Psychopathological Distress Research Articles

Impact of caregiving experience on mental health among caregivers: a comparison of eating disorder patients with purging and non-purging behaviors

Differences in mental health among primary caregivers of eating disorder patients with purging and non-purging behaviors were explored and predictors of psychopathological distress among caregivers were also determined. 177 caregivers, ranging from 29 to 75 years of age, of adults and adolescents with an ED participated in the study. The caregivers completed self-report assessments related to psychopathological distress (GSI), specific experience of caregiving and expressed emotion. Results A statistically significant difference in psychopathological distress was presented by caregivers of patients with purging behaviors (38.9%) compared with non-purging ones (25%), using a GSI cut-off point. In patients who purged, caregiver’s intrusiveness and difficulties related to eating behavior accounted for 25% of the variance and in those who did not purge, difficulties related to eating behavior, guilt, social isolation, hostility and negative attitude toward illness accounted for 44% of variance. The differences observed indicate the importance of identifying purging as a significant clinical marker of increased risk of psychopathological distress in caregivers.

Psychological and behavioural factors associated with long-term weight maintenance after a multidisciplinary treatment of uncomplicated obesity

Obesity is a multifactorial syndrome and the likelihood of success of a medical nutritional treatment (MNT) over the long term is low. As psychological and behavioural factors have an important role in both pathogenesis and the treatment of obesity, these issues were investigated in individuals with obesity who reported a long-term success or a failure in terms of weight loss following a MNT. Eighty-eight individuals of an original cohort of 251 subjects were re-evaluated 10 years after a MNT with cognitive-behavioural approach for uncomplicated obesity. Fifty-three participants were classified as failure (body weight change ≥0.5 kg) and 35 as a success (10-year body weight change <0.5 kg) of the MNT. Prior to the beginning of the weight-management program, both the Dieting Readiness Test (DRT) and the Hospital Anxiety and Depression Scale (HADS) were administered. At a 10-year follow-up after the MNT, self-reported questionnaires were administered: quality of life was assessed by the Obesity Related Well-Being (ORWELL 97) questionnaire, eating attitudes and behaviours by the Eating Disorder Examination Questionnaire (EDE-Q), the Binge Eating Scale (BES) investigated the presence and severity of binge eating and the Symptom Checklist (SCL 90-R) was used to identify the psychopathological distress. The scores of the ORWELL 97 items concerning symptoms (P = 0.005), discomfort (P = 0.03) and the total score (P = 0.02) were significantly lower in the success group. The depression score of the HADS was positively correlated with the percentage of body weight change observed 10 years after the MNT (r = 0.22; P = 0.045). The scores of the shape concern (EDE-Q) (r = 0.35; P = 0.013) and of the discomfort (ORWELL 97) (r = 0.36; P = 0.012) were significantly correlated with the percentage of body weight change 10 years after the MNT. In conclusion, this study is in agreement with the possibility that the psychological quality of life is associated even with modest amounts of weight loss in the long run. Further research should support identifying successful predictors of weight loss.

Τhe modulatory role of psychological distress in the relationship between illness perception and quality of life in patients with breast cancer.

e20657 Background: In a previous study (Gercovich et al., 2011) we found that several dimensions of Illness Perception predicted some aspects of Quality of Life. The present study introduces Psychological Distress as a variable to assess the modulatory role it plays in the association between Illness Perception dimensions and Quality of Life in patients with breast cancer, identifying which of these two variables explain further variability in the different aspects of Quality of Life. Methods: A cohort of seventy-five patients was evaluated with the Brief Illness Perception Questionnaire, the Hospital Anxiety and Depression Scale and the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ-30). We calculated bivariate and partial correlations to evaluate the associations between the illness perception dimensions and different aspects of quality of life, controlling these associations by the psychological distress measure. Subsequently, we performed linear regression analysis to evaluate which of these two variables better explains the variability in the quality of life scores. Results: Although significant associations between subscales of perception of illness and quality of life were found, most of them lost their significance when controlled by distress. In the regression models, variables that predicted the variability in the quality of life best were psychopathological diagnostic and distress. Conclusions: According to the study results, psychological distress and psychopathological diagnostic were the two variables that better explained the variability in the quality of life. For this reason it is essential to learn more about the role these variables play on the quality of life and on the morbidity and mortality associated to them.

The relationship between effortful control, current psychopathology and interpersonal difficulties in adulthood

This study examined whether the relationship between low effortful control (EC), general psychopathology and interpersonal maladjustment previously reported among children extends to adulthood. Two hundred and forty undergraduate students were assessed using the EC scale of the Adult Temperament Questionnaire, the General Severity Index of the Brief Symptom Inventory (BSI-GSI) and the interpersonal distress index of the Inventory of Interpersonal Problems–Short Circumplex (IIP-distress). Both the BSI-GSI and the IIP-distress scores were related to low levels of EC. Furthermore, interpersonal distress mediated the association between low EC and greater psychopathology severity. These results suggest that deficits in regulatory temperament among adults may be associated with experiencing greater psychopathology distress, and that this relationship may be explained by an impairment in interpersonal adjustment. Such preliminary findings may constitute a useful starting point for investigating this hypothesis among clinical populations.

1480 – Psychopathological disease and emotion regulation

Research aims to understand how psychological mechanisms influence mental health. Accordingly, much of the studies in this field has been dedicated to clarifying how emotion regulatory strategies may be associated with increased psychopathology (Gross & John, 2003). Individuals regulate their emotions in a wide variety of ways. We focus on two commonly used emotion regulation strategies: reappraisal (changing the way one thinks about a potentially emotion-eliciting event) and suppression (changing the way one responds behaviorally to an emotion-eliciting event). We analyze emotion regulation strategies (Gross & John, 2003) in order to examine their relation with a broad range of psychological problems and symptoms of psychopathology. Emotion regulation was assessed by means of the Emotion Regulation Questionnaire (ERQ, Gross & John, 2003), which taps two regulatory strategies, suppression and reappraisal. The psychopathological distress was assessed by the 90- item Symptom Checklist-90-Revised (SCL-90-R; Derogatis, 1994) by indicating the degree of distress on a scale of 0 (not at all) to 4 (extremely) caused by a list of problems during the past 7 days. The sample consisted of 548 individuals (age: M=32.97; DS=3.55 for male; M=31.29; DS=3.64 for female). Individuals who reported low levels of suppression reported the lowest levels of psychopathological symptoms. Our findings highlight that the capacity to regulate emotions may be associated with reduced psychopathology and more adaptive functioning

Dream Recall Frequency and Unusual Dream Experiences in Early Adolescence: Longitudinal Links to Behavior Problems

Unique dream patterns are related to psychopathological distress in adults. In adolescence, this was investigated almost exclusively regarding nightmares. This longitudinal study examines developmental trajectories of various adolescent-reported dream patterns, and their associations with parent-reported psychopathology (internalization and externalization problems) in early adolescence. Ninety-four 10- to 11-year-old normally developing children completed a week of sleep, dreaming, and pubertal development assessments. Parents reported behavior problems. Assessments were repeated after 1 and 2 years. Reports of unusual dreams decreased over time, and dream recall decreased among girls. Internalizing symptoms longitudinally predicted an increase in dream recall and unusual dreams. Moreover, unusual dreams longitudinally predicted increased behavior problems (internalization and externalization). Assessing dream patterns during early adolescence may help early detection of covert psychopathological distress.

Screening of cannabis-related problems among youth: the CPQ-A-S and CAST questionnaires

BackgroundCannabis use among young people is a significant problem, making particularly necessary validated screening instruments that permit secondary prevention. The purpose of this study was to analyze and compare the psychometric properties of the CAST and CPQ-A-S questionnaires, two screening instruments specifically addressing the youth population.MethodsInformation was obtained on sociodemographics, frequency of substance use, psychopathological symptoms and cannabis-use problems, and the CPQ-A-S and CAST were applied, as well as an infrequency scale for discarding responses made randomly. The sample was made up of 144 young people aged 16 to 20 that had used cannabis in the last month, of which 71.5% were boys. Mean age of the sample was 17.38 years (SD = 1.16).ResultsThe results show that from the psychometric point of view both the CAST and the CPQ-A-S are good screening instruments.ConclusionsThe CAST is shorter and presents slightly better internal consistency than the CPQ-A-S. Both instruments show high sensitivity and specificity in the detection of young people dependent on cannabis according to the DSM IV-TR criteria. The CPQ-A-S appears to show greater capacity for detecting psychopathological distress associated with use. Both questionnaires yield significant odds ratios as predictors of frequent cannabis use and of the DSM IV-TR abuse and dependence criteria. In general, the CPQ-A-S emerges as a better predictor than the CAST.

Serotonin transporter gene variants and prediction of stress-induced risk for psychological distress

The response to psychosocial stress is influenced by both psychosocial factors and genetic vulnerability. The most investigated gene in gene × environment studies in abnormal response to environmental stressors is the one coding for the serotonin transporter (SLC6A4). Variability within this gene has been associated with functional brain differences, personality dimensions, reactivity to stress and risk for various psychopathological conditions. In the present study, we set out to investigate the association of common genetic variants within SLC6A4 with state psychopathology in a community sample homogeneously exposed to stress, thus inquiring about potential genetic differences in stress sensitivity. One thousand eight hundred seventy-five young conscripts were evaluated for psychopathological distress with the 90-item Symptoms Checklist Revised in their first 2 weeks of admission to obligatory military service. Of these, 1594 were genotyped for the biallelic ins/del polymorphism (5-HTTLPR S/L) within the promoter region of SLC6A4, as well as the variation within the 'long' 5-HTTLPR allele (rs25531A/G). Homozygous for the 5-HTTLPR S allele reported significantly higher scores for paranoid ideation as compared with L-allele carriers. Slight effects on other subscales were observed, but were not significant after correction for multiple testing. Despite limitations linked to the evaluation of psychopathology by a single general scale and multiple comparisons, the present study support a role of SLC6A4 in modulating abnormal responses to environmental stress. In particular, variation within this gene may confer risk for paranoid/defensive reactions under conditions of environmental stress associated with military induction.

Immigration, trauma, living difficulties and psychopathology: a preliminary study in a primary care setting

Investigate the prevalence of Post-Traumatic Stress Disorder (PTSD), anxiety, depression and somatizations in a sample of immigrants visited in a transcultural primary care service. The relationship among psychopathological symptoms, pre-migratory events and post-migration living difficulties is also considered. We studied 101 outpatients, attending the "Caritas" Primary Care Unit for immigrants in Rome. All participants fulfilled a socio-demographic questionnaire, a checklist of traumatic events (Harvard Trauma Questionnaire, HTQ), a checklist of post-migration living difficulties (Post-Migration Living Difficulties, PMLD) and the following questionnaires: the HTQ for the assessment of post-traumatic symptoms, the Hopkins Symptom Checklist (HSCL-25) for anxiety and depression, the Bredford Somatic Inventory (BSI) for somatization. 40 patients (39.60%) had an anxiety disorder, 47 (46.13%) a depressive disorder, 16 (15.84%) a PTSD and 39 (38,6%) a somatization syndrome. All these syndromes were significantly correlated. The number of traumatic events and of post-migration difficulties significantly increased the scores on the psychopathological scales. The prevalence of psychopathological syndromes in our primary care transcultural unit was high. This not only in refugees, but also in immigrants for other reasons. Moreover, the levels of psychopathological distress were significantly influenced by the number of pre-migratory traumas and of living difficulties in the host country.

Patterns of Childhood Trauma and Psychological Distress among Injecting Heroin Users in China

BackgroundChildhood trauma has been reported as a possible cause of future substance abuse in some countries. This study reports the prevalence of childhood trauma and examines its association with psychological distress among injecting drug users from mainland China.MethodologyThe study was conducted in three government-operated drug rehabilitation facilities in Shanghai, China in 2007. The Early Trauma Inventory Self Report-Short Form (ETISR-SF) was used to evaluate 4 types (general, emotional, physical and sexual) and severity of childhood trauma, and the Symptom Checklist-90-Revised (SCL-90-R) to evaluate psychological distress.Principal FindingsAmong 341 injecting drug users who completed the study, about 80% reported one or more types of childhood trauma, specifically 53% general trauma, 56% physical abuse, 36% emotional abuse and 26% sexual abuse. Compared to female injecting drug users, males reported significantly higher scores of general trauma and physical abuse, but lower sexual abuse scores. Hierarchical linear regression analyses showed that greater physical and emotional abuse in childhood predict greater current psychopathological distress among these injecting drug users in China.ConclusionsThe results reveal a high prevalence of childhood trauma among injecting drug users in China, and it is comparable to other similar studies in Western countries. It is important to consider the role of childhood trauma in the prevention and treatment of substance abuse.

Effect of Exposure to Terrorism on Sleep-Related Experiences in Israeli Young Adults

General sleep-related experiences (Watson, 2001), including special dream states such as elevated dream recall, nightmares, hypnagogic hallucinations, flying dreams, and waking dreams, have been shown to be associated with life stress and psychopathological distress (Soffer-Dudek & Shahar, 2009). In this study, we attempted to examine these associations within the context of terror-related stress. In the week following operation Oferet Yetzuka in Israel, ninety-one participants filled out questionnaires concerning sleep experiences, psychopathological distress, and degree of exposure to terror. These participants were part of a larger study conducted three years earlier (Soffer-Dudek & Shahar, 2009). General sleep experiences (GSEs) were positively correlated to exposure to terror through media, a link that was mediated through psychopathological symptoms. Surprisingly, GSEs were negatively correlated with physical exposure variables. We suggest that GSEs may be related to a ruminative coping style (i.e., not “letting go,” both by day and by night).

Esophageal motility and symptoms in restricting and binge-eating/purging anorexia

Background Esophageal symptoms are common in anorexia nervosa, but it is not known whether they are associated with motility disorders, with different forms of the disease, and whether they respond to nutritional rehabilitation. Methods To clarify these points, 23 patients with anorexia nervosa (12 binge-eating/purging, “purgers”; 11 restricting type, “restricters”) were studied by esophageal manometry before and after 22 weeks rehabilitation. Manometric parameters of 35 age and sex-matched patients were used as controls. Patients with anorexia also filled questionnaires on eating disorder psychopathology, psychopathological distress and esophageal, gastric and colonic symptoms before and after 4 and 22 weeks of a rehabilitation program. Results Symptoms were more severe in patients than in controls. Gastric and colonic, but not esophageal symptoms improved with treatment. LES basal pressure was higher in restricters (restricters 32.1 ± 4.6; purgers 14.9 ± 2.2; controls 17.1 ± 1.1 mm Hg, p < 0.005), but still within normal range; this difference disappeared after treatment. Postdeglutitive body waves were normally propagated. Their amplitude was significantly higher in anorexia than in controls. No correlation was found between results of psychopathological tests (improved after treatment), esophageal symptoms and manometry. Conclusions In anorexia, esophageal symptoms are frequent and severe. They are not adequately explained by psychological or manometric derangements.

Gender differences in the effects of childhood psychopathology and maternal distress on mental health in adult life

To investigate gender differences in how emotional and behavioural problems (hyperactivity, emotional problems, and conduct problems) and maternal psychological distress, all measured at three time points in childhood (ages 5, 10, and 16), predict psychological distress in adult life (age 30). Longitudinal data from 10,444 cohort members of the 1970 British Cohort Study (BCS70) were used. Emotional problems in adolescence tended to be more strongly associated with adult psychological distress in men than in women. No gender differences in the association of adult psychological distress with maternal psychological distress in adolescence were found. In childhood and adolescence boys' externalizing behaviour problems tended to show more homotypic continuity than girls', but all heterotypic continuity (although very little) of behaviour problems was seen in girls. Maternal psychological distress in childhood tended to have a stronger effect on girls' than boys' emotional problems in adolescence. In general there was little evidence for gender differences either in the association of adult psychological distress with adolescent psychopathology or in the association of adult psychological distress with maternal psychological distress in adolescence. The continuity of emotional problems from childhood to adolescence to adult life was strong and similar for both sexes.

Impact of War Trauma and Posttraumatic Stress Disorder on Psychopathology in Croatian and German Patients with Severe Mental Illness

To explore posttraumatic stress symptoms and current psychopathology in a binational sample of Croatian and German participants with severe mental illness. We studied 178 inpatients from the Greifswald University (German patients, n=89) and University Hospital Zagreb and Ivan Barbot Neuropsychiatric Hospital (Croatian patients, n=89) with either major depression (n=150), schizophrenia (n=26), or bipolar disorder (n=2). Measurements included Posttraumatic Diagnostic Scale and the Symptom Check List-90-R. Participants were matched according to age, sex, and diagnosis. Croatians reported significantly more war traumatic events (64/82 vs 5/74, chi(2)(1)=77.142, P<0.001) and significantly more Croatians met the criteria for posttraumatic stress disorder (55/89 vs 27/89, chi(2)(1)=17.73, P<0.001). They also suffered from a higher level of psychopathological distress as they scored significantly higher at all Symptom Check List-90-R revised version subscales (P<0.001). The regression models demonstrated that predictors of general psychopathological distress were war trauma (P<0.001), posttraumatic stress disorder (P<0.001), and diagnosis (P=0.01). This is the first study comparing the impact of war trauma on psychopathology of participants with severe mental illness between two nations. Our results clearly indicate the importance of trauma assessment in subjects with severe mental illness, particularly in post-conflict settings.

P01-269 - Psychopathological distress, body image perception and social phobia in patients with hearing aids and cochlear implants

ObjectivesHearing-impaired adults with hearing aids or cochlear implants have been proved to suffer from social isolation and that the under-use of these devices is possibly related to its impact on one's body image. The aim of the research was to evaluate the presence of social phobia and body image preoccupation, handicap perception, social functioning and psychopathological distress in patients with hearing aids or cochlear implant.MethodA clinical group of 70 hearing aid and/or cochlear implant wearers was compared with a control group of 75 healthy adults (age: 18-65) referred to the ENT Clinic of Modena University from 01/01/09 to 01/ 09/09. Both groups were administered the following psychometric instruments: Social Functioning Questionnaire, Brief Symptom Inventory, Liebowitz Social Phobia Scale, Body Uneasiness Test. Hearing-impaired subjects were also assessed by means of the following tests: International Outcome Inventory for Hearing Aids, Attitude towards Hearing Loss Questionnaire, Hearing Handicap Inventory for Adults.Resultsthe case group statistically differed from the control group as to lower level of social functioning (p&lt; .05), higher level of somatization (p&lt; .01), obsessive compulsive behaviour (p&lt; .01), interpersonal sensitivity (p&lt; .01), depression (p&lt; .01), anxiety (p&lt; .05), phobic anxiety (p&lt; .01), paranoid ideation (p&lt; .01), psychoticism (p&lt; .01), social phobia (p&lt; .001) and body image preoccupation (p&lt; .05).ConclusionSocial phobia and body image preoccupation are critical aspects in determining the psychosocial well-being and the compliance, the benefit and the personal satisfaction of hearing-impaired subjects in using the hearing aid and/or cochlear implant.

Use of Street Methadone in Italian Heroin Addicts Presenting for Opioid Agonist Treatment

ABSTRACT It is commonly assumed that people who are addicted to certain substances would abuse any substance. This position has never been supported by validly collected and analyzed research data. In this study, the authors examine the use of street methadone by heroin addicts seeking their first agonist opioid treatment in a clinical setting. Fifty-four heroin addicts who resorted to street methadone use were compared by socio-demographic, current clinical, and disease-related variables to 251 peers who do not use street methadone. Heroin addicts who resort to street methadone use are more likely to be females and to have a higher degree of education, are less likely to engage in polyabuse (use of more than three substances), are less severely ill, have been addicted for a shorter period of time, and have been seeking treatment sooner in the course of their disease. Also, they suffer from a wider range of psychopathological distress symptoms. In Italy, resorting to street methadone does not seem to be a surrogate form of heroin addiction, but rather represents means of harm reduction, with treatment seeking occurring shortly after its initiation. This should be accounted for when deciding on take-home policies and issues of potential methadone diversion.

Association of Childhood Neglect with Adult Dissociation in Schizophrenic Inpatients

Background: Dissociation is often related to previous trauma and also occurs frequently in schizophrenia. Dissociation and psychosis may reflect a posttraumatic syndrome in some patients with schizophrenia. Sampling and Methods: In total, 80 patients diagnosed with schizophrenia were investigated by means of the Childhood Trauma Questionnaire (CTQ), the Dissociative Experience Scale and the Symptom Check List 90-R. CTQ subscales and groups reporting high and low dissociation were compared using MANOVA. Results: Childhood traumatic experiences were frequent [mean CTQ total score = 45.4 ± 17.5 (SD)]. Physical neglect was clearly associated with high dissociation, whereas abuse was not. Furthermore, there was a significant association of physical neglect with psychopathological distress not fully accounted for by dissociation. Conclusions: Dissociation may be specifically linked to childhood physical neglect in patients diagnosed with schizophrenia. Dissociation alone may not explain the effects of childhood maltreatment on adult psychopathology in schizophrenia; however, conclusions from the present study are limited due to its cross-sectional design.

P03-245 Anger, social dysfunction and psychopathological distress in hearing- impaired patients

It has been demonstrated that subjects suffering from hearing impairment present significant emotional reactions and socio-situational limitations when compared to controls (Monzani et al., 2008).Aim:To evaluate the relationship between hearing loss severity, anger expression, perceived handicap, social dysfunction and psychopathological distress in adult patients suffering from acquired hearing loss.Method:297 hearing impaired subjects were consecutively recruited by the ENT Clinic of the Modena and Reggio Emilia University from 1/1/07. Each patient were submitted to pure-tones audiometry and the pure tone average threshold (PTA) was calculated over 0.5,1, 2, 4 kHz. Socio-demographic data were collected (age, educational level, employment, marital status). Every patient was also administered the following questionnaire in their Italian validated version: Social Functioning Questionnaire, Brief Symptom Inventory, Hearing Handicap Inventory for Adults, State-Trait Anger Expression Inventory-2. Descriptive statistics were used to assess sociodemographic data; Pearson correlation coefficient was used to investigate relationships between test scores and hearing loss level.Results:Mean age was 53.79 (SD ±13.65); 44.8% were males. Hearing impairment level didn't significantly relate with objective social functioning level (p=.311), but with the subjective emotional and socio-situational perceived handicap (p=.000); moreover it significantly correlates with individual psychopathological tendency to phobic reaction (p=.006) and to anger general expression index (p=.021). Furthermore it directly relates with state anger (p=.021) and inversely relates with external expressed anger (p=.023).Conclusion:Anger felt but not expressed might be a key element in determining subjective social impairment in hearing loss patients and contribute to their well-known psychological distress.

Risk Factors for Self-Harm and Suicide in Incarcerated Young Offenders: Implications for Policy and Practice

This study identified common and unique risk factors for suicidal and self-harming (SSH) behavior in 242 incarcerated young offenders. Lifetime prevalence of suicidal ideation was 19.2% and was 18.2% for self-harm ideation; 8.4% had attempted suicide (44% in detention), and 9.1% had inflicted self-harm in the past 12 months (75% in detention). SSH young offenders reported more severe psychopathology, childhood trauma, and psychological distress than non-SSH young offenders. Past emotional abuse, current psychological distress, and depersonalization disorder were significant risk factors for suicidal ideation. Past physical abuse and current psychological distress were significant risk factors for self-harm ideation. Suicidality and self-harm co-occurred. Two approaches to the assessment of self-harm risk—past behavior and scores on a scale of self-harm risk—were compared. Some support for the equivalence of assessment methods was found; however, significant differences emerged that indicated that a multi-factorial approach to the assessment of self-harm risk is advised. Screening on entry to detention could identify young offenders at risk and direct them into treatment. The high rates of self-harm in detention suggest that the detention environment and management practices should be reviewed to identify structural elements that contribute to distress in some young offenders that for a significant minority is associated with SSH ideation and behavior.

Lebensqualität – methodologische und klinisch-praktische Aspekte mit einem Fokus auf die Augenheilkunde

Due to the demographic development in western industrialised countries, the proportion of visually impaired persons is likely to increase in the future. Currently there is a shift in scientific recognition from relative neglect of psychopathological distress in the visually impaired to better notice of disease-related subjective impairments that are detectable with specific questionnaire measures. Visual acuity primarily determines the subjective rating of visual functioning independent from the eye disease. Ophthalmic patients who show only mild symptoms from a medical point of view normally suffer considerably diminished vision-related quality of life with respect to physical, functional, mental, and social aspects. Treatment effects have been shown using vision-related quality-of-life measures for different ophthalmic diseases, particularly cataract surgery. Assessment of vision-related quality of life provides a meaningful complement to objective data.