Levels Of Overall Distress Research Articles

The Influence of Sleep and Mood on Cognitive Functioning Among Veterans Being Evaluated for Mild Traumatic Brain Injury

Veterans undergoing evaluation for mild traumatic brain injury commonly report insomnia, psychiatric symptoms, and cognitive dysfunction. This study examines the effects of self-reported amount of sleep and subjective sleep quality on neuropsychological test performance. 262 veterans were seen for neuropsychological assessment in a Veterans Affairs traumatic brain injury clinic. All participants completed measures of depression, anxiety, and sleep satisfaction, and also estimated the number of hours they slept the night before the assessment. Factor scores of attention/concentration and memory were created using factor analyses. Data were analyzed with linear regression. Depression and anxiety were significantly correlated with sleep satisfaction and predictive of cognitive ability. Both sleep satisfaction and hours slept were significantly correlated with memory, but not attention. After controlling for the effects of depression and anxiety, hours slept but not sleep satisfaction was predictive of memory test performance. Perceived sleep quality is heavily influenced by psychiatric symptoms; therefore, veterans' report of sleep satisfaction may merely reflect their overall level of distress. Sleep quantity, however, appears to uniquely contribute to memory performance. Thus, assessment of sleep is important and provides clinicians with useful information, especially among individuals with psychiatric comorbidities.

Gender, age and surgery as a treatment modality leads to higher distress in patients with cancer

Distress has been defined as a multidimensional construct that extends along a continuum, ranging from common normal feelings of vulnerability, sadness and fears to problems that can become disabling, such as depression, anxiety, panic, social isolation and existential and spiritual crisis. Several studies have pointed out the need to screen for distress in the cancer. Emotional distress has been found as a core indicator of a patient's health and well-being and has installed it as the sixth vital sign. The aim of the present study was to identify the predictors of distress in cancer patients. For the present study, a total of 760 patients with cancer in a tertiary cancer centre were assessed using the Distress Inventory for Cancer Version 2 (DIC V2). A multivariate logistic regression was carried out to identify the predictors of distress and six subscales. Female patients under the age of 44 years scheduled to undergo surgery or those who had undergone surgery predicted significantly higher levels of overall distress. Composite disease stage other than stage IV metastatic disease and being a daily wage employee predicted significantly lower levels of overall distress. Higher distress among women undergoing surgery could imply distress associated with significant cosmetic disfigurement and feeling of loss of womanhood especially in those with breast or cervix cancer. The study once again demonstrate gender and age differences in distress and also highlights the importance of knowing that cancer is confined to one organ and has not spread.

Acceptance, Mindfulness, and Values-Based Action May Counteract Fear and Avoidance of Emotions in Chronic Pain: An Analysis of Anxiety Sensitivity

People often respond with distress and avoidance to their own negative experiences, such as the physical, cognitive, and emotional aspects of depression or anxiety. When people with chronic pain respond this way, their overall level of distress may increase, they may struggle to avoid their emotional experiences, and their daily functioning may decrease. The purpose of this study was to examine the role of anxiety sensitivity (AS), or "fear of anxiety," in relation to these processes. It was predicted that those persons with chronic pain who report higher AS will also report higher emotional distress and greater disability caused by chronic pain. A second purpose was to examine whether therapeutic processes designed to reduce emotional avoidance, namely, acceptance, mindfulness, and values, could be demonstrated to reduce the role of AS in relation to this distress and disability based on a statistical model including these variables. Subjects were 125 consecutive adult patients (64.8% women) seeking services from a specialty pain service in the United Kingdom. All patients completed a standard set of measures of AS, acceptance of pain, mindfulness, and values-based action, as well as measures of pain, disability, and emotional functioning, at their initial consultation, and these data formed the basis for the current study. In correlation and regression analyses, AS was associated with greater pain, disability, and distress. In regression analyses, the 3 proposed therapeutic processes reduced the average variance accounted for by AS in patient functioning from DeltaR(2) = .21 to DeltaR(2) = .048. This means that when the 3 therapeutic variables are taken into account statistically, AS alone retained relatively little association with patient functioning. These results suggest that AS may amplify the impact of emotional distress on patient functioning in chronic pain and that processes of acceptance, mindfulness, and values-based action may reduce this effect. Humans can fear and struggle to avoid their own emotional experiences, even when these cannot harm them. Data presented here show individuals with chronic pain have more distress and disability when they manifest more fear of anxiety symptoms, and behavior patterns of "acceptance" and "mindfulness" may reduce this effect.

Approach-avoidance coping conflict in a sample of burn patients at risk for posttraumatic stress disorder

Following an acute burn injury, higher distress is consistently observed among individuals exhibiting a conflict between approach coping (e.g., processing) and avoidance coping (e.g., suppression) relative to those individuals who use only one of these methods. Study objectives were to determine if contradictory coping messages would lead to such approach-avoidance coping conflict and to determine if experiment-induced coping conflict is also associated with higher distress. Participants (n=59 adults hospitalized with acute burn injuries) were assigned randomly to experimental conditions differing in the order in which training was provided in two ways of coping with posttrauma re-experiencing symptoms (i.e., process-then-suppress versus suppress-then-process). The primary dependent variable was coping behavior during the 24-hr posttraining period. Coping behavior was categorized as approach coping (processing), avoidance coping (suppressing), or approach-avoidance coping conflict (both) on the basis of median splits on subscales assessing these behaviors. Secondary analyses examined the relationship between this experiment-induced coping conflict and re-experiencing symptoms. Results indicated that participants in the process-then-suppress condition, relative to the suppress-then-process condition, were significantly more likely to exhibit approach-avoidance coping conflict (i.e., above median split on both processing and suppressing) during the next 24 hr. Furthermore, approach-avoidance coping conflict was associated with greater re-experiencing symptoms assessed via self-report and by blinded coding of recorded speech. It is concluded that the order of coping skill training can influence treatment outcome, success of coping methods, and overall levels of distress. therefore, training in stabilizing and calming methods should precede training in active processing following stressful life events.

Psychosocial interventions for adolescent cancer patients: a systematic review of the literature

Both cancer diagnosis and the consequent treatment are particularly challenging for adolescent patients. Adjuvant psychological interventions to reduce cancer-related distress are therefore a fundamental part of a multidisciplinary treatment. Assuming that psycho-oncology has to consider developmentally specific aspects, this review summarizes empirical studies of the efficacy and effectiveness of psychosocial interventions for adolescent cancer patients. Electronic searches were conducted in four databases. Studies were included only if they were exclusively designed for adolescent cancer patients and incorporated a defined outcome measure to evaluate the effects of the implemented intervention. Only four studies fulfilled the inclusion criteria. One of those studies reported a significant improvement compared with a waitlist control group. The relevant gains were found in the overall level of distress, as well as in additional outcome variables such as knowledge of sexual issues, body image and anxiety about psychosexual issues. The remaining studies revealed no significant changes related to psychological distress and psychosocial functioning. Taken together, the findings point out that there is a lack of intervention research in psycho-oncology with adolescents. So far, there is only limited evidence for the effectiveness of psychosocial interventions to improve coping with cancer-associated problems in adolescent patients. Future research needs to be done in this population. In order to establish more conclusive results, larger samples and interventions particularly designed for adolescent patients ought to be studied.

(312) Anxiety sensitivity, experiential avoidance, and chronic pain

People often learn to respond with distress and avoidance to their own experiences of depression and anxiety. When people with chronic pain respond this way their overall level of distress may increase, they may struggle to avoid these emotional experiences, and their daily functioning may decrease. The purpose of this study was to examine the role of anxiety sensitivity (AS), or “fear of anxiety,” in relation to these processes. It was predicted that those persons with chronic pain who report higher AS would also report higher emotional distress overall and greater disability due to chronic pain.

The Long-Term Impact of Dialysis Discontinuation on Families

Little is known about the long-term psychological impact of stopping life support treatments on surviving loved ones. The authors sought to determine if there was an increase in pathologic grief in family members left behind after deaths that followed dialysis discontinuation. Phone interviews were used to collect data on demographics, attitudes, and families' comfort levels with the decision to withdraw dialysis. The Impact of Event Scale was administered to assess adaptation and stress levels. Avoidance and Intrusiveness subscales were calculated and associations with other survey data were examined using chi2 tests and analysis of variance (ANOVA). The authors contacted families in New England who had previously participated in the Baystate Dialysis Discontinuation Study. Twenty-six family members (66% of the original study sample) were interviewed approximately 55 months after patient deaths. There was a low overall level of distress and the Avoidance subscale had insufficient variability for analysis. Intrusiveness was highest for spouses and primary caregivers. Only one respondent remembered the death as having been "bad," although 62% of patients were recalled as having suffered distressing symptoms in their last days. In ascending order of importance, respondents characterized good deaths as involving mental alertness, occurring at home, taking place while asleep, being peaceful, happening in the company of loved ones, and being painless or largely painfree. Almost all of the families reported becoming more comfortable with the decision to hasten death than originally. After nearly 5 years after dialysis discontinuation, families report low levels of distress. A higher frequency of intrusive thoughts was more likely if respondents were spouses or primary caregivers as compared to adult children, siblings, or other relatives. The findings suggest that families successfully adapt to the impact of dialysis withdrawal deaths.

THE EXISTENTIAL EFFECTS OF TRAUMATIC EXPERIENCES: A SURVEY OF YOUNG ADULTS

This study examined the relation between exposure to trauma and attitudes toward existential issues. Participants were 504 undergraduate students (average age = 19.67) who answered questions on exposure to trauma, fear of death, overall distress, and meaning in life. Results indicated that those with a history of trauma exposure had higher levels of overall distress, but there were no differences in death anxiety or meaning in life. The results suggest that the positive outcomes (less fear of death and increased meaning in life) associated with exposure to traumatic events may be relatively rare, especially amongst younger adults.

Tinnitus Impact: Three Different Measurement Tools

The impact of tinnitus and overall levels of distress were measured with three assessment tools for patients with tinnitus. The Tinnitus Handicap Inventory (THI), the Symptom Checklist-90-Revised (SCL-90-R) and an activities limitations questionnaire were administered to 53 audiology patients reporting tinnitus. Forty-three percent of these patients experienced either quality of life reductions associated with tinnitus, substantial perceived handicap, and/or a high level of distress. Results from the General Severity Index (GSI) of the SCL-90-R indicated that 25% of these patients displayed distress greater than that of the general medical population. The SCL-90-R can be a useful tool for audiologists working with tinnitus patients in assessing needs for referral for psychological or psychiatric counseling.

Correlates of psychological distress following armed robbery.

Although mental health professionals have long been aware of the impact of traumatic events, it was not until 1980 that the term posttraumatic stress disorder (PTSD) was introduced into the DSM-III. Since then, one major goal of research has been to identify factors associated with distress following trauma; as yet, few reliable indicators have emerged. Within the population of armed robbery victims, this is particularly true. The purpose of this study was to investigate possible correlates of posttrauma distress in armed robbery victims, and to assess the overall level of distress within this group. A questionnaire was mailed out of 57 robbery victims, aged 15 to 65, who were recruited as study volunteers via community outreach. Severity of the trauma, vulnerability attributions, and avoidant coping were significantly related to distress level, and victims exhibited a high level of distress.

A community survey of children with severe intellectual disability and their families: psychological adjustment, carer distress and the effect of respite care.

The present paper describes a cross-sectional study of the psychosocial adjustment of 143 children with severe disability and their families identified from a regional case register for children with special needs. Thirty-eight per cent of the children had significant psychiatric morbidity. By contrast, the overall level of distress in carers was not that different from probable community prevalence figures. Nevertheless, distress among carers was consistently associated with increased disability in the child. Although respite care is a valuable resource for many carers, its use is indicative of underlying distress in the carer.

Illness uncertainty, attributional style, and psychological adjustment in older adolescents and young adults with asthma.

Examined psychological adjustment in a college sample of older adolescents and young adults (n = 49) with histories of childhood asthma. A substantial number of subjects evidenced clinically significant levels of overall distress. In addition, greater perceived asthma uncertainty and increased stable attributions for negative events were significantly associated with poorer psychological adjustment after controlling for demographic and disease variables. Further analyses revealed a moderating influence of uncertainty on attribution-adjustment relationships. These findings provide initial support for a cognitive diathesis-stress view of adjustment in long-standing asthma. Results also support a growing body of evidence suggesting that the focus of efforts to enhance adjustment to asthma need to be expanded beyond childhood and early adolescence.

Psychological distress in family members living with human immunodeficiency virus/acquired immune deficiency syndrome

This article describes the psychological distress experienced by family members living with human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS). Survey data were collected from 133 individuals, (47 parents, 53 siblings, 33 adult family members who have HIV/AIDS) representing 80 families. In-depth interview and observational data were collected from a subset of the sample. The physical and psychological health of individual family members was assessed by the 53-item Brief Symptom Inventory. Parents, siblings, and people living with AIDS (PWAs) reported higher levels of overall distress and scored higher on symptom dimensions and clinically discrete symptoms than normative comparison groups. Implications of these findings for research, clinical practice, and health and social service policy are identified and discussed.

Behind the playground walls: sexual abuse in preschools

Representing over 6 years of research with children reporting nonritualistic and ritualistic sexual abuse in preschool settings, BEHIND THE PLAYGROUND WALLS is a clear, comprehensive examination of the effects of reported molestation on young children and their families. Based on data gathered from the children, parents, and therapists in a comparison study, the book covers the effects on children's behavior, fears, PTSD symptoms, sexuality, achievement, school performance, and self-concept. Moreover, the ways in which the children and their families coped with reports of abuse and the factors associated with positive short- and long-term outcome are detailed. Part I of the book outlines the scope of the problem. Cases from two communities - alleged ritualistic abuse in several preschools in Manhattan Beach, California, and nonritualistic abuse in a preschool day care setting in Reno, Nevada - are described and compared with a control group of nonabused children from southern California. The background literature is reviewed, as are the methods, procedures, and limitations of the study. Chapters in Part II offer perspectives on what happened to the children and the patterns of disclosure in therapy. Part III concentrates on the aftermath of such cases, with separate chapters on the children's overall levels of distress and cognitive, emotional, interpersonal, sexual, and school-related effects. The impact of sexual abuse on the children's parents, families, and therapists is discussed in Part IV. Factors that were associated with positive outcome for the children, both in the short term and at follow-up 5 years after initial disclosure, are then covered in Part V. Rounding out thevolume, Part VI presents community and research perspectives on the findings by well-known child abuse experts, and concludes with the authors' recommendations for treatment. Offering important new insights on a timely and critical topic, BEHIND THE PLAYGROUND WALLS is valuable reading