Mild Distress Research Articles

Impact of the COVID-19 Pandemic on Mental Health among Patients with Chronic Ocular Conditions.

The COVID-19 pandemic had significant impacts on the mental and visual health of patients. This cross-sectional, survey-based, multicentric study evaluates the state of mental and visual health among patients with chronic ocular diseases such as glaucoma, neovascular age-related macular degeneration, diabetic retinopathy, or chronic uveitis during the lockdown period of the COVID-19 pandemic. Mental health was assessed using three questionnaires: the Patient Health Questionnaire-9 (PHQ-9), the Impact of Event Scale-Revised (IES-R), and the National Eye Institute Visual Function Questionnaire-25 (VFQ-25). A total of 145 patients completed the questionnaires. The PHQ-9 showed that most respondents (n = 89, 61%) had none or minimal depressive symptoms, while 31 (21%) had mild depressive symptoms, 19 (13%) had moderate depressive symptoms, 5 (3%) had moderately severe depressive symptoms, and 1 (1%) had severe depressive symptoms. Regarding stress surrounding the pandemic, the median IES-R showed mild distress in 16 (11%), moderate distress in 7 (5%), and severe distress in 4 (3%). The COVID-19 pandemic lockdowns had a negative impact on patients' mental health with close to 20% of the patients reporting at least moderately depressive symptoms and 19% reporting at least mildly distressful symptoms.

General Health, Posttraumatic Stress Disorder, and Coping Strategies of Nurses Working in the COVID-19 Intensive Care Units

Background: Nurses working in intensive care units (ICUs) are more in direct contact with COVID-19 patients than other healthcare team members and are more vulnerable to mental disorders. This study aimed to determine the general health status, posttraumatic stress disorder, and coping strategies of nurses employed in the COVID-19 intensive care units. Methods: It was a cross-sectional descriptive study. Using the census method, 102 nurses working in the COVID-19 intensive care units of Iran University of Medical Sciences in Tehran, Iran, were recruited as the sample in 2022. The general health questionnaire (GHQ-28), the impact of events-revised (IES-R), and the ways of coping questionnaire (WCQ) were used as research instruments. The data were analyzed using the Pearson correlation coefficient, independent t-test, and analysis of variance in SPSS software, version 16. The significance level was set at P<0.05. Results: The overall mean of general health was 32.22±12.21, indicating mild psychological distress in most nurses. Somatic symptoms had the highest mean (9.16±4.06) among the GHQ-28 subscales. The mean posttraumatic stress disorder was 39.07±14.79. The means of problem-focused and emotion-focused coping strategies were 48.03±13.44 and 40.78±11.70, respectively. Most nurses (60.8%) generally suffered posttraumatic stress symptoms and used problem-focused coping strategies to deal with stressors during the COVID-19 pandemic. No significant relationship existed between the main variables and the nurses’ characteristics (P>0.05). Conclusion: Most nurses experienced mental disorders (general health disorders and posttraumatic stress) during the COVID-19 pandemic. To reduce the psychological impact of COVID-19 on nurses, paying attention to their mental health is essential. Given the adverse effect of COVID-19 on nurses, studying the relationship between these variables and the quality of nurses’ performance is suggested.

PS04 Assessment and management of patients with vitiligo and psychological distress: clinician survey

Abstract Vitiligo is a common, pigmentary skin disorder, affecting 1% of people worldwide. People with vitiligo have a significantly higher prevalence of psychosocial comorbidities, including anxiety, depression and suicidal ideations, than nonaffected individuals (Ezzedine K, Eleftheriadou V, Jones H et al. Psychosocial effects of vitiligo: a systematic literature review. Am J Clin Dermatol 2021; 22:757–74). The British Association of Dermatologists’ (BAD) 2022 vitiligo guidelines recommend the assessment of psychosocial impact in all patients with vitiligo, with management tailored to severity (Eleftheriadou V, Atkar R, Batchelor J et al. BAD guidelines for the management of people with vitiligo 2021. Br J Dermatol 2022; 186:18–29). We conducted a UK-wide consultation exercise aimed at establishing the current assessment and management practices of patients with vitiligo who experience psychological distress due to their skin. This project was supported by the UK Dermatology Clinical Trials Network and was also distributed to BAD members. Seventy-eight responders completed the online questionnaire (83% doctors, 14% nurses and 3% psychologists). On average, responders reviewed eight patients with vitiligo in the clinic during the preceding 6 months; 37% of these patients were estimated to have moderate/severe psychological distress. Sixty-seven per cent reported routine screening for psychological impact using mainly the Dermatology Life Quality Index (56%) and Patient Health Questionnaire-9 (16%). Forty-eight per cent used no formal screening tool but asked general questions. Thirty-three per cent do not routinely screen for psychological impact. For the management of mild psychological distress, 83% of responders signpost to online resources or advise self-referral to local services; 16% wrote to the general practitioner only. For the management of moderate-to-severe psychological distress, 28% referred patients to psychiatric services, 29% to psychological services and 37% to community services. Four per cent stated they would not take any action. Interestingly, 18% were not aware of any available local, regional or national psychological services. Waiting times for urgent psychological input ranged from 2 months to 2 years. Eighty-seven per cent of responders felt that their patients with vitiligo would benefit from a tailor-made online psychological intervention targeting specific aspects of the condition and that patients with vitiligo would engage with it (80%). Digital accessibility was highlighted as the main concern by remaining responders. Sixty per cent of responders expressed interest in participating in a trial examining the effectiveness of an online-delivered psychological intervention for patients with vitiligo and moderate/severe psychological distress. In summary, significant variation exists in the assessment and management of patients with vitiligo and psychological distress. Our survey suggests an unmet need for such an online intervention and a need for educational resources to give to clinicians regarding pathways to mental health services.

Emotional Distress, Anxiety, and General Health Status in Patients With Newly Identified Small Pulmonary Nodules: Results From the Watch the Spot Trial

Anxiety and emotional distress have not been studied in large, diverse samples of patients with pulmonary nodules. How common are anxiety and distress in patients with newly identified pulmonary nodules, and what factors are associated with these outcomes? This study surveyed participants in the Watch the Spot Trial, a large, pragmatic clinical trial of more vsless intensive strategies for radiographic surveillance of patients with small pulmonary nodules. The survey included validated instruments to measure patient-centered outcomes such as nodule-related emotional distress (Impact of Event Scale-Revised) and anxiety (Six-Item State Anxiety Inventory) 6 to 8weeks following nodule identification. Mixed-effects models were used to compare outcomes between study arms following adjustment for potential confounders and clustering within enrollment site, while also examining a limited number of prespecified explanatory factors, including nodule size, mode of detection, type of ordering clinician, and lack of timely notification prior to contact by the study team. The trial enrolled 34,699 patients; 2,049 individuals completed the baseline survey (5.9%). Respondents and nonrespondents had similar demographic and nodule characteristics, although more respondents were non-Hispanic and White. Impact of Event Scale-Revised scores indicated mild, moderate, or severe distress in 32.2%, 9.4%, and 7.2%of respondents, respectively, with no difference in scores between study arms. Following adjustment, greater emotional distress was associated with larger nodule size and lack of timely notification by a clinician; distress was also associated with younger age, female sex, ever smoking, Black race, and Hispanic ethnicity. Anxiety was associated with lack of timely notification, ever smoking, and female sex. Almost one-half of respondents experienced emotional distress 6 to 8weeks following pulmonary nodule identification. Strategies are needed to mitigate the burden of distress, especially in younger, female, ever smoking, and minoritized patients, and those with larger nodules. ClinicalTrials.gov; No.: NCT02623712; URL: www. gov.

Effectiveness of Mindfulness-Based Cognitive Therapy in reducing psychological distress and improving sleep in patients with Inflammatory Bowel Disease: study protocol for a multicentre randomised controlled trial (MindIBD).

BackgroundMany patients with Inflammatory Bowel Diseases (IBD) suffer from psychological distress, fatigue and sleep disturbances, which are associated with reduced quality of life (QoL) and increased societal costs. Only limited psychosocial treatment options are available. As Mindfulness-Based Cognitive Therapy (MBCT) has demonstrated to improve psychological distress, QoL and sleep in other populations, MBCT might also be effective in patients with IBD.MethodsThe MindIBD study is a prospective, multicentre, randomised controlled trial comparing MBCT plus Treatment As Usual (TAU) versus TAU alone in a targeted number of 136 IBD patients in remission, aged 16 years and older with at least mild psychological distress (Hospital Anxiety and Depression Scale (HADS) total score ≥ 11). Primary outcome is reduction of psychological distress post-intervention, measured by the HADS. In addition, the effect of MBCT on sleep quality (including actigraphy and electroencephalography recordings), fatigue, disease activity, perceived disease control, QoL and positive mental health will be examined. Assessments will be conducted at baseline and at 3, 6, 9 and 12 months follow-up. Cost-effectiveness will be determined and a process evaluation will be conducted.DiscussionThis study will provide valuable insight into the clinical effect of MBCT on psychological distress, sleep quality, fatigue and QoL in IBD patients and into the cost-effectiveness. If effective, MBCT can be a valuable addition to the available psychosocial interventions for patients with IBD. Moreover, findings from this study may also be applicable in patients with other chronic conditions.Trial registrationClinicalTrials.gov: NCT04646785, registered on 30/11/2020.

Overmedicalization of young people’s distress is undermining and disempowering families

Cases of mild or transient distress in young people are increasingly viewed as problems that require medical intervention. As CAMHS clinicians, we argue that this overmedicalization undermines the value of social support within the family and community, and funding cuts to nonmedical support services have only compounded the problem.

The accuracy of the Psychological Distress Inventory – Revised (PDI-R) in identifying distress in oncological outpatients: A pilot study using a machine learning approach.

e24222 Background: Ever greater importance is given to psychological distress in oncological settings. Distress could have a severe adverse effect on adherence and compliance to therapies, medical treatments, and quality of life (NCCN, 2015). Moreover, psychological research is progressively increasing in oncological settings and psychological distress has rapidly gained popularity – leading to the development of scales aimed at its evaluation. In this regard, the revised version of the Psychological Distress Inventory – the PDI-R (Rossi et al., 2022) – has demonstrated excellent psychometric properties but its screening properties were limited to self-report questionnaires. Consequently, to fill this gap, this study aimed to evaluate the accuracy of the PDI-R in identifying the levels of distress of oncological outpatients compared to a diagnostic interview – using a machine learning approach. Methods: Oncological outpatients ( n = 603; mean age = 68.38, SD = 9.31; 316 males) were enrolled at the Presidio Ospedaliero of Saronno, ASST Valle Olona, Italy. Patients were tested with the PDI-R which is composed of 8 items that evaluate internal, external, and general distress. In this study, the PDI-R shows good internal consistency: McDonald’s omega = .922. Then, patients were interviewed by a psycho-oncologist who assessed distress levels of each patient. In accordance with the methodological procedures for the application of machine learning algorithms, patients were randomly divided into two different databases. The first database ( n = 400) was used to train the machine learning algorithm and the second one ( n = 203) was used to test the accuracy of its predictions. The k-nearest neighbors ( k-NN) algorithm was applied. Results: According to the clinical interview, the training database (mean age = 67.78, SD = 9.10; 212 males) shows that 76% of patients were without distress (or mild distress) and 24% had moderate or severe distress. Moreover, according to the clinical interview, the testing database (mean age = 69.58, SD = 9.62; 104 males) shows that 71% of patients were without distress (or mild distress) and 29% had moderate or severe distress. Using the 8 items of the PDI-R, the k-NN algorithm, correctly identified 193 subjects (144 true negatives and 49 true positives). At the same time, only 10 subjects (10 false negatives) were incorrectly classified – thereby showing a machine learning-based accuracy of 95%. Conclusions: These findings suggest that the PDI-R is a reliable self-report questionnaire with strong psychometric properties and high accuracy in identifying psychological distress. Its use in research and clinical practice is therefore recommended to increase the quality of both assessment and treatment of psychological distress in patients with oncological difficulties.

Association between psychological distress and disability-free life expectancy in the older Japanese adults

BackgroundOur study aimed to investigate the association between psychological distress and disability-free life expectancy (DFLE). MethodsIn 2006, a cohort study was conducted of 12,365 Japanese individuals aged ≥65 years, who were followed-up for 13 years. Psychological distress was measured using the Kessler 6-item psychological distress scale and was categorized into no (0–4), mild (5–9), moderate (10−12), and serious distress (13–24). The number of participants was 1277 (22.4 %) for mild distress, 330 (5.8 %) for moderate, and 208 (3.6 %) for serious in men, and was 1635 (24.6 %), 467 (7.0 %), and 384 (5.8 %) in women. Sex-specific DFLE was defined as the mean years a person could expect to live without disability and calculated by Interpolated Markov Chain (IMaCh) software. ResultsCompared to no distress, DFLE loss per person was 1.21, 2.61, and 4.43 years for mild, moderate, and serious distress respectively in men. At population level, DFEL loss (i.e., DFLE loss per person×number of participants) was 1545.17, 861.30, and 921.44 years for mild, moderate, and serious distress respectively in men. Accordingly, 46.4 % of the total DFLE loss was attributable to mild distress, 25.9 % to moderate, and 27.7 % to serious in men. Similarly, the results were 42.2 %, 25.4 %, and 32.4 % in women. LimitationsPsychological distress was measured only once at baseline, and 2409 participants were excluded from the analysis because of missing data on exposure. ConclusionsAt population level, almost half of the total DFLE loss could be attributable to mild distress, underscoring the importance of population strategy for all levels of distress in promoting healthy aging.

HEARING AID EFFECTIVENESS ON PATIENTS WITH CHRONIC TINNITUS AND ASSOCIATED HEARING LOSS : SYSTEMATICS REVIEW

Tinnitus, the perception of sound in the absence of an obvious external source, is even more frequent, affecting around ten percent of adults in the United States. Tinnitus is defined as the sense of sound in the absence of an obvious external source. Tinnitus is typically accompanied by hearing loss, but this is not always the case. It is conceivable for it to occur either by itself or in conjunction with a loss of hearing of any type. Tinnitus and hearing loss are both caused by a wide variety of conditions, the most frequent of which is age-related hearing loss. Other, less common causes include malignancies of the brain and skull base. Hearing loss can be broken down into three basic categories: sensorineural, conductive, or mixed (where both conductive and sensorineural components are present). The perception of sound in the absence of external acoustic stimulation for an extended length of time (more than three months) is the hallmark of chronic tinnitus. Tinnitus is quite common, with an estimated incidence of 10–15% in the adult population; however, prevalence estimates can vary widely from study to study. Tinnitus is characterized by a buzzing or ringing sound in the ear. A minority of people may experience severe psychological distress as a direct result of the situation, despite the fact that the majority of people are able to adapt to the perception and report very mild emotional distress as a result of it. Tinnitus Questionnaire (abbreviated as TQ), Tinnitus Handicap Inventory (abbreviated as THI), and Tinnitus Functional Index (abbreviated as TFI) are the three self-report questionnaires that are used the most frequently for quantifying tinnitus-related suffering. The total scores of these measures properly capture both the suffering associated with tinnitus and the change that is attributable to treatments. In patients who have tinnitus and chronic hearing loss, the use of hearing aids is successful in suppressing the symptoms; however, the usage of the device must be carried out for at least six months in order for the treatment to take effect.

Reliability and validity of the telephone-based version of the Montgomery-Asberg depression rating scale for assessing depression in individuals with primary brain tumour

Purpose This study aimed to examine interrater reliability and construct validity of the Montgomery-Asberg Depression Rating Scale (MADRS) semi-structured interview for assessing depression in adults with a primary brain tumour. Materials and methods Fifty adults with a primary brain tumour (mean age = 45.86, SD = 12.48) reporting at least mild distress (Distress Thermometer [DT] ≥ 4) were recruited from a multidisciplinary brain tumour clinic and administered a telephone-based cognitive screener, MADRS, Depression Anxiety Stress Scales (DASS) depression subscale and Generalised Anxiety Disorder-7 (GAD-7). Audiotaped interviews were transcribed and then scored by two independent raters. Results Interrater reliability for the MADRS total score was excellent (ICC = 0.98) and ranged from good to excellent (ICC = 0.83–0.96) for MADRS items. The MADRS total score was significantly associated with the DT, DASS depression, and GAD-7 (r = 0.50–0.76, p < 0.001), thus providing evidence of construct validity. Individuals with poorer cognitive function reported higher levels of depression. Conclusions The findings provide psychometric support for the MADRS as a semi-structured interview for assessing depression after brain tumour. Further research investigating the sensitivity and specificity of the MADRS is recommended.

Psychological distress in later life and incident dementia: The Ohsaki Cohort 2006 Study

BackgroundThe role of reverse causation in the association between psychological distress and incident dementia remains unclear. We investigated whether psychological distress is a risk factor for, or prodromal symptom of, dementia. MethodsA longitudinal analysis of psychological distress with incident dementia was conducted among 12,076 Japanese individuals (age ≥65 years) followed for 5.7 years. Psychological distress was measured using the Kessler 6-item psychological distress scale (0–24 points) at baseline, with participants categorized into four psychological distress groups: no (0–4), mild (5–9), moderate (10–12), and serious (13–24). Dementia cases were retrieved from the public Long-term Care Insurance database. Cox proportional hazards model was used to estimate the multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (95%CIs) for incident dementia. Stratified analysis was conducted by cognitive function (higher or lower) at baseline. ResultsDuring 60,240 person-years of follow-up, 997 individuals developed dementia. A dose-response association was found between psychological distress and dementia; however, the stratified analysis indicated that this association depended on cognitive function at baseline. Among those with higher cognitive function at baseline, a significantly elevated dementia risk was observed only for serious psychological distress (HR: 2.04, 95%CI: 1.24–3.36). Among those with lower cognitive function, both moderate (HR: 1.30, 95%CI: 1.00–1.68) and serious (HR: 1.79, 95%CI: 1.37–2.34) psychological distress showed an increased dementia risk. ConclusionThe association between late-life psychological distress and incident dementia is partly explained by reserve causation, whereby mild and moderate distress could be a prodromal symptom of dementia.

Inborn Error of Immunity Presenting with Salmonella Pericarditis and Pericardial Effusion

Salmonella infections typically occur in disorders of innate immunity with impairment in phagocyte function and/or impaired signaling in the IL-12/interferon (IFN)-gamma axis. Pericarditis/pericardial effusion has previously been reported as a rare complication of Salmonella infection.An 8-year-old, previously healthy, fully immunized Hispanic female presented with 4 days of fever and 5 days of pain in her chest, abdomen, and left shoulder. Her medical and family history was unremarkable. Chest radiograph revealed cardiomegaly, and a transthoracic echocardiogram identified a large pericardial effusion. Labs showed leukocytosis (15 K/uL), neutrophilia (ANC 12.77 K/uL), elevated CRP (287 mg/dL), and elevated BNP (607 pg/mL). Exam showed mild distress, gallop on cardiac auscultation, diminished left breath sounds, cool extremities, and 1+ peripheral pulses. She underwent pericardiocentesis, and the fluid culture was positive for Salmonella alachua. She was treated with IV ceftriaxone for 8 days, then transitioned to trimethoprim/sulfamethoxazole (TMP/SMX) to complete a 30-day total antibiotic course.Inpatient immunologic evaluation revealed T cell lymphopenia (TCL) with decreased naïve CD4+ and CD8+ T cells. Increased CD4+ and CD8+ effector memory T cells (Tem) were also observed, along with increased CD8+ TEMRA, and certain subsets of CD4+/CD8+ central memory T cells lacking CD62L. HIV testing and neutrophil oxidative burst were negative. Given her significant T cell lymphopenia, TMP/SMX prophylaxis was continued after the treatment course, and fluconazole prophylaxis was initiated due to endemic coccidiomycosis.A targeted 429-gene panel for inborn errors of immunity revealed a heterozygous missense variant of uncertain significance in PIK3CD, = c.1013G>A, p.Arg338Gln. This variant is not in gnomAD for Hispanics and is present in 0.0009% of non-Finnish Europeans. Gain-of-function (GoF) PIK3CD mutations cause a combined immunodeficiency, with increased risk of infection from encapsulated organisms, such as salmonella. However, the patient’s immunophenotype is not consistent with GoF PIK3CD mutation. She had normal transitional B cells, lack of increased senescent T cells, and absence of lymphoproliferation.TCL is likely an immunologic risk factor for Salmonella pericarditis with pericardial effusion. Though the PI3CKD variant does not appear to be pathogenic, additional functional testing for this variant is in progress.

Measuring the Level of Depression, Anxiety and Self Esteem Among Working and Non-Working Married Women of Sindh Province

Background: Depression is one of the common disabilities which is difficult to treat, hence an interesting as well as difficult to research. However, depression can be managed. The management will still a number of challenges, like failure to cut back and reoccurrence. One who has the ability to face and fight threats and weakness, and having self-satisfaction are the signs of high self-esteem. Objective: The objective of the study was to assess the level of depression, anxiety and self-esteem, among working and non-working married women of Sindh Province. This study is of great significance that it was not done before in the proposed area, where there is a crystal-clear depression and self-esteem variation in working v/s non-working women. Study design: An analytical cross-sectional study Place and Duration: Sindh Province from January to June 2022 Methodology: The research was conducted on the pre-developed questionnaire. There was a sample size of (N=67) that was collected from working and non-working women of Sindh Province Pakistan. For measuring the level of depression and anxiety, the Kessler Psychological Distress Scale (K10) scale was used for the measurement of Self-Esteem, Rosenberg Self-Esteem Scale was used among all participants. Consent was taken from all the participants of the study. For statistical data analysis, T-tests and ANOVA were used on SPSS. Results: In this study out of 67 women 47.8% were working and 52.2% were not working. Regarding psychological well-being 27% of women had severe psychological distress, 25% had moderate psychological distress, 30% were psychologically well and 18% had mild psychological distress Conclusion: The findings showed that working women have higher self-esteem than non-working women, but that non-working women have higher levels of distress than working women. This research opens the doors for further researching the causes and way forwards for low self-esteem and high distress with different dimensions. Keywords: Depression, Anxiety, Self-esteem, Working, Non-working women, Sindh Province

Attachment Style, Affective Temperament, and Psychological Distress among Mental Health Nurses during the COVID-19 Pandemic

The nursing staff is more likely to experience drastic stress, which can compromise their physical and mental health and affect the quality of their work. This study aimed to assess the attachment type and affective temperament in connection to the psychological effects of the COVID-19 pandemic on psychiatric hospital nurses. We conducted a cross-sectional online survey utilizing a convenience sample population of 100 nurses who served on the front lines during the COVID-19 outbreak. The key findings showed that most nurses reported moderate attachment anxiety, moderate affective temperament, and mild psychological distress. It is crucial to offer nurses psychological support during COVID-19 through various channels.

Abstract P6-05-33: Distress Reduction and Physical Activity Enhancement by Mobile Support Group in Breast Cancer Survivors: a randomized controlled study

Abstract Purpose Improving physical activity (PA) and reducing mental distress are important issues in the treatment of cancer survivors. This study aimed to investigate the effect of a mobile app-based community on enhancing PA and decreasing distress in breast cancer survivors. Methods We conducted a single-center, prospective, non-blinded, randomized controlled study. Subjects who got breast cancer surgery were allocated to a control group or a app-based community group (intervention) where members were able to share their daily physical activities. Daily walk steps and weekly distress scores using app-based Distress Thermometer (DT) questionnaires were collected from participants for 24 weeks. To examine the differences in levels of distress and weekly step counts for 6 months, we used a t-test method and multivariable regression modeling. Results From Jan 2019 to Apr 2020, a total of 202 participants were enrolled in this study. The intervention group showed a significant increase in weekly steps by 4,496 for 6 months (p &amp;lt; 0.001). The participants in the intervention group showed a significantly lower rate of above mild distress (DT≥3, beta[B] = -0.731, p &amp;lt; 0.001) and above moderate distress (DT≥5, B = -0.558, p &amp;lt; 0.001) compared to those in the control group for 6 months. Conclusions The mobile app-based community is an effective and less resource-intensive tool to increase PA and decrease distress in breast cancer survivors. Citation Format: Il-Yong Chung, Miyeon Jung, Sae Byul Lee, Jong Won Lee, Sei Hyun Ahn, Haekwon Chung. Distress Reduction and Physical Activity Enhancement by Mobile Support Group in Breast Cancer Survivors: a randomized controlled study [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P6-05-33.

Abstract P6-05-29: Experience of Financial Toxicity and Distress Among Individuals Diagnosed with Triple Negative Breast Cancer: Findings from the Cancer Experience Registry

Abstract Background: Financial toxicity associated with cancer and its treatment can negatively impact treatment adherence and quality of life. Individuals with triple negative breast cancer (TNBC) may be at increased risk for financial toxicity due to the aggressive nature of the disease and high rate of recurrence. The objective of this study was to characterize financial experiences of TNBC survivors, their descriptions of communication with providers concerning treatment costs, and correlations between financial toxicity and psychosocial distress. Methods: From July 2017 to August 2021, 94 individuals with TNBC took part in Cancer Support Community’s Cancer Experience Registry® (CER). Participants completed items related to financial distress, including COmprehensive Score for Financial Toxicity (COST), an 11-item (0=Not at all, 4=Very much) measure of financial well-being (range 0-44; lower scores indicate worse financial well-being), dichotomous (yes or no) items assessing patient-provider communication, and Patient-Reported Outcomes Measurement Information System-29 (PROMIS-29 v2.0). Bivariate relations were assessed using Pearson’s correlation. Results: Participants were 81% non-Hispanic White, 6% Black, and 6% Hispanic. Mean age was 52 years (SD=11.3); 14 (15%) reported household income &amp;lt;$40K. Median time since diagnosis was 2 years; 15% (n=14) reported metastatic breast cancer and 36% were currently receiving treatment. Concerning out-of-pocket cancer-related costs, 56% of our sample reported spending &amp;gt;$250 per month; 32% &amp;gt;$500; 13% &amp;gt;$1000. To reduce costs, 23% sometimes, often, or always postponed seeking psychological support, 19% delayed follow-up on recommendations, 6% postponed doctor’s appointments, and 5% skipped medication. The mean COST score was 23.0 (SD=12.3), indicating mild financial distress overall. Less than half of the sample (46%) indicated no financial toxicity (scores &amp;gt;25), 29% mild financial toxicity (scores 14-25), 22% moderate (score 1-13), and 3% severe (score of 0). The frequency of individual COST items showed 61% reported (somewhat, quite a bit, or very much) worry about future financial problems due to treatment costs; 14% were unable to meet monthly expenses; 49% reported concern about keeping their job or income; 47% reported frustration that they could not work or contribute as usual. COST scores were inversely correlated to PROMIS anxiety (r=-.45, p&amp;lt;.001), depression (r=-.44, p&amp;lt;.001), and sleep disturbance subscales (r=-.48, p&amp;lt;.001), such that lower financial well-being related to more symptomology. COST scores were positively associated with the social function subscale (r=.46, p&amp;lt;.001), so that better financial well-being related to higher social functioning. Regarding patient-provider communication, 70% reported their health care team did not discuss costs, 62% did not discuss impact of TNBC and treatment on work, and 59% did not discuss financial concerns. One-third (34%) wished they received more financial advice and assistance. Conclusion: In this sample of TNBC patients, average levels of financial toxicity were in the mild range. However, many reported moderate to severe toxicity (25%). Greater financial toxicity related to increased symptoms of anxiety, depression, sleep disturbance, and worse social functioning. Despite this, results indicate there is little patient-provider discussion about financial burden, with more than half of our sample reporting their health care team did not discuss costs, impact on work, or financial distress. One-third of participants indicated desire for more financial advice and assistance highlighting an opportunity to better serve TNBC patients, who may be at an increased risk of financial toxicity. Citation Format: Kara Doughtie, Erica E. Fortune, Heather Badt, Caroline Lawrence, Madyson L. Popalis, Melissa F. Miller. Experience of Financial Toxicity and Distress Among Individuals Diagnosed with Triple Negative Breast Cancer: Findings from the Cancer Experience Registry [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P6-05-29.

Psychiatric medication use among pregnant and breastfeeding mothers who used cannabis for mental health concerns: A cross-sectional survey study.

Use of cannabis during pregnancy and breastfeeding is increasing. Mental health concerns are reported as common reasons for maternal cannabis use, but little is known about the use of psychiatric medications in this population. This study aimed to describe psychiatric medication use among pregnant and breastfeeding mothers who used cannabis for mental health concerns. Anonymous, online cross-sectional survey. Data were collected from May 2018 to August 2019 among pregnant and breastfeeding mothers who used cannabis. This study included mothers who reported cannabis use for mental health concerns (n = 1363). The survey assessed the timing of cannabis use (during pregnancy and/or lactation); use of cannabis to address depression, posttraumatic stress disorder, or anxiety; use of psychiatric medications; psychiatric distress (Patient Health Questionnaire-4); and demographic information. Differences between groups were examined using t-test and chi-square test in SPSS. The mean age was 29.7 years; most were married (62%); 74% were White non-Hispanic, 9% Hispanic, and 17% Black, Indigenous or other People of Color. Mental health symptoms prompting cannabis use included anxiety (96%), depression (75%), and posttraumatic stress disorder (36%). Only 24% of respondents (n = 322) reported concomitant use of psychiatric medications, primarily selective serotonin reuptake inhibitors (72%, n = 232) and benzodiazepines (21%, n = 68). The composite Patient Health Questionnaire-4 showed most respondents had no (61%) or mild (27%) psychological distress; 14% screened positive for depression; and 17% screened positive for anxiety. Respondents who used psychiatric medications more often screened positive mental health concerns. Most mothers who used cannabis for mental health concerns were not taking psychiatric medications. This may be due to a mismatch between perceived mental health and screening results, un- or under-treated mental illness, or preference for cannabis over psychiatric medications. Improved management of perinatal mental health and effective patient education about risks of cannabis versus medication use are needed.

Paroxysmal AV Block

A 69 year old woman with a history of congestive heart failure and stroke presented to the emergency room with sudden onset lightheadedness leading to a fall at the grocery store and sustaining head trauma. On physical examination, she was alert and in mild distress. Her HR was 72 beats per minute and blood pressure was 196/70. A 12 lead electrocardiogram (ECG) showed normal sinus rhythm, first degree atrioventricular (AV) block and right bundle branch block. She was admitted for management of subdural hematoma which was noted on CT scan. A few hours later, patient experienced multiple episodes of long pauses leading to syncopal episodes in bed. A 12 lead ECG was obtained and is shown in Figure 1.

Sociodemographic factors and perceived patient-provider communication associated with healthcare avoidance among women with psychological distress.

To establish the extent to which psychological distress influences health avoidance behavior among women, controlling for patient provider communication and sociodemographic characteristics. Data from the 2019 Health Information National Trends Survey (HINTS 5, Cycle 3) was analyzed to obtain healthcare avoidance behavior among women aged 18 and older (n = 2788). Weighted descriptive, bivariate, and multivariable logistic regression models were conducted. Approximately 649 women or 1 in 4 women (26.7% weighted prevalence; 95% Confidence Interval [CI] 0.23%-0.29%) avoided healthcare in the past 12 months. Non-Hispanic white (62.8%) and married (55.4%) women represented a higher proportion of the sample. Bivariate analysis revealed that the odds of reporting healthcare avoidance among women with mild, moderate, and severe psychological distress (Odds Ratio [OR]: 2.26, 95% CI: 1.45-3.53, p = 0.001; OR: 3.88, 95% CI: 2.29-6.56, p < 0.001; OR: 3.08, 95% CI: 1.81-5.23, p < 0.001) was significantly higher compared to those with none-minimal psychological distress. In the adjusted model, women with moderate and severe psychological distress (Adjusted OR [AOR]:3.15, 95% CI: 1.55-6.38, p = 0.002; AOR: 2.24, 95% CI: 1.10-4.92, p = 0.044) were more likely to report healthcare avoidance than those experiencing none-minimal psychological distress. Furthermore, increasing patient-provider communication score (AOR: 0.91, 95% CI: 0.87-0.96, p < 0.001) reduced the likelihood of healthcare avoidance. Among the sociodemographic variables assessed, being younger (18-49 years) and having less than a high school degree significantly increased the chances of avoiding healthcare. A high proportion of women with psychological distress avoid necessary healthcare. Patient-provider communication quality, increasing age, and being a high school student contribute to healthcare avoidance in women. Strategies to improve health service utilization must address healthcare avoidance by developing effective health communication targeted at women with psychological distress.

Relationship Between Psychological Distress and Poverty Among Japanese Workers During the COVID-19 Pandemic: A Prospective Cohort Study.

This study aimed to examine the relationship between psychological distress and poverty among Japanese workers during the COVID-19 pandemic. An Internet-based prospective cohort study was conducted. A total of 11,081 individuals who were not experiencing poverty at baseline in December 2020 were included. The exposure variable was psychological distress evaluated using the Kessler 6 scale at baseline. The outcome variable was whether participants were experiencing poverty at the 1-year follow-up, as defined by household financial distress. Compared with individuals without psychological distress, the adjusted odds ratios of household financial distress among those with mild and severe psychological distress were 2.88 (95% confidence interval, 2.47-3.33, P < 0.001) and 3.19 (95% confidence interval, 2.52-4.04, P < 0.001), respectively. Workers' psychological distress is a notable public health concern in the context of poverty.