Lower Distress Research Articles

Lack of diversity in patients undergoing carotid artery stenting: Implications for the Distressed Community Index.

As the role of social determinants in carotid artery stenting (CAS) outcomes remains unclear, we investigated the association between the Distressed Community Index (DCI) (zip-code based) and post-CAS mortality/stroke outcomes. We analyzed patients undergoing CAS from 2015 to 2019 using the Medicare claims-linked Vascular Quality Initiative database. Patients were grouped based on high (DCI ⩾ 60) and low (DCI < 60) community distress. We analyzed 36-month mortality using Kaplan-Meier survival curves and hierarchical Cox regression, and 36-month stroke using cumulative incidence function curves and Fine-Gray models. The final cohort included 8717 patients (3032 DCI ⩾ 60), with a mean DCI score of 46.2 (± 28.5) and mean age of 74.7 (± 7.8) years. Most participants were men (64.3%), White (92.7%), and non-Hispanic/Latino (97.7%). There was no significant difference in the 36-month mortality incidence between high and low community distress groups (25.6% vs 23.5%, p = 0.22), and no significant association between high community distress and mortality (unadjusted HR: 1.04; 95% CI 0.90-1.21; adjusted HR: 1.02; 95% CI 0.89-1.17). The high community distress group experienced an elevated 36-month stroke incidence (26.8% vs 22.4%, p = 0.048), but no significant association with stroke was observed (unadjusted sub-HR: 1.12; 95% CI 1.00-1.24; adjusted sub-HR: 1.03; 95% CI 0.92-1.16). Our cohort showed underrepresentation in terms of sex, race, and ethnicity, with a skewed DCI distribution towards lower community distress. Contrary to what we know about community distress, no independent association between higher community distress and post-CAS stroke/mortality risk was found. Future work must examine whether accessibility barriers and selective CAS allocation explain our results.

Awareness of Disease Incurability Moderates the Association between Patients' Health Status and Their Treatment Preferences.

With advancing illness, some patients with heart failure (HF) opt to receive life-extending treatments despite their high costs, while others choose to forgo these treatments, emphasizing cost containment. We examined the association between patients' health status and their preferences for treatment cost containment versus life extension and whether their patients' awareness of disease incurability moderated this association. In a prospective cohort of patients (N = 231) with advanced HF in Singapore, we assessed patients' awareness of disease incurability, health status, and treatment preferences every 4 mo for up to 4 y (up to 13 surveys). Using random effects multinomial logistic regression models, we assessed whether patients' awareness of disease incurability moderated the association between their health status and treatment preferences. About half of the patients in our study lacked awareness of HF's incurability. Results from regression analyses showed that patients with better health status, as indicated by lower distress scores (odds ratio [OR] [95% confidence interval {CI}]: 0.862 [0.754, 0.985]) and greater physical well-being (1.12 [1.03, 1.21]); and who lacked awareness of their disease's incurability were more likely to prefer higher cost containment/minimal life extension treatments compared with lower cost containment/maximal life extension. This study underscores the significance of patients' awareness in disease incurability in shaping the relationship between their health status and treatment preferences. Our findings emphasize the need to incorporate illness education during goals-of-care conversations with patients and the importance of revisiting these conversations frequently to accommodate changing treatment preferences. The health status of patients with advanced heart failure was associated with their treatment preferences.Patients whose health status improved and who lacked awareness of their disease's incurability were more likely to prefer higher cost containment/minimal life extension treatments.

The emotional burden of type 1 diabetes: A cross-sectional study to understand associations between diabetes distress and glucose metrics in adulthood.

Advancements in type 1 diabetes (T1D) management, such as continuous glucose monitoring (CGM), have helped people achieve narrower glucose ranges, but associations between CGM and diabetes distress are unclear. Although higher HbA1c is associated with higher distress, associations with other glucose metrics are unknown. To better understand this relationship, we characterized diabetes distress in a sample of CGM users and compared differences in glucose metrics (measured via CGM) between those with higher versus lower distress. CGM users with T1D from the T1D Exchange Registry completed an online survey including diabetes distress (DDS-2) and shared CGM data (N = 199). CGM metrics were computed from all available data within 3 months prior to survey completion. Participants were grouped by distress level: lower (DDS-2 < 3, n = 120) or higher (DDS-2 ≥ 3, n = 79). Welch's t-tests were used to compare mean differences in CGM metrics between groups and MANCOVA was used to further probe mean differences. Approximately 39.7% participants reported higher diabetes distress. Welch's t-tests revealed participants with higher distress spent significantly more time in higher glucose ranges (above 180 mg/dL and above 250 mg/dL), less time in target glucose ranges (between 70 and 180 mg/dL and between 70 and 140 mg/dL) and had higher glucose management index values compared to those with lower distress (p < 0.01). MANCOVA models showed similar results. CGM users continue to experience diabetes distress. Moreover, higher distress appears to be associated with hyperglycaemia. These findings provide support for broader screening efforts for diabetes distress.

Transdiagnostic Risk Factors for Reasons for Smoking: Evaluating the Concurrent Role of Distress Tolerance and Anxiety Sensitivity.

Although rates of cigarette smoking have declined in the US, many individuals report experiencing significant barriers to quitting smoking, including poor mental health. Two prominent affective vulnerability factors that independently underlie both smoking behavior and processes and mental health include distress tolerance and anxiety sensitivity. However, limited work has examined the concurrent role of these factors on motivational reasons for smoking. The current study is a secondary analysis of baseline data from a nationally recruited sample of individuals (N = 156; Mage = 29.74, SD = 7.72; 69.2% female) interested in participating in a digitally delivered intervention for comorbid smoking and low distress tolerance. Two-step hierarchical linear regression was used to examine the unique role of self-reported distress tolerance and anxiety sensitivity in relation to reasons for smoking (i.e., habitual, negative affect reduction, addictive, pleasurable/relaxation, stimulation, and sensorimotor manipulation). Results indicated that lower levels of distress tolerance and greater levels of anxiety sensitivity were associated with greater sensorimotor manipulation reasons for smoking. Only distress tolerance was related to addictive, negative affect reduction, and stimulation reasons for smoking, whereas only anxiety sensitivity was related to habitual reasons for smoking. The current findings suggest that there is an explanatory utility for unique and multi-risk effects for distress tolerance and anxiety sensitivity for understanding smoking motives.

A Mindfulness-Integrated Therapeutic Approach to Enhance Client Engagement with Prolonged Exposure and Habit Reversal Therapy and Bolster Therapist Trainee Self-Efficacy and Distress Tolerance

Despite the established efficacy of exposure-based trauma treatments, such as prolonged exposure (PE), clinicians’ and clients’ concerns about these therapies hinder their widespread implementation. Clinicians report experiencing low self-efficacy and high distress when delivering PE, while patients doubt the credibility of this treatment, contributing to patient dropout. To tackle such challenges, mindfulness-based therapeutic approaches have been used. In the current case involving PTSD due to childhood sexual abuse (CSA) and coercive sex, trichotillomania, excoriation disorder, and depression, mindfulness practices and principles were woven into PE and habit reversal therapy (HRT). The therapist, a trainee with no prior trauma treatment experience, felt that her ability to manage the client’s distress during treatment and her confidence in delivering therapy was enhanced by her own mindfulness practice, and further reinforced by the pervasive integration of mindfulness throughout treatment. Likewise, the client attributed her capacity to engage in PE and HRT to the mindfulness practices and principles woven into treatment. Mindfulness also assisted in coalescing the concomitant delivery of PE and HRT. Following 21 sessions of mindfulness-integrated PE and 17 sessions of mindfulness-integrated HRT, the client no longer met criteria for PTSD and depression, eradicated her body-focused repetitive behaviors (BFRBs), and disclosed her index trauma with loved ones. These improvements were maintained at one-year follow-up, underscoring the potency of mindfulness therapeutic integration to enhance therapists’ distress tolerance and self-efficacy, clients’ treatment engagement, and overall therapeutic outcomes in complex cases.

The effects of fresh embryo transfer and frozen-thawed embryo transfer on the perinatal outcomes of single fetuses from mothers with PCOS.

To investigate the effects of fresh embryo transfer and frozen-thawed embryo transfer on perinatal outcomes among patients with PCOS. Patients who underwent in vitro fertilization and embryo transfer at the reproductive medicine center of the Affiliated Hospital of Guangdong Medical University from February 2013 to March 2021 were retrospectively analyzed. Patients were divided into the fresh embryo transfer group and frozen-thawed embryo transfer group according to whether fresh embryo transfer was performed. According to their conditions, patients were further classified into the ET-PCOS group (group A, n = 104), ET-non-PCOS group (group B, n = 212), FET-PCOS group (group C, n = 102), or FET-non-PCOS group (group D, n = 148); the general data, laboratory indicators and pregnancy outcomes of the patients were statistically analyzed, and the perinatal outcomes and related factors between the groups were compared and analyzed. The level of E2 on the HCG test day in the ET group was lower than that in the FET group. The natural birth rate of group D was lower than that of group A and group B, and the cesarean section rate was higher than that of group A and group B; the clinical pregnancy rate of group A was higher than that of group B and group D, and the difference was statistically significant (P < 0.05). There was no significant difference in the total abortion rate, early abortion rate or late abortion rate between the groups (P > 0.05). There was no significant difference in gestational age, neonatal sex or neonatal weight between the groups (P > 0.05). The incidence of placenta previa in Group B was significantly lower than that in Group D, and the difference was significant (P < 0.05). The incidence of fetal distress in Group B was significantly lower than that in Groups C and D, and the incidence of neonatal jaundice in Group D was significantly higher than that in Groups A and B (P < 0.05). In the multivariate analysis, the number of high-quality embryos was independent factors affecting clinical pregnancy, and the embryo transfer method was an independent factor affecting fetal distress and neonatal jaundice. Young PCOS patients without risk of OHSS have a high clinical pregnancy rate with fresh transplant cycles. PCOS disease itself has no significant effect on the perinatal outcomes of the mother or singleton infant. Frozen-thawed embryo transfer may increase the incidence of low placenta, fetal distress and neonatal jaundice.

Understanding the interplay of compassion fatigue and moral resilience on moral distress in ICU nurses: a cross-sectional study.

Intensive Care Unit (ICU) nurses frequently confront significant psychological challenges, including compassion fatigue, moral distress, and diminished moral resilience. These issues not only affect their well-being but also impact the quality of care provided to patients. The interplay of these factors is complex and not fully understood, particularly how compassion fatigue influences the relationship between moral resilience and moral distress. To explore the complex interplay between compassion fatigue and moral distress among ICU nurses, and to elucidate how compassion fatigue influences the protective role of moral resilience against moral distress. A cross-sectional study was conducted using a nationwide random sample of ICU nurses in China. Latent profile analysis identified subgroups based on levels of compassion fatigue. Moderation analysis examined whether compassion fatigue moderated the association between moral resilience and moral distress. Among 612 ICU nurses, latent profile analysis revealed three distinct groups with high, moderate, and low levels of compassion fatigue. Being female was protective against high compassion fatigue, while ages 30-49 yrs., lack of bachelor's degree, and dissatisfaction with salary increased compassion fatigue risk. Moderation analysis showed compassion fatigue significantly moderated the relationship between moral resilience and moral distress. Nurses with higher compassion fatigue exhibited a stronger association between low moral resilience and high moral distress. Compassion fatigue and moral distress are interconnected phenomena among ICU nurses. Demographic factors like gender, age, education, and income satisfaction impact compassion fatigue risk. High compassion fatigue impairs moral resilience, exacerbating moral distress. Comprehensive interventions targeting both compassion fatigue and moral resilience, tailored to nurses' demographic profiles, are needed to support this workforce.

Psychological distress in Aotearoa New Zealand adults with type 1 diabetes.

The psychological burden of type 1 diabetes (T1D) can negatively impact health outcomes. This study evaluates the prevalence of low mood (WHO-5), disordered eating (DEPS-R), diabetes distress (PAID) and fear of hypoglycaemia (HFS-II), in a sample of 250 New Zealand adults (8.4% Māori/91.6% non-Māori; 43.6% female/56.4% male) with T1D using validated tools. Māori and female patients indicated low mood, with lower median WHO-5 scores than non-Māori (p = 0.027) and males (p = 0.002). Māori were more likely to score in the clinical range on the WHO-5, DEPS-R, PAID and HFS-II (all p < 0.05). HbA1c was correlated with emotional well-being (rs = -0.189), diabetes distress (rs = 0.223) and disordered eating (rs = 0.389; all p < 0.001) whilst DEPS-R correlated with age (rs = -0.232) and BMI (rs = 0.343; both p ≤ 0.001). Thus, diabetes-related psychological distress is common in New Zealand adults with T1D, particularly for Māori, females and those with elevated HbA1c levels.

Prevalence and Risk Factors of Psychological Distress in Patients With Early-Stage Lung Cancer During Preoperative Period: A Cross-Sectional Study.

This study aims to investigate the prevalence of significant psychological distress and identify risk factors associated with it among early-stage lung cancer patients in the preoperative period. Lung cancer is a major cause of cancer deaths worldwide, with low survival rates and significant psychological distress. While much research has focused on distress in advanced-stage patients, less is known about the prevalence and risk factors of psychological distress in early-stage lung cancer patients before surgery. A cross-sectional study. The study included 427 early-stage lung cancer patients preparing for surgery. Researchers used a study-specific questionnaire to gather general information and employed the Distress Management Screening Measurement, Patient Health Questionnaire-9 and Generalised Anxiety Disorder-7 to assess personal situations and psychological distress levels. Statistical analyses investigated distress across various patient characteristics and examined correlations with anxiety and depression. Binary logistic regression identified significant predictors of psychological distress. The study found that 41.9% of early-stage lung cancer patients experienced significant psychological distress preoperatively, with an average score of 3.31 ± 2.18. Psychological distress was significantly positively correlated with depression (r = 0.474, p < 0.001) and anxiety (r = 0.591, p < 0.001). Significant risk factors for psychological distress included pulmonary nodules (OR = 2.884, 95% CI: 1.496-5.559), smoking history (OR = 2.092, 95% CI: 1.016-4.306) and chronic diseases (OR = 2.013, 95% CI: 1.073-3.776). Early-stage lung cancer patients often experience a high incidence of clinically significant psychological distress during the preoperative period, strongly associated with depression and anxiety. Adverse factors contributing to psychological distress include multiple indeterminate pulmonary nodules, smoking history and concurrent chronic diseases. Routine screening for psychological distress in these patients is recommended, along with personalised interventions and self-management strategies to help alleviate their distress during the perioperative period.

Character strength patterns, social support and psychological distress in adolescents and young adults with cancer: A multicenter cross-sectional study

ObjectiveAdolescents and young adults with cancer (AYAC) experience severe psychological distress worldwide. Social support was associated with reduced distress among cancer patients, but the role of character strength patterns in this association is unexplored. This study explored whether character strength patterns influence the association between social support and psychological distress in AYAC. MethodsA multicenter cross-sectional study was conducted at four hospitals in Changsha, China. Participants completed questionnaires assessing sociodemographic, distress, social support, and character strengths. Latent profile analysis determined character strength patterns, and multiple linear regression models examined the association. Interaction terms tested moderation effects, and adjusted models examined confounding, all stratified by gender. ResultsAmong 728 participants, three character strength patterns emerged: low (LCS), moderate (MCS), and high (HCS). Across all patterns, higher social support was significantly associated with lower distress in AYAC (female: β ​= ​−0.124, 95% CI ​= ​−0.051 to −0.015; male: β ​= ​−0.180, 95% CI ​= ​−0.080 to −0.030; P ​< ​0.001). AYAC with MCS and HCS experienced significantly less distress than those with LCS, across both genders. However, the association between character strength patterns and lower distress was stronger in males (MCS: β ​= ​−0.384, 95% CI ​= ​−1.898 to −1.033; HCS: β ​= ​−0.777, 95% CI ​= ​−3.420 to −2.495; P ​< ​0.001) compared to females (MCS: β ​= ​−0.284, 95% CI ​= ​−1.215 to −0.700; HCS: β ​= ​−0.593, 95% CI ​= ​−2.776 to −2.102; P ​< ​0.001). ConclusionsCharacter strength patterns didn't moderate or confound the association between social support and psychological distress, but had stronger protective effects against psychological distress than social support. Higher character strength patterns showed a stronger association with lower psychological distress, especially for males.

Association between health-related hope and distress from restrictions in chronic kidney disease and dialysis

BackgroundIn chronic kidney disease (CKD), the durability of patient adherence to fluid and dietary restrictions may depend on the degree to which they have hope that they will enjoy life. Previous cross-sectional studies have shown that higher hope was associated with lower distress from fluid and dietary restrictions and better adherence in the short term. In this study, we aimed to examine the long-term relationship of hope with distress from fluid and dietary restrictions.MethodsThis prospective observational cohort study included 444 patients with CKD undergoing dialysis in one of five Japanese nephrology centers. Hope as a predictor was measured using an 18-item health-related hope scale. Outcomes were two-item measures of distress from fluid and dietary intake restrictions using the Japanese version of the Kidney Disease Quality of Life Short Form, Version 1.3 (higher scores indicate lower levels of distress). Multivariate linear mixed models were used to estimate the association of baseline health-related hope with distress from fluid and dietary restrictions at baseline and follow-up.ResultsThe mean age of the participants was 67 years, and 31.1% of them were females. In total, 124, 98, and 222 had non-dialysis CKD, peritoneal dialysis, and hemodialysis, respectively. Higher levels of baseline health-related hope were associated with lower levels of distress from fluid restriction after one year (per 10-point increase, 2.6 points (95% confidence interval, 1.0 to 4.1)); whereas the baseline score was not associated with the distress from fluid restriction at 2 years. Similarly, higher levels of baseline health-related hope were associated with lower levels of distress from dietary restriction after one year (per 10-point increase, 2.0 points (95% confidence interval, 0.3 to 3.6)); whereas the baseline score was not associated with the distress from dietary restriction at 2 years.ConclusionsHealth-related hope, regardless of depression, can potentially mitigate long-term distress from fluid and dietary restrictions in patients with a wide range of CKD severities.Trial registrationUMIN000054710.

Effects of Virtual Reality Therapy for Patients With Breast Cancer During Chemotherapy: Randomized Controlled Trial.

Patients with breast cancer endure high levels of psychological and physical pain. Virtual reality (VR) may be an acceptable, safe intervention to alleviate the negative emotions and pain of patients with cancer. We aimed to test the long-term effects of VR on psychological distress and quality of life (QOL) with traditional care in Chinese patients with breast cancer. We also explored the intervention mechanism and the acceptability of VR. A total of 327 eligible participants were randomly assigned to a VR intervention group or a control group. The Distress Thermometer, QLQ-C30 (Quality of Life Questionnaire version 3.0), and Virtual Reality Symptom Questionnaire were assessed at baseline, postintervention (3 mo), and follow-up (6 mo). Analysis followed the intention-to-treat (ITT) principle. The generalized estimating equations model was used to analyze the longitudinal data, and the PROCESS macro was used to analyze the mediating effect. Compared with the control group, patients with breast cancer in the VR group had lower distress scores (P=.007), and higher health-related QOL scores (physical, role, emotional, cognitive, and social functioning) after 6 months (P<.05). Psychological distress had mediating effects on the longitudinal association between VR and the health-related QOL (indirect effect=4.572-6.672, all P<.05). VR intervention technology may help reduce distress and improve QOL for patients with breast cancer over time. By incorporating a mediating analysis, we showed that the QOL benefits of VR intervention was manifested through positive effects on psychological distress risk factors.

Examining the psychometric properties of the CEFIS-AYA using item response theory.

The COVID-19 Exposure and Family Impact Scale, Adolescent and Young Adult Version (CEFIS-AYA; Schwartz, L. A., Lewis, A. M., Alderfer, M. A., Vega, G., Barakat, L. P., King-Dowling, S., Psihogios, A. M., Canter, K. S., Crosby, L., Arasteh, K., Enlow, P., Hildenbrand, A. K., Kassam-Adams, N., Pai, A., Phan, T. L., Price, J., Schultz, C. L., Sood, E., Wood, J., & Kazak, A. (2022). COVID-19 exposure and family impact scales for adolescents and young adults. Journal of Pediatric Psychology, 47, 631-640. https://doi.org/10.1093/jpepsy/jsac036) was developed to assess the pandemic's effects on adolescents and young adults (AYA). Via principal component analysis, measure developers examined the structure and reliability of the CEFIS-AYA and identified seven exposure and five impact components. This study built upon prior work through use of item response theory (IRT) models to characterize the dimensionality of the CEFIS-AYA, determine the strength of relations between items and underlying trait(s), and examine associations between trait scores and pandemic-related distress. This was a secondary analysis of data collected between July 2020 and July 2021 from three studies of emerging adults (ages 18-29; N = 834). The CEFIS-AYA structure was multidimensional, with the strongest support for five traits. Trait 1 represented pandemic impact on social/emotional functioning and self-care. Trait 2 reflected other pandemic disruptions. Trait 3 represented pandemic disruptions to education and/or other milestones. Trait 4 represented pandemic impact on physical well-being. Trait 5 assessed pandemic disruptions to work/financial circumstances. Item loadings and parameters indicated variability in how consistently trait level was associated with item endorsement. Trait scores did not predict distress, except that increases in Trait 3 were associated with lower distress. The present study examined the psychometric properties of the CEFIS-AYA among emerging adults using a statistical framework better suited for modeling categorical data. The identified dimensional structure was relatively consistent with the initial psychometric evaluation of the CEFIS-AYA, albeit more parsimonious. However, replication is critical in light of sample demographic characteristics.

Heterogeneity in the association between social support and mental distress in old-age retirees – a computational approach using longitudinal cohort data

BackgroundMental distress among retirees and older people is a severe public health challenge, and information on new risk groups is needed. This study aims to identify subgroups of old-age retirees with varying associations between low social support and mental distress by applying model-based recursive partitioning (MOB).MethodsWe used the Helsinki Health Study follow-up survey data of old-age retired former municipal sector employees of the City of Helsinki, Finland. Phase 1 data were collected in 2000–2002, when all participants were employed, Phase 2 in 2007, Phase 3 in 2012, Phase 4 in 2017, and Phase 5 in 2022 (n = 4,466, 81% women). Social support and covariates were measured at each Phase 1–5 and the outcome, mental distress (Depression Anxiety Stress Scales [DASS-21]) was measured at a single occasion, during Phase 5. The three subscales and the common factor of general distress were analysed separately. An approach rooted in computational statistics was used to investigate risk factor heterogeneity in the association of low social support and mental distress. MOB combines decision trees with regression analysis to identify subgroups with the most significant heterogeneity among risk factors.ResultsMedian (IQR) general distress score from DASS-21 was 5.7 (3.0, 9.0), while Social Support Questionnaire number-score (SSQN) was 1.5 (1.15, 2.05). The primary effect modifier for the association between social support and general distress was education (p < 0.001). Those with high education had a different association of low social support and general distress than those with low or medium education. Additionally, the subgroup with low and medium education had a significant effect modification for age (p = 0.01). For the association between low social support and depressive symptoms, the moderating effect of education was dependent on gender, as men with medium–high education had the weakest association, while for women with medium–high education the association was strongest.ConclusionsOur results suggest that stratification by sociodemographic variables is justifiable when investigating risk factors of mental distress in old-age retirees. The incongruent association of low social support and depressive symptoms in men with medium–high education compared to women with medium–high education is a promising target for confirmatory research.

Meaning-Centred Coping Predicted Lower Depressive Symptoms among Caregivers with Complicated Grief.

Complicated grief is characterised by persistent low mood, intense distress and cognitive impairment. This study aimed to explore coping strategies (i.e. emotion-, problem- and meaning-centred) used by bereaved individuals facing complicated grief and how these strategies may predict psychological and cognitive outcomes. In a cross-sectional study, 20 bereaved individuals (5 males, 15 females) that aged 27 years old-65 years old (mean = 42.25, standard deviation [SD] = 9.30) were recruited following the loss of a loved one due to physical illness. Participants were screened for complicated grief and subsequently completed self-report assessments of coping strategies and depressive symptoms using Brief Grief Questionnaire (BGQ), Brief Coping Orientation to Problems Experienced (COPE) Questionnaire, Meaning-Centered Coping Scale (MCCS) and Patient Health Questionnaire-9 Items (PHQ-9). Following that, participants underwent a neurocognitive assessment of working memory using the 2-Back task. Caregivers with complicated grief suffered from moderate severity of depressive symptoms (mean = 17.45, SD = 4.43) as they were coping with the losses. Furthermore, the findings showed that MCC significantly predicted lower levels of depressive symptoms (b = -0.50, t (16) = -2.25, P = 0.04). However, coping strategies did not significantly predict working memory performance. These findings highlight the potential benefits of MCC in alleviating depressive symptoms in bereaved individuals and underscore its contribution to the development of grief interventions. Grief therapists can emphasise this coping strategy to promote healing and resilience in patients in the grief work.

Prevalence of psychotic-like experiences and their association with depression symptoms among patients entering adolescent psychiatric care

Background Psychotic-like experiences (PLEs) are common in clinical adolescent samples and form a continuum based on their frequency and intensity. PLEs can have harmful effects on both behaviour and affect. Methods Prevalence and subjective distress due to PLEs were assessed with the Prodromal Questionnaire-Brief (PQ-B) and depressive symptoms with the Beck Depression Inventory (BDI-21A) among adolescents (N = 399; 71.7% female, mean age 14.9 years, range 13–18) entering specialized adolescent psychiatric services. Various PQ-B Distress scale cut-off points were tested for their ability to detect high and low BDI scores using the superiority index, the effect size for mean difference, and spline regressions. Results The mean number of endorsed PLEs assessed with the PQ-B was 3.27 (SD 3.64; males: M 1.75; SD 2.78; females: M 3.89; SD 3.78), while mean PQ-B Distress scores were 20.33 (SD 18.03; males: M 11.84; SD 13.90; females: M 23.74; SD 18.40). The most common PLE within both genders were experiences of paranoia and suspiciousness, with a prevalence of 59.9%. BDI scores and PQ-B distress scores were strongly associated (r = 0.534, p<.001). Superiority indices, effect sizes, and spline regressions indicated that a low PQ-B Distress cut-off of 2 or 3 was most informative both when using BDI as a continuous variable and when dichotomized as mild depression (≥10) or major depressive disorder (≥16). Conclusion PLEs are common among adolescent entering psychiatric care. Even a relatively small amount of distress due to PLEs indicates clinical levels of depressive symptoms.

Psychological distress and trajectories of sleep duration among Australian adolescents: a prospective cohort study

ObjectivesThis study investigated the association between indicators of psychological distress and well-being and trajectories of sleep duration among a cohort of Australian adolescents.DesignA prospective cohort of adolescents was followed over...

Baseline financial distress and cost-related social risks among participants in the Cancer Financial Experience (CAFÉ) trial.

172 Background: Cancer Financial Experience (CAFÉ) is a multi-site, three-arm randomized controlled trial to test the impact of a novel financial navigation intervention on financial distress among cancer patients. We compared the baseline prevalence of financial distress among CAFÉ trial participants, using two instruments (InCharge and COST), and assessed cost-related social risks. Methods: Three hundred seventy one (n=371) participants were consented and randomized between August 2021-March 2023. Eligible participants (n=2033) included adults (18+ years of age), diagnosed with invasive cancer within 120 prior to a recent visit to a CAFÉ study clinic/site, members of Kaiser Permanente Northwest or Kaiser Permanente Washington, and spoke English or Spanish. Following consent, participants were randomized to one of three trial arms: enhanced usual care; brief intervention; enhanced intervention. The two primary trial outcomes were: financial distress, measured using the InCharge Financial Distress/Financial Well-Being scale, and cancer-specific health-related quality of life, measured by the FACT-G7 scale. Additionally, we collected the COST measure and cost-related social risks. All participant-reported outcomes, demographic, and socioeconomic data were collected via telephone survey at baseline and 12 months by trained interviewers. Survey data was stored in REDCap. Descriptive statistics were used to assess participant demographic, socioeconomic, and outcome data at baseline. Results: Among randomized participants (n=371), mean age was 61 years (standard deviation=14 years), 63% were female, 11% Hispanic, 9% Asian, 8% Black , 61% married or living with partner, 31% were employed full-time, 37% retired, 44% had annual income of $20000-$74999, 45% had Medicare, and 38% had breast cancer. At baseline, InCharge scores showed 31% (n=113) of participants had high, 19% had moderate, and 50% had low financial distress. Based on COST scores, 2.2% (n=16) of participants had high, 63% had moderate, and 39% had low financial distress. Forty percent (n=148) of participants reported any cost-related social risk, including heat and electricity (15%) and housing (15%). Conclusions: Baseline findings from the CAFÉ trial indicate that nearly one-third of patients with cancer may have high financial distress around the time of diagnosis, though this may vary by screening tool. The ideal screening tool for use at diagnosis is worthy of further study. Assessing and assisting patients with social risks, including financial distress, is essential to advancing cancer health equity. Clinical trial information: NCT05018000 .

Impact of Cancer Care Financial Assistance Program on client financial toxicity and emotional distress.

204 Background: The financial impact of cancer can include high out-of-pocket costs, compensatory trade-offs (e.g., postponing treatment), and emotional distress. Cancer Care developed its Financial Assistance (FA) Program to assist with cancer-related costs and reduce client financial and emotional burden. We examined the impact of Cancer Care ’s FA Program on financial toxicity and emotional distress in clients undergoing cancer treatment. Methods: 731 patients enrolled in Cancer Care ’s FA Program (1/23-12/23) completed an evaluation survey. Clients were primarily women (71%); mean age=58 ( SD =13); 47% were non-Hispanic White, 33% non-Hispanic Black, 12% Hispanic. 84% were not employed; median household income $20K; 98% insured. Most frequent diagnoses: breast (26%), multiple myeloma (8%), and colon (5%) cancers; mean years since diagnosis=3 ( SD =6). All were on treatment (85% chemo; 38% radiation; 13% hormone; 11% immunotherapy). We used descriptive and multivariable regression analyses to examine the impact of FA and the correlates of reduced financial stress (yes/no) and emotional distress (not at all–extremely), controlling for socio-demographics. Results: The median grant award was $300 (max: $3000). FA was most often used for transportation (48%), household costs (43%), food (40%), and medical costs (30%). Only 38% of clients were aware of non-insurance financial resources during treatment. Financial compensatory trade-offs included delaying treatment (19%), choosing a less expensive treatment (7%), and stopping treatment (5%). Regarding financial toxicity, 61% reported that FA reduced their financial stress. In logistic regression, factors associated with greater likelihood of reduced financial stress after FA were larger grant amounts ( OR =1.05; p =.04), using FA for transportation ( OR =1.59; p =.00) or medical costs ( OR =1.44; p =.04), and unemployment ( OR =1.69; p =.02). Regarding emotional distress, 67% were distressed/extremely distressed before FA, vs. 25% after FA ( t =-21.72; p =.00). In linear regression, using FA for medical costs was associated with lower distress ( B =-.29; p =.00), and stopping treatment due to finances was associated with higher distress ( B =.52; p =.00), controlling for baseline distress. Using FA for other needs was not significantly associated with reduced financial/emotional distress. 50% said FA met their needs well/very well; 78% were satisfied/very satisfied with the program. Conclusions: Our results show the impact of Cancer Care ’s FA Program on reducing client financial toxicity and emotional distress, known factors in treatment adherence, quality of life, and survival. Notably, use of FA for medical and transportation costs, and grant amount, were significantly associated with improved client outcomes. Clients using funds for other basic needs may have multiple stressors requiring comprehensive multilevel support beyond FA alone.

Mitigating psychological distress in the workplace: The role of perceived insider status in leader-follower cognitive style congruence

This study examines the impact of leader-follower cognitive style congruence on employee psychological distress, with a specific emphasis on the mediating role of perceived insider status. Using data from a major financial institution in China, the findings reveal that higher cognitive style alignment between leaders and followers is associated with a significant reduction in employee psychological distress. Grounded in Conservation of Resources (COR) theory, the study demonstrates that cognitive style congruence enhances predictability and facilitates the conservation of psychological resources, effectively mitigating psychological distress. Notably, employees led by intuitive leaders report lower distress levels compared to those led by analytic leaders. These results underscore the critical importance of cognitive style congruence in fostering employee well-being and offer actionable insights for enhancing organizational practices.