Psychophysical Distress Research Articles

COVID-19 Explained to Children in Italy: A Comparison between Institutional Guidelines and Narratives

Among the indirect consequences of the COVID-19 pandemic on the mental health of children and adolescents, most studies, both nationally and internationally, have found an increase in anxious-depressive symptoms, sometimes associated with suicide attempts. Institutions and public health professionals therefore developed textual documents and multimedia products to provide guidelines to set up, among other things, a narrative of the event capable of responding to the psycho-physical distress of children and adolescents and ultimately reducing symptoms. At the same time, individual educators, writers, and YouTubers offered alternative products (accessed through the web) to respond to the same needs. This paper intends to analyse and compare the narrative suggested and packaged by both types of producers mentioned to detect the linguistic-textual and pragmatic choices and their effect.

How and When May Technostress Impact Workers' Psycho-Physical Health and Work-Family Interface? A Study during the COVID-19 Pandemic in Italy.

Although a growing body of research has analyzed the determinants and effects of technostress, it is still unclear how and when technostress would impact workers' psycho-physical health and work-family interface during the pandemic. To fill this gap, this study tests the mediating mechanisms and the boundary conditions associated with the impact of technostress on workers' psycho-physical well-being and work-family conflict. A total of 266 Italian workers completed online questionnaires measuring (traditional vs. remote) working modalities, technostress, fear of COVID-19, working excessively, psycho-physical distress, work-family conflict, loss of a loved one due to COVID-19, and resilience. Structural equation models were performed. Results indicated that technostress was positively related to psycho-physical distress and work-family conflict, as mediated by fear of COVID-19 and working excessively, respectively. The loss of a loved one exacerbated the effects of fear of COVID-19 on psycho-physical health, while resilience buffered the effects of working excessively on work-family conflict. Since numerous organizations intend to maintain remote working also after the COVID-19 emergency, it is crucial to study this phenomenon during its peaks of adoption, to prevent its potential negative outcomes. The implications of these findings for theory and practice are discussed.

The immersive experience of virtual reality during chemotherapy in patients with early breast and ovarian cancers: The patient's dream study.

BackgroundA virtual reality experience (VRE) could represent a viable non-pharmacological intervention to reduce and better manage the main factors of psychophysical distress related to the diagnosis and treatment of cancer.AimThe “Patient’s Dream” study was a two-arm randomized controlled trial conducted at the Regina Elena National Cancer Institute – IRCCS (Rome, Italy) from April 2019 to January 2020 to evaluate VRE impact in patients affected by breast or ovarian cancer. Before starting the first cycle of chemotherapy (CT), patients were randomized to receive the VRE (VRE arm) as “distraction therapy” or to entertain themselves with conventional means (control arm). The primary aims were the assessment of psychological distress, anxiety and quality of life between the two study arms. Secondary endpoints were the perceived time during the first course of CT and the acute and late toxicity.ResultsFourty-four patients were enrolled, 22 patients were randomly assigned to the VRE arm and 22 to the control arm. Collected data underline the absence of prevalent disturbs of anxiety and depression in both groups. Nevertheless, even if the state anxiety values before and after CT decreased in both groups, this reduction was statistically significant over time only in the VRE arm. The duration of therapy perceived by patients undergoing distraction therapy was significantly shorter when compared to the control group. The use of VRE during the first CT cycle appeared to reduce asthenia outcomes.ConclusionObtained data suggest that the VRE positively influenced the levels of state anxiety among cancer patients and support the continuous research on VRE as a distraction intervention, with the aim to meet the clinical need for effective nonpharmacologic adjunctive therapies.Clinical trial registration https://clinicaltrials.gov/ct2/show/NCT05234996, identifier NCT05234996.

791 Virtual visits in HF outpatient management during COVID-19-related lockdown

AimsFollowing the COVID‐19 pandemic‐related lockdown period in Italy, people have experienced psycho-physical distress. Many hospitals were converted in COVID-19 healthcare places and many specialist outpatient’s services were drastically reduced. Virtual visits may represent a strategy to overcome the lack of HF outpatient’s services, during this period. Our own experience underlines the importance of virtual visits to face the clinical and health status deterioration, associated with COVID-19, in HF outpatients.Methods and resultsWe conducted an observational study, enrolling consecutive HF outpatients, previously hospitalized at the Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences of Sapienza University of Rome, who were discharged within 31 March 2019, and 30 April 2019. Two follow-up periods were scheduled: (i) within 20–30 days after the beginning of lockdown (ii) at 3 months after lockdown’s end. Virtual visits were conducted through telephone, assessing changes in clinical and health status; the latter was assessed through the short version of the Kansas City Cardiomyopathy Questionnaire (KCCQ-12). According to the presence of at least one sign of HF deterioration, patients were divided into two groups: Group 1: patients who experienced a modification in at least one clinical parameter suggestive of HF deterioration. Group 2: patients who do not experienced any modification of HF deterioration clinical parameter. KCCQ-12 mean scores were compared between the two groups, at both scheduled virtual visits, in order to evaluate any change in HF outpatients’ health status, during and after the COVID-19-related-lockdown. 160 HF outpatients have been included in the study: 63 in the group 1, 97 in the group 2. At the first virtual visit, group 1 reported significantly lower mean KCCQ-12 score, compared to group 2 [46.2 (±14.6) vs. 53.8 (±11); CI: 95% 11.6 to − 3.6; P = 0.0003]. At the second virtual visit, group 1 patients reported a slightly, but not statistically significant, lower mean KCCQ-12 score, compared to group 2 [52.2 (± 13.3) vs. 53.1(±14.4); 95% CI: −5.4 to 3.6; P = 0.69]. Comparing the KCCQ-12 mean scores of each group between the two scheduled virtual visits, group 1 reported a statistically significant increase at the second visit, compared to the first [52.2 (±13.3) vs. 46.2 (±14.6); CI: 95% 1.1–11; P = 0.017]. Group 2 showed no statistically significant variation of mean KCCQ-12 score between the two follow-up periods [53.1 (±14.4) vs. 53.8 (±11); CI: 95% −4.3 to 3; P = 0.704].Conclusionswe observed a significant worsening of health status in HF outpatients who have experienced clinical deterioration. Therefore, patients were either hospitalized or received the optimization of diuretic and anti-hypertensive therapies. A significant health status improvement was observed at three months after the end of the lockdown, suggesting the importance of virtual visit as an adequate method to follow-up HF outpatients, reporting particular benefits in those with worsening of HF clinical signs and health status.

175years of anesthesia and narcosis-Towards a"human right to unconsciousness"

Der „Äthertag“, ein Schlüsselmoment in der Geschichte der Menschheit, jährt sich am 16. Oktober 2021 zum 175. Mal. Nachdem der Zahnarzt William T. G. Morton in Boston die erste erfolgreiche öffentliche Äthernarkose gegeben hatte, schien es von nun an möglich, Menschen mit vertretbarem Risiko vor Schmerz zu bewahren und gleichzeitig durch die Induktion von Bewusstlosigkeit vor psychischen Folgeschäden zu schützen. Der Philosoph Peter Sloterdijk spricht von einem „Recht auf Nicht-Dabei-Sein-Müssen“, das die Anästhesie dem Menschen seit 1846 ermöglicht, und leitet daraus „gewissermaßen ein Menschenrecht auf Ohnmacht“ ab. Die Umsetzung dieser Idee liegt jedoch in weiter Ferne. Zum einen fehlt in vielen Ländern in großer Zahl qualifiziertes Personal, um selbst Narkosen für lebensnotwendige Operationen durchführen zu können. Zum anderen ist über Jahrzehnte klar geworden, dass die Anästhesie für die Menschheit nicht nur segensreich ist, sondern auch ihre „dunkle Seite“ zeigen kann: Substanzmissbrauch, Einsatz von Anästhetika bei Folterungen und Hinrichtungen. Zudem ist der Stellenwert der Anästhetika bei Wiederbelebungsmaßnahmen, in der Palliativmedizin und zur Erleichterung von Hinrichtungen unklar oder umstritten. Letztlich sind auch die erforderlichen förmlichen Schritte zur (völker)rechtlichen Anerkennung eines „Menschenrechts auf Ohnmacht“ bislang nicht vollzogen worden.

Psychosocial health of patients with tobacco-related cancers in Assam, India.

The diagnosis and effects of complicated cancer treatment often cause psychophysical distress in the patient. The psychosocial concerns that arise because of the diagnosis and treatment-seeking process of cancer are often overlooked. Considering the significance, the study attempts to understand the effect of treatment-seeking processes on the psychosocial health of tobacco-related cancer (TRC) patients. Using explanatory sequential design, 100 participants were interviewed in the quantitative phase of the study, followed by in-depth interviews of 11 participants who had diverse treatment-seeking experiences. Hindi version of the Self-Reporting Questionnaire 20 (SRQ-20) was used to examine the TRC patient's common mental disorders (CMD). A high incidence of CMD (73%) was reported by cancer patients in the Barak Valley of Assam. TRC patient's socio-demographic characteristics, health attributions and general existential questions regarding the diagnosis of cancer were found to influence their mental health. Also, it was revealed that informational supports were negatively correlated with the CMD of the patient. The study suggested for strengthening social support and networks at different levels to improve patient's psychosocial health. Emphasising on building small social institutions, it advocates for engaging practitioners of modern and alternative medicine to comprehensively address patient's psychosomatic needs.

Acculturation of Syrian Refugees in Germany

Since 2011, there has been an ongoing civil war in Syria between various militant groups, ISIS, and the Syrian government, in response to the oppressive regime of the Syrian government of President Bashar al-Assad. As a result, the largest migration that the world has seen since the Second World War has transpired. Approximately 13 million Syrians have been forcefully displaced from their homes, making this one of the largest humanitarian crises of our time. Many Syrians have sought refuge in neighbouring countries, as well as in Europe, the United States, and Canada. There is notably little research on refugee adaptation in Europe, which is the focus of this study. Using aspects of the Multidimensional Individual Differences Acculturation (MIDA) model, this study looked to examine the sociocultural and psychophysical adaptation of Syrian refugees in Germany. Measures that were excluded from the current version of the MIDA model were Ingroup Contact and Outgroup Contact. Researchers at Ludwig Maximilians University Munich administered paper and pencil surveys to 265 participants in Nuremberg, Germany who were attending vocational and language schools. Results displayed a significant relationship between Psychosocial Resources and Integration, and Psychophysical Distress; Co-National Connectedness and Integration; and Hassles and Psychophysical Distress. This study looks to inform host country government policies about positive integration strategies for refugee adaptation.

Burnout in Home Palliative Care: What Is the Role of Coping Strategies?

The study examines psychophysical distress of health-care professionals providing home-based palliative care. The aim is to investigate potential correlations between dimensions of burnout and different coping strategies. The present study is an observational cross-sectional investigation. The study involved all the home palliative care teams of an Italian nonprofit organization. Of a total of 275 practitioners working for the organization, 207 (75%) decided to participate in the study and complete questionnaires. Questionnaires employed were Maslach Burnout Inventory, General Health Questionnaire 12, Psychophysiological Questionnaire of CBA 2.0, and Coping Orientation to Problems Experienced. Professionals were physicians (50%), nurses (36%), and psychologists (14%). There were no exclusion criteria. Data were processed by SPSS 23 and analyses employed were Spearman ρ, Mann-Whitney U test, and 1-way analysis of variance on ranks. Among participants, a low number of professionals were emotionally exhausted (11%) or not fulfilled at work (20%), whereas most of them complained of depersonalization symptoms (67%). Emotional exhaustion and depersonalization were found to be associated with avoidance coping strategies, whereas problem-solving and positive attitude were negatively associated with emotional exhaustion and positively with personal accomplishment. Moreover, using avoidance strategies was related to a worse psychological and physical condition. Findings suggest the need to provide professionals training programs about coping and communication skills tailored to fit the professionals' needs according to their work experience in palliative care and aimed at improving the approach to patients and relatives.

Psychometric validation of the Brief Symptom Inventory 25 Forensic (BSI-25-F)

ABSTRACTThe Brief Symptom Inventory 25 Forensic (BSI-25-F) is a screening instrument for measuring the psychophysical distress of prisoners and forensic patients. The aim of the study was to validate the instrument. For this purpose, 165 forensic patients, 312 general psychiatric patients, and 1359 people from the general population completed the BSI-25-F. In addition, the data of the long-term prisoners who were studied when the instrument was originally developed were used for comparison. The item analyses revealed acceptable to very good item characteristics within the target samples of the prisoners and the forensic patients for the majority of the items. Reliability tests also showed acceptable to good values for the target samples. The differential validity but not the factorial validity could be proved. To conclude, the new BSI-25-F represents an economic, practicable, and reliable screening instrument for identifying prisoners who are in a need of treatment.

Awake Cranioplasty: A Case Series

Background: Cranioplasty restores the normal cranial architecture and protective functions of the skull and may play a role in normalizing cerebrospinal fluid dynamics in patients undergoing large craniectomies. It has a definitive impact on restoration of normal intracranial physiology and improvement of patient neurological condition. Anesthesia for awake neurosurgery procedure poses a unique challenge to anesthesiologists. Objective: To present cases of awake cranioplasty and describe the principles of anesthetic management during this procedure. Case description: 3 patients who have skull defect underwent cranioplasty procedure. Patients were managed with dexmedetomidine load of 1 mcg/kg over 10-15 min followed by infusion at rates of 0.2 mcg/kg/hr to 0.7 mcg/kg/hr and a local infiltration without airway instrumentation. Discussion: Awake cranioplasty offers great advantages with respect to patient outcome. In this type of procedure, the anesthesiologist’s goal is to make the operation safe and effective and reduce the psychophysical distress of the patient. Personal experience, careful planning, and attention to detail are the basis for obtaining good awake cranioplasty results. Dexmedetomidine is a highly specific α2 adrenoceptor agonist with sedative, analgesic, anesthetic sparing effect, awake if neither stimulated brain protection with no addiction effect nor suppress ventilation. Patients treated with dexmedetomidine will be sedated, comfortably but is easily aroused. Conclusion: Awake cranioplasty procedures were successfully performed with stable hemodynamic intraoperative and no complications during procedure. Dexmedetomidine has been shown to provide sedation and analgesia without significant respiratory depression and has been used successfully in these settings.

Psychological distress in medical patients 30days following an emergency department admission: results from a prospective, observational study.

BackgroundPsychological distress in medical patients admitted to the emergency department (ED) is not well studied. Our aim was to investigate the extent of psychological distress in a broad and unselected medical patient sample 30 days after ED admission and its association with socio-demographic and clinical variables.MethodWe used data from a prospective observational cohort study including 1575 consecutive adult medical patients presenting to the ED with acute somatic conditions. Outcome variables were patient’s psychological distress measured by the 4-item Patient Health Questionnaire (PHQ–4) and self-rated health assessed 30 days after ED admission using telephone interviews. Risk factors included socio-demographic variables (e.g. gender, marital status), clinical presentation (e.g. illness severity, main initial diagnosis) and course of illness (e.g. rehospitalisation, length of hospital stay).ResultsA total of 38 % of patients had evidence for psychological distress 30 days after ED admission. Multivariate analysis found female gender (adjusted odds ratio [aOR] 1.35, 95 % confidence interval [CI] 1.02 to 1.78), comorbid psychiatric disorder (aOR 1.63, 95 % CI 1.08 to 2.62), discharge to a post-acute care institution (aOR 1.47, 95 % CI 1.03 to 2.09), unplanned rehospitalisation (aOR 2.38, 95 % CI 1.47 to 3.86), and unplanned visit at general practitioner (aOR 4.75, 95 % CI 2.57 to 8.80) to be associated with distress at day 30 following ED admission.ConclusionsOne month after ED admission a significant number of patients still show a moderate amount of psychophysical distress. Strongest related variables were course of illness, in particular unplanned general practitioner visits. Future interventional studies should assess possibilities to reduce distress in patients at increased risk.Trial registrationNCT01768494, January 9, 2013 (registration date), February 25, 2013 (enrolment of first participant).

Caregiving for patients in vegetative and minimally conscious states: perceived burden as a mediator in caregivers' expression of needs and symptoms of depression and anxiety.

Involvement of family members is crucial to provide daily informal caring to patients in vegetative state and minimally conscious state. Previous studies showed that perceived burden is a risk factor for informal caregivers as it increases psychophysical distress. This research further investigated the relationship between these factors and aimed at providing a model that thoroughly describes this mechanism of functioning. In the frame of a national survey on people with disorders of consciousness, 487 informal caregivers of children and adult patients in vegetative and minimally conscious state were administered measures of depression, anxiety, caregiver needs, and family strain. Regression models proposed by Baron and Kenny and the Sobel test were adopted to investigate the relationship between depressive and anxiety symptoms, perceived burden and needs expressed. Our study shows that the relation between those symptoms and needs is mediated by burden, where higher burden accentuates and lower burden mitigates the needs expressed by caregivers. Our findings demonstrate that psychosocial components of the burden perceived by caregivers of patients with disorders of consciousness play a key role in shaping those caregivers' needs, especially their needs for information and communication. We recommend implementation of comprehensive steps to meet the needs of these caregivers, steps that incorporate improved economic and public health programs, social support, and use of psychological interventions to ameliorate caregivers' psychological distress and decrease their burden.

Safety and effectiveness of drug therapy for the acutely agitated patient (Part I)

Acute agitation occurs in a variety of medical and psychiatric conditions, and the management of agitated, abusive, or violent patients is a common problem in the emergency department. Rapid control of potentially dangerous behaviors by physical restraint and pharmacologic tranquillization is crucial to ensure the safety of the patient and health-care personnel and to allow diagnostic procedures and treatment of the underlying condition. The purpose of this article (the first in a 2-part series) is to review the extensive safety data published on the antipsychotic medications currently available for managing situations of this type, including older neuroleptics like haloperidol, chlorpromazine, and pimozide as well as a number of the newer atypical antipsychotics (olanzapine, risperidone, ziprasidone). Particular attention is focused on the ability of these drugs to lengthen the QT interval in surface electrocardiograms. This adverse effect is of major concern, especially in light of the reported relation between QT interval and the risk of sudden death. In patients with the congenital long-QT syndrome, a long QT interval is associated with a fatal paroxysmal ventricular arrhythmia knownas torsades de pointes. Therefore, careful evaluation of the QT-prolonging properties and arrhythmogenic potential of antipsychotic drugs is urgently needed. Clinical assessment of drug-induced QT-interval prolongation is strictly dependent on the quality of electrocardiographic data and the appropriateness of electrocardiographic analyses. Unfortunately, measurement imprecision and natural variability preclude a simple use of the actually measured QT interval as a surrogate marker of drug-induced proarrhythmia. Because the QT interval changes with heart rate, a rate-corrected QT interval (QTc) is commonly used when evaluating a drug’s effect. In clinical settings, themost widely used formulas for rate-correction are those of Bazett (QTc=QT/RR^0.5) and Fridericia (QTc=QT/RR^0.33), both of which standardize themeasuredQTinterval to an RRinterval of 1 s (heart rate of 60 bpm).However, QT variability can also be influenced by other factors that are more difficult to measure, including body fat, meals, psycho-physical distress, and circadian and seasonal fluctuations.

Psychophysical Distress and Alexithymic Traits in Chronic Fatigue Syndrome with and without Comorbid Depression

Patients with chronic fatigue syndrome (CFS) often report a comorbid depressive disorder. Comorbid depression may negatively influence the long-term outcome of CFS therefore it must be correctly diagnosed and treated. The aim of the present study is to provide a clinical and psychometric assessment of CFS patients with and without depressive features. A comparative analysis between 57 CFS subjects (CDC, 1994), 17 of whom with a comorbid depression, and 55 matched healthy volunteers was assessed to evaluate the presence of any psychophysical distress and alexithymic traits, by means of Symptom Checklist-90-R (SCL-90R) and Toronto Alexithymia Scale (TAS-20). The severity of fatigue was also assessed in all CFS patients using the Fatigue Impact Scale (FIS). With regard to psychiatric comorbidity, the SCL-90R scores showed higher levels of somatic complaints in CFS patients than in healthy subjects, whereas augmented depressive and obsessive-compulsive symptoms were observed only in the depressed CFS subgroup. When comparing the TAS-20 scores, we observed a selective impairment in the capacity to identify feelings and emotions, as measured by the Difficulty in Identifying Feelings subscale (DIF), non-depressed CFS patients showing an intermediate score between depressed CFS and healthy controls. Finally, in terms of FIS scores, a statistical trend versus a higher fatigue severity in depressed CFS patients, with respect to non-depressed ones, was observed. In conclusion, comorbid depression in CFS significantly increased the level of psychophysical distress and the severity of alexithymic traits. These findings suggest an urgent need to address and treat depressive disorders in the clinical care of CFS cases, to improve social functioning and quality of life in such patients.

Efficacia e tossicità della terapia farmacologica per il controllo del paziente acutamente agitato (I parte)

Acute agitation occurs in a variety of medical and psychiatric conditions, and the management of agitated, abusive, or violent patients is a common problem in the emergency department. Rapid control of potentially dangerous behaviors by physical restraint and pharmacologic tranquillization is crucial to ensure the safety of the patient and health-care personnel and to allow diagnostic procedures and treatment of the underlying condition. The purpose of this article (the first in a 2-part series) is to review the extensive safety data published on the antipsychotic medications currently available for managing situations of this type, including older neuroleptics like haloperidol, chlorpromazine, and pimozide as well as a number of the newer atypical antipsychotics (olanzapine, risperidone, ziprasidone). Particular attention is focused on the ability of these drugs to lengthen the QT interval in surface electrocardiograms. This adverse effect is of major concern, especially in light of the reported relation between QT interval and the risk of sudden death. In patients with the congenital long-QT syndrome, a long QT interval is associated with a fatal paroxysmal ventricular arrhythmia known as torsades de pointes. Therefore, careful evaluation of the QT-prolonging properties and arrhythmogenic potential of antipsychotic drugs is urgently needed. Clinical assessment of drug-induced QT-interval prolongation is strictly dependent on the quality of electrocardiographic data and the appropriateness of electrocardiographic analyses. Unfortunately, measurement imprecision and natural variability preclude a simple use of the actually measured QT interval as a surrogate marker of drug-induced proarrhythmia. Because the QT interval changes with heart rate, a rate-corrected QT interval (QTc) is commonly used when evaluating a drug's effect. In clinical settings, the most widely used formulas for rate-correction are those of Bazett (QTc=QT/RR^0.5) and Fridericia (QTc=QT/RR^0.33), both of which standardize the measured QT interval to an RR interval of 1 s (heart rate of 60 bpm). However, QT variability can also be influenced by other factors that are more difficult to measure, including body fat, meals, psycho-physical distress, and circadian and seasonal fluctuations.

Multidisciplinary Approach to the Treatment of Bone Metastases: Osteo-Oncology Center, a New Organizational Model

Bone metastases are responsible for high morbidity in cancer patients. The frequency of pain and other serious complications associated with such metastases depends on the site and type of lesions and preventive therapy. The present paper aims to inform the scientific community about a new organizational health care model specifically designed for patients with bone metastases, in the hope of stimulating the creation of similar initiatives whose goals are to decrease the high morbidity of this pathology, reduce the frequency of complications, limit psychophysical distress of patients, and improve quality of life. In January 2005, an Osteo-Oncology Center was opened in our institute to provide multidisciplinary care (19 specialists involved) for patients with bone metastases, to train physicians, and to conduct research in the field. In its first three years of activity, 601 multidisciplinary team consultations were made and a total of 425 patients were seen. The most frequent primary tumor site was the lung in males and the breast in females. Upon presentation at the Center, 79% of patients reported experiencing a level of pain (median pain intensity, 3.69) that interfered with normal daily activities. An anonymous questionnaire was also completed on the quality of the service provided: 75% of patients were very satisfied, 23% were satisfied, 1% responded "I don't know", and only 1% expressed dissatisfaction. Our preliminary results confirm the usefulness of a multidisciplinary center for the management of patients with bone metastases, especially in terms of decreasing psychophysical suffering.

Acculturation of Iranians in the United States, the United Kingdom, and the Netherlands

The present study tested the generalizability of a multidimensional individual difference acculturation (MIDA) model in three cultural contexts. The model includes three predictor variables (Psychosocial Resources, Connectedness, and Hassles), predicting three outcome adaptation variables (In-Group Contact, Out-Group Contact, and Psychophysical Distress). The roles of two dimensions of acculturation attitudes (toward Own Culture Maintenance and New Culture Acquisition) were also included in the model. The model was tested and validated with three samples of Iranian immigrants living in the United States, the Netherlands, and the United Kingdom. The results provided support for the multidimensional model. The relations between each variable in the model are discussed with reference to the demographic variation of the samples and the complexity of societal context.

Patients in a persistent vegetative state: caregiver attitudes and reactions.

This exploratory study investigated the problems encountered by caregivers of long-stay hospital patients in a persistent vegetative state. Sixteen primary caregivers completed questionnaires designed to assess their personality, psychophysical distress, coping strategies and caregiving-related problems. Males showed a higher level of emotional distress and neuroticism than females. All of the caregivers used situation-oriented coping strategies less over time. had apparently unsatisfactory family relationships, and their emotional distress increased with disease duration. The thoughts of the possible death of the patient were associated with anxiety and depressive symptoms. The caregivers' everyday lives were characterized by limited social relationships, and indoor and outdoor interests. Our study underlines the importance of psychosocially assessing PVS patient caregivers, who are often alone in coping with a irreversible situation. It also introduces a questionnaire (FSQ2) that seems to be sufficient to assess the caregiving-related problems.

Sex and Race in the Determinants of Psychophysical Distress: A Reappraisal of the Sex-Role Hypothesis

Sex and Race in the Determinants of Psychophysical Distress: A Reappraisal of the Sex-Role Hypothesis

Sex and Race in the Determinants of Psychophysical Distress: A Reappraisal of the Sex-Role Hypothesis

To explain zwmen's higher rates of psychological distress, researchers often argue that sex roles differentially expose the sexes to variables associated with distress or render zwmen and men unequally vulnerable to role-related stress. To test these claims, ut use National Center for Health Statistics data on physical symptoms of distress, collected during physical examinations for 6,672 adults. Using multiple regression, ur assess the independent effects of marital status, employment, occupation, income, and age. The sex-specific analyses reveal several significant race interactions but very few significant sex differences. We cannot reject the null hypothesis that men and uxmen are equally affected by paid employment. Rather, our results suggest that the sexes are differently exposed to sex-role related stress through different risks of disrupted marriages, unemployment and low income. Data from hospital admissions, psychiatric care, and community surveys indicate that married women's rates of psychological disress' exceed men's (Gove,a,b; Gove and Tudor,a,b; Pearlin; Radloff; Thoits; Tweed and Jackson; Warheit et al.; but see Dohrenwend and Dohrenwend,a,b, for a dissenting view). This difference might reflect either differential exposure or vulnerability (Kessler,b) to factors associated with emotional distress or an unequal propensity to report distress. Among unmarried women the difference is reversed (Gove,a; Radloff), so biological predisposition can*Earlier versions of this paper were read at the 1978 American Sociological Association meetings and at the Conference on the Future of the Family, University of Warsaw, Poland, December 1978. We are grateful to Michael R. Geerken, Walter Gove, Lowell L. Hargens, Karen Miller, and anonymous referees for helpful comments on earlier drafts of this paper, and to Carolyn Muffins for editorial assistance. We are, of course, responsible for any errors. This research was supported in part by an Indiana University Faculty Grant-in-Aid. Address correspondence to Barbara E Reskin, Department of Sociology, University of Michigan, Ann Arbor, MI 48109-1382.