintenance dialysis or transplantation experience an exhausting physical, financial, and psychological burden. Strategies to address these profound challenges are needed. This interview-based study elicited the challenges faced by people and family members who care for patients from rural towns who are receiving dialysis or kidney transplantation. The barriers and difficulties reported included traveling long distances, needing to move to larger towns and leaving their homes, feeling concerned for the long-term effects on their children, physical exhaustion, and financial issues. Additional efforts are needed to identify the means by which caregivers and their families in rural towns can obtain support to care for those with kidney failure.

Intravenous IgM-enriched immunoglobulins in critical COVID-19: a multicentre propensity-weighted cohort study

BackgroundA profound inflammation-mediated lung injury with long-term acute respiratory distress and high mortality is one of the major complications of critical COVID-19. Immunoglobulin M (IgM)-enriched immunoglobulins seem especially capable of mitigating the inflicted inflammatory harm. However, the efficacy of intravenous IgM-enriched preparations in critically ill patients with COVID-19 is largely unclear.MethodsIn this retrospective multicentric cohort study, 316 patients with laboratory-confirmed critical COVID-19 were treated in ten German and Austrian ICUs between May 2020 and April 2021. The primary outcome was 30-day mortality. Analysis was performed by Cox regression models. Covariate adjustment was performed by propensity score weighting using machine learning-based SuperLearner to overcome the selection bias due to missing randomization. In addition, a subgroup analysis focusing on different treatment regimens and patient characteristics was performed.ResultsOf the 316 ICU patients, 146 received IgM-enriched immunoglobulins and 170 cases did not, which served as controls. There was no survival difference between the two groups in terms of mortality at 30 days in the overall cohort (HRadj: 0.83; 95% CI: 0.55 to 1.25; p = 0.374). An improved 30-day survival in patients without mechanical ventilation at the time of the immunoglobulin treatment did not reach statistical significance (HRadj: 0.23; 95% CI: 0.05 to 1.08; p = 0.063). Also, no statistically significant difference was observed in the subgroup when a daily dose of ≥ 15 g and a duration of ≥ 3 days of IgM-enriched immunoglobulins were applied (HRadj: 0.65; 95% CI: 0.41 to 1.03; p = 0.068).ConclusionsAlthough we cannot prove a statistically reliable effect of intravenous IgM-enriched immunoglobulins, the confidence intervals may suggest a clinically relevant effect in certain subgroups. Here, an early administration (i.e. in critically ill but not yet mechanically ventilated COVID-19 patients) and a dose of ≥ 15 g for at least 3 days may confer beneficial effects without concerning safety issues. However, these findings need to be validated in upcoming randomized clinical trials.Trial registrationDRKS00025794, German Clinical Trials Register, https://www.drks.de. Registered 6 July 2021.

Psychological Distress and Suicide Correlated with Long-Life Expectancy in Advanced Cancer Patients

OBJECTIVE Advances in systemic therapy together with better diagnostic and surgical techniques have contributing to survival improvement of many tumor types. Patients with cancer have an increased risk of suicide and the psychological impact of cancer is due the diagnosis itself, side effects of the therapy and cancer-related symptoms. METHOD The purpose of this study is to present the clinical case of an advanced gastrointestinal stromal tumor patient who committed suicide after 6 years of treatment. RESULT A 49-years-old male with a history positive only for an anxiety-depressive disorder was diagnosed with a locally advanced gastrointestinal stromal tumor. After 6 months of neoadjuvant imatinib, with stable disease, the patients decided to undergo surgery, with the subsequent resumption of adjuvant imatinib. Once the patient experienced disease progression, he preferred a surgical approach, even though he was aware that surgery was not the standard treatment and that a second-line systemic therapy was recommended. When the start of a second line therapy was the only possible treatment option, the patient has resigned himself to the idea that he would never be able to heal from cancer. After few months of second-line therapy he died of suicideSIGNIFICANCE OF RESULTS This case report shows that suicidality in cancer patients is a continuum spectrum from wanting to live, through the decreasing will to live, the readiness to die and then actively ending one’s life. Multidisciplinary teams should focus their attention not only on the disease itself but also on the cancer-related long-term psychological distress. Therefore, patient palliative care on psychological aspects should be improved strengthening psycho-social interventions during the entire cancer treatment history, not only at the end of life.

Spatial suitability analysis for site selection of refugee camps using hybrid GIS and fuzzy AHP approach: The case of Kenya

The refugee crisis forces various security, economic and natural weight on host nations. To house refugees, camps are considered a preferred option by humanitarian agencies and governments. The siting of refugee camps is an inherently complex and multidisciplinary task and can result in further displacement and long-term risks and distress to people of concern. This study proposes a geospatial decision-making approach combining geographic information systems (GIS) technology and fuzzy-analytical hierarchy process (F-AHP) method to assess land suitability and identify the optimal sites of refugee camps in Kenya. Four main factors and 19 evaluation criteria relevant to geographical, environmental, infrastructure, and social aspects are thoroughly investigated. The F-AHP is applied to determine the weights of the adopted criteria in consultation with three experts. The geospatial analysis is established using ArcGIS Pro software to derive the suitability map of refugee camps. The results concluded that Kenyan territory is classified into four ranks, low suitable represents 6.5% of the total surface area, 10.6% moderate suitable, 10.3% suitable, and 7.5% high suitable. Further, the analysis showed that the existing camps are located in unsuitable areas, whether north or east. Thus, the current study recommends moving these camps to areas far away from the flooded risk lands. In addition, eighteen new camps sites were suggested to host current and future refugees as well. The majority of these sites are located in Northeast, Northwest, and Northern Kenya, near the Kenyan borders with refugees' countries of origin. The findings revealed that the proposed new locations have superlative m2/refugee and approved the minimum area for a refugee (45 m2) defined by UNHCR.

The Economic Burden of Hospital Costs on Families With Type 1 Diabetes Mellitus Children: The Role of Medical Insurance in Shandong Province, China.

ObjectiveThis study estimates the economic burden imposed on families by comparing the hospitalization costs of T1DM children with and without medical insurance in Shandong province.MethodsOur data comprised 1,348 T1DM inpatient records of patients aged 18 years or younger from the hospitalization information system of 297 general hospitals in 6 urban districts of Shandong Province. Descriptive statistics are presented and regression analyses were conducted to explore the factors associated with hospitalization costs.ResultsChildren with medical insurance had on average total hospitalization expenditures of RMB5,833.48 (US$824.02) and a hospitalization stay of 7.49 days, compared with the children without medical insurance who had lower hospitalization expenditures of RMB4,021.45 (US$568.06) and an average stay of 6.05 days. Out-of-pocket expenses for insured children were RMB3,036.22 (US$428.89), which is significantly lower than that of the uninsured children (P < 0.01). Out-of-pocket (OOP) expenditures accounted for 6% of the annual household income of insured middle-income families, but rose to a significant 25% of the annual income for low-income families. These OOP expenditures imposed a heavy economic burden on families, with some families experiencing long-term financial distress. Both insured and uninsured families, especially low-income families, could be tipped into poverty by hospitalization costs.ConclusionHospitalization costs imposed a significant economic burden on families with children with T1DM, especially low-income insured and uninsured families. The significantly higher hospitalization expenses of insured T1DM children, such as longer hospitalization stays, more expensive treatments and more drugs, may reflect both excess treatment demands by parents and over-servicing by hospitals; lower OOP expenses for uninsured children may reflect uninsured children from low-income families forgoing appropriate medical treatment. Hospital insurance reform is recommended.

Online Self-Management for Chronic Burn Pain: Results of a Randomized Controlled Trial

Following burn injury, survivors experience high rates of chronic pain and psychosocial concerns, including post-traumatic stress disorder (PTSD) and depression. Despite long-term pain and distress, survivors have limited access to effective pain psychology treatments after discharge in the United States. The current study compared the efficacy of an online self-management program for chronic pain after burn injuries to a time equivalent education control. The Take Charge of Burn Pain Recovery (TCBR-Pain) program involved seven online chronic pain coping modules based on cognitive-behavioral therapy. Adults at least six months post burn injury hospital discharge and experiencing pain greater than 3/10 severity were recruited and randomized into the TCBR-Pain (N = 47) or Control program (N = 49). Outcomes were assessed at pre-treatment, immediately post-treatment, 2-month, and 5-month follow-up. Full program completion was lower for the TCBR-Pain group (53%) relative to the Control group (90%). Linear models were fit to outcomes, adjusting for pre-treatment scores, adherence, and completion. On average, the TCBR-Pain group reported lower pain intensity relative to the Control group at post-treatment (MTCBR-Pain = 3.2, SDTCBR-Pain = 1.8; MControl = 4.1, SDControl = 1.9; p < .001). Among secondary outcomes, the TCBR-Pain group reported lower pain catastrophizing (MTCBR-Pain = 14.0, SDTCBR-Pain = 10.3; MControl = 17.6, SDControl = 11.8; p = .03) and borderline effects toward lower PTSD symptoms (MTCBR-Pain = 14.0, SDTCBR-Pain = 6.5; MControl = 16.0, SDControl = 6.1; p = .08) at post-treatment relative to the Control group. Although preliminary, these findings suggest online self-management programs can serve a role in delivering effective pain psychology interventions to survivors with chronic burn pain. The TCBR-Pain program attrition rate was higher than the Control program, but lower than typical e-health intervention attrition rates (60–80%). However, future research is needed to improve patient engagement in online pain self-management programs.

Factors affecting the emotional wellbeing of women and men who experience miscarriage in hospital settings: a scoping review

BackgroundMiscarriage can be a devastating event for women and men that can lead to short- and long-term emotional distress. Studies have reported associations between miscarriage and depression, anxiety, and post-traumatic stress disorder in women. Men can also experience intense grief and sadness following their partner’s miscarriage. While numerous studies have reported hospital-related factors impacting the emotional wellbeing of parents experiencing miscarriage, there is a lack of review evidence which synthesises the findings of current research.AimsThe aim of this review was to synthesise the findings of studies of emotional distress and wellbeing among women and men experiencing miscarriage in hospital settings.MethodsA systematic search of the literature was conducted in October 2020 across three different databases (CINAHL, MEDLINE and PsycInfo) and relevant charity organisation websites, Google, and OpenGrey. A Mixed Methods appraisal tool (MMAT) and AACODS checklist were used to assess the quality of primary studies.ResultsThirty studies were included in this review representing qualitative (N = 21), quantitative (N = 7), and mixed-methods (N = 2) research from eleven countries. Findings indicated that women and men’s emotional wellbeing is influenced by interactions with health professionals, provision of information, and the hospital environment. Parents’ experiences in hospitals were characterised by a perceived lack of understanding among healthcare professionals of the significance of their loss and emotional support required. Parents reported that their distress was exacerbated by a lack of information, support, and feelings of isolation in the aftermath of miscarriage. Further, concerns were expressed about the hospital environment, in particular the lack of privacy.ConclusionWomen and men are dissatisfied with the emotional support received in hospital settings and describe a number of hospital-related factors as exacerbators of emotional distress.Implications for practiceThis review highlights the need for hospitals to take evidence-informed action to improve emotional support services for people experiencing miscarriage within their services.

Unravelling the complex interactions between self-awareness, cognitive change, and mood at 6-months post-stroke using the Y-shaped model

ABSTRACT We investigated the relationships between cognitive change following stroke, awareness of cognitive impairments, and mood to further understanding of change processes influencing psychological outcomes post-stroke in line with the “Y-shaped” process model. Patients (n = 143; M age = 73 years, SD = 13.73; 74 males) were assessed at 3-weeks (T1) and 6-months (T2) post-stroke and had completed the Oxford Cognitive Screen (T1 and T2), the Cognitive Failures Questionnaire (CFQ; T2), and the Hospital Anxiety and Depression Scale (HADS; T2). An ANCOVA controlling for disability relating to activities of daily living (ADL) revealed that awareness of cognitive impairment was significantly lower in participants with moderate-severe cognitive impairment. Regression analysis indicated that greater awareness of cognitive impairment and reduced independence in ADL were associated with greater emotional distress at T2. Cognitive improvement was associated with lower emotional distressat T2. Contrary to the awareness hypothesis, moderation analyses suggest that this effect was largest for those most cognitively impaired at T1. Findings emphasize the importance of monitoring stroke patients’ capacity to be self-aware when assessing and formulating long-term post-stroke distress and have potential implications for improving long-term emotional status in those most cognitively impaired post-stroke, e.g., through psychoeducation, cognitive rehabilitation, and emotional support.

Experiences and Needs of Caregivers of Adult Patients With Hematologic Malignancies During Treatment: A Qualitative Longitudinal Study.

Family caregivers play a vital role in providing care and support for patients with life-threatening hematologic diseases. Extensive patient care needs and long-term treatment trajectories can negatively affect the health of caregivers. Despite the importance of supporting caregivers, few studies examine family caregivers' experiences and support needs during treatment. To explore the role, experiences, and needs of family caregivers of patients with hematologic malignancies during treatment. An exploratory longitudinal qualitative study using serial semistructured interviews with caregivers of hematologic patients was carried out. Data were analyzed using thematic analysis. A sample of 16 caregivers completed 47 interviews. Three themes and 2 subthemes were identified: (1) committing to an unconditional mission while adjusting to a changeable situation: developing resilience over time; (2) being an invisible and inseparable sufferer: cultivating hope one day at a time; and (3) balancing between sacrificing one's own needs and self-care. During treatment, caregivers face long-term psychological and physical distress, social isolation, and loneliness due to the extended life-threatening situation imposing shifting challenges and needs. Future research should explore the concept of social support in caregiver resilience and investigate psychosocial interventions in hematologic caregivers. Healthcare professionals should address caregiver needs throughout the patient's treatment and provide new supportive initiatives to lessen the burden of care in hematologic caregivers. Facilitating peer support and deploying a family-oriented approach considering the patient-caregiver dyad as a subject for care have implications for clinical nursing practice.

Mass Trauma and Long-Term Psychological Distress

Abstract. Older widowed women in postconflict and postdisaster settings are a potentially vulnerable group due to both exposure to multiple potentially trauma events and ongoing stressors. Drawing from conservation of resources theory, in this study, we tested a model predicting variation in psychological distress among a sample of widows over 50 years of age ( N = 256) in Eastern Sri Lanka. Exposure to traumatic events and degree of damage from the 2004 tsunami were hypothesized to be associated with psychological distress (anxiety, depression, and posttraumatic stress) indirectly through two contextual stressors (unmet physical needs and economic strain). We fit an unconstrained path model including direct effects from trauma exposure and tsunami damages to mental health distress, followed by a constrained model removing direct effects. We retained the constrained model as the most parsimonious based on a nonsignificant χ2 difference test. In that model, higher exposure to trauma was significantly associated with more problems with unmet physical needs (β = .11, p = .054) and greater economic strain (β = .28, p &lt; .001). Higher levels of tsunami damages are significantly associated with greater economic strain (β = .04, p &lt; .05). These two intermediary variables were, in turn, associated with more severe symptoms of distress. Health problems were controlled in both the intermediary and outcome variables revealing significantly higher distress in association with more health problems. The results highlight the importance of assessing both the impacts of trauma and loss and the ongoing economic deprivation among this population.

Predictors for psychological distress of young burn survivors across three years: A cohort study of a burn disaster in Taiwan.

PurposeThe study aims to investigate long‐term psychological distress and its risk factors in the burn survivors.DesignA longitudinal study with follow‐up interviews was conducted from November 2015–June 2018. A post‐burn baseline interview was conducted 6 months after the event, followed by annual surveys for three years.MethodsThe burn survivors received structured assessment through telephone in the four‐wave interviews, including the five‐item Brief Symptom Rating Scale (BSRS‐5); two‐item Patient Health Questionnaire (PHQ‐2); four‐item Startle, Physiological Arousal, Anger, and Numbness Scale (SPAN‐4); and six‐item Impact of Event Scale (IES‐6) alongside demographic data and other health‐related assessment.FindingsA total of 180 respondents with the mean age of 23 years old completed the four waves of interview. Using the BSRS‐5 as the outcome, each variable had different input in psychological distress during the follow‐up years. The main finding was that the SPAN‐4 score could predict more than 62% of psychological distress between 6 months and 3 years after the disaster. The generalized estimating equation demonstrated that SPAN‐4, IES‐6, family functioning impairment, hypnotics use, adaptation to the event, and PHQ‐2 could predict psychological distress. However, the variable of follow‐up year did not exemplify significant estimation in the model.ConclusionsThe results indicated that different factors had various influences on psychological distress across the four follow‐up stages. PTSD‐like symptoms, depression, and anxiety were the most common psychological problems experienced by the young burn cohort in the longitudinal post‐traumatic period.Clinical relevanceHealthcare providers should be aware of psychological consequences of traumatic events within up to a 3‐year post‐burn period, particularly post‐traumatic stress, depression, and anxiety symptoms.

Mental Health Consequences of the COVID-19 Pandemic Long-Term Exposure in Italian Dermatologists.

The present study aimed at assessing the consequences of prolonged exposure to COVID-19 distress on mental health in non-frontline health care workers. For this purpose, we have conducted a survey on 425 Italian dermatologists, in the period February–March 2021. The psychopathological symptoms, depression, anxiety, post-traumatic stress symptoms (PTSD), as well as resilience, have been evaluated. The main factors that influence the physician’s psychological health have been also investigated. Our study showed that the physicians older than 40 years, as well as those who lived this period in company, reported more personal resources, better managing the distress. Resilience, COVID-19 beliefs, COVID-19 working difficulties, and age were the common predictors of the severe psychopathological symptoms. An interesting result is that the lower level of resilience was the most powerful predictor of a more severe depression, as well as of a higher severity of generalized anxiety disorder, but not of COVID-19 PTSD. The fear of COVID-19 was the most powerful predictor of COVID-19 PTSD. Home conditions and previous SARS-CoV2 infection constituted significant predictors of severe depressive symptoms, but not of anxiety and COVID-19 PTSD. These results are useful in a better understanding of protective and risk factors involved in COVID-19 long-term distress exposure.

Pulsed ultrasound for bone regeneration - outcomes and hurdles in the clinical application: a systematic review.

Impaired bone-fracture healing is associated with long-term musculoskeletal disability, pain and psychological distress. Low-intensity pulsed ultrasound (LIPUS) is a non-invasive and side-effect-free treatment option for fresh, delayed- and non-union bone fractures, which has been used in patients since the early 1990s. Several clinical studies, however, have questioned the usefulness of the LIPUS treatment for the regeneration of long bones, including those with a compromised healing. This systematic review addresses the hurdles that the clinical application of LIPUS encounters. Low patient compliance might disguise the effects of the LIPUS therapy, as observed in several studies. Furthermore, large discrepancies in results, showing profound LIPUS effects in regeneration of small-animal bones in comparison to the clinical studies, could be caused by the suboptimal parameters of the clinical set-up. This raises the question of whether the so-called "acoustic dose" requires a thorough characterisation to reveal the mechanisms of the therapy. The adequate definition of the acoustic dose is especially important in the elderly population and patients with underlying medical conditions, where distinct biological signatures lead to a delayed regeneration. Non-industry-funded, randomised, double-blind, placebo-controlled clinical trials of the LIPUS application alone and as an adjuvant treatment for bones with complicated healing, where consistent control of patient compliance is ensured, are required.

Long-Term Neurological and Psychological Distress Symptoms among Smallholder Farmers in Costa Rica with a History of Acute Pesticide Poisoning.

Studies suggest that acute pesticide poisonings (APP) may be linked with long-term neurological effects. To examine long-term neurological and psychological distress symptoms associated with having experienced an APP, we conducted a cross-sectional study of 300 conventional and organic smallholder farmers from Zarcero County, Costa Rica, May–August 2016. We collected self-reported data on sociodemographic characteristics, occupational history, pesticide exposure, APPs, neurological and psychological distress symptoms (using the Brief Symptom Inventory (BSI)). Adjusted logistic regression models were fit. A total of 14% of the farmers (98% male) reported experiencing at least one APP during their lifetime. Self-reported APP was associated with neurological symptoms during the 12 months prior to interview (e.g., fainting (Odds Ratio: 7.48, 95% Confidence Interval: 1.83, 30.74), shaking hands (3.50; 1.60, 7.60), numbness/tingling in hands or feet (3.23; 1.66, 6.32), insomnia (2.53; 1.34, 4.79), accelerated heartrate (2.42; 1.03, 5.47), dizziness (2.38; 1.19, 4.72), increased irritability/anger (2.37; 1.23, 4.55), low energy (2.33; 1.23, 4.46), and difficulty concentrating (2.01; 1.05, 3.85)). Farmers who reported an APP in the ten years prior to interview experienced increased odds of abnormal BSI scores for hostility (4.51; 1.16, 17.70) and paranoid ideation (3.76; 0.99, 18.18). Having experienced an APP may be associated with long-term neurological and psychological distress symptoms.

Psychologic Distress and Quality of Life After ICU Treatment for Coronavirus Disease 2019: A Multicenter, Observational Cohort Study.

A prospective, observational cohort study. Postcoronavirus disease 2019 clinics of three hospitals in Rotterdam, the Netherlands. Adult patients admitted for coronavirus disease 2019 to the ICU, who visited the postcoronavirus disease 2019 follow-up clinic. The primary outcomes were psychologic distress and overall and mental health-related quality of life, assessed using the Impact of Event Scale-Revised, Hospital Anxiety and Depression Scale, Short-Form 36, and European Quality of Life 5D, 6 weeks, 3 months, and 6 months post hospital discharge. Second, we compared 3-month psychologic and mental health-related quality of life outcomes with a historical critical illness survivor cohort and overall and mental health-related quality of life with the Dutch population. We included 118 patients with a median age of 61 years (95% range, 36-77 yr) of whom 79 (68%) were male. At 6 weeks, 13 patients (23%) reported psychologic distress, copresence of probable psychiatric disorders was common, and no decline in psychologic distress was observed throughout follow-up. Coronavirus disease 2019 patients tend to suffer less from posttraumatic stress disorder and reported less severe symptoms of anxiety (Hospital Anxiety and Depression Scale Anxiety Score: 3 [0-17] vs 5 [0-16]; estimated mean difference 2.3 [95% CI, 0.0-4.7]; p = 0.05) and depression (Hospital Anxiety and Depression Scale Depression Score: 3 [0-15] vs 5 [0-16]; estimated mean difference 2.4 [95% CI, 0.1-2.4]; p = 0.04) than the historical critical illness cohort. Overall and mental health-related quality of life increased over time. Coronavirus disease 2019 ICU survivors reported better mental health-related quality of life than our historical cohort, but overall and mental health-related quality of life was still poorer than the Dutch population. Psychologic distress was common in coronavirus disease 2019 ICU survivors and remained similar until 6 months after hospital discharge. Health-related quality of life increased over time and was higher than in a historical cohort, but was lower than in the Dutch population. Our findings highlight that coronavirus disease 2019 ICU survivors should be monitored after ICU treatment to detect possible psychologic distress.

O-196 The impact of providing couples with their IVF-prognosis on the expectations and anxiety of women and men

Abstract Study question What is the impact of providing couples with their IVF-prognosis on expectations and anxiety in women and men on the day of embryo transfer? Summary answer Only couples with a less than average IVF-prognosis updated their high expectations and IVF-prognosis was negatively associated with anxiety, especially in women. What is known already Female IVF-patients are known to expect a pregnancy rate per IVF-cycle of no less than 49-55%. Qualitative interviews and a survey showed that well informed women expect unrealistically high pregnancy rates as they think that their (family’s) fertility and their clinic is better than average. Several prognostic models have recently been published. The adapted van Loendersloot model including clinical and laboratory characteristics proved performant for our clinic (AUC=0.74) and was validated internally (Devroe et al, BMJ Open, 2020). The impact of providing couples with their IVF-prognosis on expectations and wellbeing of female and male patients has yet to be studied. Study design, size, duration A prospective survey, questioning a final sample of 148 partnered individuals, completing their 2nd-6th IVF-cycle (2019-2020) in a University clinic, on the days of oocyte aspiration (OA) and fresh embryo transfer (ET). Thirty other partnered individuals declined participation (participation rate=85%) and 26 were excluded due to ET-cancellation. The IVF-prognosis (live birth rate, LBR, per completed IVF-cycle including fresh and frozen ETs from the same ovarian stimulation) was calculated with the adapted van Loendersloot model. Participants/materials, setting, methods Each partner reported their perception of their expected IVF-LBR on a visual analogue scale on the day OA. After being informed on their IVF-prognosis by gynaecologists, they re-rated their expected IVF-LBR and filled out the reliable ‘STAI-State-Anxiety Inventory’ on the day of fresh ET. Linear mixed models, taking account of partnering and assessing the association with gender, explored whether individuals updated their expected IVF-LBR after receiving their IVF-prognosis and whether IVF-prognosis and anxiety were associated. Main results and the role of chance The mean IVF-prognosis was 30.9% (±16.8). The 148 partnered individuals had a mean expected IVF-LBR of 59.1% (±20.0) on the day of OA (no gender effect; p = 0.079). After being informed on their IVF-prognosis (day of ET), women’s and men’s mean expected IVF-LBR was 50.9% (±24.5) and 58.1% (±22.1), respectively (gender effect; p = 0.002). Linear mixed models, including couple and time as random factors, did not show an effect of time on expected IVF-LBRs (p = 0.15). Although women were more likely than men to update their expected IVF-LBR (p = 0.002), the updates were not significantly different from the IVF-LBR expected on the day of OA (p = 0.10). Women were more anxious than men (41.5±10.6 and 21.9±7.2, respectively, p &amp;lt; 0.001) after being given their IVF-prognosis. Linear mixed models, including couple as a random factor, showed an association between IVF-prognosis and anxiety (p = 0.016), especially in women (gender effect; p = 0.004). Subgroup analysis showed that partnered individuals with lower than average prognoses (n = 78) did update their expected IVF-LBR (p = 0.036) while others (n = 70) did not update their expected IVF-LBR (p = 0.761). Among the subgroup with lower prognoses women were more likely to update their expected IVF-LBR than men (p = 0.013), while no gender effect was observed among the subgroup with higher IVF-prognoses (p = 0.078). Limitations, reasons for caution This is an explorative study in preparation of an adequately powered randomized controlled trial, testing whether couples who are informed on their IVF-prognosis update their expected IVF-LBR and whether this causes anxiety, as compared to care as usual in which couples are not informed on their IVF-prognosis. Wider implications of the findings Men and especially women with a less than average prognosis update their IVF-expectations after having received this prognosis which may trigger anxious reactions. These findings should be re-examined in an RCT. Following up the effect of sharing IVF-prognoses on longer-term distress and IVF-discontinuation would be interesting. Trial registration number not applicable

Heterogeneous mental health development during the COVID-19 pandemic in the United Kingdom

The COVID-19 pandemic and the mitigation measures by governments have upended the economic and social lives of many, leading to widespread psychological distress. We explore heterogeneity in trajectories of psychological distress during the pandemic in the United Kingdom and relate this heterogeneity to socio-demographic and health factors. We analyze nine waves of longitudinal, nationally representative survey data from the UK Household Longitudinal Study (N=15{,}914), covering the period from early 2020 to mid-2021. First, latent class mixture modelling is used to identify trajectories of psychological distress. Second, associations of the trajectories with covariates are tested with multinomial logistic regressions. We find four different trajectories of distress: continuously low, temporarily elevated, repeatedly elevated, and continuously elevated distress. Nearly two fifths of the population experienced severely elevated risks of distress during the pandemic. Long-term distress was highest among younger people, women, people living without a partner, those who had no work or lost income, and those with previous health conditions or COVID-19 symptoms. Given the threat of persistent stress on health, policy measures should be sensitized to the unintended yet far-reaching consequences of non-pharmaceutical interventions.

Predicting Financial Distress of Small and Medium-Sized Entities

Unhealthy financial conditions may be widespread and cause long-term distress, resulting in constraints on investment activities, capital flows, and performance of firms. Thus , it is critical for businesses to recognise the factors that can lead to organizational failure and take appropriate steps to avoid such a situation. The current study examines the measurement of financial distress among 53 small and medium enterprises (SMEs) in Malang over a two-year period (2018 and 2019).Financial r atios used as predictors are the ratios of Liquidity, Leverage to Asset, and Return on Asset (ROA). The sample was chosen based on the completeness of SMEs' financial data from 201 8 to 201 9 . This study included 53 SMEs, the majority of which were culinary, fashion, and digital start-ups. The finding of 5% significance suggested that the model could be used to forecast financial problems of SMEs in Malang .The results of this investigation revealed that a company's financial stability, profitability, and debt have a significant effect on its ability to survive bankruptcy. R Square of 0.592indicates the uncertainty which can be expressed by an independent variable to be 59.2%.

Patient-Reported Distress in Hodgkin Lymphoma Patients on Active Therapy Vs. Long-Term Survivors

Background: The National Comprehensive Cancer Network (NCCN) defines distress as an unpleasant emotional experience associated with the psychosocial complications of cancer. While distress is known to occur in 25-33% of patients with cancer, little is known about differences in distress across types of hematologic malignancies. Hodgkin lymphoma (HL) is a hematologic malignancy with a relatively good prognosis, where the goals of therapy are to cure patients and minimize the need for further treatment. First-line treatment includes combination chemotherapy and/or radiation, both of which are associated with an increased risk of late, therapy-related complications. We hypothesized that patients with HL suffer significant distress, and aimed to describe the severity and sources of distress among HL patients receiving active therapy vs. those who are long-term survivors.Methods: We performed a retrospective cohort study using electronic medical records. Eligible patients had pathologically confirmed HL and were seen in Duke Cancer Institute clinics between July 1, 2013 and November 16th, 2016. Patient-reported distress was assessed as part of routine care using the NCCN Distress Thermometer (DT). The DT includes an 11-point scale reflecting the overall distress level and an accompanying 39-item “problem list.” Per the NCCN, a score of 4 or more signifies distress warranting clinical intervention (i.e., actionable distress). We abstracted data from the electronic medical record, including the DT score and accompanying “problem list” items, demographics, disease characteristics, and treatment regimens. Poisson regression was used to estimate the incidence of actionable distress.Results: Data were abstracted for 304 patients with median age at diagnosis of 36 years, 56% Stage I/II disease, and 25% Early/Favorable prognosis. There were 106 (34.9%) receiving active treatment during the study period, 54 (17.8%) attending follow-up clinics after surviving less than 5 years, and 144 (47.4%) in follow-up for 5 or more years. DT data were available for 1,524 (72.2%) of the 2,110 clinical encounters for these patients. There was a median of 3 thermometers/patient (interquartile range [IQR]: 1-7, range: 1-47). Overall, distress scores were low (median DT=1, IQR: 0-4). Distress levels were similar with respect to proximity to active treatment, but the occurrence of actionable distress (>=4) was markedly different in these three patient groups; 450 (29.5%) of the 1,524 thermometers were actionable, with 300 (66.6%) of these from patients who were on active treatment, 38 (8.4%) from patients surviving < 5 years, and 112 (24.9%) from patients surviving >= 5 years. The incidence of actionable distress differed significantly between the cohorts (Table 1), with patients on treatment having an incidence rate more than 4 times that of either of the survivor cohorts. Fatigue, pain and worry were the three most frequently reported problems in all patients. However, we noted that these symptoms were more likely to be reported in patients on treatment than either of the survivor cohorts (Figure 1). Distinct differences were also observed in the survivor cohorts, with the short-term survivors being less likely to report symptom distress than those surviving 5 or more years. When separated by problem domain the majority of reported problems were physical (e.g., fatigue, pain; 60-70% in each cohort) and emotional (e.g., depression, worry; 20-25% in each cohort).Conclusion:Patients receiving active therapy are at markedly increased risk of experiencing distress. Problems reported by HL patients represent primarily physical symptoms, but emotional problems represent a substantial proportion of the distress burden as well, even among long-term survivors Patterns of symptom distress suggest that those surviving beyond 5 years may face more frequent challenges compared with shorter-term survivors who recently completed therapy, although the types of issues faced by these survivor cohorts appear to be similar. Overall, patients on therapy experience more distress, yet distress occurs in long-term survivors as well. Although HL therapy aims to achieve a complete remission as quickly as possible while minimizing late effects, long-term attention to distress screening and management is needed regardless of outcomes, given the longer-term distress caused by physical symptoms and psychological concerns. [Display omitted] DisclosuresTroy:GamidaCell: Honoraria; The Emmes Corporation: Consultancy; The Community Data Roundtable: Consultancy. Feliciano:Seattle Genetics: Employment, Equity Ownership. Richhariya:Seattle Genetics: Employment, Equity Ownership. LeBlanc:Helsinn Therapeutics: Consultancy, Honoraria; Otsuka: Membership on an entity's Board of Directors or advisory committees; Cambia Health Foundation: Research Funding; AstraZeneca: Research Funding; Flatiron Health: Consultancy; Janssen: Honoraria; Seattle Genetics: Research Funding; Pfizer: Consultancy; Celgene: Honoraria; Boehringer Ingelheim: Membership on an entity's Board of Directors or advisory committees; American Cancer Society: Research Funding.