Related Distress Research Articles

The Impact of Event Scale-Revised: Examining Its Cutoff Scores among Arab Psychiatric Patients and Healthy Adults within the Context of COVID-19 as a Collective Traumatic Event.

The Impact of Event Scale-Revised (IES-R) is the most popular measure of post-traumatic stress disorder (PTSD). It has been recently validated in Arabic. This instrumental study aimed to determine optimal cutoff scores of the IES-R and its determined six subscales in Arab samples of psychiatric patients (N = 168, 70.8% females) and healthy adults (N = 992, 62.7% females) from Saudi Arabia during the COVID-19 pandemic as a probable ongoing collective traumatic event. Based on a cutoff score of 14 of the Depression Anxiety Stress Scale 8-items (DASS-8), receiver operator curve (ROC) analysis revealed two optimal points of 39.5 and 30.5 for the IES-R in the samples (area under the curve (AUC) = 0.86 & 0.91, p values = 0.001, 95% CI: 0.80-0.92 & 0.87-0.94, sensitivity = 0.85 & 0.87, specificity = 0.73 & 0.83, Youden index = 0.58 & 0.70, respectively). Different cutoffs were detected for the six subscales of the IES-R, with numbing and avoidance expressing the lowest predictivity for distress. Meanwhile, hyperarousal followed by pandemic-related irritability expressed a stronger predictive capacity for distress than all subscales in both samples. In path analysis, pandemic-related irritability/dysphoric mood evolved as a direct and indirect effect of key PTSD symptoms (intrusion, hyperarousal, and numbing). The irritability dimension of the IES-R directly predicted the traumatic symptoms of sleep disturbance in both samples while sleep disturbance did not predict irritability. The findings suggest the usefulness of the IES-R at a score of 30.5 for detecting adults prone to trauma related distress, with higher scores needed for screening in psychiatric patients. Various PTSD symptoms may induce dysphoric mood, which represents a considerable burden that may induce circadian misalignment and more noxious psychiatric problems/co-morbidities (e.g., sleep disturbance) in both healthy and diseased groups.

Chelsea Manning, national security, and the cishetero/homonormative logics of protection

Abstract‘I feel like a monster’, typed Chelsea Manning, referring partly to her gender identity but mostly to her job in the US military. Morally conflicted by what she saw and read while serving in Iraq, extremely isolated from her unit and experiencing emotional distress in relation to her gender identity, Manning would act on these stressors by leaking hundreds of documents to Wikileaks, and coming out as a (trans) woman. While she was quick to be classified as either a hero or a traitor, her case evades such dichotomisation and calls for more sophisticated readings. While a lot has been written on Manning in queer and transgender studies, surprisingly little has been published on this case in International Relations, not even in the quickly growing field of Queer IR. Yet Manning’s case helps highlight many of its core concerns in relation to issues of power, security, and sovereignty. In fact, what is often lost when reading the Manning case are the queer and trans logics of protection that were disrupted by Manning’s disclosures and that made such disruption possible. These dominant logics rely upon a culture of secrecy that must be preserved for performances of national security to hold true.

STUDY OF DEPRESSION, ANXIETY & STRESS AMONG FAMILY MEMBERS OF HOSPITALIZED COVID-19 PATIENTS IN A TERTIARY CARE HOSPITAL OF CENTRAL GUJARAT.

Background: COVID-19 pandemic has caused mental health issues along with physical, social, and economic issues in both patients and their relatives.COVID-19-positive patients were hospitalized in isolation with no or limited access to relatives. These conditions may have contributed to signicant psychological distress in relatives and this study was designed to assess the same. Objectives: To nd the prevalence of Depression, Anxiety, and Stress among Relatives of hospitalized COVID-19 patients. Methods: A cross-sectional quantitative tertiary care hospital-based study was conducted after approval from Institutional Human Ethics Committee. Relatives of hospitalized COVID-19 patients were assessed by purposive sampling method using Semi-Structured Performa including socio-demographic details, illnessrelated details, and DASS-21 (Depression, Anxiety, and Stress scale-21) via a telephonic mode of interview. Results: A total of 200 relatives of COVID-19 positive turned negative patients were interviewed on the rst day of the COVID 19 negative report. Majority of participants were male,mean age 41 years,literate,married & having rst degree relation with the patient. The prevalence of Depression, Anxiety and Stress was 12%. On individual parameters, Depression, Anxiety and Stress was found 25%,21%,and 20% respectively. Female relatives were signicantly associated with depression (χ2= 8.689,P=.003) & anxiety(χ2= 5.790,P=.016) where as longer hospitalization was signicantly associated with anxiety(χ2= 10.216,P=.006) and stress(χ2= 8.936,P=.011). Conclusions: Relatives of COVID-19 patients had a signicant amount of psychological stress. Female gender of relatives and longer duration of hospitalization of patients were important predictors

Feasibility and effect of a self-help online acceptance and commitment therapy program focused on repetitive negative thinking for Colombian young women

Online psychological interventions (OPI) are evidence-based programs that provide mental health treatment over the internet. Meta-analytic data suggests that OPI's effectively treat emotional symptomatology. RNT-focused ACT consider psychological inflexibility and RNT as trans-diagnostic process that significantly predict emotional symptomatology. The present study analyzed the effect of a self-help OPI which contents have previously shown content validity, user feasibility and effectivity. This is an open trial design with repeated measures of emotional symptomatology and behavioral change processes. Bayesian analysis of variance for repeated measures was conducted with JASP for each variable, Bayes Factors (BF10) determined how much the evidence favored OPI effect. Effect sizes, reliable and significant change and moderation analyses were also conducted. 18 cisgender women around 30 years old mostly heterosexual, single and unemployed finished the OPI. There is decisive evidence for OPI effect on emotional symptomatology and behavioral change processes (experiential avoidance, cognitive fusion and RNT). There is also anecdotal evidence for the moderating role of the number of hierarchical RNT triggers (abstract private events), their type and intimate partner relationship distress as well as anecdotal evidence against the moderating role of being a psychologist. Results need to be considered in the context of the study limitations and future research should explore the program's feasibility and effect in other populations and cultures. However, the program is feasible and efficacious for the treatment of emotional symptomatology at least for young cisgender women in Colombia.

Echocardiographic detection of transpulmonary bubble transit during coronavirus-2019 disease (COVID-19)

BackgroundTranspulmonary bubble transit (TPBT) detected with contrast echocardiography is reported as a sign of intrapulmonary arteriovenous shunt. However, its pathological meaning is not clear during coronavirus-2019 disease (COVID-19) related acute respiratory distress syndrome (ARDS). Our aim was to determine the prevalence and clinical significance of TPBT detection during COVID-19 related ARDS. MethodsWe carried out a prospective observational study performed in a high complexity intensive care unit from Argentina. Patients with COVID-19 related ARDS underwent transthoracic echocardiography with saline contrast. Moderate-to-large TPBT was defined as right-to-left passage of at least twelve bubbles to left chambers after at least three cardiac cycles and complete opacification of the right atrium. ResultsWe analyzed the results of 28 patients (24 men and 4 women). Seventy-five percent of the patients received invasive mechanical ventilation. Moderate-to-large TPBT was detected in 1 patient (3.5%). Among the 27 patients without significant TPBT, 23 had no TPBT and 4 had a minor TPBT. TPBT was not associated with invasive mechanical ventilation requirement (p=0.5737) nor in-hospital mortality (p=1). ConclusionsTPBT was not associated with severe hypoxemia or invasive mechanical ventilation requirement, although more studies are needed to further clarify its contributing role in COVID-19 hypoxemia.

The Impact of COVID-19 Related Distress on Antenatal Depression in Australia

Globally, the impact of COVID-19 on mental health has been significant. Pregnant women are known to be a vulnerable population in relation to mental health. In Australia, there was an unprecedented demand during the pandemic for mental health services, including services for pregnant women. Maternal mental health has unique and enduring features that can significantly shape a child's overall development and poor maternal mental health can have considerable social and economic costs. This cross-sectional study evaluated symptoms of antenatal depression and COVID-19-related distress in a sample of two hundred and sixty-nine pregnant women residing in Australia aged between 20 and 43 (M = 31.79, SD = 4.58), as part of a larger study. Social media advertising was used to recruit participants between September 2020 and November 2021. Prevalence rates for antenatal depression were found to be higher in this study (16.4%) compared with previous Australian prevalence rates (7%). COVID-19 distress in relation to having a baby during a COVID-19 outbreak significantly predicted symptoms of antenatal depression, B = 1.46, p < 0.001. Results from this study suggest that mothers and families may have increased mental health vulnerabilities as a consequence of the pandemic for some time yet.

MEASURING THE LEVEL OF PSYCHOLOGICAL DISTRESS AND ITS IMPACT ON QUALITY OF LIFE AMONG INFERTILE WOMEN IN SOUTH PUNJAB, PAKISTAN

This research study was planned to check the level of psychological distress in relation with the infertility among women. This study also explored the impact of this psychological distress with the level of quality of life among women. In this connection, a sample of (N=284) was approached by using purposive sampling technique. To measure the variables two valid and reliable scales were administered and the collected responses were further analyzed by using SPSS. The results revealed that the infertile women were facing moderate level of psychological distress. Both the level of depression and anxiety were at moderate level among the infertile women. Similarly, the quality of life was lower among infertile women. The analysis also showed that the women with anxiety and depression scored lower quality of life scale. Furthermore, there was a significant correlation between psychological distress i.e. depression and anxiety with the level of quality of life among infertile women. On the basis of results, the study concluded that infertile women are suffering from anxiety and depression with lower level of quality of life. Hence, there is a dire need to address this issue and implement some interventions to reduce the level of psychological distress and uplift the quality of life of infertile women in south Punjab, Pakistan. Keywords: Anxiety, Depression, Infertility, Quality of life, Psychological distress.

Pain intensity and psychological distress show different associations with interference and lack of life control: A clinical registry-based cohort study of >40,000 chronic pain patients from SQRP.

Both chronic pain and depressive and/or anxiety symptoms are associated with negative impacts on daily living, including interference and lack of life control. However, little is known about how pain and psychological distress affect these impacts. The first aim was to assess how pain intensity, psychological distress, and social support interact with interference and lack of life control. A second aim was to investigate whether the strength of these relationships is moderated by the presence or absence of depression and/or anxiety. Patient-Reported Outcome Measures (PROMs), which are available in the Swedish Quality Registry for Pain Rehabilitation (SQRP), were retrieved for patients with chronic pain (N = 40,184). A theoretical model with the constructs/latent variables pain intensity, psychological distress, interference, lack of life control, and social support was proposed and analyzed using Partial Least Squares Structural Equation Modelling (PLS-SEM). Indicators for these constructs were identified from the PROMs of the SQRP. Two models of the total cohort, which differed with respect to the causal relationship between pain intensity and psychological distress, were investigated. The moderating effects of anxiety and/or depression were also analyzed. Relatively low correlation and explanatory power (R 2 = 0.16) were found for the pain intensity-psychological distress relationship. Pain intensity had a stronger effect on interference than on lack of life control. The reverse was found for psychological distress - i.e., psychological distress seemed to have a higher negative influence on function than on interference. The underlying assumption of the causal relationship between pain intensity and psychological distress determined how strong pain intensity and psychological distress influenced interference and lack of life control. Social support showed very similar absolute significant correlations with interference and lack of life control. Interference and lack of life control showed relatively weak associations. The psychological distress level was a moderating factor for several of the paths investigated. A clinical treatment consequence of the low correlation between pain intensity and psychological distress may be that clinically treating one may not reduce the effect of the other. The relative importance of pain intensity and psychological distress on interference and lack of life control depends on the underlying assumption concerning the pain intensity-psychological distress relationship. Interference and lack of life control showed relatively weak associations, underscoring the need to clinically assess them separately. Social support influenced both impact constructs investigated. The cohort display heterogeneity and thus presence of definite signs of anxiety and/or depression or not was a moderating factor for several of the associations (paths) investigated. The results are important both for the assessments and the design of treatments for patients with chronic pain.

Learning how relationships work: a thematic analysis of young people and relationship professionals’ perspectives on relationships and relationship education

IntroductionRelationships in various forms are an important source of meaning in people’s lives that can benefit their health, wellbeing and happiness. Relationship distress is associated with public health problems such as alcohol misuse, obesity, poor mental health, and child poverty, whilst safe, stable, and nurturing relationships are potential protective factors. Despite increased emphasis on relationship education (RE) in schools, little is known about the views of relationship professionals on relationship education specifically, and how this contrasts with the views of young people (YP).ObjectivesThis Wellcome Centre for the Cultures and Environments of Health funded Beacon project seeks to fill this gap by exploring their perspectives and inform the future development of relationship education.MethodsWe conducted focus groups with YP (n=4) and interviews with relationship professionals (n=10). The data was then thematically analysed.ResultsThemes from YP focus groups included: ‘Good and bad relationships’; ‘Learning about relationships’; ‘the role of schools’ and ‘Beyond Relationship Education’. Themes from interviews with relationship professionals included: ‘essential qualities of healthy relationships’; ‘how YP learn to relate’ and ‘the role of RE in schools’.ConclusionsYP and relationship professionals recognised the importance of building YP’s relational capability in schools with a healthy relationship with oneself at its foundation. Relationship professionals emphasised the need for a developmental approach, stressing the need for flexibility, adaptability, commitment and resilience to maintain relationships over the life course. YP often presented dichotomous views, such as relationships being either good or bad relationships, and perceived a link between relationships and mental health. Although not the focus of current curriculum guidance, managing relationship breakdowns and relationship transitions through the life course were viewed as important with an emphasis on building relational skills. This research suggests that schools need improved RE support, including specialist expertise and resources, and guidance on signposting YP to external sources of help. There is also potential for positive relationship behaviours being modelled and integrated throughout curriculums and reflected in a school’s ethos. Future research should explore co-development, evaluation and implementation of RE programmes with a range of stakeholders.Disclosure of InterestNone Declared

Relationships Between Burnout and Resilience: Experiences of Physical Therapists and Occupational Therapists During the COVID-19 Pandemic.

Research on burnout among physical therapists and occupational therapists in the context of the coronavirus disease 2019 (COVID-19) pandemic is limited. Resilience may be important for reducing burnout and promoting well-being among rehabilitation specialists, especially during periods of elevated occupational demand and stress. The purpose of this study was to investigate experiences of burnout, COVID-19 pandemic-related distress, and resilience among physical therapists and occupational therapists during the first year of the COVID-19 pandemic. Physical therapists and occupational therapists working in a university-affiliated health system were invited to complete an online survey assessing burnout, COVID-19 pandemic-related distress, state- and trait-like resilience, physical activity, sleep disturbance, and financial concerns. Multiple linear regressions were used to examine variables associated with burnout as well as the contribution of specific aspects of resilience to burnout. Greater COVID-19 pandemic-related distress was associated with greater emotional exhaustion and depersonalization, whereas state-like resilience at work was associated with lower emotional exhaustion, greater personal accomplishment, and lower depersonalization. Analyses examining the impact of specific components of resilience at work suggested that several components are associated with less burnout, with finding one's calling being particularly relevant for all 3 domains of burnout. Symptoms of burnout were reported by many physical therapists and occupational therapists. COVID-19-related distress and state-like resilience at work, particularly the perception of finding one's calling, emerged as consistently being associated with burnout in the context of the COVID-19 pandemic. These findings can inform the development of interventions to reduce burnout among physical therapists and occupational therapists amid the continuing COVID-19 pandemic.

Social support, distress and well-being in individuals experiencing Long-COVID: a cross-sectional survey study

ObjectivesIncreasingly attention of the COVID-19 pandemic is directed towards its long-term effects, also known as Long-COVID. So far, Long-COVID was examined mainly from a medical perspective, leaving psychosocial effects of...

MOTHER-CHILD RELATIONSHIP IN THE CONTEXT OF DOMESTIC VIOLENCE

IntroductionMother-child relationship has a major role in a child’s cognitive, emotional and behavior shaping. Unfortunately, in the context of domestic violence, this relationship can be negatively impacted becoming strained or distant.ObjectivesTo assess the quality of Mother-Child Relationship in the context of domestic violence or intimate partner violence. And to investigate the factors influencing negatively the Mother-Child Relationship.MethodsThis is a descriptive and analytical cross-sectional study, conducted among abused women and their children, recruited from associations combatting violence against women, from Moulay abdellah hospital of Salé, and from consultation at the university psychiatric hospital Arrazi of Salé, through a hetero-questionnaire that includes socio-demographic characteristics and scales measuring the quality of mother-child relationship (IPA, CAM) and psychological distress of the mother and the child (EMMDP).ResultsFrom the results observed in women and children recruited in our study, we retain that various elements are impacting the mother-child relationship, such as psychological maternal functioning, child’s behavior functioning, parenting qualities, insecurity of child’s attachment, unhealthy internalized representations…ConclusionsA better understanding of the factors influencing mother-child relationship, can allow us to offer more tailored supports and could enable interventions promoting recovery and women’s and children’s well-being in the context of domestic violence.Disclosure of InterestNone Declared

PSYCHOLOGICAL DISTRESS AND ACADEMIC SELF-EFFICACY OF COLLEGE STUDENTS: THE MODERATING ROLE OF ANXIETY AMIDST THE COVID-19 PANDEMIC

The distress and anxiety brought about by the academic demands negatively influences student performance during the abrupt shift to full-online classes. However, the literature indicates that self-efficacy significantly alleviates the negative effect of distress and anxiety.The current study aims to determine the relationship of COVID-19 related distress and academic self-efficacy as well as investigate if anxiety is a moderator that aggravates the distress of Angeles University Foundation college students. A total of 223 college students’ participants were acquired from a voluntary convenience sample and participants answered the questionnaires through Google Forms, namely: The Online Learning Self-Efficacy (OLSE), The Kessler Psychological Distress Scale (K6), and The Coronavirus Pandemic Anxiety Scale (CPAS-11). Additionally, all statistical analyses were conducted using SPSS 23. Moreover, the hierarchical regression was conducted to determine if COVID-19 distress predicted academic self-efficacy (ASE) with anxiety as the moderator. The findings indicate that COVID-19 distress and anxiety negatively affect the beliefs of the students in their capacity to perform academic tasks. However, evidence failed to support the moderating role of anxiety between Covid-19 distress and academic self-efficacy.

Psychological distress in relation to blood pressure among Andhra Pradesh state road transport corporation bus drivers, Vijayawada

Background: One of the major health problem worldwide is elevated blood pressure (BP). Prior research had shown that hypertensives experience psychological distress, although pre-hypertensives have not yet been subject to this research. Objectives were to assess the major risk factors of increasing BP among bus drivers and to assess psychological distress in relation to BP levels. Methods: A cross sectional study was conducted among Bus drivers aged above 20 years, study was carried out between July to October of 2022, a sample of 135 was taken. Inferential statistics such as Pearson Chi square test and an unpaired independent-sample t-test was used to assess the difference between pre-hypertensive and hypertensive individuals on GHQ score. Results: In the present study (n=135), 47% were normotensive, 34% were in hypertensive stage and 19% were in pre-hypertensive stage. On assessment of psychological distress in relation to BP among bus drivers the mean of (General health questionnaire) GHQ-12 was found to be 17.57 among hypertensives and 17.86 among pre-hypertensives. Two tailed significance value of 0.768 was observed between pre-hypertensive and hypertensive individuals indicating that psychological distress had significant effects. Conclusions: The prevalence of hypertension and pre-hypertension was among bus drivers, leading to cardio vascular diseases which in turn causes increased morbidity and mortality, lowering individual productivity and having an impact on the national economy. The prevalence of non-communicable diseases should be monitored by lifestyle changes and periodic screenings.

Traumatic brain injury and relationship distress during military deployment and reunion

AbstractObjectiveThis study seeks to advance the literature by disentangling the effects of deployment‐acquired traumatic brain injury (TBI) from comorbid postconcussive symptoms and PTSD symptoms on relationship distress.BackgroundBecause TBI poses challenges to military marriages, understanding the predictors of relationship distress after TBI is important for helping service members cope with the effects of the injury.MethodSurvey data from the U.S. Army STARRS Pre–Post Deployment Study, collected from 2,585 married service members before and after a combat deployment to Afghanistan, evaluated predictors of relationship distress 9 months after homecoming.ResultsDeployment‐acquired TBI corresponded with more relationship distress controlling for predeployment brain health, but its predictive power was eclipsed by concurrent postconcussive symptoms and concurrent PTSD symptoms. Concurrent PTSD symptoms accounted for twice as much variance in relationship distress than concurrent postconcussive symptoms.ConclusionTargeting and treating comorbid conditions may be essential for supporting military marriages after TBI.Implications: Military command, policymakers, and medical professionals may find value in broadening support services for TBI to include resources addressing postconcussive symptoms, PTSD symptoms, and relationship distress.

A trifecta: patterns in orgasm consistency, relational satisfaction, and sexual satisfaction.

We based this study on the sexual wholeness model, which considers emotional, physical, and meaning elements of sexuality, and previous research that indicates variability in the associations among orgasm consistency, relational satisfaction, and sexual satisfaction. We performed a person-based latent class approach to examine variables linked with the trifecta of orgasm consistency, relational satisfaction, and sexual satisfaction. We used a Mechanical Turk sample that consisted of 1645 sexually active participants (1032 women) to evaluate classes and related variables. Women divided into 5 classes and men into 3 classes. High orgasm consistency alone did not ensure sexual or relational satisfaction. We found that 5 groups emerged for women: high orgasm/low satisfaction (6%), low trifecta (8%), low orgasm/high satisfaction (16%), moderate orgasm/high satisfaction (15%), and high trifecta (55%). For men, 3 groups emerged: lower orgasm/high satisfaction (12%), moderate trifecta (14%), and high trifecta (74%). We also found that high orgasm consistency for women did not guarantee relational and sexual satisfaction, nor did lower orgasm consistency for men or women guarantee problematic relational and sexual satisfaction. Communication, attachment, and sexual harmony were key elements associated with positive trifecta outcomes. Clinicians and educators may emphasize the importance of these variables when individuals encounter sexual or relational distress. Data analytic techniques revealed a variety of groups for men and women and associations between a host of physical, psychological, and meaning variables and the trifecta of orgasm consistency, relational satisfaction, and sexual satisfaction. However, this study is cross-sectional and correlational, which limits the conclusions that we can draw from it. While the variables of orgasm consistency, relational satisfaction, and sexual satisfaction are each informative, together they help clinicians, educators, and researchers better understand the complexity of sex.

Bereavement outcomes of carers of patients with high grade glioma: Experiences of support before and after the death

Carers of people with High Grade Glioma (HGG) completed a survey assessing their anxiety, depression, and grief in addition to open-ended questions exploring their experiences of support pre- and post-death (N = 25). One-third reported borderline or clinical levels of anxiety, depression, and grief related distress. Given the poor prognosis and rapid deterioration of patients with HGG, the findings highlight the importance of sensitive communication about prognosis early in the disease trajectory, information tailored to disease stage, the initiation of a referral to psychological support services, and timely discussions about the preferred place of care and death.

A confirmatory factor analysis of a cognitive model of COVID-19 related anxiety and depression

The mental health impact of the COVID-19 pandemic has been significant, with many regions across the globe reporting significant increases in anxiety, depression, trauma, and insomnia. This study aims to validate a potential cognitive model of maintenance factors of COVID-19 related distress by examining psychological predictors of distress, and their goodness-of-fit as a coherent model. Participants from the general population (n = 555) were recruited using a cross-sectional on-line survey design, assessing Demographic factors, Anxiety, Depression, Loneliness, COVID-19 related distress, Trauma Cognitions related to COVID-19, Rumination, Safety Behaviours, Personality Factors, and Mental Effort related to COVID-19. A series of stepwise linear regressions found that components of the model were significant and accounted for a large percentage of variance when examining Covid-19 related distress (R2 = 0.447 Covid Stress Scale), Anxiety (R2 = 0.536 DASS-Anxiety Subscale) and Depression (R2 = 0.596 Depression DASS-subscale). In a confirmatory factor analysis, Loneliness, Post-Traumatic Cognitions about Self, Post-Traumatic Cognitions about the World, Emotional Stability, and Mental Effort related to COVID-19 loaded onto a single factor. The final model showed adequate fit (CFI = 0.990, TLI = 0.983, RMSEA = 0.053 (0.027–0.080), GFI = 0.986, SRMR = 0.0216, χ2 = 23.087, p = .006). The results highlight the importance of cognitive factors, such as post-traumatic cognitions, rumination, and mental effort in maintaining COVID-19 related distress.

How does corporate social responsibility affect financial distress? The moderating role of corporate governance

PurposeThis study aims to investigate the impact of corporate social responsibility (CSR) on the financial distress (FD) of firms listed on the Pakistan Stock Exchange (PSX). Furthermore, the moderating effect of corporate governance (CG) on the CSR–distress relationship is investigated in this study.Design/methodology/approachThe final sample of the study includes 117 companies from 2008 to 2021. The sample firms' CSR engagement is assessed using a multidimensional financial approach, and the likelihood of FD is determined using Altman's Z-score. The governance level is measured using the governance index, which includes 29 governance provisions. To achieve the research objectives, the system generalized method of moments estimator is used. Furthermore, several tests are performed to assess the robustness of the study's findings. The analysis was carried out using STATA software version 15.FindingsThe authors find that CSR is significantly inversely related to FD. The governance mechanism was discovered to be inversely related to FD. Furthermore, corporate governance strengthens the negative relationship between CSR and FD. In addition, the authors find that CSR is significantly inversely related to FD in firms with strong CG mechanisms but has no effect on FD in firms with weak CG mechanisms.Practical implicationsThe findings of this study provide policymakers, business managers, regulators and investors with a better understanding of the relationship between the quality of CSR investments and the likelihood of FD in Pakistani firms, as well as the role of CG in this context.Originality/valueThis study contributes to our understanding of the role of CG in the CSR-distress relationship in an emerging market. This suggests that policymakers should prioritize CG quality while anticipating the impact of CSR on corporate FD.

The relationship of social determinants and distress in newly diagnosed cancer patients

Patients with a new cancer diagnosis can experience distress when diagnosed. There are disparities in treatment of cancer patients based on social determinants, but minimal research exists on the relationship of those social determinants and distress after a new cancer diagnosis. Our goals were to determine the social determinants associated with distress after a new cancer diagnosis and determine the relationship of distress with outcome. Patients with a new cancer diagnosis at one institution from January 2019 to December 2020 were analyzed. Patients were given the National Comprehensive Cancer Network (NCCN) distress thermometer during their first visit. Demographics, tumor characteristics, clinical variables and survival were recorded. Patients were also asked to share specific factors that led to distress, including: (1) financial, (2) transportation, (3) childcare and (4) religious. A total of 916 patients returned distress thermometers. Mean age was 59.1 years. Females comprised 71.3 (653/916) percent of the cohort. On Dunn’s multiple comparison, the following factors were associated with increased distress level: female (p < 0.01), ages 27 to 45 (p < 0.01), uninsured (p < 0.01) and unemployed (p < 0.01). Patients with higher distress scores also experienced worse overall survival (p < 0.05). Females, young patients, uninsured patients and unemployed patients experience more distress after a new cancer diagnosis. Increased distress is independently associated with worse overall survival. Social determinants can be used to predict which patients may require focused interventions to reduce distress after a new cancer diagnosis.