Measures Of Emotional Distress Research Articles

Using Patient-Reported Outcome Measures to Identify Factors Associated with Impaired Physical Function in Younger and Older Adults Living with Sickle Cell Disease

Background Improvements in disease management techniques have led to increases in the life expectancy of individuals with sickle cell disease (SCD). Despite the increasing number of older adults with SCD (defined as age ≥ 40 years), there is limited data on how symptoms experienced by this population such as pain, sleep, depression, and fatigue impact how they function day-to-day. In this study, we sought to determine which modifiable patient-reported factors most strongly correlate with patient reported physical function in adults with SCD. Understanding factors associated with impaired physical function will provide targets for future interventional studies to improve function. Methods We conducted a cross-sectional study at a single academic sickle cell center. Participants completed the Adult Sickle Cell Quality of Life Measurement Information System (ASCQ-Me) Stiffness Impact and Sleep Impact surveys and the Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function, Pain Intensity, Pain Interference, Fatigue, Cognitive Function, and Emotional Distress measures. For ASCQ-Me, higher scores imply better self-reported health. For PROMIS, higher scores mean higher levels of the concept being measured. Relationships between the variables thought to influence SCD experience were explored using analytical networks and centrality measures (INSIGHTS, Nanbar Health's data analysis and 3D visualization tool) that built upon calculated pairwise Spearman correlations of the non-normal variable set. Results Surveys were administered to 92 participants with 97% of participants completing all surveys. The mean score for each item was obtained across all participants. Scores were then stratified by age group and t-tests were performed to compare scores on results between groups for each ASCQ-Me and PROMIS measure. Across those who completed both surveys, the mean age was 43 (SD 13.7). The mean age for older adults was 54 (SD 8.6) and the mean age for younger adults was 30 (SD 5.5). More participants were female (58%) than male (42%). Genotypes included HbSS (58%), HbSβ 0-thalassemia (5%), HbSC, (24%), and HbSβ +-thalassemia (13%). The mean score on PROMIS Physical Function for all participants was 48.7 with 18% of responders reporting impaired physical function (score ≤ 40). Older adults had lower mean scores on PROMIS Physical Function (46.4) vs. for younger adults (51.6, p <0.05). The strongest correlations were between PROMIS Physical Function and ASQME Stiffness Impact (r s= 0.66; p<0.001), PROMIS Pain Intensity (r s= -0.61; p<0.001), PROMIS Pain Interference, (r s= -0.61; p<0.001), and ASCQ-Me Fatigue (r s = -0.55; p<0.001). There was a moderate positive correlation between PROMIS Physical Function and ASCQ-Me Sleep Impact (r s= 0.40; p<0.001) and PROMIS Cognitive Function (r s=0.36 p < 0.001) implying better sleep and better cognitive function were associated with better patient reported physical function. Lastly, better physical function had a low-moderate association with PROMIS Emotional Distress (r s= - 0.24; p < 0.05). We assessed relationships between all of the patient-reported outcome measures and found that the strongest relationships were between Pain Intensity and Pain Interference (r s= 0.69), Pain Intensity and Stiffness (r s= -0.67), and Fatigue and Cognitive Function (r s= -0.69). There was no central node identified (Figure). Conclusion Each factor evaluated in this study showed a statistically significant and clinically meaningful relationship to patient reported physical function. One of our major findings was that when mapped against each other, there was no central node explaining the identified correlations between the variables assessed. These results suggest that physical functioning is multifactorial and that there exist multiple modifiable factors that may influence function in people with SCD. Factors associated with physical function will serve as targets for future interventional studies to maintain and improve function in adults with SCD.

A Mindfulness-Based Resiliency Program for Caregivers of Patients With Severe Acute Brain Injury Transitioning Out of Critical Care: Protocol for an Open Pilot Trial.

Caregivers of patients with severe acute brain injuries (SABI) that lead to coma and require intensive care unit (ICU) treatment often experience chronic emotional distress. To address this need, we developed the Coma Family (COMA-F) program, a mindfulness-based resiliency intervention for these caregivers. We will conduct an open pilot trial of COMA-F (National Institutes of Health Stage IA). Here we describe our study protocol and proposed intervention content. We will enroll 15 caregivers of patients with SABIs during their loved one's hospital course from 3 enrollment centers. A clinical psychologist will deliver the COMA-F intervention (6 sessions) over Zoom (Zoom Video Communications, Inc) or in person. We will iterate COMA-F after each caregiver completes the intervention and an exit interview. English-speaking adults who have emotional distress confirmed by the clinical team and are the primary caregivers of a patient with SABI are eligible. The adult patient must have been admitted to the neuro-ICU for SABI and (1) have had a Glasgow Coma Scale score below 9 while not intubated or an inability to follow meaningful commands while intubated at any point during their hospitalization for >24 hours due to SABI; (2) will be undergoing either tracheostomy or percutaneous endoscopic or surgical gastrostomy tube placement or have already received one or both; and (3) have a prognosis of survival >3 months. We will identify eligible caregivers through screening patients' medical records and through direct referrals from clinicians in the neuro-ICU. During the intervention we will teach caregivers mind-body and resilience skills, including deep breathing, mindfulness, meditation, dialectical thinking, acceptance, cognitive restructuring, effective communication, behavioral activation, and meaning-making. Caregivers will complete self-report assessments (measures of emotional distress and resilience) before and after the intervention. Primary outcomes are feasibility (recruitment, quantitative measures, adherence, and therapist fidelity) and acceptability (treatment satisfaction, credibility, and expectancy). We will conduct brief qualitative exit interviews to gather feedback on refining the program and study procedures. We will examine frequencies and proportions to determine feasibility and acceptability and will analyze qualitative exit interview data using thematic analysis. We will also conduct 2-tailed t tests to explore signals of improvement in emotional distress and treatment targets. We will then conduct an explanatory-sequential mixed methods analysis to integrate quantitative and qualitative data to refine the COMA-F manual and study procedures. This study has been approved by the institutional review board at 1 of the 3 enrollment centers (2023P000536), with approvals at the other 2 centers pending. We anticipate that the study will be completed by late 2024. We will use our findings to refine the COMA-F intervention and prepare for a feasibility randomized controlled trial. ClinicalTrials.gov NCT05761925; https://clinicaltrials.gov/study/NCT05761925. PRR1-10.2196/50860.

Do early life traumas moderate the impact of cumulative pandemic stress on anger?

Do early life traumas condition the psychological consequences of pandemic stressors? Using national data from the Crime, Health, and Politics Survey (May-June 2021), we examine whether early life traumas buffer or amplify the impact of cumulative pandemic stressors (CPS) on anger, an understudied measure of emotional distress. We examine two competing perspectives. The trauma amplification perspective posits that people who experience early life traumas are especially vulnerable to subsequent stressors, while the trauma resiliency perspective suggests the opposite, that people who experience traumas in early life are less vulnerable to subsequent stressors. The trauma resiliency perspective was partially supported by our analyses. Although early life traumas abated the impact of three or more pandemic stressors on anger, we failed to observe any attenuation at lower levels of pandemic stress exposure. We extend previous research by recasting the common stress proliferation model as a stress modification model and by focusing on feelings of anger. Findings are discussed in the context of social stress, mental health, and the COVID-19 pandemic.

COMT Val158Met and BDNF Val66Met Single-Nucleotide Polymorphisms Are Not Associated With Emotional Distress One Year After Moderate-Severe Traumatic Brain Injury.

Emotional distress is a common, but poorly addressed, feature of moderate-severe traumatic brain injury (TBI). Previously identified sociodemographic, psychological, and injury-related factors account for only a small proportion of the variability in emotional distress post-TBI. Genetic factors may help to further understand emotional distress in this population. The catechol-O-methyltransferase (COMT) Val158 and brain-derived neurotrophic factor (BDNF) 66Met single-nucleotide polymorphisms (SNPs) have been identified as possible contributory factors to outcomes after TBI. We investigated whether the COMT Val158 and BDNF 66Met SNPs were associated with emotional distress 1 year after moderate-severe TBI, and whether these associations were moderated by age, sex, and TBI severity (as measured by the duration of post-traumatic amnesia [PTA]). Moderate-severe TBI survivors (COMT, n = 391; BDNF, n = 311) provided saliva samples after admission to a TBI rehabilitation hospital. At a follow-up interview ∼1 year after injury, participants completed a self-report measure of emotional distress (Hospital Anxiety and Depression Scale; HADS). Multiple linear regression models were constructed for each SNP to predict total scores on the HADS. Neither COMT Val158 nor BDNF 66Met carriage status (carrier vs. non-carrier) significantly predicted emotional distress (COMT, p = 0.49; BDNF, p = 0.66). Interactions of SNP × age (COMT, p = 0.90; BDNF, p = 0.93), SNP × sex (COMT, p = 0.09; BDNF, p = 0.60), SNP × injury severity (COMT, p = 0.53; BDNF, p = 0.87), and SNP × sex × age (COMT, p = 0.08; BDNF, p = 0.76) were also non-significant. Our null findings suggest that COMT Val158 and BDNF 66Met SNPs do not aid the prediction of emotional distress 1 year after moderate-severe TBI, neither in isolation nor in interaction with age, sex and injury severity. The reporting of null findings such as ours is important to avoid publication bias and prompt researchers to consider the challenges of single-gene candidate studies in understanding post-TBI outcomes. Analyses in larger samples that incorporate multiple genetic factors and their relevant moderating factors may provide a greater understanding of the role of genetics in post-TBI emotional distress.

Rural-urban differences in distress, quality of life, and social support among Canadian young adult cancer survivors: A Young Adults with Cancer in Their Prime (YACPRIME) study.

Geographic location plays a significant role in the health and wellbeing of those with cancer. This project explored the impact of rurality and social support on distress and quality of life in young adults (YAs) with cancer in Canada. The current research analyzed data from the Young Adults with Cancer in Their Prime (YACPRIME) study. Participants completed measures of emotional distress (10-item Kessler Psychological Distress Scale), quality of life (12-item Short-form Health Survey), and social support (Medical Outcomes Study-Social Support Survey). Rural and urban-dwelling survivors were compared using MANOVAs. Bivariate analyses were conducted to explore associations between distress and social support. Of the sample (N = 379), 26% identified their location as rural. Rural YA cancer survivors reported higher distress and worse physical health-related quality of life (HRQOL) than survivors from urban areas but similar levels of mental-health-related quality of life. Social support appeared to have a marginally greater effect on psychosocial outcomes for urban participants. All types of social support were associated with lower levels of distress. However, different types of social support were associated more strongly with distress depending on a participant's geography. Rural-dwelling YA cancer survivors experience significantly more distress and poorer physical HRQOL than urban-dwelling survivors. Different needs and preferences for social support may influence the psychological health of rural cancer survivors. Additional research is needed to determine how best to understand and address distress in rural YAs with cancer.

Protective positive psychology factors and emotional distress after cardiac arrest

BackgroundThere is a critical need to identify factors that can prevent emotional distress post-cardiac arrest (CA). CA survivors have previously described benefitting from utilizing positive psychology constructs (mindfulness, existential well-being, resilient coping, social support) to cope with distress. Here, we explored associations between positive psychology factors and emotional distress post-CA. MethodsWe recruited CA survivors treated from 4/2021–9/2022 at a single academic medical center. We assessed positive psychology factors (mindfulness [Cognitive and Affective Mindfulness Scale-Revised], existential well-being [Meaning in Life Questionnaire Presence of Meaning subscale], resilient coping [Brief Resilient Coping Scale], perceived social support [ENRICHD Social Support Inventory]) and emotional distress (posttraumatic stress [Posttraumatic Stress Checklist-5], anxiety and depression symptoms [PROMIS Emotional Distress – Anxiety and Depression Short Forms 4a]) just before discharge from the index hospitalization. We selected covariates for inclusion in our multivariable models based on an association with any emotional distress factor (p < 0.10). For our final, multivariable regression models, we individually tested the independent association of each positive psychology factor and emotional distress factor. ResultsWe included 110 survivors (mean age 59 years, 64% male, 88% non-Hispanic White, 48% low income); 36.4% of survivors scored above the cut-off for at least one measure of emotional distress. In separate adjusted models, each positive psychology factor was independently associated with emotional distress (β: −0.20 to −0.42, all p < 0.05). ConclusionsHigher levels of mindfulness, existential well-being, resilient coping, and perceived social support were each associated with less emotional distress. Future intervention development studies should consider these factors as potential treatment targets.

Does Level of Social Support During Rejection Affect Pain Sensitivity and Distress?

This study investigated whether level of social support would decrease emotional distress and physical pain sensitivity following rejection. Healthy undergraduate students received varying levels of social support from a close companion during the Partial Future Life Alone rejection paradigm. Participants also completed baseline and post-stressor measures of physical pain sensitivity as well as post-stressor measures of emotional distress. Results indicated that all levels of social support benefited rejected participants by either buffering and/or improving fundamental needs, mood, and pain to levels comparable to non-rejected participants; however, passive support resulted in the fewest beneficial outcomes. The current study provides preliminary evidence that even minimal levels of support during rejection benefits or at least neutralizes associated pain and distress outcomes.

Effects of a Nurse-led Survivorship Care Program on the Health and Resilience of Primary Caregivers of Patients With Advanced Head and Neck Cancer: A Randomized Controlled Trial

The present study aimed to evaluate the effects of a nurse-led survivorship care program (SCP) on emotional distress, social support, physical health, mental health, and resilience in primary caregivers of patients with advanced head and neck cancer. A randomized controlled trial was conducted. One hundred patient-primary caregiver dyads were randomized into the nurse-led SCP group (experimental) or the usual care group (control). Participants completed a self-reported questionnaire, including measures of emotional distress, social support, physical health, mental health, and resilience. After 6 months, the experimental group reported a significant improvement in emotional distress, social support, physical health, mental health, and resilience. Compared with the control group, measures of emotional distress, physical health, overall resilience, and the resilience aspects of equanimity and perseverance improved in the experimental group. An SCP may feasibly help alleviate emotional distress, improve social support, increase physical and mental health, and strengthen resilience in the primary caregivers of patients with head and neck cancer. Health care providers should encourage primary caregivers to join an SCP. The nurse-led SCP can be applied before patients complete treatment, which may increase the positive effect on physical health and adaptation.

Stressors in health care and their association to symptoms experienced by gender diverse people

ObjectivesMany individuals whose gender does not align with the sex they were assigned at birth (gender diverse [GD] people) report stressful health care encounters. We examined the relationship of these stressors to symptoms of emotional distress and impaired physical functioning among GD people. Study designThis study was conducted using a cross-sectional design with data from the 2015 United States Transgender Survey. MethodsComposite metrics of health care stressors and physical impairments were developed, and the Kessler Psychological Distress Scale (K-6) provided a measure of emotional distress. Linear and logistic regression were used to analyze the aims. ResultsA total of 22,705 participants from diverse gender identity subgroups were included. Participants who experienced at least one stressor in health care during the past 12 months had more symptoms of emotional distress (β = 0.14, P < .001) and 85% greater odds of having a physical impairment (odds ratio = 1.85, P < .001). Transgender men exposed to stressors were more likely than transgender women to experience emotional distress and have a physical impairment, with other gender identity subgroups reporting less distress. Black participants exposed to stressful encounters reported more symptoms of emotional distress than White participants. ConclusionsThe results suggest that stressful encounters in health care are associated with symptoms of emotional distress and greater odds of physical impairment for GD people, with transgender men and Black individuals being at greatest risk of emotional distress. The findings indicate the need for assessment of factors that contribute to discriminatory or biased health care for GD people, education of health care workers, and support for GD people to reduce their risk of stressor-related symptoms.

Cognitive mechanisms and resilience in UK-based general practitioners: cross-sectional findings.

Being a general practitioner (GP) is a stressful occupation, and the strain GPs are under can have negative effects on their psychological well-being, as well as on the patients' experience of healthcare. Resilience can help buffer against this and is a dynamic process by which one can cope with adversity and stress. This study aimed to identify modifiable cognitive mechanisms related to resilience in GPs, specifically interpretation bias and cognitive reappraisal. One hundred and fourteen GPs completed an online cross-sectional correlational study. This comprised questionnaires assessing resilience, emotional distress, work environment and cognitive mechanisms (emotion regulation), as well as a task assessing interpretation bias. Resilience of GPs was negatively correlated with measures of emotional distress. Furthermore, resilience was positively correlated with positive interpretation bias (r = 0.60, ρ = 0.60, P < 0.01) and cognitive reappraisal (r = 0.39, ρ = 0.40, P < 0.01). In a hierarchical regression, positive interpretation bias (B = 0.25, SE B = 0.06, β = 0.39, P < 0.01) was a significant independent predictor of resilience when controlling for depression, anxiety and stress. This is the first study to establish an association between resilience and positive interpretation bias and cognitive reappraisal in GPs. Future research should use longitudinal designs to determine if they have a causal role in promoting resilience, and importantly whether interventions focusing on these processes may foster resilience in less resilient GPs.

The Relationship of Adverse Childhood Experiences and Emotional Distress in Young Adults.

Emerging evidence notes increased depression, anxiety, and stress among the general population during the COVID-19 pandemic. However, little is known about populations at increased risk for emotional distress as the pandemic continues. Persons with adverse childhood experiences (ACE) are one group that may be at higher risk for emotional distress. The aim of this study is to examine whether young adults, particularly Black young adults, with histories of ACEs report more emotional distress during the pandemic than those with no ACE exposure. Using a cross-sectional, quota sampling approach, 100 Black and 100 White young adults were recruited using online sources (e.g., University website, Facebook). Due to the pandemic, participants were screened via Zoom and, if eligible, completed a demographic questionnaire, emotional distress measures (i.e., anxiety, depression, stress), and the ACE Questionnaire online via a Qualtrics survey. Structural equation modeling (SEM) analysis examined the ACE and emotional distress relationship, and multigroup SEM assessed racial differences. High levels of both emotional distress and ACEs were observed. Black young adults reported significantly more ACEs than Whites. ACEs were significantly associated with each measure of emotional distress regardless of race or other covariates. Findings reveal that during the pandemic, persons exposed to ACEs reported greater emotional distress than those with no ACE exposure. Nurses must screen patients for both emotional distress and ACE to target those at higher risk for early intervention and initiate treatment as needed to mitigate long-term mental health consequences.

The effects of mindfulness meditation versus CBT for anxiety on emotional distress and attitudes toward seeking mental health treatment: a semi-randomized trial

Older adults often avoid seeking psychological treatment, thus challenging their ability to cope effectively with anxiety, stress, and depression. The current study aimed to compare the effects of a mindfulness intervention with cognitive behavioral therapy (CBT) on measures of emotional distress and attitudes toward seeking mental health treatment among older adults. Twenty-four seniors were assigned to three groups: (1) Mindfulness-based intervention for seniors (MBIS), (2) CBT for anxiety, or (3) a care-as-usual control group. Participants in the two intervention groups of eight weekly sessions were randomly assigned. Results showed that attitudes toward seeking psychological treatment and depression, anxiety, and worry levels were evaluated before and after the interventions. Following both interventions, participants considered the prospect of utilizing psychological treatment more positively, whereas no changes were observed in the control group. Interestingly, worry levels were eased only in the MBIS group, and anxiety levels were eased only in the CBT group. Our findings support the understanding that cognitive group interventions can effectively achieve their intended aim (decreasing worry or anxiety) and positively impact attitudes toward psychological treatment.Trial registration: clinicaltrials, NCT04165005, 15/11/19.

Interaction between APOE ɛ4 and Age Is Associated with Emotional Distress One Year after Moderate-Severe Traumatic Brain Injury.

Emotional distress is common following moderate-severe traumatic brain injury (TBI) and is associated with poorer post-injury outcomes. Previously investigated sociodemographic, psychological, and injury-related factors account for only a small proportion of variance in post-TBI emotional distress, highlighting a need to consider other factors such as genetic factors. The apolipoprotein E gene (APOE) has been commonly studied in the TBI literature, with the ɛ4 allele linked to worse neuronal repair and recovery. Few studies have investigated the potential relationship between APOE ɛ4 and emotional distress after moderate-severe TBI, and results have been varied. We examined whether APOE ɛ4 was associated with emotional distress 1 year following moderate-severe TBI, and whether this relationship was moderated by age, sex, and TBI severity (as indexed by the duration of post-traumatic amnesia [PTA]). Moderate-severe TBI survivors provided saliva samples following inpatient admission to a TBI rehabilitation hospital. They completed a self-report measure of emotional distress, the Hospital Anxiety and Depression Scale (HADS), at a follow-up interview ∼1 year post-injury. Complete genetic and follow-up data were available for 441 moderate-severe TBI survivors (mean age = 39.42 years; 75% male). We constructed a linear regression model that included APOE ɛ4 carriage status (carrier vs. non-carrier) and interactions with age, sex, and TBI severity (APOE × age, APOE × sex, APOE × age × sex, and APOE × PTA duration) to predict total score on the HADS, while covarying for the main effects of age, sex, PTA duration, and previous head injury. There was a significant main effect of APOE ɛ4, whereby ɛ4 carriers reported less emotional distress than non-carriers (p = 0.04). However, we also found a significant interaction with age such that APOE ɛ4 carriers reported increasingly greater emotional distress with older age compared with non-carriers (p = 0.01). A sensitivity analysis (n = 306) suggested that the APOE × age interaction, and main effects of age and previous head injury, were not unique to individuals with pre-injury mental health problems (n = 136). However, the main effect of APOE ɛ4 was no longer significant when individuals with pre-injury mental health problems were removed. Our findings highlight the importance of considering moderation of genetic associations, suggesting that APOE ɛ4 may be a risk factor for emotional distress specifically among older survivors of moderate-severe TBI. If these findings can be independently replicated, APOE ɛ4 carriage status, interpreted in the context of age, could be incorporated into risk prediction models of emotional distress after moderate-severe TBI, enhancing targeted early detection and intervention efforts.

Improving well-being for individuals with persistent pain after surgery for breast cancer, lobular carcinoma in situ, or ductal carcinoma in situ: A randomized clinical trial

>276,000 Americans will be diagnosed with invasive breast cancer, lobular carcinoma in situ, or ductal carcinoma in situ this year and most will undergo breast surgery as part of their care. Although prognosis is excellent, many patients experience persistent post-surgical pain (PSP), which has no satisfactory pharmacological treatment. The causal contributions of pain-associated psychological factors (e.g., catastrophic thoughts about pain, psychological flexibility, self-efficacy) to the continuing burden of PSP have not yet been determined and may be opportune intervention targets. The randomized trial described here will compare the benefits of three manualized behavioral interventions for individuals with PSP. Participants will receive either: 1) self-guided health education (SGHE); 2) interventionist-guided health education (IGHE); or 3) interventionist-guided pain coping skills training with elements of acceptance and commitment therapy that specially target catastrophic thoughts about pain, self-efficacy, and psychological flexibility (CST-PSP). Participants will prospectively complete validated assessments of primary outcomes (PSP severity and interference) at baseline (pre-intervention) and 3-, 6-, and 12-months later. Validated measures of emotional distress and cancer-specific distress will be assessed as secondary outcomes. To test their roles as drivers of PSP, catastrophic thoughts about pain, self-efficacy, and psychological flexibility, will be assessed and statistically analyzed as mediators of hypothesized beneficial effects. The interventions' impacts on pain sensitivity and central sensitization will be investigated to test these physiological pathways as proximal drivers of PSP. To better characterize the patient experience, additional validated measures will be explored for associations with PSP, along with demographic and clinical factors.Trial registration: https://clinicaltrials.gov/ct2/show/NCT04225585, registered January 13, 2020

Attachment insecurity predicts outcomes in an ACT-CBT group therapy for adults in a physical rehabilitation centre.

Adapting to chronic illness or disability is accompanied by acute and ongoing illness stressors. Psychological factors such as emotional distress and low self-efficacy are common experiences in chronic illness and disability and interfere with adaptation and psychosocial outcomes such as health-related quality of life. Transdiagnostic group psychotherapy may provide a parsimonious approach to psychological treatment in rehabilitation care by targeting shared illness stressors across mixed chronic illnesses and disabilities, and shared processes that maintain psychological symptoms. Attachment theory may explain individual differences in outcomes and help identify individuals at risk of poor health-related quality of life trajectories. Adults (N=109) participated in an 8-week process-based ACT-CBT psychotherapy group at a tertiary care physical rehabilitation centre between 2016 and 2020. Participants completed measures of emotional distress, self-efficacy, health-related quality of life, and attachment at pre- and post-treatment. Multilevel analyses indicated that patients improved on most outcomes at post-treatment. Attachment anxiety at pre-treatment was associated with more positive outcomes. Reliable change indices suggest clinically meaningful change for the majority of participants, but most were not recovered. Results provide proof-of-concept for the transdiagnostic group intervention and suggest that a longer course of treatment may be clinically indicated. Results warrant replication with larger and more diverse samples, and more robust designs.

Measuring PROMIS® Emotional Distress in Early Childhood.

Create and validate developmentally sensitive parent-report measures of emotional distress for children ages 1-5 years that conceptually align with the Patient-Reported Outcome Measurement Information System (PROMIS®) pediatric measures. Initial items were generated based on expert and parent input regarding core components of emotional distress in early childhood and review of theoretical and empirical work in this domain. Items were psychometrically tested using data from two waves of panel surveys. Item response theory (IRT) was applied to develop item calibration parameters (Wave 1), and scores were centered on a general U.S. population sample (Wave 2). Final PROMIS early childhood (EC) instruments were compared with existing measures of related constructs to establish construct validity. Experts and parents confirmed the content validity of the existing PROMIS Pediatric emotional distress domains (i.e., anger, anxiety, and depressive symptoms) as developmentally salient for young children. Existing items were adapted and expanded for early childhood by employing best practices from developmental measurement science. Item banks as well as 4- and 8-item short forms, free from differential item functioning across sex and age, were constructed for the three domains based on rigorous IRT analyses. Correlations with subscales from previously validated measures provided further evidence of construct validity. The PROMIS EC Anger/Irritability, Anxiety, and Depressive Symptoms measures demonstrated good reliability and initial evidence of validity for use in early childhood. This is an important contribution to advancing brief, efficient measurement of emotional distress in young children, closing a developmental gap in PROMIS pediatric emotional distress assessment.

Torturing environments and multiple injuries in Mexican migration detention

Mexico’s role in the US-Central American migration regime is threefold: not only is it a country of origin, and a transit country, but also increasingly becoming a receiving country for migrants who flee from violence, insecurity and poverty. The Mexican state responds with detention enforcement. Clinical research usually puts emphasise on the negative impact of detention enforcement on the detainees‘ mental health. Yet, it often disregards the spatial configurations of detention centres and their socio-political context. This study aims to fill this gap by analysing how such factors create harmful environments that affect both the detainees‘ mental health and their social life in Mexico’s migration detention centres. The study’s mixed method approach builds on semi-structured interviews with a sample of N = 56 migrants of diverse nationalities and varying socioeconomic status of whom 22 were still detained while 34 had been released. The interviews include the Torturing Environment Scale (TES), a novel instrument for the analysis of detention environments, as well as clinical psychological measures of emotional distress. Additional n = 10 in-depth interviews with human rights advocates to explore the interconnections between the detention environments, their impact on mental health, and Mexican migration politics. Facultative counter-mappings of the detention centres complement the interviews. Without exception, all interviews of detainees underline that the manipulation of detention conditions creates torturing environments that cause harm to basic physiological and psychological needs. A comparison between detained vs. released interviewees revealed lasting feelings of fear and shame. The study emphasises that immigration detention immobilises migrants in a necropolitical limbo, which destroys hope as much as human integrity. It indicates that detention is part of deterrence politics, which perpetuates harm and inequality through detention and deportation. Highlighting structural human rights violations, the findings stress the need to review current migration policies.

Lower motor function prior to the Covid‐19‐imposed lockdown predicts emotional distress in older adults with T2D

BackgroundType 2 diabetes (T2D) is associated with accelerated cognitive decline and increased dementia risk. Lockdowns imposed due to the Covid‐19 outbreak led to unprecedented changes in the life of older adults. However, little is known about emotional distress consequences. We assessed associations of grey matter (GM) volumes (N=179), cognitive and motor functions (N=403) with emotional distress of older adults with T2D from the Israel Diabetes and Cognitive Decline Study (IDCD).MethodsDuring the first Covid‐19‐related lockdown in Israel, we applied a phone questionnaire, which included information about anxiety (“Over the last two weeks, how much have you been bothered by Feeling anxious or nervous?”; Anxiety levels now compared to before Covid‐19), depression (“Over the last two weeks, how much have you been bothered by feeling sad, down, or uninterested in life?”; sad feelings now compared to before Covid‐19), general well‐being (“How are you feeling in general?”), optimism towards the future (“Are you optimistic towards the future?”). Grey matter (GM) volumes (measured by high resolution T1‐weighted MRI), cognitive (a global measure summarizing 14 cognitive tests) and motor function (gait speed and grip strength), are routinely assessed by the IDCD study. Spearman correlation adjusting for age, sex, education, HbA1c and duration of T2D (as well as TICV for the GM analyses) examined associations of GM, cognitive and motor functions with emotional distress measures.ResultsThe sample averaged 72 years of age (SD=4.4), and 14 years of education (SD=3.5); 40.9% were female. Lower grip strength prior to lockdown was associated with increased sadness (r=‐0.21, p<0.001) and anxiety (r=‐.011, p=0.020), less optimism (r=0.10, p=0.042) and lower general feeling (r=0.17, p=0.0005). Slower gait speed was associated with increased sadness (r=0.13, p=0.005). Lower GM was associated with greater anxiety during the lockdown (r=‐0.19, p=0.011) and compared to before Covid‐19 (r=‐0.19, p=0.012). Global cognition was not associated with any of the emotional distress measures.ConclusionsMotor function, but not cognitive function, were associated with lockdown imposed emotional distress in older adults with T2D. These associations point to the importance of good motor function and physical conditioning in emotional well‐being related to acute stress related to stay‐at‐home‐orders.

Machine Learning-Based Predictive Modeling of Anxiety and Depressive Symptoms During 8 Months of the COVID-19 Global Pandemic: Repeated Cross-sectional Survey Study.

BackgroundThe COVID-19 global pandemic has increased the burden of mental illness on Canadian adults. However, the complex combination of demographic, economic, and lifestyle factors and perceived health risks contributing to patterns of anxiety and depression has not been explored.ObjectiveThe aim of this study is to harness flexible machine learning methods to identify constellations of factors related to symptoms of mental illness and to understand their changes over time during the COVID-19 pandemic.MethodsCross-sectional samples of Canadian adults (aged ≥18 years) completed web-based surveys in 6 waves from May to December 2020 (N=6021), and quota sampling strategies were used to match the English-speaking Canadian population in age, gender, and region. The surveys measured anxiety and depression symptoms, sociodemographic characteristics, substance use, and perceived COVID-19 risks and worries. First, principal component analysis was used to condense highly comorbid anxiety and depression symptoms into a single data-driven measure of emotional distress. Second, eXtreme Gradient Boosting (XGBoost), a machine learning algorithm that can model nonlinear and interactive relationships, was used to regress this measure on all included explanatory variables. Variable importance and effects across time were explored using SHapley Additive exPlanations (SHAP).ResultsPrincipal component analysis of responses to 9 anxiety and depression questions on an ordinal scale revealed a primary latent factor, termed “emotional distress,” that explained 76% of the variation in all 9 measures. Our XGBoost model explained a substantial proportion of variance in emotional distress (r2=0.39). The 3 most important items predicting elevated emotional distress were increased worries about finances (SHAP=0.17), worries about getting COVID-19 (SHAP=0.17), and younger age (SHAP=0.13). Hopefulness was associated with emotional distress and moderated the impacts of several other factors. Predicted emotional distress exhibited a nonlinear pattern over time, with the highest predicted symptoms in May and November and the lowest in June.ConclusionsOur results highlight factors that may exacerbate emotional distress during the current pandemic and possible future pandemics, including a role of hopefulness in moderating distressing effects of other factors. The pandemic disproportionately affected emotional distress among younger adults and those economically impacted.

Validation of the Korean Version of the Patient-Reported Outcomes Information System® Emotional Distress Measures

Purpose: This methodological study aimed to translate the Korean version of the Patient-Reported Outcomes Measurement Information System® item bank-emotional distress (i.e., depression, anxiety, and anger) for adults and evaluate its psychometric properties. Methods: Translation involved forward translation, back translation, expert review, harmonization and quality assurance, and cognitive testing. Psychometric properties were evaluated with a community sample of 201 adults. To assess the unidimensionality of the measures, we used factor analysis to examine construct validity. Results: All items of the Patient-Reported Outcomes Measurement Information System item bank-emotional distress measures were translated through a rigorous translation process, and semantic, conceptual, and normative equivalences between the original and Korean version were ensured. Exploratory factor analysis revealed that all items loaded on one dominant factor. The Korean Patient-Reported Outcomes Measurement Information System measures demonstrated acceptable psychometric properties and unidimensionality. Conclusion: The Korean version of the Patient-Reported Outcomes Measurement Information System item bank-emotional distress (i.e., depression, anxiety, and anger) for adults is reliable and valid. Hence, it may be utilized extensively in clinical and research settings and contribute to patient-centered care.