Multiple Psychosocial Domains Research Articles

Towards the standardisation of adult person-reported outcome domains in diabetes research: A Consensus Statement development panel.

Diabetes is unique among chronic diseases because clinical outcomes are intimately tied to how the person living with diabetes reacts to and implements treatment recommendations. It is further characterised by widespread social stigma, judgement and paternalism. This physical, social and psychological burden collectively influences self-management behaviours. It is widely recognised that the individual's perspective about the impact of trying to manage the disease and the burden that self-management confers must be addressed to achieve optimal health outcomes. Standardised, rigorous assessment of mental and behavioural health status, in interaction with physical health outcomes is crucial to aid understanding of person-reported outcomes (PROs). Whilst tempting to conceptualise PROs as an issue of perceived quality of life (QoL), in fact health-related QoL is multi-dimensional and covers indicators of physical or functional health status, psychological and social well-being. This complexity is illuminated by the large number of person reported outcome measures (PROMs) that have been developed across multiple psychosocial domains. Often measures are used inappropriately or because they have been used in the scientific literature rather than based on methodological or outcome assessment rigour. Given the broad nature of psychosocial functioning/mental health, it is important to broadly define PROs that are evaluated in the context of therapeutic interventions, real-life and observational studies. This report summarises the central themes and lessons derived in the assessment and use of PROMs amongst adults with diabetes. Effective assessment of PROMs routinely in clinical research is crucial to understanding the true impact of any intervention. Selecting appropriate measures, relevant to the specific factors of PROs important in the research study will provide valuable data alongside physical health data.

Development of a short form of the Cardiac Distress Inventory

BackgroundCardiac distress may be viewed as a persistent negative emotional state that spans multiple psychosocial domains and challenges a patient’s capacity to cope with living with their heart condition. The Cardiac Distress Inventory (CDI) is a disease-specific clinical assessment tool that captures the complexity of this distress. In busy settings such as primary care, cardiac rehabilitation, and counselling services, however, there is a need to administer briefer tools to aid in identification and screening. The aim of the present study was to develop a short, valid screening version of the CDI.MethodsA total of 405 participants reporting an acute coronary event in the previous 12 months was recruited from three hospitals, through social media and by direct enrolment on the study website. Participants completed an online survey which included the full version of the CDI and general distress measures including the Kessler K6, Patient Health Questionnaire-4, and Emotion Thermometers. Relationship of the CDI with these instruments, Rasch analysis model fit and clinical expertise were all used to select items for the short form (CDI-SF). Construct validity and receiver operating characteristics in relation to the Kessler K6 were examined.ResultsThe final 12 item CDI-SF exhibited excellent internal consistency indicative of unidimensionality and good convergent and discriminant validity in comparison to clinical status measures, all indicative of good construct validity. Using the K6 validated cutoff of ≥ 18 as the reference variable, the CDI-SF had a very high Area Under the Curve (AUC) (AUC = 0.913 (95% CI: 0.88 to 0.94). A CDI-SF score of ≥ 13 was found to indicate general cardiac distress which may warrant further investigation using the original CDI.ConclusionThe psychometric findings detailed here indicate that the CDI-SF provides a brief psychometrically sound screening measure indicative of general cardiac distress, that can be used in both clinical and research settings.

Facial Filler in Facial Paralysis: A Prospective Case Study and Multidimensional Assessment.

Background: Facial filler is emerging as a nonsurgical alternative for addressing static asymmetry in facial paralysis (FP). Objectives: To elucidate the patient experience for facial filler and to facilitate preprocedure counseling and education. Materials and Methods: Patients receiving hyaluronic acid filler for FP at a tertiary academic medical center were prospectively recruited. Primary outcomes included patient-reported pain, facial symmetry (on a visual analog scale), and the results of quality-of-life surveys (FACE-Q satisfaction with facial appearance [SFA], FACE-Q psychosocial distress [PSD], Patient Health Questionnaire-9 [PHQ-9], and Euro Quality of Life 5-Dimension [EQ5D]) preprocedure and at 1 and 14 days postprocedure. Results: Twenty patients (90% women, average age 55 ± 11) completed the study. Sites of filler included the cheek, lower lip, nasolabial fold, chin, and temple regions. Patients reported minimal pain at postprocedure days (PPDs) 1 and 14. Patient-perceived symmetry scores improved significantly (p < 0.0001), as did FACE-Q SFA and FACE-Q PSD scores (p < 0.0001, <0.0001) when comparing preprocedure with PPD 14. Depression, assessed by PHQ-9, and the anxiety/depression domain of EQ5D, decreased after treatment (p = 0.016, 0.014) but no change was observed in the other domains of EQ5D. Conclusion: Facial filler for FP can be performed with minimal morbidity (pain, impact on daily routine, and complications) and leads to improvements across multiple psychosocial domains.

The cardiac distress inventory: A new measure of psychosocial distress associated with an acute cardiac event

BackgroundMany challenges are posed by the experience of a heart attack or heart surgery which can be characterised as ‘cardiac distress’. It spans multiple psychosocial domains incorporating patients’ responses to physical, affective, cognitive, behavioural and social symptoms and experiences related to their cardiac event and their recovery. Although some measures of the psychological and emotional impacts of a cardiac event exist, none provides a comprehensive assessment of cardiac distress. To address this gap, the study aimed to develop a Cardiac Distress Inventory (CDI) using best practice in instrument design.MethodAn item pool was generated through analysis of cognate measures, mostly in relation to other health conditions and through focus group and individual review by a multidisciplinary development team, cardiac patients, and end-users including cardiac rehabilitation co-ordinators. The resulting 144 items were reduced through further reviews to 74 for testing. The testing was carried out with 405 people recruited from three hospitals, through social media and by direct enrolment on the study website. A two-stage psychometric evaluation of the 74 items used exploratory factor analysis to extract the factors followed by Rasch analysis to confirm dimensionality within factors.ResultsPsychometric analysis resulted in the identification of 55 items comprising eight subscales, to form the CDI. The subscales assess fear and uncertainty, disconnection and hopelessness, changes to roles and relationships, overwhelm and depletion, cognitive challenges, physical challenges, health system challenges, and death concerns. Validation against the Kessler 6 supports the criterion validity of the CDI.ConclusionThe CDI reflects a nuanced understanding of cardiac distress and should prove to be a useful clinical assessment tool, as well as a research instrument. Individual subscales or the complete CDI could be used to assess or monitor specific areas of distress in clinical practice. Development of a short form screening version for use in primary care, cardiac rehabilitation and counselling services is warranted.

Effect of Gender-affirming Facial Feminization Surgery on Psychosocial Outcomes.

This study investigates the effect of gender-affirming facial feminization surgery (FFS) on psychosocial outcomes in patients with gender dysphoria. Comprehensive analyses of psychosocial outcomes after gender-affirming FFS are absent in the literature resulting in a paucity of information on the impact of FFS on quality of life as well as ramifications in health insurance coverage of FFS. Scores from 11 validated, quantitative instruments from the Patient-Reported Outcomes Measurement Information System (PROMIS) assessing anxiety, anger, depression, global mental health, global physical health, satisfaction with sex life, positive affect, emotional support, social isolation, companionship, and meaning and purpose. Patients within the preoperative group (pre-FFS) were evaluated >30 days before surgery and patients within the postoperative group (post-FFS) were evaluated ≥10 weeks after surgery. A total of 169 patients [mean (SD) age, 33.5 (10.8) years] were included. Compared with the pre-FFS group (n=107), the post-FFS group (n=62) reported improved scores anxiety (56.8±8.8 vs 60.1±7.9, P =0.01), anger (47.4±7.6 vs 51.2±9.6, P =0.01), depression (52.2±9.2 vs 57.0±8.9, P =0.001), positive affect (46.6±8.9 vs 42.9±8.7, P =0.01), meaning and purpose (49.9±10.7 vs 46.2±10.5, P =0.03), global mental health (46.7±7.6 vs 43.1±9.2, P =0.01), and social isolation (52.2±7.5 vs 55.4±7.4, P =0.01). Multivariable analysis to account for the effects of other gender-affirming surgeries, hormone therapy duration, preexisting mental health diagnoses, socioeconomic disparities, and patient-reported quality of social relationships on psychosocial functioning demonstrated that completion of FFS was independently predictive of improved scores. Gender-affirming FFS improves the quality of life by multiple psychosocial domains in transfeminine patients.

53-LB: Youth and Parents’ Experiences Using the Insulin-Only Bionic Pancreas

The Insulin-only Bionic Pancreas (BP) Pivotal Trial compared the BP initialized only with body weight vs. standard-of-care (SC) . The BP autonomously determines all insulin doses. Meals are announced without carbohydrate counting. For youth aged 6-17 the mean adjusted difference of HbA1c at 13 weeks between BP and SC was -0.5% (95% CI: -0.7, -0.2, P&amp;lt;0.001) : percent of time &amp;lt;54 mg/dl was not different between groups. Focus groups with youth who used the BP and their parents were conducted at the trial’s end. Youth reported positive experiences: improved A1c, increased independence, less parent worry and texting about glucose, less family diabetes conversations, less cognitive and emotional burden, less time managing diabetes, less worries about nighttime lows, more sleep, easier mealtimes, and easier school management. Children felt parents trusted them more and parents spent less time managing glucose at night. Some reported increased lows and others less. Some found challenges with exercise while others found it managed exercise well. Some found the BP took too long to learn their body and to correct high glucose. Concerns included: not having a snack announcement, site change frequency, small insulin capacity, lack of insulin-on-board information, poor backlighting, screen timing out too fast, and not having a clip or being waterproof. Parents reported positive experiences: pride in the child’s independence, less cognitive and emotional burden, less time managing diabetes, less diabetes conversations, and better school experiences. Most reported improved sleep and easier mealtimes. Some found challenges with exercise while others found it managed exercise well. Some found improved TIR and less lows while others found more lows or delays in correcting highs. Some found the system learned their child while others felt the system struggled. Parents were concerned that the low insulin warning did not go to parents’ phones. Youth and parent perspectives highlight experiences in learning and using the BP and offer insights related to multiple psychosocial domains which can guide future innovations. Disclosure K. R. Howard: None. K. P. Garza: None. M. Feldman: None. J. Weissberg-benchell: None. Bionic pancreas research group: n/a. Funding National Institute of Diabetes Digestive and Kidney Diseases (#1UC4DK108612-01)

Body Image Distress and Its Associations From an International Sample of Men and Women Across the Adult Life Span: Web-Based Survey Study.

BackgroundPrevious research on body image distress mainly relied on samples that were small, generally homogeneous in age or sex, often limited to one geographical region, and were characterized by a lack of comprehensive analysis of multiple psychosocial domains. The research presented in this paper extends the international literature using the results of the web-based Global Health and Wellbeing Survey 2015. The survey included a large sample of both men and women aged ≥16 years from Australia, Canada, New Zealand, the United Kingdom, or the United States.ObjectiveThe main objectives of this study are to examine body image distress across the adult life span (≥16 years) and sex and assess the association between body image distress and various psychosocial risk and protective factors.MethodsData were extracted from the Global Health and Wellbeing Survey 2015, a web-based international self-report survey with 10,765 respondents, and compared with previous web-based surveys conducted in 2009 and 2012.ResultsThe body image distress of young Australians (aged 16-25 years) significantly rose by 33% from 2009 to 2015. In 2015, 75.19% (961/1278) of 16- to 25-year-old adults reported body image distress worldwide, and a decline in body image distress was noted with increasing age. More women reported higher levels of body image distress than men (1953/3338, 58.51% vs 853/2175, 39.22%). Sex, age, current dieting status, perception of weight, psychological distress, alcohol and other substance misuse, and well-being significantly explained 24% of the variance in body image distress in a linear regression (F15,4966=105.8; P<.001).ConclusionsThis study demonstrates the significant interplay between body image distress and psychosocial factors across age and sex.

Multi-Informant Assessments of Individual Differences in Adolescents’ Socio-Evaluative Fears: Clinical Correlates and Links to Arousal within Social Interactions

Socially anxious adolescents often display fears of negative evaluation (FNE) and fears of positive evaluation (FPE). The Bivalent Fear of Evaluation model posits that FNE and FPE represent two poles of socio-evaluative fears, and that individuals may simultaneously display high levels of FNE and FPE (high FNE/FPE). To what degree do adolescents who display high FNE/FPE differ in psychosocial functioning from adolescents who display high concerns on one domain and not the other (either high FNE/low FPE, or low FNE/high FPE), or low concerns on both domains (i.e., low FNE/FPE)? We tested this broader question (a) across multiple psychosocial domains, (b) using multiple informants’ reports to identify adolescents’ patterns of socio-evaluative fears, and (c) in relation to adolescents’ reactions to anxiety-provoking social situations with unfamiliar peers. One-hundred twenty-seven 14–15-year-old adolescents and their parents completed measures of adolescents’ FNE, FPE, and domains of psychosocial functioning (i.e., social anxiety, safety behaviors, depressive symptoms, psychosocial impairments). Adolescents participated in several social interaction tasks with unfamiliar peers. Adolescents self-reported on their arousal during these tasks and the unfamiliar peers with whom they interacted completed measures of social anxiety about the adolescent. High FNE/FPE adolescents tended to display poorer psychosocial functioning relative to adolescents who displayed other patterns of socio-evaluative fears. Based on adolescent-classified groups, high FNE/FPE adolescents displayed greater self-reported arousal during social interactions, relative to the other groups. Identifying adolescents’ patterns of socio-evaluative fears may inform interpretations of the individual differences among adolescents’ clinical presentations of social anxiety.

Assessing the psychosocial needs of newly diagnosed patients with nonsmall cell lung cancer: Identifying factors associated with distress.

The Psychosocial Screen for Cancer (PSSCAN-R) questionnaire is a validated screening tool used to identify the psychosocial needs of patients with cancer. It assesses patients' perceived social supports and psychosocial needs, and the presence of symptoms of depression and anxiety. The study goals were to assess the prevalence and factors associated with distress in patients with newly diagnosed nonsmall cell lung cancer (NSCLC). All patients with NSCLC referred to BC Cancer centers from 2011 to 2015, who completed a prospective PSSCAN-R questionnaire at the time of their first visit, were included in the study. Demographics and baseline disease characteristics were collected retrospectively. The chi-squared test, Fisher exact test, and logistical regression analysis were used to compare factors associated with the presence of distress based on sex, age, stage of disease, and performance status (PS). A total of 4281 NSCLC patients completed the PSSCAN-R questionnaire. Baseline characteristics: 70% were greater than or equal to 65, 50% female, 52% metastatic disease, 47% Eastern Cooperative Oncology Group (ECOG) greater than or equal to two. Patients who were female, less than 65, have metastatic disease and poor PS were more likely to report subclinical or clinical symptoms of anxiety. Symptoms of depression were associated with younger, female, poor PS patients, and social isolation. Newly diagnosed patients with NSCLC are likely to report clinical symptoms of anxiety and depression and have a high number of concerns in multiple psychosocial domains. Resource development for lung cancer patients should be based on their care needs with careful consideration of patients' age, gender, stage, and social situation to optimally support their psychosocial needs during treatment and follow-up.

The Psychosocial Impact of Cleft in a Western Australian Cohort Across 3 Age Groups.

Management of a cleft of the lip and/or palate (CL/P) involves a multidisciplinary team approach lasting from birth to potentially postskeletal maturity. This condition is complex, with both medical and psychosocial implications that may place individuals with a cleft at higher risk of developing psychosocial problems. A self-administered questionnaire was completed by a sample from the Western Australian cleft population comprising 3 age groups: child (n = 100), adolescent (n = 101), and adult (n = 158). Public speaking, being photographed, special relationships, and participation in school were identified as the areas most impacted by having a cleft. Hearing and speech were reported to have a higher importance than facial and dental appearance. Participants rated support given to them by their parents as the most important, with high ratings for treatment providers. For teasing, the impact of cleft was significantly higher among participants with cleft lip and palate for both the adolescent and adult age groups. There was little significant difference by gender across the variables, which suggests that males are just as likely to require support as females. The impact of a cleft across multiple psychosocial domains needs to be recognized and addressed as part of craniofacial team care across age groups.

The PERMA-Profiler: A brief multidimensional measure of flourishing

Abstract: In the book Flourish (2011), Seligman defined wellbeing in terms of five pillars: Positive emotion, Engagement, Relationships, Meaning, and Accomplishment, or PERMA. We developed the PERMA-Profiler as a brief measure of PERMA. We first compiled hundreds of theoretically relevant items. Three studies ( N = 7,188) reduced, tested, and refined items, resulting in a final set of 15 questions (three items per PERMA domain). Eight additional filler items were added, which assess overall wellbeing, negative emotion, loneliness, and physical health, resulting in a final 23-item measure. A series of eight additional studies ( N = 31,966) were conducted to test the psychometrics of the measure. The PERMA-Profiler demonstrates acceptable model fit, internal and cross-time consistency, and evidence for content, convergent, and divergent validity. Scores are reported visually as a profile across domains, reflecting the multidimensional nature of flourishing. The PERMA-Profiler adds to the toolbox of wellbeing measures, allowing individuals to monitor their wellbeing across multiple psychosocial domains.

Exploring military social work from a social justice perspective

Calls to enhance military social work content in social work education present unique challenges for a discipline historically associated with social justice and advocacy for peace. The consequences of war demand intervention along multiple psychosocial domains. However, the question remains as to how social workers can address the discrepancies between social work values and military culture. This article argues that the context-bound nature of social work highlights the reciprocal relationship between macro and micro factors intrinsic to military issues. This provides a holistic understanding of the military system and can enhance educational content on military issues to include international perspectives.

Psychosocial Effects of Repetitive Surgeries in Children With Early-Onset Scoliosis

The use of growing instrumentation in children with early-onset scoliosis (EOS) has created interest in determining if these repetitive procedures are prompting the development of lasting psychosocial problems. Given the increasing role of this treatment modality in the management of EOS, this study aimed to assess the psychological status of this patient population and to determine factors associated with worse scores in various psychosocial domains. A cross-sectional assessment of 34 EOS patients was performed utilizing 2 well-established, caregiver-completed psychiatric instruments: the Child Behavior Checklist (CBCL) and the Strength and Difficulties Questionnaire. Scores were calculated for 15 CBCL and 6 Strength and Difficulties Questionnaire domains and subdomains and grouped as "Normal" or "Abnormal" according to published normative values. The prevalence of abnormal scores was within each instrument subdomain and was compared with the national norms. Domain scores were also correlated with age at first scoliosis surgery, total number of operative procedures, and total number of growing instrumentation surgeries. A higher prevalence of Abnormal scores were found in multiple psychosocial domains in our cohort as compared with national normative data. Children with Abnormal CBCL "Total Problems" domain scores were younger at the time of first scoliosis surgery (2.50 vs. 5.52 y). Normal and Abnormal scoring groups showed significant differences in the number of (1) total surgeries; (2) total scoliosis surgeries; and (3) growing instrumentation surgeries in multiple domains on both instruments. Aggression, Rule-breaking, and Conduct were positively correlated with total number of surgeries. Our findings showed a higher prevalence of Abnormal psychosocial scores in multiple domains in multioperated EOS patients as compared with national norms. Our findings suggest that EOS patients with abnormal psychosocial scores were younger at the time of their initial scoliosis surgery. The number of repetitive surgeries also correlated positively with 3 behavioral problem scores. Although healthier scores were seen in 1 positive behavioral domain in more operated children suggesting the potential for "posttraumatic growth," the other findings of this study are concerning given the increasing use of this treatment modality and indicate a need for ongoing screening and mental health care in this high-risk population. Level III--case-control.

The psychosocial context of pregnancy smoking and quitting in the Millennium Cohort Study

Background:Although pregnancy is a time when women have increased motivation to quit smoking, approximately half of female smokers persist in smoking throughout their pregnancies. Persistent pregnancy smokers are known to...

Hierarchical relationships between borderline, schizotypal, avoidant and obsessive–compulsive personality disorders

Comorbidity among personality disorders is widely considered problematic. The validity of one proposed solution, diagnostic hierarchies, was investigated in the current study with respect to borderline, schizotypal, avoidant, and obsessive-compulsive personality disorders. One approach used discriminant functions, derived from multiple psycho-social domains, that were used to classify comorbid individuals from the Collaborative Longitudinal Personality Disorder study (CLPS) to explore the possibility of hierarchical precedence of one personality disorder over another. A second approach examined the incremental increase in R(2)-value in predicting functioning and personality provided by each diagnosis over each other diagnosis. Obsessive-compulsive personality disorder was consistently subordinate to other diagnoses, whereas other indications of hierarchical relationships were domain-specific. Results indicate minimal support for an over-arching hierarchical pattern among studied personality disorders, and suggest the inclusion of all relevant diagnoses in clinical practice.

Self-esteem and mortality: prospective evidence from a population-based study.

Self-esteem is considered to be importantly associated with both psychosocial states such as depression as well as physical health. There are no population-based studies that examine the association between self-esteem and mortality. The objective of this study was to assess whether low self-esteem was prospectively associated with increased risk of death in a population-based sample of Finnish men. A sample of 2682 male residents of Kuopio, Finland were interviewed and followed prospectively as part of the Kuopio Ischemic Heart Disease Risk Factor Study (KIHD). Characteristics of the KIHD sample at baseline included self-esteem, measured by the Rosenberg ten-item scale, socioeconomic factors, behavioral risk factors, other psychosocial characteristics, and prevalent diseases. Mortality was ascertained through linkage to the Finnish national death registry. We assessed the relationship between self-esteem and all-cause mortality using Cox proportional hazards models. Low self-esteem was associated with a two-fold [hazard ratio (HR)=2.0, 95% confidence interval (CI)=1.3-3.2] increase in age-adjusted mortality. This relationship was partially explained by behavioral and socioeconomic factors, and prevalent diseases, and fully explained by other psychosocial characteristics (hopelessness, depression, cynical hostility, and sullenness). When adjusted for hopelessness alone there was no increased risk associated with low self-esteem (HR=1.3, 95% CI=0.8-2.2). This study found no association between self-esteem and all-cause mortality after adjustment for other psychosocial characteristics, primarily hopelessness. Our understanding of the observed relationships between some psychosocial factors and mortality may be improved by simultaneous measurement of multiple psychosocial domains, thus diminishing the potential for residual confounding.

Psychosocial outcomes of alcohol involvement and dysphoria in women: a 16-year prospective community study.

Alcohol involvement, dysphoria, and their combined effects, may have long-term psychosocial consequences. However, because of weaknesses in existing literature, the exact relationships are unclear, as are the relative contributions of either construct or their combined effects to later psychosocial outcomes. This study tests the relationships between these conditions during late adolescence andyoung adulthood as predictors of adult marital, relational and job satisfaction; divorce; perceived opportunity; and job stability. We also test the influence of a change (increase or decrease) in alcohol involvement, dysphoria, or their combined association, on adult psychosocial functioning. This study used three waves of data from an ethnically diverse, longitudinal community sample (N = 305 women) assessed over a 16-year span. The measures used have established validity and reliability. Structural equation models revealed that a second-order factor reflecting alcohol involvement and dysphoria during young adulthood was a stronger predictor of psychosocial maladjusument in adulthood than either alcohol involvement or dysphoria alone, predicting decreased satisfaction in multiple psychosocial domains (marriage, relationships and employment). An increase in the shared association between alcohol involvement and dysphoria from late adolescence to young adulthood reduced adult perceived opportunity. Early intervention is crucial. Clinicians should emphasize the screening for and treatment of alcohol involvement, dysphoria, and their combined effects, in late adolescence and young adulthood. Psychoeducational and treatment efforts to raise awareness of long-term consequences of these conditions are critical.

Assessment of coercive and noncoercive pressures to enter drug abuse treatment

This paper reports preliminary data derived from a standardized interview scoring procedure for detecting and characterizing coercive and noncoercive pressures to enter substance abuse treatment. Coercive and noncoercive pressures stemming from multiple psychosocial domains are operationalized through recourse to established behavioral principles. Inter-rater reliability for the scoring procedure was exceptional over numerous rater trials. Substantive analyses indicate that, among clients in outpatient cocaine treatment, ‘coercion’ is operative in multiple psychosocial domains, and that subjects perceive legal pressures as exerting substantially less influence over their decisions to enter treatment than informal psychosocial pressures. Implications for drug treatment planning, legal and ethical issues, and directions for future research are proposed.