Moderate Distress Research Articles

Point-of-care ultrasound evaluation of blunt abdominal trauma.

An 18-year-old male without any significant medical history presented to the emergency department (ED) for evaluation of severe generalized abdominal pain that began immediately after sliding head first into second base during a baseball game. He also reported 2 episodes of non-bloody, non-bilious vomiting. Upon arrival, the patient was in moderate distress secondary to pain and with the following vital signs: temperature 36.8°C, blood pressure 117/75 mmHg, heart rate 127 beats per minute, respiratory rate 19 breaths per minute, and oxygen saturation 100% on room air. Physical examination revealed significant diffuse abdominal tenderness to palpation; however, the abdomen was without rebound, guarding, or peritoneal signs. A focused assessment with sonography for trauma (FAST) examination was subsequently performed that demonstrated intra-abdominal free fluid (Figure 1). General surgery was immediately consulted based on the abnormal point-of-care ultrasound (POCUS) findings. Computed tomography of the abdomen/pelvis confirmed a moderate amount of fluid and blood within the peritoneal cavity as well as a localized mesenteric hematoma of the right mid lower abdomen (Figure 2). The patient was taken for emergent diagnostic laparoscopy converted to an open small bowel resection with findings of a large mesenteric hematoma with intra-abdominal hemorrhage secondary to a mesenteric vessel tear at a ruptured Meckel's diverticulum. Mesenteric hematoma with intra-abdominal hemorrhage from ruptured Meckel's diverticulum. The FAST examination, which is highly specific for detecting intra-abdominal free fluid, is an essential bedside tool for the ED evaluation of trauma.1-5 To the best of our knowledge, this is the first description of emergency physician-performed FAST, which identified a rare complication of intra-abdominal hemorrhage from a ruptured Meckel's diverticulum. Pertinent to our case, a positive FAST conveys valuable prognostic information in normotensive patients with blunt abdominal trauma.6, 7 The POCUS ultrasound findings were critical in expediting confirmatory imaging and emergent surgical consultation. This report illustrates the imperative role of a timely FAST for hemodynamically stable patients in the particular setting of blunt abdominal trauma. The authors have nothing to disclose. This research was supported in part by HCA Healthcare and/or an HCA Healthcare affiliated entity. The views expressed in this publication represent those of the author(s) and do not necessarily represent the official views of HCA Healthcare or any of its affiliated entities.

Distress and Living with Diabetes: Defining Characteristics Through an Online Survey.

IntroductionThere is considerable evidence for diabetes reducing quality of life. The impact of such a diagnosis on mental health is less well understood and was subsequently explored here.MethodsOnline PHQ-9 scores (which calculate the severity of depression), Diabetes Distress Screening Scale (DDSS) and EQ-5D-5L (quality-of-life) questionnaires were completed by patients with diabetes, followed by the extraction of data where possible from responders’ clinical records.ResultsA total of 133 people submitted questionnaires. However, not all data items could be completed by each patient; 35% (45/130) had type I diabetes mellitus (T1DM); 55% (64/117) were women. The overall median age of 117 responders was 60 (IQR 50–68 years). The median aggregated response scores were: EQ-5D-5L 0.74 (IQR 0.64–0.85) (lower quality of life than UK population median of 0.83), DDSS 1.9 (IQR1.3–2.7) (≥ 2 indicates moderate distress) and PHQ-9 5 (IQR2-11) (≥ 5 indicates depression). Higher diabetes distress (DDSS)/lower quality of life EQ-5D-5L/higher depressive symptoms (PHQ-9) linked to female sex (DDSS 0.5/25% above median), younger age (< 50 years DDSS 0.7/35% above median), fewer years after diagnosis (< 10 years DDSS 0.8/40% above median), and obesity (BMI > 35 DDSS 0.6/30% above median). Additionally, a HbA1c reading of ≤ 48 mmol/mol was associated with higher DDSS scores, as did a reduction of more than 5 mmol/mol in HbA1c over the last three HbA1c measurements. The 30 individuals with a history of prescribed antidepressant medication also showed higher diabetes distress scores (DDSS 0.9, equating to 45% above the median). The DDSS score elevation came from an increase in emotional burden and regimen-related distress. DDSS scores were not significantly linked to diabetes type, insulin use, absolute level/change in blood glucose HbA1c. Physician-related distress showed a similar pattern.ConclusionsA low level of stress in relation to diabetes management may be associated with lower HbA1c. The larger impact of diabetes on mental health in younger women/people with shorter diabetes duration should be noted when considering psychosocial intervention/behavior change messaging. Physician-related distress is a potentially remediable factor. However, this sample was self-selecting, limiting generalization to other samples.

Facing facial weakness: psychosocial outcomes of facial weakness and reduced facial function in facioscapulohumeral muscular dystrophy

Purpose To assess the psychosocial outcomes of facial weakness in facioscapulohumeral muscular dystrophy (FSHD). Materials and methods A cross-sectional survey study. The severity of facial weakness was assessed by patients (self-reported degree of facial weakness) and by physicians (part I FSHD clinical score). Questionnaires on facial function, psychosocial well-being, functioning, pain, and fatigue were completed. Regression analyses were performed to explain variance in psychosocial outcomes by demographic and disease variables. Results One hundred and thirty-eight patients participated. They reported mild to moderate psychological distress, no to mild fear of negative evaluation, and moderate to good social functioning. However, patients with severe self-reported facial weakness scored lower in social functioning. Patients with more facial dysfunction experienced more fear of negative evaluation and lower social functioning. Furthermore, younger age, presence of pain, fatigue, walking difficulty, and current or previous psychological support were associated with lower psychosocial outcomes. Overall, patients report moderate to good psychosocial functioning in this study. The factors contributing to lower psychosocial functioning are diverse. Conclusions A multidisciplinary, personalized approach, focusing on coping with physical, emotional, and social consequences of FSHD is supposed to be helpful. Further research is needed to assess the psychosocial outcomes of facial weakness in younger patients. Implications for rehabilitation Research on the psychosocial consequences of facial weakness in facioscapulohumeral muscular dystrophy (FSHD) is limited. Patients with FSHD experience mild to moderate psychosocial distress, partly due to overall disease severity, such as reduced mobility, and partly due to facial weakness and reduced facial function. Self-reported degree of facial weakness and facial dysfunction were related to lower psychosocial outcomes (social functioning, fear of negative evaluation, and psychological distress). Physician-reported degree of facial weakness was not related to psychosocial outcomes, suggesting an absence of a strong correlation between observed facial weakness and experienced disease burden in this study. This calls for a multidisciplinary, personalized approach with a focus on coping with physical, emotional, and social consequences of FSHD.

Latent class analysis of health, social, and behavioral profiles associated with psychological distress among pregnant and postpartum women during the COVID-19 pandemic in the United States.

BackgroundThere is a growing body of literature documenting negative mental health impacts from the COVID‐19 pandemic. The purpose of this study was to identify risk and protective factors associated with mental health and well‐being among pregnant and postpartum women during the pandemic.MethodsThis was a cross‐sectional, anonymous online survey study distributed to pregnant and postpartum (within 6 months) women identified through electronic health records from two large healthcare systems in the Northeastern and Midwestern United States. Survey questions explored perinatal and postpartum experiences related to the pandemic, including social support, coping, and health care needs and access. Latent class analysis was performed to identify classes among 13 distinct health, social, and behavioral variables. Outcomes of depression, anxiety, and stress were examined using propensity‐weighted regression modeling.ResultsFit indices demonstrated a three‐class solution as the best fitting model. Respondents (N = 616) from both regions comprised three classes, which significantly differed on sleep‐ and exercise‐related health, social behaviors, and mental health: Higher Psychological Distress (31.8%), Moderate Psychological Distress (49.8%), and Lower Psychological Distress (18.4%). The largest discriminatory issue was support from one's social network. Significant differences in depression, anxiety, and stress severity scores were observed across these three classes. Reported need for mental health services was greater than reported access.ConclusionsMental health outcomes were largely predicted by the lack or presence of social support, which can inform public health decisions and measures to buffer the psychological impact of ongoing waves of the COVID‐19 pandemic on pregnant and postpartum women. Targeted early intervention among those in higher distress categories may help improve maternal and child health.

IL-17A )rs2275913; G197A) gene polymorphism as predictor for disease severity and its correlation with IL-17 serum levels in COVID-19 patients

Severity of symptoms in COVID-19 has been shown to result from a cytokine storm. Interleukin (IL)-17 is one of these various cytokines, which results in a proinflammatory response, systemic inflammatory symptoms, inflammatory cell infiltration of lung tissue and thus leads to the massive lung pathology and multiorgan failure. Gene polymorphisms in the regulatory regions of cytokine-encoding genes affect the amounts of cytokines produced and possess a fundamental role in infectious diseases. This study aimed to investigate the role of IL-17A (rs2275913; G197A) gene polymorphism as predictor of disease severity and its correlation with IL-17 serum levels in COVID-19 patients. A group of 70 COVID-19 patients and 17 age and sex-matched control subjects were enrolled in the present work. Patients were classified into two groups moderate, severe and acute respiratory distress (ARDS) cases, defined according to the criteria established by the world health organization. Quantitative real time-polymerase chain reaction was done to detect IL-17A (rs2275913; G197A). Serum IL-17 levels were assessed by an enzyme-linked immunosorbent assay in both patients and controls. The distribution of different IL-17A G/A genotypes among COVID-19 patients were 44.3% for GG genotype, 44.3% for AG genotype and 11.4% for AA genotype. Genotypes among the control group were 43.8% for GG genotype, 50% for AG genotype and 6.3% for AA genotype. G allele distribution was 66.4%, 68.8% in patient and control group, respectively, and A allele was 33.6% and 31.3%, respectively. There was no association between the different genotypes, disease severity or IL-17 serum levels in the patient group. In conclusion, despite the possible role of IL-17 in the pathogenesis of inflammation, there was no association between IL-17 polymorphism and disease severity or IL-17 serum levels among Egyptian COVID-19 patients.

Psychological Stress and its Consequences for the Cost of Illness: a Longitudinal Study in Germany

ZusammenfassungZiel der Studie Die Studie verfolgt das Ziel, die Effekte der psychischen Belastung auf die Höhe und die Zusammensetzung der Krankheitskosten (ambulante Kosten, Krankenhauskosten, Rehabilitationskosten, Arzneimittelkosten) im Zeitverlauf zu überprüfen. Methodik Im Längsschnittdesign untersuchten wir die psychische Belastung von 3.287 Studienteilnehmern der erwachsenen Allgemeinbevölkerung anhand der Hospital Anxiety and Depression Scale (HADS) und ihren Effekt auf die Höhe und die Zusammensetzung der Krankheitskosten aufgrund von psychischen Erkrankungen im Jahr der Befragung t0 und den beiden Folgejahren [t1] {t2}. Ergebnisse Im Vergleich zur Referenzgruppe, die keine psychischen Belastungen aufweist, waren die Krankheitskosten in der Gruppe mit geringen psychischen Belastungen um den Faktor 2,0 [2,2] {1,5}, bei jenen mit moderater psychischer Belastung um den Faktor 3,7 [4,2] {3,1} und bei jenen mit schweren psychischen Belastungen um den Faktor 7,5 [9,0] {5,2} signifikant erhöht. Im Zeitverlauf zeigten sich signifikante Effekte auf die Krankheitskosten nur an den beiden äußeren Rändern der psychischen Belastungsgrade (keine und schwere psychische Belastungen) mit einer Tendenz zur Mitte. Mit zunehmendem Grad psychischer Belastung dominierten Krankenhauskosten die Gesamtkosten aufgrund psychischer Belastung und der Anteil der ambulanten Krankheitskosten an den Gesamtkosten nahm ab. Schlussfolgerung Mit dem Grad psychischer Belastung steigen die Krankheitskosten steil an. Die Progredienz psychischer Erkrankungen zu verhindern, ist deshalb nicht nur aus individueller, sondern auch aus gesundheitsökonomischer Perspektive bedeutsam.

PSYCHOLOGICAL DISTRESS AMONG PARENTS OF CHILDREN WITH SPECIAL NEEDS

Psychological distress referred to an emotional suffering state characterized by depression such as lost interest and hopelessness and anxiety symptoms such as felt tension and restlessness. Parents of children with special needs were likely to be at a higher risk of psychological distress since they might experience many challenges to raise the children. t The long-term issues of children with physical-motor disorders and mental retardation and the need for continuous treatment, these parents would experience high levels of stress and frequently became depressed, frustrated, and disappointed with their children development This study aimed to identify the severity of psychological distress of the parents among special needs children and the relationship between demographic variables and parents' psychological distress among special needs children. A total of 224 parents with special needs children in Terengganu were involved. The psychological distress of parents was measured by using Kessler Psychological Distress Scale (K10). Results indicated 36.6% of parents were having severe distress, 21% were experiencing moderate distress and, 21.9% had mild distress. Parent’s job status had indicated a positive significant correlation between severity of psychological distress (r = 0.148, N = 224, p &lt; 0.05). The other variables such as parent's age, parent’s gender, child’s age and diagnosis, parent’s marital status, and parent's education level had shown no significant correlation between the severities of psychological distress. In conclusion, most parents were having psychological distress. Nevertheless, only the job status had demonstrated an impact on the psychological distress of parents.

Incidence and Risk Factors for Hyponatremia in Hospitalized Children with Lower Respiratory Tract Infections

Lower respiratory tract infection (LRTI) is an important cause of hospitalization in pediatric population. Hyponatremia is frequently present in children hospitalized with pneumonia and bronchiolitis and is associated with poorer outcomes. We conducted a study to identify the risk factors for hyponatremia in hospitalized children with LRTI and to evaluate the relationship between serum sodium levels and severity of respiratory distress. A total of 147 patients between 2 months and 12 years of age, admitted with the diagnosis of LRTI at the Mahatma Gandhi Mission Hospital and Medical College, a tertiary hospital in Navi Mumbai, Maharashtra, India, between December 2017 and November 2019, were studied prospectively. Patients with any other comorbidities were excluded. The severity of respiratory distress at presentation was graded using the Clinical Respiratory score (CRS). Serum electrolytes were sent within 1 hour of hospital admission. Median age of enrolled patients was 14 months. Overall, 23 (16%) children had mild respiratory distress, 97 (66%) had moderate respiratory distress, and 26 (18%) had severe distress. The incidence of hyponatremia in children admitted with LRTI was 66% and majority of them (70%) had mild hyponatremia. The incidence, as well as severity of hyponatremia differed significantly with etiology (p &lt; 0.05). An inverse correlation was found between serum sodium levels and CRS at presentation (r = − 0.26, p = 0.001). In multivariate analyses, parenchymal disease was an independent risk factor for development of hyponatremia (adjusted odds ratio [aOR] = 5.64 (2.52–12.59), p &lt; 0.001). Incidence and severity of hyponatremia in children with LRTI increased with severity of respiratory distress and presence of parenchymal disease.

Spillover effect of psychological distress from distressed to non-distressed spouse: A cohort study for midlife married couples in Japan

BackgroundFew studies have evaluated the impact of spousal psychological distress on an individual's distress over time based on detailed measurements of mental status. Hence, we investigate the spillover effect of spousal psychological distress. MethodsThis cohort study included 11,819 individuals (men, 51.4 %), aged 50–59 (mean 54.7) years, selected from the Japanese nationally representative longitudinal study from 2005 to 2016. Participants were categorized according to their spousal score on the Kessler Psychological Distress Scale (K6) as follows: 0, 1–4, 5–8, 9–12, and 13–24. The incidence of at least moderate distress (K6 ≥ 5) or serious distress (K6 ≥ 13) was determined during follow-up. A complementary log-log discrete time hazard model was constructed. ResultsA total of 5912 and 857 cases of at least moderate and serious distress were identified, with follow-up durations of 72,669 and 105,515 person-years, respectively. Compared with the spousal K6 of 0 group, the multivariable hazard ratios (95 % confidence intervals) of at least moderate distress and serious distress were 1.13 (1.07–1.20) and 1.00 (0.85–1.18) for spousal K6 of 1–4, 1.29 (1.19–1.39) and 1.14 (0.93–1.40) for 5–8, 1.42 (1.26–1.60) and 1.28 (0.95–1.72) for 9–12, and 1.46 (1.22–1.73) and 2.14 (1.49–3.07) for 13–24, respectively. No significant sex differences were observed. LimitationsPsychological distress was based on self-reported data without diagnosis by psychiatrists. ConclusionsHigh spousal K6 score contributed to a subsequent higher incidence of one's own at least moderate and serious distress.

Self-efficacy mediates the associations of diabetes distress and depressive symptoms with type 2 diabetes management and glycemic control

BackgroundAdults with type 2 diabetes (T2D) often experience two common diabetes-related psychological distress: diabetes distress and depressive symptoms. Both are associated with adverse diabetes outcomes including poor self-management and glycemic control. However, diabetes distress and depressive symptoms differ in their associations with diabetes outcomes in T2D patients. ObjectiveThis study proposes a hypothetical model to examine whether self-efficacy mediates the adverse effects of depressive symptoms and/or diabetes distress on self-care behaviors and glycemic control. Additionally, we examined the bi-directional relationships between diabetes distress and depressive symptoms to identify potential underlying mechanisms. MethodsThis study conducted in 15 rural health clinics in Jiangsu province China. 900 adults with T2D participated in the prospective cohort study. The data Diabetes distress (the 17-item Diabetes Distress Scale, DDS17), depressive symptoms(the 10-item Center for Epidemiologic Studies Depression Scale, CESD-10), self-efficacy, self-care behaviors (diet and physical activity), metabolic variables (fasting plasma glucose, FPG) and demographic characteristics were assessed at baseline. Subsequent 12-month Hemoglobin A1C (HbA1c) were measured after baseline. Hierarchical multiple regression and bootstrap mediation analysis were used to test the effects and pathways among these associations. ResultsOf 843 participants (93.67%) of total cohort with available subsequent 12-month HbA1c levels, mean age was 66.08 years and 66.55% were women, 25.15% of them had depressive symptoms (CES-D ≥ 10), 12.20% had moderate diabetes distress (mean DDS ≥2) and 4.98% had the both two psychological distress. Hierarchical multiple regression showed higher DDS score significantly predicted unhealthy diet(β = −1.10, P < 0.001) but not physical activities, while CESD score was negatively associated with physical activity (β = −0.06, P < 0.001) but not diet. No independent effects of the two psychological distress variables on subsequent 12-month HbA1c were observed. Mediation analysis supported that elevated self-efficacy solely mediated the negative effect of both diabetes distress and depressive symptoms on diet (DDS score: β = −0.238, 95 BCE% CI [−0.350, −0.141]; CESD score: β = −0.010, 95 BCE% CI [−0.016, −0.005]), physical activities (DDS score: β = −0.446, 95 BCE% CI [−0.630, −0.283]; CESD score: β = −0.019, 95 BCE% CI [−0.030, −0.010]) and subsequent 12-month HbA1c (DDS score: β = 0.105, 95 BCE% CI [0.030,0.189]; CESD score: β = 0.004, 95 BCE% CI [0.001,0.009]). Additionally, the interplay of diabetes distress and depressive symptoms exerts their effects on diabetes outcomes directly and indirectly via self-efficacy. ConclusionsSelf-efficacy may contribute to better diabetes outcomes and ameliorate negative effects of diabetes distress and depressive symptoms.

Absolute quantification of plasma mitochondrial DNA by droplet digital PCR marks COVID-19 severity over time during intensive care unit admissions.

Increased plasma mitochondrial DNA concentrations are associated with poor outcomes in multiple critical illnesses, including COVID-19. However, current methods of cell-free mitochondrial DNA quantification in plasma are time-consuming and lack reproducibility. Here, we used next-generation sequencing to characterize the size and genome location of circulating mitochondrial DNA in critically ill subjects with COVID-19 to develop a facile and optimal method of quantification by droplet digital PCR. Sequencing revealed a large percentage of small mitochondrial DNA fragments in plasma with wide variability in coverage by genome location. We identified probes for the mitochondrial DNA genes, cytochrome B and NADH dehydrogenase 1, in regions of relatively high coverage that target small sequences potentially missed by other methods. Serial assessments of absolute mitochondrial DNA concentrations were then determined in plasma from 20 critically ill subjects with COVID-19 without a DNA isolation step. Mitochondrial DNA concentrations on the day of enrollment were increased significantly in patients with moderate or severe acute respiratory distress syndrome (ARDS) compared with those with no or mild ARDS. Comparisons of mitochondrial DNA concentrations over time between patients with no/mild ARDS who survived, patients with moderate/severe ARDS who survived, and nonsurvivors showed the highest concentrations in patients with more severe disease. Absolute mitochondrial DNA quantification by droplet digital PCR is time-efficient and reproducible; thus, we provide a valuable tool and rationale for future studies evaluating mitochondrial DNA as a real-time biomarker to guide clinical decision-making in critically ill subjects with COVID-19.

The Association Between Food Insecurity and Psychological Distress Among Graduate Health Professions Students

ObjectivesTo determine the prevalence of and examine the association between food insecurity and psychological distress among graduate health professions students during the COVID-19 pandemic. MethodsBetween January and March 2021, a cross-sectional web-based survey was administered through Qualtrics to a convenience sample of graduate health professions students enrolled in a northeastern public university. Bivariate and multinomial logistic regressions were used to analyze the data. ResultsFive hundred and fifty-five students completed the survey for a response rate of 11.97%. The sample was predominately female (69%) and non-Hispanic (88.4%) with a mean age of 27.2 ± 5.9 years. Nearly one-fifth (18.4%) of students reported some level of food insecurity in the past year, and 37.3% reported experiencing mild (22.3%) or moderate (15.0%) psychological distress over the past 30 days. Bivariate analyses revealed students who reported food insecurity were more likely receiving financial support requiring repayment (p = 0.003), supporting others with person income (p < 0.001), had moved in with another individual due to financial problems (p < 0.001), or reported loss of income related to the COVID-19 pandemic (p < 0.001). After adjusting for nine covariates including age, ethnicity, sex at birth, annual personal income, etc., in the multinomial logistic regression model, students who reported food insecurity were 2.17 and 3.87 times more likely to experience mild and moderate psychological distress, respectively, than their food secure counterparts. ConclusionsFood insecurity was associated with psychological distress in graduate health professions students. Due to the potential negative effects food insecurity can have on academic and clinical performance, multifaceted screening methods and interventions are needed to improve the physical and mental well-being of future healthcare professionals. Funding SourcesNo external funding was used to support this research.

42-LB: Distress in Living with Diabetes Links to Age, Sex, Weight, and Good Glycaemic Control

Diabetes impacts on mental health. We investigated patient characteristics of those most at risk and consequences for glycaemic control. Depression (PHQ-9) , Diabetes Distress Screening Scale (DDSS) and Quality of Life (EQ5D) on-line questionnaires were completed by people with diabetes and linked to data extracted data from responders’ clinical records. Sources of distress were also considered through evaluating sub-scales Emotional, Physician, Regimen and Interpersonal DDSS scores. 130 responses with 34% T1DM, 56% women, median age 59 (IQR47-67) years were recorded. The median scores were EQ5D=0.74 (IQR 0.64 - 0.85) UK median 0.83; DDSS=1.9 (IQR1.3-2.7) (≥2 indicates moderate distress) and PHQ9=5 (IQR2-11) (≥5 indicates depression) . Higher DDSS/lower EQ5D5L/higher PHQ-9 within the response group were linked to female sex (DDSS 0.5/25% above median) , younger age (&amp;lt;50years DDSS 0.7/35% above median) , fewer years after diagnosis (&amp;lt;10years DDSS 0.8/40% above median) , and obesity (BMI&amp;gt;35 DDSS 0.6/30% above median) . 33 people with good (HbA1c≤48mmol/mol) or improving glycaemic control (HbA1c reduced by 2mmol/mol since previous reading) had higher DDSS = 2.4 versus the others = 1.9. The link between individual DDSS and PHQ-9 scores was significant r2=0.4, while the association to EQ5D was less r2=0.11. For 30 people with history of anti-depressant medication use, DDSS was 0.9/45% above median, showing medical diagnosis confirmed self-reported distress. DDSS scores did not significantly link to diabetes type or insulin use. Physician related DDSS higher scores came from women, younger age, overweight, early years after diagnosis, plus history of antidepressant use. This is potentially remediable. Level of distress is associated/maybe required in achieving and maintaining lower HbA1c. The impact on mental health of younger women/people with shorter diabetes duration should be noted when considering psychosocial intervention/behaviour change messaging. Disclosure A. H. Heald: None. U. Waheed: None. M. Stedman: None. A. N. Paisley: None. E. Solomon: None.

55-OR: Veterans with Type 2 Diabetes: An Explanatory Sequential Mixed-Methods Approach to Understanding Diabetes Distress

Diabetes Distress (DD, i.e., regimen, emotional, interpersonal, clinician) in adults with type 2 diabetes (T2DM) is associated with poor glycemic control, poorer diet and exercise, and more T2DM complications. We describe a multi-phased study to develop and test a tailored intervention to reduce DD to improve health outcomes. Phases 1-3 identified factors related to DD in Veterans with T2DM to inform intervention development. We used an explanatory sequential mixed methods design to identify how Veterans with T2DM experienced DD. Veterans (n=210) completed measures (DD, depression, empowerment, stigma) . A subset of Veterans (n=36) also completed in-depth qualitative interviews. We fit a multivariable linear regression to examine associations with DD score. We completed thematic analysis on interview transcripts. We integrated measurement and interview data using matrices and analyzed results by medication type, hemoglobin A1c (HbA1c) , and severity of DD (low, moderate, high) . Mean age was 63 years (SD 10.2) ; 15% female; 69% non-white; 56% on insulin; mean A1c 8.9% (SD 2.0) ; mean DD score was 2.0 (SD 0.9) , indicating moderate distress. In the regression model, female gender (β= -0.31; 95% CI: -0.57, -0.04) , diagnosis of multiple mental health comorbidities vs. one condition (β=-0.29; 95% CI: -0.55, -0.03) , higher depression symptom (β=0.15; severity (95% CI: 0.08, 0.23) and stigma (β=0.02; 95% CI: 0.01, 0.04) were associated with higher DD. Higher T2DM self-efficacy (β=-0.34; 95% CI: -0.51, -0.18) was associated with lower DD. Interviews elaborated on themes including the impact of pain and comorbidities on DD. Integrating the measurement and interview data indicated that experiences of DD varies by many characteristics based on medication type, HbA1c, and severity of DD. Elucidating contributors to DD in Veterans using mixed methods will improve our ability to develop a tailored intervention addressing DD in a manner relevant to Veteran populations. Disclosure A.Lewinski: Other Relationship; Otsuka America Pharmaceutical, Inc., PhRMA Foundation. S.J.Barcinas: None. H.B.Bosworth: Advisory Panel; Sanofi, Board Member; preventics diagnostics, Consultant; VIDYA, webmed, Research Support; Boehringer Ingelheim International GmbH, improved Patient Outcomes, Merck &amp; Co., Inc., Novo Nordisk, Otsuka America Pharmaceutical, Inc. M.J.Crowley: None. A.S.Jeffreys: None. C.Coffman: None. C.Whitfield: None. T.Howard: None. A.Shapiro: None. E.S.Mcconnell: None. P.Tanabe: None. Funding Durham Center of Innovation to Accelerate Discovery and Practice Transformation (CIN 13-4) and VA HSR&amp;D grants #18-234 (to AAL) and #08-027 (to HBB) .

Assessment of Psychological Distress and Coping Strategies among Dental Undergraduate Students in a Malaysian University during COVID-19 Pandemic

Objective: Drastic changes took place in Malaysia due to COVID-19 pandemic including education where the students had to undergo remote teaching and learning at their respective hometown to prevent the spread of COVID-19. This change in the mode of learning is a stressful event faced by the students. This study aimed to assess the psychological distress and the coping strategies of undergraduate dental students during COVID-19 pandemic.Materials and Methods: A cross sectional study was conducted on a sample of 224 undergraduate students of Faculty (Kulliyyah) of Dentistry in the academic session of 2020/2021. The psychological distress level was assessed using the Kessler psychological distress scale (K10) and the coping mechanisms of the students were determined using the Brief-cope questionnaire.Results: The rate of severe psychological distress was found to be 40.18%, while 22.32% and 18.75% had mild and moderate distress respectively. Students that are less than 21 years old showed a significantly lower mean of psychological distress compared to students above 21 years old. There was no statistically significant difference in psychological distress in terms of gender. More students showed approach coping strategy than avoidant coping. Approach coping showed a negative correlation with psychological distress while avoidant coping showed a statistically significant positive correlation with psychological distress.Conclusion: Psychological distress during COVID-19 pandemic is occurring at a high rate among dental students. Psychological distress level is increased in students with avoidant coping strategies.

568-P: Predictors of Engagement and Adherence in a Text Messaging Diabetes Intervention for Hispanics

Mobile health delivery of diabetes self-management education and support (DSME/S) can reduce barriers among racial/ethnic minority populations (e.g., Hispanics) , but little is known about how participant characteristics shape adherence and engagement with mHealth interventions. The current study examined this using data from Dulce Digital-Me, a randomized trial that tested an adaptive mHealth DSME/S intervention among 3Hispanic adults with poorly managed type 2 diabetes from a Federally Qualified Health Center in San Diego, CA. In addition to core educational content, participants in three intervention arms received text messages with ecological momentary assessment (EMA) of health behaviors and prompts to check their blood glucose (BG) over 24 weeks. Linear regression models examined associations of age, sex, diabetes duration, health literacy (Single Item Literacy Scale) , and diabetes distress (Diabetes Distress Scale-17) at baseline with the percentage of EMA and BG checks completed, controlling for study arm. Average participant age was 52.6 years ± 11.5; 70% were female. Younger age (B=-.88) , longer diabetes duration (B=.51) , lower health literacy (B=-4.7) , and lower diabetes distress (B=-6.7) predicted significantly higher EMA completion, while only lower distress (B=-4.5) predicted higher BG check completion (all ps&amp;lt;.05) . Follow-up analyses revealed that those with moderate distress tended to have higher completion rates than those with low or high diabetes distress. Overall, these results were in line with prior research in predominantly non-Hispanic samples, with the exception of health literacy, where we typically see a positive association with mHealth engagement. This finding may reflect that our intervention content was written for populations of lower literacy levels. Future qualitative research should expand on these findings to explore who adheres to and engages most with mHealth DSME/S. Disclosure T.Clark: None. A.L.Fortmann: Consultant; Ascensia Diabetes Care, Employee; Dexcom, Inc. A.Philis-tsimikas: Advisory Panel; Bayer AG, Novo Nordisk, Research Support; Lilly Diabetes, National Institute of Diabetes and Digestive and Kidney Diseases, Novo Nordisk, Viking Therapeutics. K.L.Savin: None. H.Sandoval: None. S.R.Spierling bagsic: None. L.Gallo: None. Funding National Institutes of Health (NCT03130699)

Food Insecurity and Diabetes: Evidence of Psychosocial Consequences During the COVID-19 Pandemic in the United States

ObjectivesTo analyze the associations between food insecurity (FI) and diabetes distress (DD) related to COVID-19 in adults with pre-diabetes/diabetes in the United States (US). MethodsWe fielded a national, web-based survey among low-income adults in the US (N = 1,756). Measures included FI status, using the 18-item USDA Household Food Security Module, and DD, using the 17-item Diabetes Distress Scale. Multinomial logistic regression models examined the relationship between FI and DD among adults with pre-diabetes, type-1, or type-2 diabetes (n = 317). ResultsOverall, 58.4% of participants reported little/no distress, 15.7% reported moderate distress and 25.9% reported high distress. Adults with FI had a higher prevalence of high DD (43.3% vs. 13.5%) and moderate DD (23.3% vs. 11.9%) compared to individuals with food security (p < 0.001). Compared to individuals with food security, individuals experiencing FI had clinical levels of distress (moderate or high) for the emotional burden subscale (70.4% vs. 27.7%), regimen-related subscale (71.4% vs. 34.7%), interpersonal subscale (23.6% vs. 58.64% vs. 23.6%) and physician-related subscale (57.4% vs. 17.1%). ConclusionsDuring the COVID-19 pandemic, FI was associated with higher DD among individuals with pre-diabetes/diabetes in the US. Healthcare providers should screen for DD and connect patients to resources to help manage their food and mental health needs. Funding SourcesThis research was supported by a grant from Poverty Solutions at the University of Michigan. In addition, JAW was supported by the National Institutes of Diabetes and Digestive And Kidney Diseases of the National Institutes of Health (Award #K01DK119166) and CWL was supported by the Eunice Kennedy Shriver National Institute for Child Health and Human Development (Award #4R00HD084758). HP was funded as a Sight and Life Scholar by the Sight and Life Global Nutrition Research Institute.

Association of Social Anxiety Disorder and Physical Activity With Psychological Distress During COVID-19 Imposed Lockdown: A Medical Student Survey From a Developing Country

AimsCOVID-19 imposed lockdowns have impacted the mental health of medical students worldwide. However, the relationship of social anxiety disorder with psychological distress during the pandemic has not been studied. The objective of this study was to assess the association of social anxiety disorder and physical activity with psychological distress in medical students during COVID-19 imposed lockdown.Methods256 medical students (M/F: 144/112) took part in this online cross-sectional survey conducted in September 2020 during a government imposed lockdown. Kessler-10 (K10) questionnaire, social interaction anxiety scale (SIAS) and international physical activity questionnaire (IPAQ) - short form were used to assess psychological distress, social anxiety and physical activity, respectively. Data were analysed using SPSS v25, with application of multivariate logistic regression to assess association of various factors with psychological distress.ResultsOut of 256 medical students, 73 (28.5%) had severe psychological distress and 105 (41.0%) had mild to moderate distress. A logistic regression model to assess the effect of social anxiety disorder, level of physical activity and gender with the likelihood of having severe psychological distress was statistically significant (p &lt; 0.001) with overall accuracy of 73.8%. The risk of developing severe psychological distress was higher among females [OR 2.13 (95% CI 1.17–3.87), p = 0.013] and those with social anxiety disorder [OR 4.56 (95% CI 2.27–9.16), p &lt; 0.001]. Low physical activity was not a significant risk factor for psychological distress [OR 0.88 (95% CI 0.35–2.23), p = 0.794].ConclusionThis study shows that COVID-19 imposed lockdown has adversely affected the mental health of medical students. Female students and those with social anxiety disorder are at more risk of developing severe psychological distress.

Impact of COVID-19 on Mental Health among the Armed Forces Personnel

Introduction: There is a wide consensus that the COVID-19 pandemic not only affects physical health, but also mental health and well-being. It can lead to heightened levels of distress and cause anxiety, fear, denial or depressive symptoms among the military personnel. Objective: To assess the impact of COVID-19 on mental health among the confirmed cases of Armed Forces Personnel of Sylhet and Jalalabad Cantonment. Methods: A total of 180 participants were selected using convenience sampling. The mental health was assessed by a 22 items Impact of Event Scale-Revised (IES-R) adopted from Horowitz 1979. The scale comprised of 3 subscales of intrusion, avoidance and hyper-arousal which represents major symptoms of post-traumatic stress. Stress for job, financial issue, home and feeling horrified or helpless due to the COVID-19 were also assessed. Results: This study revealed that 47.7% were experiencing moderate distress whereas 30.1% were experiencing high to severe post-COVID stress. Mean stress was observed as 41.5 ± 19.0. Mean Intrusion (34.9 ± 22.9) and Hyper-arousal (27.8 ± 23.5) depicted mild to moderate but Avoidance (58.5 ± 20.9) revealed a higher level of stress. A majority were not at all stressed for their job (56.7%) or financial issue (49.4%). But stress for family (28.4%), feeling horrified (35.6%) and helpless (36.6%) were quite high. Conclusion: The study observed a moderate to high prevalence of mental health symptoms among the COVID affected personnel which was considered to be significant and demands appropriate intervention. JAFMC Bangladesh. Vol 17, No 2 (December) 2021: 7-11

Neighborhood cohesion and psychological distress across race and sexual orientation

IntroductionWe investigate the association neighborhood cohesion, as source of social support, has with psychological distress among white, Black, and Latinx lesbian, gay, and bisexual (LGB) individuals, compared to heterosexual individuals in the United States. MethodWe estimate zero-order multinomial logistic regression models to assess the likelihood of moderate and severe psychological distress among respondents. ResultIn the models accounting for neighborhood cohesion and all other covariates, white, Black, and Latinx lesbian, gay, and bisexual individuals are more likely to meet the criteria for moderate and severe psychological distress than non-LGB people. ConclusionNeighborhood cohesion has differing impact on psychological distress outcomes by racial/ethnic-sexual orientation groups, but in general provides a greater magnitude of protection against moderate psychological distress for non-LGB groups and a greater magnitude of protection against severe psychological distress for LGB groups.