Psychological Distress Symptoms Research Articles

Efficacy of Internet-based Cognitive Behavioral Therapy for Hong Kong University Students: A Randomized Controlled Trial

Purpose: This study examined the efficacy of a 10-week internet-based cognitive behavioral therapy (iCBT) program “REST Online” for Hong Kong university students with mild to moderate levels of psychological distress. Method: A total of 206 Hong Kong university students were randomized into: (1) web-based and (2) app-based iCBT, and (3) waitlist control (WLC) groups. Results: Compared with the WLC group, the participants in the two iCBT groups showed a significant reduction in psychological distress, depression and anxiety symptoms, and negative thoughts and emotions, and significant increase in positive thoughts and emotions, with medium to large effect sizes. The positive effects were sustained at the 3-month follow-up test. No significant intervention effects were found between the two iCBT groups except for anxiety symptoms. Discussion: The findings were discussed in terms of program design and service delivery, and suggestions for delivering digital mental health service in Hong Kong universities were proposed.

Key Psychosocial Health Outcomes and Association With Resilience Among Patients With Adult Congenital Heart Disease

BackgroundAdult congenital heart disease (ACHD) can negatively impact quality of life (QOL). Strengthening resilience may improve this and other psychosocial outcomes important for living a meaningful life. ObjectivesThe purpose of this study was to describe resilience and key psychosocial health outcomes in ACHD and evaluate the associations between resilience and these outcomes. MethodsWe conducted a prospective cohort study of outpatients with moderate or complex ACHD between May 2021 and June 2022. Participants completed surveys at baseline and 3 months, evaluating resilience (Connor-Davidson Resilience Scale-10), health-related QOL (EQ5D-3L, linear analog scale), health status (Euroqol visual analog scale), self-competence (Perceived Competence Scale), and psychological symptom burden (Hospital Anxiety and Depression Scale) and distress (Kessler-6). ResultsThe mean participant age (N = 138) was 41 ± 14 years, 51% were female, and 83% self-identified as non-Hispanic White. ACHD was moderate for 75%; 57% were physiologic class B. Mean (SD) baseline resilience score (Connor-Davidson Resilience Scale-10) was 29.20 ± 7.54. Participants had relatively good health-related QOL, health status, and self-competence, and low psychological symptom burden and distress. Higher baseline resilience was associated with better values of all outcomes at 3 months (eg, 1 point higher resilience was associated with 0.92 higher linear analog scale; 95% CI: 0.52-1.32) with or without adjustment for demographics. After further adjusting for the baseline psychosocial measure, only the association between resilience and QOL measures at 3 months remained statistically significant. ConclusionsResilience is positively associated with health-related QOL for outpatients with moderate or complex ACHD, though relationships are small in magnitude. Study findings can guide the application of resilience-building interventions to the ACHD population.

PHYSICAL ACTIVITY AND MENTAL HEALTH IN AUSTRALIAN ADULTS WITH PSYCHOLOGICAL DISTRESS

INTRODUCTION & AIMS Adults with mental health concerns face compounded barriers to physical activity engagement. We recently conducted a randomised controlled trial to determine whether a lifestyle intervention targeting PA and nutrition was non-inferior to psychotherapy in managing depression (the CALM non-inferiority trial). While we demonstrated non-inferiority, participants assigned to the lifestyle intervention demonstrated improvements in dietary adherence and intake but not self-reported activity measures. The aim of this sub-study was to analyse actigraphy-derived measures to identify whether objective changes occurred and determine whether these were associated with mental health. METHODS This study included a sub-set of 36 of the 70 participants assigned to the lifestyle therapy intervention from the larger trial (ACTRN12621000387820) who were recruited based on indicative depression (Distress Questionnaire Scale 8+). A Fitbit Charge-2 measured daily steps (n), distance travelled (km), floors climbed (n) and minutes in sedentary, light, moderate and vigorous activity. Questionnaires measured psychological distress (Kessler-10), anxiety (Generalised Anxiety Disorder scale-7) and depressive symptoms (Patient Health Questionnaire-9). Linear mixed models determined within-group change over time. Spearman rank correlation coefficients examined associations between change scores over 8-weeks. RESULTS From baseline to 8-week follow-up, floors climbed increased 38% (mean change [95%CI]: 2.8 [0.0, 5.5], P=0.047) and minutes sedentary increased 9% (66.9 [20.8, 133.0], P=0.004). We found no change in daily steps, distance travelled, or minutes spent lightly, moderately, or vigorously active. Reducing sedentary time was associated with reduced depressive symptoms (rs=0.350, P=0.043), similarly increasing time spent in vigorous activity was associated with reduced psychological distress (rs=0.346, P=0.045). CONCLUSION Changes in activity were mixed, however vigorous physical activity and reduced sedentary time were associated with improved mental health in adults with psychological distress participating in a lifestyle therapy intervention for depression. Future investigations should seek to quantify minimum changes required to benefit mental health in this vulnerable population.

Psychological Distress and Attitudes Toward Seeking Professional Psychological Help among Transwomen in Indonesia

Transwomen are one of the minority groups in Indonesia vulnerable to a high level of psychological distress. The level of psychological distress can indicate the need to seek psychological help. The most basic component of seeking help is attitude. Without a positive attitude, individuals are less likely to have the intention of seeking help and do seeking help. This study aimed to investigate the level of psychological distress, attitudes toward seeking professional psychological help, and the relationship between symptoms of psychological distress with attitudes toward seeking professional psychological help in 117 samples of transwomen in Indonesia. Results indicated that 72% of participants were classified as having a high level of psychological distress. A negative association between anxiety symptoms and psychological openness indicated that the more symptoms of anxiety that participants were experiencing, the less likely they were to open up about their psychological problems.

Exploring the experience of presenteeism among fathers returning to work following a perinatal death

ABSTRACT Perinatal death is a frequent event that affects one in five pregnancies in western countries. It disrupts parents’ different life spheres, including their work. Fathers, more specifically, usually return to work quickly after their loss. Given the significant psychological impacts of this traumatic experience, they are likely to engage in presenteeism, i.e. reporting to work while still mourning their loss and experiencing psychological distress. However, few studies have documented this phenomenon. To fill this gap, the present study seeks to understand the nature, underlying motivations and perceived repercussions of presenteeism in fathers returning to work following a perinatal death. Semi-structured interviews were conducted with 41 fathers who experienced an early or late perinatal death. Thematic analysis indicates that many fathers returned to work while still experiencing acute symptoms of psychological distress and thus engaged in presenteeism. For most fathers, presenteeism was involuntary and associated with working conditions beyond their control (e.g. workload, lack of paid leave). However, some participants returned to work out of intrinsic interest. Fathers perceived that their act of presenteeism affected them personally, as well as their organization, and their family (i.e. spouse, other children).

Problematic Online Behaviours among University Students and Associations with Psychological Distress Symptoms and Emotional Role Limitations: A Network Analysis Approach

AbstractVery little research has simultaneously explored the interactions between generalized problematic internet use (GPIU), problematic social media use (PSMU), problematic online gaming (POG), psychological distress, and emotional well-being among university students. Therefore, the present study aimed to determine (i) the associations between GPIU, PSMU, and POG symptoms, (ii) whether symptoms of these three problematic online behaviours form distinct entities, and (iii) whether there are associations between problematic online behaviours, psychological distress symptoms, and emotional role limitations using network analysis. A total of 807 Spanish university students participated (57.7% female; Mage = 21.22 years [SD = 3.68]). Two network models were computed. Network 1 showed a complex interaction of nodes, with particularly strong connections between analogous symptoms of GPIU and PSMU. Symptoms organised into distinct dimensions, featuring a unique dimension for POG symptoms, one that includes preoccupation and a conflict symptom of GPIU, and two other dimensions with symptoms of GPIU and PSMU. Network 2 showed significant connections between GPIU and depression, GPIU and emotional role limitations, PSMU and anxiety, PSMU and emotional role limitations, POG and depression, and POG and anxiety. The findings support the conceptualization of GPIU as a nonspecific disorder, the independence of PSMU and POG as distinct constructs, and aligning with perspectives that separate POG from the GPIU spectrum. The study reinforces the model of compensatory internet use and emphasizes the impact of problematic online behaviours on emotional well-being. The findings have practical implications for the assessment and intervention of problematic online behaviours.

Mobile apps to reduce depressive symptoms and alcohol use in youth: A systematic review and meta-analysis: A systematic review.

Among youth, symptoms of depression, anxiety, and alcohol use are associated with considerable illness and disability. Youth face many personal and health system barriers in accessing mental health care. Mobile applications (apps) offer youth potentially accessible, scalable, and anonymous therapy and other support. Recent systematic reviews on apps to reduce mental health symptoms among youth have reported uncertain effectiveness, but analyses based on the type of app-delivered therapy are limited. We conducted this systematic review with youth co-researchers to ensure that this review addressed the questions that were most important to them. The objective of this review is to synthesize the best available evidence on the effectiveness of mobile apps for the reduction of depressive symptoms (depression, generalized anxiety, psychological distress) and alcohol use among youth. We conducted electronic searches of the following bibliographic databases for studies published between January 1, 2008, and July 1, 2022: MEDLINE (via Ovid), Embase (via Ovid), PsycINFO (via Ovid), CINAHL (via EBSCOHost), and CENTRAL (via the Cochrane Library). The search used a combination of indexed terms, free text words, and MeSH headings. We manually screened the references of relevant systematic reviews and included randomized controlled trials (RCTs)for additional eligible studies, and contacted authors for full reports of identified trial registries or protocols. We included RCTsconducted among youth aged 15-24 years from any setting. We did not exclude populations on the basis of gender, socioeconomic status, geographic location or other personal characteristics. We included studies which assessed the effectiveness of app-delivered mental health support or therapy interventions that targeted the management of depressive disorders and/or alcohol use disorders. We excluded apps that targeted general wellness, apps which focused on prevention of psychological disorders and apps that targeted bipolar disorder, psychosis, post-traumatic stress disorder,attention-deficit hyperactivity disorder,substance use disorders (aside from alcohol), and sleep disorders. Eligible comparisons included usual care, no intervention, wait-list control, alternative or controlled mobile applications. We included studies which reported outcomes on depressive symptoms, anxiety symptoms, alcohol use and psychological distress over any follow-up period. We standardized the PICO definitions (population, intervention, comparison, and outcome) of each included study and grouped studies by the type of therapy or support offered by the app. Whenever app design and clinical homogeneity allowed, we meta-analyzed outcomes using a random-effects model. Outcome data measured using categorical scales were synthesized using odds ratios. Outcome data measured using continuous scales were synthesized as the standardized mean difference. We assessed the methodological quality of each included study using the Cochrane Risk of Bias 2.0 tool and we assessed certainty of the evidence using the GRADE approach. From 5280 unique citations, we included 36 RCTs published in 37 reports and conducted in 15 different countries (7984 participants). Among the 36 included trials, we assessed two with an overall low risk of bias, 8 trials with some concern regarding risk of bias, and 26 trials with a high risk of bias. Interventions varied in the type of therapy or supports offered. The most common intervention designs employed mindfulness training, cognitive behavioral therapy (CBT), or a combination of the two (mindfulness + CBT). However, other interventions also included self-monitoring, medication reminders, cognitive bias modification or positive stimulation, dialectical behavioral therapy, gamified health promotion, or social skill building. Mindfulness apps led to short term improvements in depressive symptoms when compared to a withheld control (SMD = -0.36; 95%CI [-0.63, -0.10]; p = 0.007, n = 3 RCTs, GRADE: very low certainty) and when compared to an active control (SMD = -0.27; 95%CI [-0.53, -0.01]; p = 0.04, n = 2 RCTs, GRADE: very low). Apps delivering this type of support also significantly improved symptoms of anxiety when compared to a withheld control (SMD = -0.35; 95% CI [-0.60, -0.09]; p = 0.008, n = 3 RCTs, GRADE: very low) but not when compared to an active control (SMD = -0.24; 95% CI [-0.50, 0.02]; p = 0.07, n = 2 RCTs, GRADE: very low). Mindfulness apps showed improvements in psychological stress that approached statistical significance among participants receiving the mindfulness mobile apps compared to those in the withheld control (SMD = -0.27; 95% CI [-0.56, 0.03]; p = .07, n = 4 RCTs, GRADE: very low). CBT apps also led to short-term improvements in depressive symptoms when compared to a withheld control (SMD = -0.40; 95%CI [-0.80, 0.01]; p = 0.05, n = 2 RCTs, GRADE: very low) and when compared to an active control (SMD = -0.59; 95%CI [-0.98, -0.19]; p = 0.003, n = 2 RCTs, GRADE: very low). CBT-based apps also improved symptoms of anxiety compared to a withheld control (SMD = -0.51; 95%CI [-0.94, -0.09]; p = 0.02, n = 3 RCTs, GRADE: very low) but not when compared to an active control (SMD = -0.26; 95% CI [-1.11, 0.59]; p = 0.55, n = 3 RCTs, GRADE: very low). Apps which combined mindfulness and CBT did not significantly improve symptoms of depression (SMD = -0.20; 95%CI [-0.42, 0.02]; p = 0.07, n = 2 RCTs, GRADE: very low) or anxiety (SMD = -0.21; 95% CI [-0.49, 0.07]; p = 0.14, n = 2 RCTs, GRADE: very low). However, these apps did improve psychological distress (SMD = -0.43; 95% CI [-0.74, -0.12]; p = 0.006, n = 2 RCTs, GRADE: very low). The results of trials on apps to reduce alcohol use were inconsistent. We did not identify any harms associated with the use of apps to manage mental health concerns. All effectiveness results had a very low certainty of evidence rating using the GRADE approach, meaning that apps which deliver therapy or other mental health support may reduce symptoms of depression, anxiety and psychological distress but the evidence is very uncertain. We reviewed evidence from 36 trials conducted among youth. According to our meta-analyses, the evidence is very uncertain about the effect of apps on depression, anxiety, psychological distress, and alcohol use. Very few effects were interpreted to be of clinical importance. Most of the RCTs were small studies focusing on efficacy for youth at risk for depressive symptoms. Larger trials are needed to evaluate effectiveness and allow for further analysis of subgroup differences. Longer trials are also needed to better estimate the clinical importance of these apps over the long term.

The COVID-19 pandemic, psychologists' professional quality of life and mental health.

Psychologists are at known risk of work-related stress, secondary trauma, and burnout. The COVID-19 pandemic increased stress and anxiety for communities worldwide and corresponded with an increased demand for mental health services. Our study investigated the impact of COVID-19 on psychologists' professional quality of life, psychological symptoms, and work-related stress in Aotearoa, New Zealand (NZ). Ninety-nine registered psychologists were recruited via NZ professional psychology organizations, representing 3% of the total workforce. Survey data collected included symptoms of compassion fatigue and satisfaction, psychological symptoms, COVID-19-related stress and resilience, and professional and personal circumstances during the third year of the pandemic, 2022. Seventy percent reported that their work stress had increased, and 60% reported that their caseload intensity had increased during the COVID-19 pandemic. Psychologists reported receiving little to no additional personal or professional support, while 55% reported increased personal responsibilities during the pandemic (for example, closed childcare and schools during lockdowns). High rates of compassion fatigue (burnout and secondary traumatic stress) and low resilience were reported. We observed that psychological distress was higher than the community averages before the pandemic and comparable with frontline healthcare professionals. Compassion fatigue was associated with COVID-related stress, psychological distress, years in practice, and more frequent supervision, but not with working with at-risk clients, levels of personal support, or having children at home. Despite these difficulties, high Compassion Satisfaction scores were also reported, with over 90% indicating they had no intention of leaving the profession in the foreseeable future. Psychologists' compassion fatigue appears to have worsened during the COVID-19 pandemic, as have their symptoms of psychological distress. Increased workplace and clinical demands, telehealth difficulties, stress relating to the pandemic, inadequate support, and increased personal responsibilities were reported by psychologists. Mental health workforces are not immune to the personal and professional impacts of crises and are at risk of burnout and secondary traumatic stress. We hope that increased awareness and understanding of psychologists' own difficulties during COVID-19 can be used to better tackle future crises and support mental health professionals.

Heterogeneity of health-related quality of life after mild traumatic brain injury with systemic injury: a cluster analytic approach

Purpose Health-related quality of life (HRQoL) is a key component of evaluating outcome after mild traumatic brain injury (mTBI). As outcome is heterogeneous following mTBI, it is relevant to examine individual differences in HRQoL. This study investigated whether multiple homogenous subgroups could be meaningfully identified, 10 weeks after hospitalised mTBI with systemic injury, on the basis of HRQoL profiles. Methods Ninety-one adults were assessed for HRQoL, pain, fatigue, sleep quality, psychological distress, cognition and post-concussion symptoms. Results Cluster analyses revealed three separate subgroups based on physical, mental, social and energy HRQoL. One group (42%) demonstrated normative levels of HRQoL on all subdomains. The remaining two groups demonstrated significantly reduced HRQoL on all subdomains. These groups had equivalently poor mental, social and energy HRQoL, but the smallest group (27%) had significantly poorer physical HRQoL. Multinomial logistic regression revealed that pain significantly and independently predicted group membership for the particularly poor physical HRQoL group. Fatigue was the only significant independent predictor of group membership for the remaining group with reduced HRQoL. Conclusion These findings suggest more than 50% of hospitalised individuals with mTBI and systemic injury, have reduced HRQoL, 10 weeks after mTBI. Pain and fatigue warrant clinical attention in these individuals. IMPLICATIONS FOR REHABILITATION Mild traumatic brain injury is a common event that has been shown to be associated with persistently reduced health-related quality of life in approximately 50% of individuals 6 to 12 months after injury. Health-related quality of life likely varies between individuals after injury Relative to the “normal” population, most individuals in this cohort of individuals with mTBI and systemic injury had reduced mental, social and energy quality of life 10 weeks after injury. Fatigue and pain are important factors in reduced health-related quality of life after mTBI with systemic injury. Further research is needed to determine whether these fatigue and pain issues are related to mTBI-factors, such as headache, and/or related to systemic injury factors, which are common in the mTBI population.

Pharmacological Treatment for Terminal Agitation, Delirium and Anxiety in Frail Older Patients.

Psychological distress symptoms in the last days of life often contribute to the overall symptom burden in frail older patients. Good symptom management practices are crucial to ensure high-quality end-of-life care in an aging population, though the best pharmacological approach to treat these psychological symptoms has yet to be established. To identify current evidence-based and practice-based knowledge of pharmacological interventions for the treatment of agitation, delirium, and anxiety during the last days of life in frail older patients. A systematic, mixed methods review was performed through MEDLINE via PubMed and EMBASE from inception until February 2022 and updated through March 2023. National and international guideline databases and grey literature were searched for additional studies and guidelines. Four quantitative studies, two non-randomized and two descriptive, were identified. No randomized controlled trials met inclusion criteria. No qualitative studies were withheld. The three consensus-based protocols that were found through citation searching and screening of grey literature did not meet the standards for inclusion. Haloperidol is recommended in consensus-based guidelines for delirium and is widely used, but high-quality evidence about its efficacy is missing. Better control of agitation or refractory delirium might be achieved with the addition of a benzodiazepine. There is no evidence available about the treatment of anxiety in the last days of life in frail older patients. This mixed methods review demonstrates the lack of good quality evidence that is needed to help clinicians with pharmacological treatment decisions when confronted with psychological symptoms in the last days of life in frail older patients. Population aging will only emphasize the need for further research in this specific population.

Effects of sleep disturbance, cancer-related fatigue, and psychological distress on breast cancer patients’ quality of life: a prospective longitudinal observational study

More attention has gone to researching the cancer-related fatigue (CRF)–sleep disturbance (SD)–psychological distress (PD) symptom cluster in breast cancer patients during the chemotherapy period, but the change trend and heterogeneous development track in the whole treatment stage remain unclear, and it is also unclear whether the appearance of and changes in one symptom cause changes in other symptoms and quality of life (QoL). This study, using breast cancer patients’ data collected through a validated questionnaire, examined the relationships between SD, CRF, PD, and QoL using latent growth modeling analyses. CRF developmental trajectories showed an upward trend over five surveys (slope = 0.649, P < 0.001); PD showed a significant weakening trend (slope = − 0.583, P < 0.001); SD showed an increasing trend (slope = 0.345, P < 0.001), and QoL showed a statistically significant weakening trend (slope = − 0.373, P < 0.001). The initial CRF (coefficient = − 0.233, P < 0.01), PD (coefficient = − 0.296, P < 0.01), and SD (coefficient = − 0.388, P < 0.001) levels had a statistically significant negative effect on initial QoL level. The linear development rate of PD was statistically significant and negatively affected that of QoL (coefficient = − 0.305, P < 0.05), whereas the quadratic development rate of SD negatively affected that of QoL (coefficient = − 0.391, P < 0.05). Medical staff should identify the change characteristics of different variables based on SD, CRF, PD, and QoL change trajectories, and advance the intervention time, as changes in variables affect other variables’ subsequent changes.

Parents’ Psychological Distress During COVID-19: Correlates and Relations with Parents’ Engagement in Early Education

ABSTRACT The COVID-19 pandemic has caused a wide range of psychological problems among parents and posed significant challenges to their mental health. However, there is a lack of research exploring the antecedents and consequences of parents’ psychological distress during the pandemic. This study investigated the familial and individual antecedents and childrearing outcomes of psychological distress (depression, anxiety, worry, and loneliness) among 504 parents of preschool children in Zhengzhou, China. Research Findings: The results showed that both familial (family socioeconomic status, changes in family income during the pandemic, family physical health, and household chaos) and individual (resilience) factors were related to parents’ symptoms of psychological distress. Loneliness was negatively related to parents’ involvement in children’s education, and feelings of worry were positively associated with increases in the parents’ time spent engaging with children indoors (e.g. helping children with homework and disciplining children). Practice or Policy: The findings underscore the significance of identifying the risk factors of parents’ psychological distress during the pandemic. They also have important implications for the design of parent- and family-based interventions to alleviate the adverse effects of the pandemic on parents’ psychological distress and childrearing practices.

Co-occurring psychological distress and alcohol or other drug use among Indigenous Australians: Data from the National Aboriginal and Torres Strait Islander Health Survey.

To determine the prevalence and demographic, social and health characteristics associated with co-occurring psychological distress symptoms, risky alcohol and/or substance use among a national sample of Aboriginal and Torres Strait Islander people aged 15 years or older. This study uses secondary cross-sectional data from the 2018-19 National Aboriginal and Torres Strait Islander Health Survey (NATSIHS). Data were collected via face-to-face interviews with those living in private dwellings across Australia. Participants were Aboriginal and Torres Strait Islander people (n = 10,579) aged 15 years or older. Data pertaining to psychological distress, alcohol and substance use were obtained and weighted to represent the total population of Aboriginal and Torres Strait Islander people in Australia. A total of 20.3% participants were found to have co-occurring psychological distress, risky alcohol use and/or substance use, and 4.0% reported co-occurrence of all three conditions. Female participants in a registered marriage and fully engaged in study or employment had lower rates of co-occurring conditions. Poorer self-rated health, one or more chronic conditions and increased experiences of unfair treatment and physical harm in the past 12 months were associated with increased rates of co-occurring conditions. A range of potential risk and protective factors were identified for co-occurring psychological distress, risky alcohol and/or substance use among Aboriginal and Torres Strait Islander people. This information is critical for planning effective holistic strategies to decrease the burden of suffering imposed upon the individual, family and community members impacted by co-occurring conditions.

161 Peer Caregiver Navigation for Hospice Caregivers of Cancer Patients: A Feasibility Study

OBJECTIVES/GOALS: To evaluate the feasibility, acceptability, and appropriateness of a 1:1 peer-delivered psychosocial support intervention to family caregivers of hospice patients with cancer, and determine a range of potential effects of the intervention on psychological distress symptoms and perceptions of the caregiving experience. METHODS/STUDY POPULATION: Quantitative and qualitative data were collected from hospice caregivers of cancer patients who participated in a non-controlled pilot feasibility trial of a 1:1, peer-delivered psychosocial intervention called Peer Caregiver Navigation (PCN). The purpose of this study was to evaluate the feasibility, acceptability, and appropriateness of delivering PCN to hospice family caregivers of cancer patients, and to determine a range of potential effects of PCN on caregivers’ anxiety symptoms, depressive symptoms, self-efficacy, and benefit finding. Qualitative data were analyzed using deductive thematic analysis. For our study outcomes, we used both parametric and nonparametric t-tests to examine mean differences between outcomes at baseline and midpoint, and baseline and endpoint. RESULTS/ANTICIPATED RESULTS: The findings demonstrate that Peer Caregiver Navigation (PCN) is acceptable, appropriate, and feasible to deliver to hospice family caregivers of cancer patients. Appropriateness of our selected target outcomes was determined by confirming expected measurement change in depressive symptoms (lower), anxiety symptoms (lower), benefit finding (higher), and self-efficacy (higher). Exit interviews revealed that participants responded favorably to our selected measures for these outcomes and to our data collection time intervals. Moreover, recruitment and consenting processes, survey completion rates, and attrition outcomes (i.e., study exit due to active withdrawal vs. patient death) were analyzed to inform recruitment and retention feasibility for future studies. DISCUSSION/SIGNIFICANCE: Peer Caregiver Navigation (PCN) was determined to be feasible, acceptable, and appropriate to hospice family caregivers of patients with cancer. Moreover, PCN has the potential to improve caregivers' symptoms of psychological distress by providing them much needed psychoeducation, coping skills training, and emotional support.

Childhood Maltreatment and Body Mass Index in Older Adults With Chronic Illness

BackgroundChildhood trauma has been associated with greater psychological and physical morbidity, including a greater risk of developing coronary artery disease (CAD). Emotional dysregulation and increased body mass index (BMI) may be involved. This study evaluated whether (1) childhood maltreatment is associated with a higher BMI at study onset and with greater increases in BMI 5 years later among older adults with CAD or other chronic illnesses; (2) sex and/or CAD status moderate these results; and (3) baseline symptoms of anxiety, depression, and perceived stress (emotional dysregulation) mediate the association between childhood maltreatment and BMI at follow-up. MethodsA total of 1232 men and women (aged 60.86 [6.95] years) completed validated questionnaires on childhood maltreatment and symptoms of psychological distress. The weight and height of the participant were measured, and the BMI was calculated using the weight (kg)/height (m2) ratio. ResultsChildhood maltreatment was not significantly associated with BMI at study onset nor at follow-up. This relation did not differ as a function of sex nor CAD status. Although childhood maltreatment was associated with significantly greater psychological distress at study onset (all P < 0.001), the latter was not found to mediate this relation at follow-up. ConclusionsIn contrast to previous literature, childhood maltreatment was not associated with BMI nor with the change in BMI over 5 years in men and women with chronic disease. However, as psychological distress increases risk for morbidity and mortality, it may represent an important target for prevention and intervention in survivors of childhood maltreatment.

A Review of Medication Errors and the Second Victim in Pediatric Pharmacy

The concept of the second victim, described as the sense of victimization of health care professionals following the exposure to a traumatic, unanticipated medical error, was first introduced in 2000 by Albert W. Wu. Since then, the concept has gained immense traction and inspired the generation of assistance programs for second victims. With most second victim occurrences resulting from medication errors, pediatric pharmacists are at a high risk of experiencing second victim phenomenon. Second victims may experience both psychological and physical symptoms of distress often akin to post-traumatic stress disorder. Typical trajectories for second victims, as well as typical support needs, have been previously described, with several organizations responding by creating formal programs designed to support their staff in the events of traumatic workplace experiences. Most support programs involve peer-to-peer support, group sessions, and programs designed to increase coping skills. Additional resources are available for health care workers who do not have formalized support programs at their institution, although these are limited. Despite these resources, institutions across the country have room for additional growth in their support of employees who become second victims to tragedy.

176 Repetitive Traumatic Brain Injuries Are Associated With Poorer Outcomes at 1-Year and 3-7 Years After Index Injury

INTRODUCTION: Traumatic brain injury (TBI) patients are at risk for subsequent TBIs. Research on the longitudinal impact of repetitive TBI is limited. METHODS: The 18-center TRACK-TBI study enrolled subjects who presented to hospital and received head computed tomography (CT) within 24-hours of TBI between 2014-2018. Subjects were interviewed regarding post-index TBI during follow-up. Data from subjects aged = 17-years with 1-year or 3-7-year outcomes were extracted. Outcome measures included functional (GOSE:Glasgow Outcome Scale-Extended), post-concussive symptoms (PCS) (RPQ:Rivermead Post-Concussion Symptoms Questionnaire), psychological distress (BSI-18:Brief Symptom Inventory-18), depression (PHQ-9:Patient Health Questionnaire-9), post-traumatic stress disorder (PCL-5:PTSD-Checklist for DSM-5), and quality of life (QOL) (QOLIBRI-OS:Quality of Life After Brain Injury-Overall Scale). Multivariable regressions were adjusted for demographic, socioeconomic, and injury severity factors, and for multiple comparisons. Mean-differences (B), relative risks (RR), and 95% confidence intervals [CI] were reported. RESULTS: In 1,572 subjects, 3.2% and 12.2% sustained post-index TBI at 1-year and 3-7-years, respectively; 2.4% sustained multiple post-index TBIs at 3-7-years. Risk factors included psychiatric history, prior TBI, and extracranial injury severity. At 1-year, post-index TBI was independently associated with incomplete recovery (GOSE&lt;8; RR = 1.75 [1.04-2.94]), decreased QOL (QOLIBRI-OS: B = -15.9 [-22.6, -9.1]), and increased severity of PCS, psychological distress, PTSD, and depression (RPQ: B = 8.1 [4.2-11.9], BSI-18: B = 5.3 [2.1-8.6]; PCL-5: B = 7.8 [3.2-12.4]; PHQ-9: B = 3.0 [1.5-4.4]); effects were conserved at reduced magnitudes at 3-7-years. Multiple (=2 vs. 1) post-index TBIs were associated with greater symptom severities across all outcome measures. CONCLUSIONS: Post-index TBI is associated with incomplete functional recovery, increased PCS, psychological distress, PTSD, and depressive symptom severities, and decreased QOL at 1- and 3-7-years post-injury. Sustaining multiple post-index TBIs further increases symptom severity across all outcome domains. Institutional processes and resources for TBI prevention, education, counseling, and follow-up are greatly needed.

Prevalence and Correlates of Night Eating Syndrome, Insomnia, and Psychological distress in Primary Care Patients with Obesity: A Cross-Sectional Study.

Management of obesity is challenging for both patients and healthcare workers. Considering the low success rate of current interventions, this study aimed to explore the prevalence and associated factors of night eating syndrome (NES), insomnia, and psychological distress among individuals with obesity in order to plan comprehensive obesity management interventions. A cross-sectional study on a convenient sample from five primary healthcare centers in Port Said, Egypt, was conducted from November 2020 to March 2021. Socio-demographic and clinical characteristics were collected in addition to the assessment of NES, insomnia, and psychological distress using the Arabic versions of the Night Eating Diagnostic Questionnaire (NEQ), the Insomnia Severity Index (ISI), and the Patient Health Questionnaire -4 (PHQ-4) scales, respectively. Associations of NES, insomnia and psychological distress were assessed by multiple regression analysis. We performed Bonferroni adjustments for multiple comparisons. We included 425 participants with obesity with a mean age of 45.52 ± 6.96 years. 54.4% were females and the mean body mass index (BMI) was 35.20 ± 4.41 kg/m2. The prevalence rates of NES, insomnia, and psychological distress were 21.6% (95% CI: 17.7 - 25.6%), 15.3% (95% CI: 11.9 - 18.7%), and 18.8% (95% CI: 15.1 - 22.6%), respectively. NES was significantly associated with younger age (OR 0.974, p=0.016), physical inactivity (OR 0.485, p=0.010), insomnia (OR 2.227, p=0.014), and psychological distress (OR 2.503, p=0.002). Insomnia showed strong associations with NES (OR 2.255, p=0.015), and psychological distress (OR 5.990, p<0.001). Associated factors of psychological distress symptoms included insomnia (OR 6.098, p<0.001) and NES (OR 2.463, p=0.003). The prevalence rates of NES, insomnia, and psychological distress were high among primary care patients with obesity, and these conditions were interrelated. Optimal obesity management necessitates individualized and targeted multidisciplinary care plans that take into consideration individual patients' mental, behavioral, and dietary habits needs.

Antagonistic personality and symptoms of psychological distress: Feeling less bad about being impaired

People will inevitably encounter life problems, and symptoms of mental distress that arise from these problems, such as low self-esteem, unhappiness, or anxiety, may motivate people to change or seek professional help. While antagonistic personality features are often associated with increased impairment, positive mental distress relations are weak or inconsistent. It is possible that people with antagonistic personality features may be aware of their impairments yet suffer less mental distress from them. Here, we tested this “antagonistic-buffering hypothesis.” Participants (N = 446) completed measures assessing sadism, psychopathy, impairments in various life domains, and signifiers of mental distress. Results supported the antagonistic-buffering hypothesis: Sadism and psychopathy were associated with greater self-reported impairments, and the positive association between impairments and mental distress was smaller as a function of sadism and psychopathy. These effects could not be attributed to sex and held across tested domains of life impairment.

Non-adaptive cognitive emotion regulation mediates the relationship between disease uncertainty and acute stress disorder in patients with ischaemic stroke.

During epidemic outbreaks, hospitalized patients, especially those with cerebrovascular disease, were identified as a vulnerable group suffering from acute stress disorder (ASD) and consequent psychological distress. For stroke patients, not only will they suffer from physical illness, but the uncertainty of illness caused by sudden illness may also cause patients to experience different degrees of ASD. Relevant studies have shown that the impact of ASD on individuals may vary according to age, gender, disease characteristics, individual personality, treatment methods, income level, family support, cognitive psychology and other factors. However, non-adaptive cognitive emotion regulation plays a crucial role in influencing individual psychological states. At present, the risk factors of ASD after stroke and the mechanism between illness uncertainty and cognitive emotion regulation are not fully understood. Therefore, we focus on exploring the predictive effects of general demographic and disease-related characteristics, maladaptive cognitive emotion regulation, and illness uncertainty on ASD after stroke, and make hypotheses. When a disease acts on the body, the patient will have the corresponding cognition of the disease, and ASD will appear at the same time. Then the maladaptive cognitive emotion regulation as an important mediating variable can aggravate the level of acute stress disorder and be verified. We used a cross-sectional design, which can be used to investigate the distribution of a disease or health condition and its related factors in a specific population at a specific time, so as to describe the distribution of the disease or health condition and its relationship with related factors. A total of 256 hospitalized patients with ischemic stroke were enrolled, including 145 males and 111 females, aged from 26 to 90 years, with a mean age of (64.71 ± 12.20) years. All patients completed and returned a self-report questionnaire that included demographic information, illness uncertainty, cognitive emotion regulation, and ASD. We then compared the differences in general demographic data, illness uncertainty, and maladaptive cognitive emotion regulation in acute stress disorders. The majority of hospitalized stroke patients (67.6%) developed ASD due to the COVID-19 pandemic and were therefore at risk for PTSD. More than one third (39.1%) of stroke survivors also suffered from severe psychological distress. More specifically, younger stroke patients are more likely to experience ASD than older patients. Although higher illness uncertainty scores indicate more severe ASD, adaptive cognitive emotion regulation was a protective factor. Given that individuals with ASD are susceptible to PTSD, it is critical to follow up hospitalized patients with ischemic stroke for screening for PTSD and referral to appropriate psychological services. Maladaptive cognitive emotion regulation can increase the impact of uncertainty on the traumatic experience of stroke patients. Therefore, health care institutions should increase their efforts to provide psychosocial support services to hospitalized patients and make continuous efforts to screen for symptoms of trauma and psychological distress in hospitalized stroke patients.