Measures Of Psychological Distress Research Articles

Smile, You’re on Camera: Investigating the Relationship between Selfie Smiles and Distress

Background: This study examined the relationship between (1) participant smiling in daily “selfie” videos and (2) self-reported distress. Given the extensive use of digital devices for sharing expressions of non-verbal behavior, and some speculation that these expressions may reveal psychological states—including emotional distress—we wanted to understand whether facial expression in these TikTok-like videos were correlated with standardized measures of psychological distress. Based on the work of Paul Ekman and others, which posits that facial expressions are universal reflections of people’s inner states, we predicted that smiling would be inversely related to psychological distress. Method: Twenty-four undergraduate students, aged 18+ years (M = 18.35, SD = 2.75), were prompted to record a two-minute selfie video each evening during two weeks of data collection (i.e., 14 total days). They were instructed to describe various aspects of their day. They also completed self-report questionnaires at the end of each assessment week, including the Depression Anxiety Stress Scale (DASS), Perceived Stress Scale (PSS), and the Pittsburgh Sleep Quality Index (PSQI). Results: A counterintuitive effect was observed whereby smiling intensity during selfie videos was positively correlated with individual differences in anxiety, depression, and stress. Discussion: This study challenges the common view that facial expressions necessarily reflect our inner emotions. It provides preliminary evidence that a mobile sensing app that captures selfies—along with other naturalistic data—may help elucidate the relationship between facial expressions and emotions.

A Four Country Study of Strangulation-related Alterations in Consciousness in Women who have Experienced Intimate Partner Violence: Co-occurrence with Traumatic Brain Injuries and Measures of Psychological Distress.

At least one in three women experience intimate partner violence (IPV) in their lifetime. The most commonly sustained IPV-related brain injuries include strangulation-related alterations in consciousness (S-AICs) and traumatic brain injuries (TBIs). Moreover, survivors of IPV-related S-AICs and/or TBIs often demonstrate psychological distress such as depression, anxiety, and post-traumatic stress. However, the co-occurrence of S-AICs and TBIs, and whether such TBIs may be moderate to severe, has not been systematically examined, and most data have been collected from women in North America. The purpose of this study was to examine the co-occurrence of IPV-related S-AICs and TBIs across a range of geographical locations and to determine the extent to which these S-AICs are related to psychological distress. Women who had experienced physical IPV (N=213) were included in this secondary analysis of retrospectively collected data across four countries (Canada, USA, Spain, and Colombia). The Brain Injury Severity Assessment (BISA) was used to assess IPV-related BI across all sites. Because various questionnaires were employed to assess levels of depression, anxiety, and PTSD at each site, we created a standardized composite score by converting raw scores into Z-scores for analysis. Mann Whitney U tests and Chi square tests were conducted to examine differences between women with- versus without-experience of S-AICs and to discover if there was a relationship between the occurrence of S-AICs and TBIs. Analysis of variance, and analysis of covariance (to control for the potential confounding effects of age, education, and non IPV-related TBI) were used to compare levels of psychological distress in women who had or had not experienced S-AICs. Approximately 67% of women sustained at least one IPV-related BI (i.e., TBI and/or S-AIC). In a sub-sample of women who sustained at least one IPV-related BI, approximately 37% sustained both S-AICs and TBIs, 2% sustained only S-AICs (with no TBIs), and 61% sustained TBIs exclusively (with no S-AICs). Furthermore, women who had sustained S-AICs (with or without a TBI) were more likely to have experienced a moderate to severe BI than those who had not sustained an S-AIC (BISA severity subscale: U=3939, p=0.006). Additionally, women who experienced S-AICs (with or without a TBI) reported higher levels of psychological distress compared to women who never experienced S-AICs, irrespective of whether they occurred once or multiple times. These data underscore the importance of assessing for S-AIC in women who have experienced IPV and when present, to also assess for TBIs and the presence of psychological distress. Unfortunately, there were methodological differences across sites precluding cross-site comparisons. Nonetheless, data were collected across four culturally and geographically diverse countries, and therefore highlight IPV-related BIs as a global issue which needs to be aggressively studied with policies established and then implemented to address find.

Psychosocial Outcomes Associated With Types and Intensities of Physical Activity in People With Spinal Cord Injury: The Mediating Role of Self-Efficacy and Functionality.

Low rates of participation and quality of life (QoL) and high rates of psychological distress are common in spinal cord injury (SCI) population. Research has supported the mediating role of self-efficacy and functionality in improving psychosocial outcomes. Furthermore, evidence supports the impact of physical activity (PA) on psychosocial variables, but little is known about the types and intensities of PA. The objective of this study was to determine whether functionality and/or general self-efficacy (GSE) mediate the relationships between the various types of PA: (1) lifestyle and (2) leisure-time physical activity(LTPA); and various intensitiesof PA: (1) mild, (2) moderate, and (3) heavy PA with participation, psychological distress, and perception of QoL. The Physical Activity Recall Assessment for SCI, and measures of functionality, GSE, participation, psychological distress, and perception of QoL were administered to 159 participants. Path analysis was performed using Jeffrey's Amazing Statistics Program. GSE significantly mediated, and functionality partially significantly mediated, the relationship between LTPA and psychosocial outcomes. GSE and functionality did not mediate the relationship between lifestyle activity and psychosocial outcomes. It is recommended that people with SCI perform LTPA on a regular basis to achieve psychosocial benefits. These programs should be accompanied by strategies to improve GSE.

Schneiderian First Rank Symptoms Significantly Predict a Dissociative Disorder Diagnosis in Psychiatric In-Patients

ABSTRACT Previous empirical studies on the relationship between psychotic symptoms and dissociative disorders focused on auditory hallucinations only or employed limited statistical analyses. We investigated whether the frequency of Schneiderian first rank symptoms (FRS) predicts the presence or absence of a dissociative disorder (DD). Psychiatric in-patients (n = 116) completed measures of dissociation, FRS and general psychological distress (GPD). DD diagnoses were confirmed by multidisciplinary teams or administering the Structured Clinical Interview for DSM-IV Dissociative Disorders-Revised (SCID-D-R). The FRS were recorded in the Multidimensional Inventory of Dissociation (MID) and a mean score obtained for 35 relevant items: Voices arguing, voices commenting, made feelings, made impulses, made actions, influences on body, thought withdrawal, and thought insertion. A global severity index (GSI) of GPD was obtained from the Symptom Checklist–90–Revised (SCL-90-R). Logistic regression models examined whether FRS predict diagnostic classification of patients under a DD (n = 16) or not (n = 100), controlling for GSI. The overall fit of the model was significant (p = .0002). DD was correctly classified using frequency of FRS, controlling for GSI. The latter was moderately associated with FRS (r = 0.56). FRS more than doubled the odds of a DD diagnosis (odds = 2.089; 95% CI = 1.409–3.098; correct classification rate 87.1%). The study provides convincing evidence that FRS are closely related to DDs. FRS should alert clinicians to consider DDs in differential diagnosis of psychiatric in-patients. Future research should analyze whether FRS also predict a diagnosis of schizophrenia or other psychiatric disorders.

Tackling poor mental health and self-harming tendencies among students: Indicative evidence of the effectiveness of a novel partnership-based approach to intervention

Poor mental health and self-harm are becoming increasingly common in student populations. Strategic partnerships between universities and NHS mental health services can ensure that students have access to appropriate support. The current paper reports on a pilot service evaluation of a brief therapy service for students who have recently self-harmed, namely University-Community Outpatient Psychotherapy Engagement (U-COPE) service. The aim of the pilot evaluation was to ascertain the efficacy of the U-COPE service as well as offer insights around partnership working between university and NHS mental health services in relation to the design, implementation, and delivery of the U-COPE service. Students completed measures of psychological distress before and after the intervention, as well as across the four therapy sessions. There was a reduction in psychological distress between assessment and discharge. Psychological distress also reduced significantly between the first and final therapy session. Most students (93%) continued their programme of study from the year in which they had accessed the U-COPE service to their next year of study. The provision of brief, relational psychotherapy to students presenting with self-harm related difficulties is a novel approach to intervention. The success of this approach illustrates how multiple organisations play a role in supporting student mental health, bringing a blend of diverse skills and expertise together. Although the U-COPE service shows promise as a brief intervention for students who self-harm, these findings should be treated with caution due to the small sample size. Further investigation of this brief intervention is warranted to ascertain whether U-COPE has a long-term impact on difficulties and distress-related behaviours.

Predictors of self-reported word-finding difficulties in glioma patients – a longitudinal study

ABSTRACT Background Word-finding difficulties are a common self-reported concern in glioma patients known to negatively affect social participation and life satisfaction. Discrepancies between self-reported difficulties and performance on objective tests have been reported, but studies are seldom conducted longitudinally. Aims The aim of the present study was to examine the occurrence of self-reported word-finding difficulties before and during the first year after glioma surgery. In addition, we investigated whether self-reported word-finding difficulties were predicted by standardized language tests and psychological distress. Methods and procedures Twenty-three patients with gliomas (grade 1–3) were assessed pre-surgery, at six and twelve months follow-up. Self-reported word-finding difficulties were addressed with the item I am able to find the right word(s) to say what I mean, from the Functional Assessment of Cancer Therapy – Brain (FACT-Br). Confrontation naming was tested with the Boston Naming Test (BNT), word production with a semantic fluency test and word knowledge with a vocabulary test. Self-reported measures of psychological distress were assessed with the Hospital Anxiety and Depression Scale (HADS). Ordinal regression models were used to examine predictors of self-reported word-finding difficulties. Outcomes and results Word-finding difficulties were reported by 68% of the patients pre-surgery, increasing to 90% and 85% at the following assessments. Significant changes were observed in the magnitude of reported concerns between pre-surgery assessment and six months follow-up. Regression analyses demonstated that self-reported word-finding difficulties were predicted by psychological distress and vocabulary pre-surgery and vocabulary at six months follow-up, whereas confrontation naming and semantic fluency did not become significant in any of the assessments. Conclusion Our results indicate that self-reported word-finding difficulties occurred in a high percentage of glioma patients throughout the first year of illness. Patients reported increased difficulties after surgery that were not predicted by confrontation naming or semantic fluency but by vocabulary performance. The results imply further that psychological distress is a factor that should be taken into account. Self-reported function is an important supplement to objective testing and can provide indications about mental health status and the patients` perspective on language related challenges in everyday life.

Association between Burn Location and Psychological Distress: A Burn Model System National Database Study.

Burn injuries often lead to psychological distress, from depression and anxiety to adjustment concerns and posttraumatic stress. There is some evidence that the anatomical location of burn injuries (e.g., head/neck, feet) has a specific negative impact on psychological functioning. The purpose of this study was to examine the associations between burn injury location and emotional distress. First, we administered self-report questionnaires to burn survivors with ≤ 5% TBSA at a single adult outpatient burn clinic. Second, we used a cross-sectional analysis of the Burn Model System National Database. The mean values of each measure of psychological distress (i.e., quality of life, self-esteem, depression, posttraumatic stress, anxiety, and, for contrast, posttraumatic growth) were examined for each anatomical location for those participants with a burn in those anatomical areas against those with burn in other areas, Using Kruskal-Wallis tests to compare psychological distress, we found no significant differences in outcome measures in either sample analyzed in our study. These findings contrast with prior literature indicating the negative psychological impact of burn injuries to certain locations in the body. Further research should explore whether larger burns (i.e., greater than 5% TBSA) affecting critical areas of the body may be associated with psychological distress.

Social support and psychotherapy outcomes for international students in university/college counseling centers

Objective: To explore the relationship between international students’ social support at intake and international student distress at end of treatment. Participants: Data was collected from participants (n = 40,085) from 90 United States universities using the Center for Collegiate Mental Health (CCMH) database. Methods: Participants completed measures of psychological distress and perceived social support. Using multilevel modeling, we predicted participants’ distress at end of treatment by international student status, social support, race, and length of therapy. Results: We found that international students who reported lower social support at intake ended treatment with higher levels of psychological distress when distress at intake was controlled compared to United States peers. Conclusions: Understanding the significance of social support for international students can help to inform mental healthcare professionals’ approach to psychotherapy.

Psychometric validation of the 15-item Patient Health Questionnaire – Anxiety and Depression Scale (PHQ-ADS) to assess psychological distress in breast cancer survivors

ObjectivePsychological distress persists amongst breast cancer survivors, so reliable assessment of symptoms is essential. The Patient Health Questionnaire Anxiety and Depression Scale (PHQ-ADS) is a composite measure of depression and anxiety and has been used to measure distress. This study aimed to evaluate the psychometric properties of the PHQ-ADS within breast cancer survivors. MethodBreast cancer survivors (N = 280) were recruited online and followed up at 12-months. Depression (PHQ-8) and anxiety (GAD-7) items formed the composite PHQ-ADS score. Additional measures included: distress thermometer (convergent validity), fear of cancer recurrence and COVID distress (discriminant validity), and self-compassion (predictive validity). Confirmatory factor analysis (CFA) using weighted least squares mean and variance adjusted estimation was undertaken. ResultsOne, two, and bifactor models underlying the PHQ-ADS were evaluated. The bifactor model had the most appropriate model fit overall. Omega hierarchical for the general distress factor was 0.914, accounting for 82% of explained variance. This suggests the PHQ-ADS is sufficiently unidimensional to warrant use of a total composite score. The PHQ-ADS demonstrated strong convergent and moderate discriminant validity. Self-compassion was an independent predictor of distress at 12-months. ConclusionsThe PHQ-ADS is a valid measure for psychological distress in breast cancer survivors prescribed hormone therapy.

Social capital and changes of psychologic distress during early stage of COVID-19 in New orleans

Here we report on the relationship between measures of social capital, and their association with changes in self-reported measures of psychological distress during the early period of the COVID-19 pandemic. We analyze data from an existing cluster randomized control trial (the Healthy Neighborhoods Project) with 244 participants from New Orleans, Louisiana. Changes in self-reported scores between baseline (January 2019–March 2020) and participant’s second survey (March 20, 2020, and onwards) are calculated. Logistic regression is employed to examine the association between social capital indicators and measures of psychological distress adjusting for key covariates and controlling for residential clustering effects. Participants reporting higher than average scores for social capital indicators are significantly less likely to report increases in psychosocial distress between pre and during the early stage of the COVID-19 pandemic. Those who report higher than average sense of community were approximately 1.2 times less likely than those who report lower than average sense of community scores to experience increases in psychological distress before and during the global pandemic (OR 0.79; 95% CI 0.70,0.88, p ≤ 0.001), even after controlling for key covariates. Findings highlight the potentially important role that community social capital and related factors may play in the health of underrepresented populations during times of major stress. Specifically, the results suggest an important role of cognitive social capital and perceptions of community membership, belonging, and influence in buffering changes of mental health distress experienced during the initial period of the COVID-19 pandemic among a sample of residents.

Validation of the ACSID-11 for consistent screening of specific Internet-use disorders based on ICD-11 criteria for gaming disorder: A multitrait-multimethod approach

IntroductionWith the inclusion of gaming disorder in the ICD-11, diagnostic criteria were introduced for this relatively new disorder. These criteria may be applied to other potential specific Internet-use disorders. The 11-item Assessment of Criteria for Specific Internet-use Disorders (ACSID-11) was developed for consistent screening of gaming disorder, online buying-shopping disorder, online pornography-use disorder, social networks-use disorder, and online gambling disorder. This study tested the construct validity of the ACSID-11, including convergent and divergent measures. MethodsThe ACSID-11 measures five behavioral addictions with the same set of items by following the principles of the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). The ACSID-11 was administered to a convenience sample of active Internet users (N = 1597) together with validated and established measures of each specific Internet-use disorder along with screeners for mental health. Included are the Ten-Item Internet Gaming Disorder Test (IGDT-10), the Bergen Shopping Addiction Scale (BSAS), the Problematic Pornography Consumption Scale (PPCS), the Bergen Social Media Addiction Scale (BSMAS) and the Berlin Inventory of Gambling behavior – Screening (BIG-S). The ACSID-11 was compared convergently and divergently through a multitrait-multimethod approach along with contingency tables with the other Internet-use disorder screeners. ResultsThe multitrait-multimethod results shows that each behavior assessed with the ACSID-11 has moderate to strong correlations (r's from 0.462 to 0.609) with the scores of the corresponding established measures and, furthermore, positive correlations (r's from 0.122 to 0.434) with measures of psychological distress and further shows that the ACSID-11 can be used for a comprehensive assessment of different behaviors. The contingency tables reveal large divergences between the ACSID-11 and other screening instruments concerning the classification of problematic specific Internet use based on the given cut-off values. ConclusionThe current work provides additional validation for the ACSID-11. Accordingly, this tool can be considered as reliable and valid for the simultaneous assessment of different Internet-use disorders: gaming disorder, online buying-shopping disorder, online pornography use disorder, social networks use disorder, and online gambling disorder. With a subsequent clinical validation of the scale and the proposed cut-off score, the ACSID-11 will be a thoroughly validated useful screening tool for clinical practice.

Self-esteem, Social and Affective Outcomes of Students with Special Educational Needs in Tertiary Education

The core values of inclusive education (IE) proclaim to provide equal educational opportunities to all students regardless of disabilities or special educational needs (SEN). Nonetheless, there were no consistent indications that IE was beneficial to students with SEN. Despite lacking solid evidence for the efficacy of IE, more and more students with SEN completed their secondary education and pursue their studies in tertiary education. This study was conducted in an institute of tertiary education to investigate psychosocial outcomes of inclusive practice. A total of 91 students with special educational needs participated in this study. Validated outcome measures of global self-esteem, social relationship, and psychological distress were incorporated in a questionnaire for online data collection. Results showed that students with SEN were able to maintain good social relationship with their peers, but their global self-esteem was significantly lower and their psychological distress was higher than their peers without SEN. Students with mental illness or emotional problems were most vulnerable to academic stress of tertiary education, whereas students with physical and sensory impairments were very well adjusted and their psychosocial outcomes were not significantly different from their pees without SEN. Findings of the study were discussed and implications of the findings for IE research considered.

Self-concept clarity in social anxiety: psychometric properties and factor structure of the Self-Concept Clarity Scale in a social anxiety disorder sample

ABSTRACT Background The Self-Concept Clarity Scale (SCCS) is a 12-item self-report measure that assesses self-concept clarity (SCC). Previous research has identified a relationship between lower SCC and higher levels of social anxiety. As a measure of positive psychological well-being, the SCCS can be used as a tool to examine and monitor SCC in populations with social anxiety disorder (SAD) who appear to be susceptible to inconsistent or unstable self-concept. However, the scale has yet to be validated with a SAD sample. Methods A confirmatory factor analysis (CFA) was conducted on the SCCS data of sample of 87 individuals who met criteria for a diagnosis of SAD (M = 20.15, SD = 3.55; 83% female) and the reliability, convergent validity and norm scores of the SCCS with a SAD were also investigated. Results Results of the CFA supported a unidimensional factor structure. The SCCS was found to have good internal consistency (Cronbach’s α = .80) and SCCS scores were found to correlate with measures of psychological distress and social fears, however, no correlation was found with measures of social anxiety behaviours. Also, overall results found that the SAD sample scored lower on SCC than other clinical samples in previous literature. Conclusions These findings suggest that the SCCS is a psychometrically sound measure with unidimensional factor structure and demonstrated reliability and validity with a SAD sample, although additional research is warranted to replicate and extend the results of the current research.

Abstract C001: A pilot study of palliadelic treatment with psilocybin to reduce psychological distress and improve quality of life in patients with advanced pancreatic adenocarcinoma

Abstract Background: Psychological distress is a common reaction to a cancer diagnosis and its treatment. Distress impacts quality of life, adherence to treatment, decision making and survival. Patients with pancreatic adenocarcinoma (PDAC) experience exceptionally high rates of psychological distress, most commonly depression, anxiety and suicidality. Psilocybin, a serotonergic psychedelic which is the active component in “magic mushrooms,” is a promising treatment for several mental health disorders. Prior studies in patients with cancer have combined a single dose of psilocybin with preparation and integration counseling and have shown significant, rapid and sustained improvement in depression, anxiety and quality of life. These studies have primarily been conducted in psychiatry or neuroscience clinics in heterogenous groups of patients, many of whom had completed cancer treatment. This study will evaluate the feasibility and safety of psilocybin-assisted therapy delivered in the outpatient palliative care clinic in patients with advanced PDAC who are receiving chemotherapy. Methods: This is a single center, open label pilot study of a psilocybin-assisted therapy integrated with palliative care in patients with advanced PDAC. The primary endpoints are the feasibility and safety of this strategy when integrated into routine palliative care. Secondary endpoints include short term changes in depression, anxiety and demoralization and changes in neuronal activity by functional MRI (fMRI). After 2-4 outpatient preparation sessions with a palliative medicine physician (PMP), the subject will take psilocybin (25mg capsule) at an individual session supported by a PMP and a trained mental health professional. Up to 3 integration sessions with a PMP will follow. Patient-reported measures of psychological distress and quality of life will be assessed at baseline, after the psilocybin dose and periodically during follow-up. Neuronal changes will be measured using fMRI before and after the psilocybin dose. Eligible patients are adults (ECOG 0-3) with advanced PDAC with adequate organ function. Patients with psychiatric conditions which preclude safe cessation of psychotropic drugs or requires hospitalization, a personal or family history of schizophrenia, psychotic disorder or bipolar disorder, who have a high risk of suicide or have serious or uncontrolled hypertension or cardiovascular disease are ineligible. Given the exploratory nature of the study, a formal statistical assessment of the sample size was not conducted. Twelve evaluable subjects will provide sufficient power to detect large effect sizes (Cohen’s d1.0) in the secondary endpoints. Wilcoxon signed rank test will determine the reduction in distress scores before and after the psilocybin session. Enrollment began in June 2023; two subjects have enrolled. The study is funded by the Jim Young Pancreatic Cancer Research Memorial Fund. Psilocybin is provided by Usona. ClinicalTrials.gov Identifier: NCT05220046 Citation Format: Kelsey A. Klute, Lou Lukas, Soonjo Hwang, Yeongjin Gwon, Mridula Krishnan, Jean Grem, Sunil Hingorani, Jody Koenig Kellas. A pilot study of palliadelic treatment with psilocybin to reduce psychological distress and improve quality of life in patients with advanced pancreatic adenocarcinoma [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Pancreatic Cancer; 2023 Sep 27-30; Boston, Massachusetts. Philadelphia (PA): AACR; Cancer Res 2024;84(2 Suppl):Abstract nr C001.

Measuring culturally and contextually specific distress among Afghan, Iraqi, and Great Lakes African refugees.

Culturally and contextually valid measurement of psychological distress is critical, given the increasing numbers of forcibly displaced people and transnational migration. This study replicates an inductive process that elicited culturally specific expressions, understandings, and idioms of distress among Afghans to develop culturally specific measures of distress for Great Lakes Africans and Iraqis and expands this methodology to include a focus on the contexts of refugees resettled in the United States. To create the measures, we adapted Miller et al.'s (2006) model for the Afghan Symptom Checklist (ASCL) and conducted 18 semistructured qualitative interviews that attended to refugees' multiple settings; the impact of potentially traumatic events initially and postresettlement; and the experiences and impact of resettlement stressors. We tested the newly developed measures and existing ASCL with 280 recently resettled refugees (< 3 years) from Afghanistan, the Great Lakes region of Africa, and Iraq to assess factor structure, reliability, and construct validity. We successfully replicated and adapted a process for creating culturally specific measures of distress to create reliable and valid scales that consider culturally and contextually specific distress among several groups of forcibly displaced people. Our results highlight the salience of individuals' social contexts and how they are manifested as idioms of distress, bringing together two key areas of research: the social construction of mental health and social determinants of mental health. These findings have implications for improving measurement of psychological distress and for developing multilevel interventions that are culturally resonant and address factors beyond the individual level. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Addiction Treatment Outcomes: Examining the Impact of an Inpatient Program for Substance Use Disorders and Concurrent Mental Distress

ABSTRACT Substance use disorders (SUDs) affect over 35 million individuals worldwide and are associated with significant harms. Residential treatment is an essential component of Canada’s approach to combating SUDs, offering highly intensive and specialized acute services. Historically, residential treatment facilities have quantified the success of their program(s) solely based on program completion. However, there has been a recent movement toward empirically evaluating programs using standardized measures of distress. The purpose of this study was to evaluate whether the inpatient residential program for SUDs at Edgewood Treatment Centre is effective in providing substantive improvement of a range of addiction and mental health symptoms. The current study assessed both addiction related and psychological outcomes. Specifically, we examined whether patients improved on various measures of functional impairment, addiction-related symptoms, traumatic stress, and psychological distress, following completion of the 7-week inpatient addiction program. Findings suggested that there were significant improvements in emotion regulation, and decreases in substance dependence, substance cravings, anxiety, depressive symptoms, and traumatic stress between admission and discharge.

Therapist and client perceptions of the working alliance: Codevelopment, linear growth, variability, and client functioning.

Using longitudinal client and therapist working alliance ratings, previous research examined how alliance: average value, linear growth, variability, stability (autocorrelation), and partner responsiveness were associated with client outcome. However, no research simultaneously examined all of these dimensions. Omitting important variables in analyses could lead to overestimation of related effects. Therefore, the purpose of this study was to examine these effects simultaneously. Therapists (N = 45) and clients (N = 236) rated alliance after every session (N = 10,720) and clients completed a measure of psychological distress after every eighth session. We used dynamic structure equation modeling to model longitudinal ratings using the longitudinal actor-partner interaction and location-scale models. Across sessions, there were significant linear growth and significant variability in client and therapist alliance ratings. The variability indicates multiple "V" patterns, which have been associated with alliance ruptures. Both actor effects were significant, showing session-to-session stability for client and therapist alliance. In addition, client-partner effect was significant, indicating higher-than-usual client alliance in a session predicting an increase in therapist alliance in the subsequent session. Growth in neither client-rated nor therapist-rated working alliances was significantly associated with client improvement. Lower variabilities (fewer fluctuations) in both client- and therapist-rated working alliances were associated with better outcomes. Higher therapist-actor and partner effects were associated with client improvement, but client-actor and partner effects were not associated with client improvement. Average working alliances were not associated with client improvement. Implications for practice and research were discussed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Psychosocial Experiences in an Australian Rural Cancer Service: Mixed-Method Insights into Psychological Distress and Psychosocial Service Barriers

Purpose. To examine psychosocial and well-being concerns throughout the cancer experience, from prediagnosis to survivorship. Whilst most oncology research focuses on patients, the role and experiences of families and caregivers are increasingly recognised as a core component of health service delivery. Moreover, research suggests that geography is an important consideration, with evidence of rural inequities in health service provision and access. Aims. (i) To examine the unique patient and caregiver experiences of rural people in three rural cancer treatment centres in New South Wales (NSW) and (ii) to examine the barriers to rural patients and caregivers accessing psycho-oncological support in NSW. Methods. A convergent parallel mixed-method evaluation of the psychosocial experiences of rural patients and caregivers accessing cancer services through three health services in rural NSW was undertaken (N = 125). Measures of psychological distress as well as quantitative and qualitative barriers data were collected. Results. Approximately, one-third of the participants reported moderate to severe distress. Patients and caregivers reported systemic, intrapersonal, interpersonal, and pandemic-specific barriers in accessing quality psychosocial healthcare. Conclusions. These results suggest that cancer patients and caregivers in rural NSW may experience elevated levels of psychological distress and barriers in accessing psychosocial care. The combination of high psychological need for patients and caregivers with reduced availability of psychosocial support services has substantial implications for psychological wellbeing and service provision. Underdetection of psychosocial need and a lack of support services pose a significant challenge for rural people with cancer and for those who care for them; this must be an urgent priority for quality improvement and equitable healthcare provision.

Lingering Effects of COVID-19 Stressors on Mental Health and Alcohol Use in Middle Aged to Older Adults

BackgroundOlder adults have faced not only health threats but grave mental health challenges since the emergence of the Coronavirus disease 2019 (COVID-19) pandemic. Using factor analysis, this study is the first to identify the underlying dimensions of COVID-19-related stressors, then examine the relationship between these factors and mental health and alcohol use/misuse longitudinally in a middle aged to older adult sample in the United States. MethodsAs part of a long-term follow-up study, 921 survey participants completed measures of COVID-related stressors, psychological distress, and alcohol use/misuse in a 2020 survey. An exploratory factor analysis was conducted to examine the dimensionality of COVID-related stress. Regression models were utilized to examine relationships between the extracted factors and depression, anxiety, and alcohol-related outcomes measured approximately one year later, in 2021. ResultsFour dimensions of COVID-19 stressors were extracted, including 1) jobs, finances and loss of routine; 2) practical difficulties; 3) social worries and challenges; and 4) supply shortages. Practical difficulties were associated with higher depression at follow-up, while jobs, finances and loss of routine were associated with past 12 month frequency of intoxication at follow-up. Conclusions: Challenges from the pandemic may have longer-term implications for mental health in older adults past the acute phase of the pandemic. It is important to allocate sufficient attention and resources to the prevention of late life depression and mental health as policymakers and health professionals continue to deal with the pandemic and future variants of the virus.

Aging Makes the Heart Grow Fonder: Age Influences Hearing Ability and Interactions between Psychological Phenomena in Patients with Chronic Tinnitus.

(1) Background: Risk factors for chronic tinnitus comprise interactions of individuals' hearing difficulties and psychological distress-including anxiety, depression, and perceived stress levels. Both groups of factors likely become more pronounced with age, although mixed literature has also suggested increases in psychological resilience over time. To this end, only a few studies have delineated direct and indirect effects of age on audiological and psychological variables that might influence tinnitus-related distress in patients with chronic tinnitus. (2) Methods: N = 678 patients with chronic tinnitus completed audiological assessments alongside self-report measures of psychological and tinnitus-related distress. Path analyses investigated the effect of age on patients' tinnitus-related distress via both audiological and psychological variables. (3) Results: Age was significantly associated with both hearing ability and psychological distress indices, with perceived stress and anxiety decreasing with aging. Different mediation models revealed that the association between age and tinnitus-related distress was mediated completely by hearing ability and partly by perceived stress and anxiety. (4) Conclusions: Whilst interactions of individuals' hearing ability and psychological distress levels maintain tinnitus-related distress across the age span, the weighting of these factors may shift with age. Treatment approaches should consider hearing ability across the lifespan. Psychological factors should be individually conceptualized, considering both distress-related and potential resilience factors in old age.