Psychological Distress Symptoms Research Articles

Organizational Change Strategies to Support High-Quality Behavioral Health Care for LGBTQ Individuals.

There is growing recognition of the need to provide high quality behavioral health care for Lesbian, Gay, Bisexual, Transgender, and Queer/Questioning (LGBTQ) individuals. Research suggests that the LGBTQ community experiences high levels of psychological distress, psychological trauma, and other mental health symptoms as a result of minority stress. Despite these findings, the LGBTQ community continues to face barriers when seeking affirming behavioral health treatment. Using an established framework, this commentary highlights one behavioral health managed care organization's (BHMCO) work towards organizational change in the hopes of creating an affirming and inclusive environment for individuals influenced by the BHMCO (e.g., staff, members, behavioral health providers). In this commentary, we: (1) discuss the importance and role of insurers in promoting strategies to increase and deliver high quality care for LBGTQ individuals, (2) outline the steps our organization took to implement changes, (3) highlight the lessons learned throughout this process, and (4) provide recommendations for future efforts.

Temporal dynamics in mental health symptoms and loneliness during the COVID-19 pandemic in a longitudinal probability sample: a network analysis

Figuring out which symptoms are central for symptom escalation during the COVID-19 pandemic is important for targeting prevention and intervention. Previous studies have contributed to the understanding of the course of psychological distress during the pandemic, but less is known about key symptoms of psychological distress over time. Going beyond a pathogenetic pathway perspective, we applied the network approach to psychopathology to examine how psychological distress unfolds in a period of maximum stress (pre-pandemic to pandemic onset) and a period of repeated stress (pandemic peak to pandemic peak). We conducted secondary data analyses with the Understanding Society data (N = 17,761), a longitudinal probability study in the UK with data before (2019), at the onset of (April 2020), and during the COVID-19 pandemic (November 2020 & January 2021). Using the General Health Questionnaire and one loneliness item, we computed three temporal cross-lagged panel network models to analyze psychological distress over time. Specifically, we computed (1) a pre-COVID to first incidence peak network, (2) a first incidence peak to second incidence peak network, and (3) a second incidence peak to third incidence peak network. All networks were highly consistent over time. Loneliness and thinking of self as worthless displayed a high influence on other symptoms. Feeling depressed and not overcoming difficulties had many incoming connections, thus constituting an end-product of symptom cascades. Our findings highlight the importance of loneliness and self-worth for psychological distress during COVID-19, which may have important implications in therapy and prevention. Prevention and intervention measures are discussed, as single session interventions are available that specifically target loneliness and worthlessness to alleviate mental health problems.

Effects of interdisciplinary pain rehabilitation programs on neuropathic and non-neuropathic chronic pain conditions – a registry-based cohort study from Swedish Quality Registry for Pain Rehabilitation (SQRP)

Background and aimNeuropathic pain arises as a direct consequence of a lesion or disease affecting the somatosensory system. Pharmacological treatments for neuropathic pain often fail despite following guidelines. Interdisciplinary Pain Rehabilitation Programs (IPRP) are an effective intervention for chronic pain conditions. Little research has investigated whether IPRP can benefit patients with chronic neuropathic pain compared to other chronic pain conditions.This study assesses the real-world effects of IPRP on patients with chronic neuropathic pain compared to non-neuropathic patients using Patient-Reported Outcome Measures (PROMs) available in the Swedish Quality Registry for Pain Rehabilitation (SQRP).MethodsA neuropathic group of patients (n = 1,654) were identified in two steps. This group was compared to a non-neuropathic group (n = 14,355) composed of common diagnoses (low back pain, fibromyalgia, whiplash associated disorders, and Ehlers-Danlos Syndrome) in relation to background variables, three overall outcome variables, and mandatory outcome variables (pain intensity, psychological distress symptoms, activity/participation aspects and health-related quality of life variables). Of these patients 43–44% participated in IPRP.ResultsAt assessment, the neuropathic group reported significantly (with small effect sizes (ES)) more physician visits the previous year, older age, shorter pain durations, and less spatial extent of the pain (moderate ES). Moreover, for the 22 mandatory outcome variables, we found only clinically insignificant differences according to ESs between the groups. For patients participating in IPRP, the neuropathic group displayed equal or in some cases slightly superior results compared to the non-neuropathic group.Discussion and conclusionAfter assessing the real-world effects of IPRP, this large study found that neuropathic pain patients can benefit from the IPRP intervention. Both registry studies and RCTs are needed to better understand which patients with neuropathic pain are most suitable for IPRP and to what extent special considerations need to be made for these patients within the framework of IPRP.

Evidence-based trends and association between symptom disturbance and physical activity among pregnant women: A longitudinal study.

Women usually decrease their physical activity (PA) after becoming pregnant. The change in PA may influence their symptom distress (SD). The changes and correlations between SD and PA throughout pregnancy remain unclear. The aims of this study were to describe PA and SD trajectories across all three trimesters and examine their correlations during pregnancy. A repeated-measure longitudinal study with convenience sampling at a hospital in Northern Taiwan was performed. Participants were recruited at 8-16 weeks of gestation, and two follow-up visits were performed at 24-28 weeks of gestation (second trimester) and after 36 weeks of gestation (third trimester). A total of 225 participants completed the study. The participants completed the Pregnancy Physical Activity Questionnaire (PPAQ) and Pregnancy-related Symptom Disturbance Scale (PSD), and sociodemographic and prenatal variables were recorded. Throughout pregnancy, SD decreased then increased, showing an overall upward trend, whereas PA showed the opposite pattern, increasing then decreasing, with an overall downward trend. Sedentary activity was positively correlated with both physical and psychological SD during the second and third trimesters. Exceeding the Institute of Medicine's recommendations for gestational weight gain, having childcare support, sport/exercise-type, and light-intensity PA were negatively associated with the physical and psychological SD, while a history of miscarriage and sedentary-intensity PA were positively associated with the physical and psychological SD. While several factors, including light-intensity PA, were found negatively associated with the physical and psychological SD, sedentary-intensity PA were positively associated with the physical and psychological SD, our findings shed light on future intervention strategies to relieve SD and decrease sedentary behavior among pregnant women.

Prevalence and predictors of psychological distress and common mental health concerns among Filipino university teachers amid the COVID‐19 pandemic

AbstractThe current pandemic has drastically changed the academic landscape, causing distressing experiences among students and teachers. While there are increasing studies demonstrating the psychological experiences of students during the pandemic, only a few have examined the mental health conditions of university teachers. The present study sought to address this gap by investigating the prevalence of psychological distress and common mental health disorders and their pandemic‐related risk factors among Filipino university teachers. A total of 1110 university teachers self‐reported their psychological distress, generalized anxiety, and major depression symptoms through an online assessment. Findings of the study revealed the overall prevalence of psychological distress at 55.6%, and anxiety and depression were 17.0% and 28.4%, respectively. Younger teachers (i.e., aged ≤31 years old) and those who have less than a year of teaching experience are more likely to reach the cut‐off scores for all outcomes. Further, teachers who have experienced pandemic‐related adversities are highly vulnerable to psychological distress, generalized anxiety, and depression. These results offer important implications for creating psychosocial interventions that will help teachers manage their distresses amid the pandemic situation.

Correlation Between the Prevalence of Temporomandibular Disorders and Their Association With Psychological Distress in Central Saudi Arabia.

Background In this study, we aimed to determine the prevalence of temporomandibular disorders (TMDs) and their association with psychological distress in the central region of Saudi Arabia. Methodology In this cross-sectional study, a questionnaire was sent randomly to residents of Al-Qassim province. They were asked to complete a TMD pain screener, the Patient Health Questionnaire-4 (PHQ-4), and the Generalized Anxiety Disorder Scale (GAD-7). Correlations between symptoms of pain-related TMDs and PHQ-4 and GAD-7 scores were analyzed using Spearman's correlation test. Frequencies and percentages were calculated for sex, age, TMD, PHQ-4, GAD-7, and TMD pain-screener responses. A chi-square test was performed to determine the association between demographic data and psychological profiles. Results The majority of the respondents (59.4%) reported at least one symptom of pain-related TMDs. The TMD pain score was positively correlated with PHQ-4 and GAD-7 scores. Conclusions Residents of the Al-Qassim region who experienced elevated levels of psychological distress had significantly more pain-related TMD symptoms. These findings imply a link between psychological distress and TMD symptoms.

Resilience and psychological distress among burn survivors.

Burn is one of the highly occurring injuries worldwide. In case of an acid attack, survivors are considered an embarrassing element for the family. In other words, survivors' dignity is judged by the scars on their faces and bodies. Burn survivors experience physical pain of wounds, along with unseen psychological agony. Here, resilience is the most captivating phenomenon that can lead the survivor to normalcy in life after experiencing such traumas. The current study is aimed to explore the role of resilience in the psychological distress of burn survivors. 160 burn survivors were selected with an age bracket of 18-78 years from indoor hospital settings. To explore resilience, Urdu translated version of the Connor-Davidson Resilience Scale (CD-RISC) by Naz (2011) was used and for symptoms of psychological distress, Urdu version of Depression Anxiety Stress Scale- 21 (DASS-21) by Aslam and Kamal (2017). was also used. The data were analyzed via SPSS 23. Findings revealed that there is a significant negative relationship between resilience and psychological distress among burn survivors. Moreover, resilience predicted psychological distress. A significant difference was found between types of burn on depression and anxiety. Furthermore, the relationship between resilience to stress and depression is moderated by age of the burn survivor at the time of the incidence. A significant negative relationship between age with psychological distress among burn survivors was observed. The treatment period was associated positively with resilience and negatively with stress among burn survivors. Results also revealed no significant gender difference. However, a significant difference was found between types of burn on depression and anxiety. The findings of current study would be helpful for the medical professionals, mental healthcare providers, and policymakers who can help to develop and implement rehabilitation programs and mental health demands for the said population and can initiate and plan resilience promoting programs that would help promote adaptive coping to deal with trauma.

Immigration Transition and Symptom Distress Changes by a Technology-Based Intervention: Asian American Breast Cancer Survivors.

Technology-based programs using computers and mobile devices are known to be effective in providing information and support to marginalized populations including immigrants. Yet, little is still known on the factors that may influence the effectiveness of technology-based programs in improving symptom experience, including immigration transition, especially among Asian American breast cancer survivors. This study aimed to identify the characteristics related to immigration transition that significantly affected the symptom distress changes by a technology-based information and coaching/support program among Asian American breast cancer survivors. This secondary analysis was conducted with the data from 102 Asian American breast cancer survivors from a randomized clinical trial in progress. Multiple instruments were used: the questions on background characteristics and immigration transition and the Memorial Symptom Assessment Scale-Short Form. The data were analyzed using repeated-measurement analyses and decision tree analyses. The mean changes in the symptoms distress scores were as follows: -0.12 (SD, 0.47) in the Global Distress Index scores; -0.08 (SD, 0.43) in the physical symptom distress scores; and -0.15 (SD, 0.65) in the psychological symptom distress scores. The characteristics with the highest impact on the symptom distress score changes included the immigration age for Global Distress Index and physical symptom distress score and the level of acculturation for psychological symptom distress score.

The Adaptive, Pain Sensitive, and Global Symptoms Clusters: Evidence from a Patient-Based Study.

The largest epidemiologic study conducted about painful temporomandibular disorders (pTMDs) to date identified 3 clusters of individuals with similar symptoms-adaptive, pain sensitive, and global symptoms-which hold promise as a means of personalizing pain care. Our goal was to compare the clinical and psychological characteristics that are consistent with a pTMD clinical examination among patients who are seeking care and assigned to the different clusters. This cross-sectional study used data from the medical records of patients attending Duke Innovative Pain Therapies between August 2017 and April 2021 who received a pTMD diagnosis (i.e., myalgia) and consented to have their data used for research. Data included orofacial and pain-related measures, dental features, and psychological measures. We used the Rapid OPPERA Algorithm to assign clusters to patients and multinomial regression to determine the likelihood (odds ratios [OR] and 95% confidence intervals [CI]) of being assigned to the pain sensitive or global symptoms cluster attributed to each measure. In total, 131 patients were included in this study and assigned a cluster: adaptive (n = 54, 41.2%), pain sensitive (n = 49, 37.4%), and global symptoms (n = 28, 21.4%). The PS cluster displayed greater numbers of temporomandibular joint sites (OR, 1.29; 95% CI, 1.01 to 1.65) and masticatory (1.48; 1.19 to 1.83) and cervical (1.23; 1.09 to 1.39) muscles with pain evoked by palpation. The GS cluster displayed greater scores of pain catastrophizing (1.04; 1.01 to 1.06) and perceived stress (1.23; 1.03 to 1.46) and was more likely to report persistent pain (16.23; 1.92 to 137.1) of higher impact (1.43; 1.14 to 1.80). Our findings support that care-seeking patients with pTMDs who are assigned to the GS cluster display a poorer psychological profile, even though those assigned to the PS cluster display more measures consistent with orofacial pain. Findings also establish the PS cluster as a group that does not display psychological comorbidities despite being hypersensitive. This study informs clinicians that patients seeking care for painful temporomandibular disorders, in specific cases of myalgia, can be classified into 1 of 3 groups that display unique profiles of symptoms. Most importantly, it emphasizes the importance of examining patients with painful temporomandibular disorders in a holistic manner that includes assessing symptoms of psychological distress. Patients with greater psychological distress will likely benefit from multidisciplinary treatment strategies that may include psychological treatments.

An Assessment of Psychological Distress Symptoms and Accessing Mental Health Treatment Among Aging Incarcerated Persons

ABSTRACT There has been a “graying” of the prison population during the last several decades. Little research has been done on the psychological distress symptoms and treatment access of the growing older incarcerated population. This study considers how age affects rates of psychological distress symptoms and mental health treatment for incarcerated persons. Data included state respondents from the Survey of Prison Inmates, 2016. Ordinal logistic regression was used to assess the relationship between psychological distress symptoms and aging in prison. Binary logistic regression was used to examine the relationship between accessing mental health treatment and aging in prison. Older incarcerated individuals were more likely than younger incarcerated individuals to report feeling symptoms of psychological distress if they were not currently accessing treatment. Older individuals who had accessed treatment in prison were more likely to be currently accessing treatment than younger incarcerated individuals, and the longer one was incarcerated the less likely one was to access treatment. How do we ensure that those who need treatment are getting it? Especially those who have been incarcerated for a long time. Overall, this study shows that older incarcerated persons need continued access to treatment tailored to their unique needs as a group.

The Anthropologist as Audience: Engaged Listening among Khmer Rouge Survivors and Ukrainian War Refugees

Although the Khmer Rouge regime was responsible for the deaths of roughly 2.2 million Cambodians—and the persecution and abuse of millions more—only a handful of survivors have been able to testify at the tribunal established to prosecute former leaders of the regime. Partly to address this gap, an NGO affiliated with the tribunal has been offering ‘Testimonial Therapy’ for the past decade as a form of reparation for survivors with symptoms of psychological distress. For 16 months, I followed survivors undergoing this therapy, during which they developed a testimonial narrative of their life story in collaboration with a local mental health worker. In this Position Piece, I consider Myers’ conception of ‘moral agency’ (2015) in relation to this process of personal narrative creation, and the critical importance of audience engagement. I then reflect on my own positionality as both ethnographer and active listener, tracing how this affective posture has been formed not only through fieldwork, but also through engagement with family narratives of loss in the context of war-torn Ukraine.

Strengths and Resilience Among Central American Parents Seeking Asylum in the United States

This study examined the experiences of immigrant parents seeking asylum in the United States after recently fleeing the Northern Triangle region of Central America, attending both to the traumatic events and the strengths that mitigate this experience. The study employs a convergent parallel mixed-methods design to describe the experiences of 51 parents after being processed by U.S. immigration officials for seeking asylum. Quantitative analyses measured trauma exposure and psychological distress and posttraumatic stress symptoms, as well as religiosity, dispositional optimism, and perceived quality of life. Qualitative analyses examined migratory experiences more deeply. Quantitative findings suggest that participants displayed high levels of resilience as evidenced by the low endorsement of mental health symptoms associated with trauma despite high violence and trauma exposure. Qualitative analyses revealed two themes underscoring strengths that mitigated the compounded trauma experienced by participants, including: (a) protective factors, and (b) plans for the future. In addition, several subthemes emerged within each of these broader themes. Qualitative findings highlight that asylum seekers come to the United States for the sake of their families, especially their children. Participants shared their desire to ensure the safety of their family and children and their hope of being better able to take care of them. These desires and hopes common among participants in our study not only motivated them to leave their home countries but also helped them to press forward in their journeys. Study results show that religiosity, hope, and optimism also played important roles in sustaining these immigrant parents during their journeys.

Anticipatory stress, state policy contexts, and mental health during the COVID-19 pandemic

Substantial economic disruptions during the COVID-19 pandemic upended daily life and contributed to a widespread symptom of psychological distress during this period. Disruptions also led to more concerns about future stressful events related to financial hardship, or economic-related anticipatory stress, with the potential to undermine mental health. Although prior research provides ample evidence that state policies can impact mental and physical health, it has not considered how state policy contexts reduce adverse psychological outcomes stemming from economic-related anticipatory stress. The present study uses national survey data from the Census Bureau's Household Pulse Survey (April 2020–October 2020) to examine the extent to which state policy contexts moderate the association between economic-related anticipatory stress and depression/anxiety. We find that states with stronger social safety nets weakened the impact of anticipatory stress on depression/anxiety. This finding held for different types of anticipated economic hardships (i.e., reduced income, difficulty paying rent, difficulty affording food), as well as for policies that existed prior to COVID-19 and policies enacted in response to COVID-19. Findings provide strong evidence that state policies may buffer against poor mental outcomes for people who even anticipate facing economic uncertainty during the COVID-19 pandemic. We provide insight into how state policy contexts can shape individual experiences in ways that impact the mental health outcomes of the United States population.

The relationship between psychological distress, depressive symptoms, emotional eating behaviors and the health-related quality of life of middle-aged korean females: a serial mediation model

BackgroundThis study aimed to examine the effects of psychological distress, depressive symptoms, and emotional eating behaviors on the health-related quality of life of middle-aged Korean females. This study provides primary data for developing an intervention program to improve the health-related quality of life of middle-aged females.MethodsMiddle-aged females between 35 and 64 years old, from July 22 to August 10, 2021, were included in this study. The mediating effects of depressive symptoms and emotional eating behaviors on the relationship between psychological distress and health-related quality of life were investigated. A cross-sectional survey was conducted on 325 subjects. Researchers conducted questionnaires measuring psychological distress, depressive symptoms, emotional eating behavior, and health-related quality of life.ResultsThe findings of this study demonstrated a correlation between the severity of a female’s depressive symptoms and the degree of their psychological distress, indicating that severe depressive symptoms were associated with negative emotions, which increased emotional eating behaviors. Additionally, more severe depressive symptoms indicated a lower health-related quality of life. Higher psychological distress was associated with increased emotional eating behaviors and lower health-related quality of life. The total and direct effects of psychological distress on the health-related quality of life were statistically significant.ConclusionsIn this study, psychological distress, depressive symptoms, and emotional eating behaviors affected the health-related quality of life of middle-aged Korean females. This study also confirmed that psychological distress had a direct effect on health-related quality of life. These findings serve as primary data for evidence-based intervention programs that alleviate emotional health problems, such as psychological distress and depressive symptoms in middle-aged females. Moreover, nurses can help develop effective treatment strategies to improve health-related quality of life by identifying and assessing potential symptoms of psychological distress, depressive symptoms, and emotional eating behaviors.

Group trauma focused cognitive behavior therapy for parents of premature infants compared to individual therapy intervention

BackgroundThe current study compares results of a group-based intervention developed to reduce symptoms of posttraumatic stress, depression, and anxiety in parents of premature infants with a prior study using an individual version of the treatment manual. Methods26 mothers of preterm infants (25–34 weeks' gestational age; >600 g) received 6 sessions of trauma-focused cognitive behavior therapy (CBT). Outcomes were compared with those of a previously published RCT, which tested an individual therapy based on the same model in a group of 62 mothers. Results were also compared across in-person and telehealth treatment. ResultsFrom baseline to follow up, the individual intervention showed greater improvement in trauma symptoms assessed with the Davidson Trauma Scale (d = 0.48, p = 0.016), although both conditions showed clinically significant improvement. Similar patterns were found for maternal depression and anxiety. In-person treatment was found to be superior to telehealth treatment administered during the COVID-19 pandemic, although the difference was not significant. ConclusionsGroup-based trauma focused CBT is an effective treatment modality for parents of premature infants with symptoms of psychological distress but not as effective as individual therapy using the same treatment model.

STEP-COVID: a pilot study of a prenatal intervention for pregnant women during the COVID-19 pandemic

The COVID-19 pandemic has been associated with a global increase in psychological distress in pregnant women. This study evaluated the effects of STEP-COVID, a six-session mentalization-based prenatal group program offered online during the COVID-19 pandemic. The 100 participants were allocated to STEP-COVID or to the natural trajectory of prenatal care. Pre- and post-intervention assessments included measures of psychological distress, post-traumatic symptoms and positive affectivity. Perception of change during pregnancy on resilience-promoting factors was also assessed at post-intervention. A significant decrease in psychological distress and post-traumatic symptoms and an increase in positive affectivity were observed in participants in the intervention condition, whereas only post-traumatic symptoms improved in the control condition. Women who participated in STEP-COVID also reported greater changes during pregnancy on resilience-promoting factors than women in the control condition. Results hold promise for buffering the effect of the pandemic on the mental health of pregnant women using brief online interventions. Clinical trial registration: NCT05419167 (15/06/2022)

Psychological Distress During COVID-19 Confinement in Persons After Metabolic Surgery

Background: People suffering from obesity often experience distress and psychopathological symptoms that decrease after undergoing metabolic surgery; the confinement caused by the COVID-19 pandemic impacted the whole population in this regard. Given that individuals undergoing metabolic surgery are at increased risk of developing these disorders, it is important to identify them in order to prevent or treat them appropriately. Therefore, this study aims to determine the relationship between COVID-19-related psychological distress and psychopathological symptoms in people who underwent metabolic surgery. Methods: A cross-sectional study was conducted including 102 participants more than six months after undergoing metabolic surgery. Sociodemographic information was collected, as well as psychological distress related to COVID-19 and psychopathological symptoms measured using the SCL-90R. A Structural Equation Model was developed to evaluate the effects and correlation between variables. Results: 90.2% of the participants were women, 84% had undergone gastric sleeve surgery while the rest had undergone Roux-en-Y gastric bypass surgery. The model obtained showed a significant correlation between the subscales of the SCL 90-R and COVID-19 related psychological distress and both were negatively correlated with the age of the participants. The COVID-19-related psychological distress factor had a significant effect on fear of contagion, perception and knowledge of risk of contagion, with risk perception being the most explained with 95.8% of variance explained. In addition, the final model showed adequate goodness-of-fit indicators. Conclusions: Psychological distress caused by pandemic and confinement is evidenced by higher scores on the SCL-90R instrument in persons with metabolic surgery. However, further studies and psychometric testing with more homogeneous samples in terms of sex and surgical technique are required.

Evaluating depression anxiety and stress assessment before and during the COVID-19 pandemic using generalisability theory.

The current study investigated the assessment of depression, anxiety, and stress during normal and COVID-19 pandemic conditions. Generalisability theory (G-theory) was applied to examine stable and dynamic aspects of psychological distress and the overall reliability of the Depression, Anxiety and Stress Scales (DASS-21), using data from two independent samples collected on three occasions with 2- to 4-week intervals. The US data (n = 115) was collected before the COVID-19 pandemic, and the New Zealand (NZ) data (n = 114) was obtained during the pandemic. The total DASS-21 demonstrated excellent reliability in measuring enduring symptoms of psychological distress (G = .94-.96) across both samples. While all DASS-21 subscales demonstrated good reliability with the pre-pandemic US sample, the subscales' reliability was below an acceptable level for the NZ sample. Findings from this study indicate that the overall psychological distress is enduring and can be reliably measured by the DASS-21 across different conditions and populations, while shifts across depression, anxiety and stress levels are likely during emergency and uncertainty, as seen in the COVID-19 pandemic.

A preliminary investigation of the mental health of parents of young children who stutter

IntroductionWhile research has shown that parents of preschool-aged children who stutter (CWS) may be negatively affected by their child's stuttering, few studies have investigated their mental health. If parents of CWS have poor mental health, this may impact stuttering treatment choices, the conduct of treatment, stuttering treatment outcomes, and the development of stuttering treatments. Methods82 parents (74 mothers and 8 fathers) of preschool-aged children who stutter (aged 1–5) were recruited upon application for an assessment for their child. A survey battery extracting quantitative and qualitative information about symptoms of potential depression, anxiety, stress, and psychological distress, as well as the emotional effect of stuttering on parents was administered and the results summarized. ResultsData from standardised measures revealed similar incidence as normative data for the presence of stress, anxiety or depression (1 in 6 parents) and distress (almost 1 in 5 parents). However, more than half of the participants reported experiencing a negative emotional effect due to their child's stuttering and a large proportion also reported that stuttering influenced their communication with their child. ConclusionsSpeech-language pathologists (SLPs) should broaden the scope of their duty of care to include the parents of CWS more fully. Parents should be provided with informational counselling or other support services that will help reduce worry and anxiety related to negative emotions.

Santé mentale des médecins libéraux français pendant la deuxième vague de COVID 19

IntroductionThe 2019 coronavirus (COVID-19) pandemic has caused a public health crisis worldwide. Concerns have been expressed about the rapid deterioration of mental health among primary care physicians among whom burnout already had a high prevalence prior to the pandemic. However, there is little data on private doctors during the pandemic. France experienced a second wave with a second lockdown. We aimed to assess and compare physicians’ burnout, anxiety and depression symptoms and insomnia between general practitioners (GP) and all other private specialists during the second Covid-19 wave. MethodsWe conducted an online survey of private practitioners registered on Doctolib® (n=32,655), the interface software most used by private practitioners for booking medical appointments in France. Doctors were invited by email to complete an online survey in November 2020. Inclusions were closed on 1st December. The 2nd lockdown lasted from 30th October to 15th December 2020. We used the Copenhagen Burnout Inventory (CBI) to assess burnout syndrome. A mean score of>50 in at least one subscale defined burnout. The Hospital Anxiety and Depression Scale assessed anxiety and depression symptoms. We used two cut-offs, 8 (>7) and 11 (>10), as both are validated in the ability to find cases. The Insomnia Severity Index (ISI) measures sleep-related complaints among physicians (cut-off >7). To link variations in the psychological scales to the COVID-19 pandemic, one of the items asked explicitly whether participants considered that “the COVID-19 epidemic we are currently experiencing is a source of excess stress, psychological suffering or burnout”. Approval for this study was obtained from the local institutional review board of the University of Paris-Saclay, France. The questionnaires were collected anonymously. Statistical significance was tested using the chi-square test and student's t-test to compare the prevalence between GPs and other specialities. Subsequently, logistic regression models were run for statistically significant associations. Results1992 physicians replied, a response rate of 12.8% of those who received the invitation email. Among them, 79.4% suffered from psychological distress (symptoms of anxiety or depression or burnout), of which 71.3% suffered from burnout, 26.7% from depressive symptoms, 58.9% from anxiety symptoms and 45.8% from insomnia. There was no difference in gender between GPs and specialists, but there was an age difference (P<0.001). GPs had a higher prevalence of burnout (OR=1.33 CI95 [1.09;1.63]) and took more psychotropic drugs (1.38 CI95 [1.05;1.81]). They were also more likely to perceive their stress as work-related (OR=1.50 CI95 [1.23;1.81]) or COVID-19-related (OR=1.43 CI95 [1.16;1.77]). ConclusionOur study is the first to assess the mental health of private practitioners in the second wave in association with COVID-19 stress. Firstly, GPs who provide primary care have a significantly higher burnout rate than other doctors. Secondly, COVID-19 stress is associated with more significant psychological distress. Thirdly, almost 80% of the private doctors surveyed suffer from psychological pain, and 71% suffer from burnout. This study has strengths and limitations. Firstly, this study assesses mental health and stress related to its COVID-19 association. Second, this is the largest population of private physicians during the COVID-19 pandemic. The low response rate is the main limit of this study. The alarming rates of psychological distress among private doctors and, in particular, GPs should lead to intervention to help doctors reduce stress, burnout and other mental disorders. This study gives a picture of the situation during the second wave and the lock-in, and we need to be cautious with the next waves.