Related Distress Research Articles

A Retrospective Observational Study of Problems Faced by Children and Adolescents with Cancer: A 5-year Experience from a Pediatric Psycho-Oncology Service in India

AbstractIntroduction Psychological concerns are common in children and adolescents with cancer, for which they require referral to specialist services. There is a dearth of pediatric psycho-oncology services in India. There are limited studies on emotional and related distress in children.Objectives To evaluate the types of problems and associated factors in children and adolescents with cancer referred to the pediatric psycho-oncology service in a tertiary care oncology center in India.Materials and Methods A retrospective analysis of all referrals to the institution's pediatric psycho-oncology service over 5 years was performed. Patients newly referred to the service, up to 18 years of age, with a cancer diagnosis, on active disease-modifying treatment or supportive care or following up within 2 years of completion of treatment were included. Patients not on any disease-modifying treatment and receiving the best supportive care only were excluded as needs and problems would differ in this group. Patients whose medical records were incomplete were excluded too. Descriptive measures and tests of association were performed for analysis.Results Of the 278 children referred to the service in 5 years, 66.5% were males. The average age was 11 years (standard deviation [SD]: 4.5). Most children had hematolymphoid cancers (58.2%). All reported problems were mainly emotional/behavioral (59%), physical health-related (21%), and academic (14%). Male children, referred from outpatient clinics and undergoing treatment with palliative intent, had more emotional problems, but these factors were not statistically significant.Conclusion Children and adolescents with cancer had different problems, most commonly emotional/behavioral and physical health-related. Age, gender, and treatment intent were factors associated with emotional problems. Psychosocial care services for children and adolescents with cancer are necessary for low-resource settings.

Patterns of Psychological Distress and Well-Being among Adults in Relation to Gender during COVID-19 Pandemic

AbstractCoronavirus disease-2019 (COVID-19) pandemic has led to the worsening of mental health of people in terms of increased psychological distress and decreased psychological well-being. The study was designed to understand the influence of COVID-19 pandemic on psychological distress and well-being. Present study also explored the variances in psychological distress and well-being in relation to development stages (young adulthood and adulthood), gender (males and females), people who had been infected by coronavirus and those not infected, and respondents whose immediate family members/relatives/friends/classmates had been infected by coronavirus and those not infected. An online survey was conducted in the midst of the pandemic. Responses of 250 respondents were gathered and analysed using the General Well-being Questionnaire developed by Veit and Ware in 1983. The results indicated that COVID-19 pandemic played a significant role in determining psychological distress and well-being. Gender differences in psychological distress and well-being are present with males being high on psychological distress and females being high on psychological well-being. Adults were found to be high on psychological distress than young adults. It was also revealed that as a person (respondent himself/immediate family/friends/relatives) becomes infected and recovers, their psychological distress declines, and well-being increases, probably because of reduced fear of being infected again. Along with other demographic variables, developmental stages and gender differences also played a crucial role in psychological distress and well-being of adults.

Eight-Year Retrospective Study of Young Adults in a Diabetes Transition Clinic.

The transition of people from paediatric to adult diabetes services is associated with worsening glycaemia and increased diabetes-related hospitalisation. This study compared the clinical characteristics of those with and without mental health conditions among attenders at a diabetes young adult clinic diabetes before and after changes in service delivery. Retrospective audit of 200 people with diabetes attending a Sydney public hospital over eight years corresponding to the period before (2012–2016) and after (2017–2018) restructuring of a clinic for young adults aged 16–25 years. Characteristics of those with and without mental health conditions (depression, anxiety, diabetes related distress, eating disorders), were compared. Among clinic attenders (type 1 diabetes n = 184, 83.2%), 40.5% (n = 89) had a mental health condition particularly, depression (n = 57, 64%), which was higher among Indigenous than non-Indigenous people (5.6% vs. 0.8%, p = 0.031) but similar between diabetes type. Over eight years, those with, compared with those without a mental health condition had higher haemoglobin A1c (HbA1c) at the last visit (9.4% (79 mmol/mol) vs. 8.7% (71 mmol/mol), p = 0.027), the proportion with diabetic ketoacidosis (DKA 60.7% vs. 42.7%, p = 0.009), smoking (38.4 vs. 13.6%, p = 0.009), retinopathy (9.0 vs. 2.3%, p = 0.025), multiple DKAs (28.4 vs. 16.0%, p = 0.031) were significantly higher. Having a mental health condition was associated with 2.02 (95% confidence intervals 1.1–3.7) fold increased risk of HbA1c ≥9.0% (75 mmol/mol). Changes to the clinic were not associated with improvements in mental health condition (39.0% vs. 32.4%, p = 0.096). In conclusion, we found that mental health conditions, particularly depression, are common in this population and are associated with diabetes complications. Diabetes type and clinic changes did not affect the reported mental health conditions. Additional strategies including having an in-house psychologist are required to reduce complication risks among those with mental health conditions.

Mediating mechanisms for maternal mental health from pre- to during the COVID-19 pandemic: Mediators of maternal mental illness during COVID-19.

BackgroundMothers have experienced a near doubling of depression and anxiety symptoms pre- to during the COVID-19 pandemic. The identification of mechanisms that account for this increase can help inform specific targets for mental health recovery efforts. The current study examined whether women with higher levels of depression and anxiety symptoms pre-pandemic, reported higher levels of depression and anxiety symptoms during the pandemic, and whether these increases were mediated by perceived stress, strained relationships, coping attitudes, participation in activities, alcohol use, and financial impact.MethodsMothers (n = 1,333) from an ongoing longitudinal cohort (All Our Families; AOF) from Calgary, Alberta, Canada, completed online questionnaires prior to (2017–2019) and during the COVID-19 pandemic (May-July 2020). Mothers reported on depressive and anxiety symptoms pre- and during the pandemic, as well as perceived stress, engagement in physical and leisure activities, coping, alcohol use, and financial impact of the pandemic.ResultsIn unadjusted analyses, maternal depression and anxiety symptoms pre-pandemic were strongly associated with COVID-19 depressive (r = 0.57, p<.01) and anxiety symptoms (r = 0.49, p<.01). Significant indirect effects between maternal depressive symptoms pre- and during COVID-19 were found for coping behavior (abcs=0.014, 95%CI=0.005, 0.022, p=.001), perceived stress (abcs=0.22, 95%CI=0.179, 0.258, p<.001), and strained relationships (abcs=0.013, 95%CI= 0.005, 0.022, p=.003). For maternal anxiety symptoms pre- and during COVID-19, significant indirect effects were observed for perceived stress (abcs=0.012, 95%CI=0.077, 0.154, p=.003) and strained relationships (abcs=0.010, 95%CI=0.001, 0.018, p=.03).ConclusionsPerceived stress, coping attitudes, and interpersonal relationships are three potential intervention targets for mitigating COVID-19 related mental distress in mothers.

An Exploration of Dyadic Relationship Approach-Avoidance Goals and Relationship and Sexual Satisfaction in Couples Coping with Endometriosis.

Endometriosis affects women of reproductive age and is associated with higher levels of sexual and relational distress. Despite the relational context of endometriosis, the research pertaining to dyadic relationship goals is lacking. An exploration of the relationship goals of couples coping with endometriosis can facilitate the understanding of potential protective mechanisms that mitigate the relational components of the condition. Guided by the approach-avoidance theoretical framework, the current cross-sectional study aimed to examine the role relationship goals play in sexual and relationship satisfaction in couples coping with endometriosis. Approach goals relate to the pursuit of a positive outcomes, whereas avoidance goals relate to the avoidance of negative outcomes. Women with endometriosis and their partners (N = 61) completed an online survey measuring relationship goals and relationship and sexual satisfaction. The study results indicated that, for women, their own and their partner's higher relationship approach goals were linked to higher sexual satisfaction. For partners of women with endometriosis, their own higher relationship approach goals were associated with their own higher relationship satisfaction. Higher relationship avoidance goals in both women with endometriosis and partners were associated with higher relationship satisfaction. The study's findings highlight relationship goals as relevant to the relational and sexual experience of couples coping with endometriosis. When treating women with endometriosis, the inclusion of partners and consideration of factors beyond the physical illness are important for a holistic management approach.

Mindfulness May Buffer Psychological Distress in Adolescents during the COVID-19 Pandemic: The Differential Role of Mindfulness Facets.

The COVID-19 pandemic strongly impacts adolescents’ mental health, a population particularly vulnerable to mental disorders, highlighting the need to identify protective factors against COVID-19 related psychological distress to inform policies and intervention strategies. Previous research suggests that mindfulness may be a promising factor that can lower the risk of detrimental psychological consequences related to the COVID-19 pandemic. However, it is currently unknown which aspects of mindfulness contribute most to its protective effects. Moreover, previous studies mainly focused on adult samples. The present study aimed to address this gap by investigating the impact of specific mindfulness facets on adolescents’ COVID-19 related psychological functioning. 246 Dutch-speaking adolescents were recruited via social media to complete a cross-sectional online survey between June 29 and October 11, 2020. Participants were 16–18 years of age, most of them women (71%), and the majority followed the highest level of Belgian secondary education. Logistic regression analyses were performed to test the differential effects of each mindfulness facet on psychological functioning. Our results identified decentering as the facet of mindfulness that was uniquely associated with decreased worry and stress, improved mental health and quality of life, as well as with an increase in social connectedness with others following the outbreak of the COVID-19 pandemic. Unexpectedly, decentering was negatively associated with adolescents’ helping behaviour during compared to before the pandemic. Implications for research on and application of mindfulness are discussed. Taken together, these findings suggest that the facet of decentering, among all facets of mindfulness, may represent the main protective factor against psychological distress during the COVID-19 pandemic.

The interplay of self-critical rumination and resting heart rate variability on subjective well-being and somatic symptom distress: A prospective study

ObjectiveThe aim of this prospective study was to investigate the association of self-critical rumination, autonomic function (indexed by a time domain metric of resting heart rate variability-RMSSD), subjective well-being and somatic symptom distress. Method84 healthy participants (73 females; mean age = 23.56, SD = 3.35 years) completed the Somatic Symptom Severity Scale of the Patient Health Questionnaire and Mental Health Continuum Short Form at two timepoints (at baseline and six months later). Resting heart rate variability (HRV) was assessed at baseline, along with content specific rumination using the Self-Critical Rumination Scale. Four moderation analyses were performed to test these associations. ResultsThe interaction between resting HRV and self-critical rumination significantly explained somatic symptom distress at baseline. For those participants who had high resting HRV, somatic symptom distress was basically independent from the level of self-critical rumination. At the same time, lower resting HRV was associated with higher somatic symptom distress, especially in the presence of more ruminative thoughts. Prospectively, however, the interaction between rumination and resting HRV was not a significant predictor of somatic symptom distress. The association between resting HRV and self-critical rumination did not explain the variance on subjective well-being, but subjective well-being was negatively related to self-critical rumination. ConclusionOur findings potentially indicate that self-critical rumination could have a long-term negative impact on psychological functioning, even in a non-clinical sample, and highlight that a lower level of parasympathetic activation, assessed with RMSSD, might be an important factor in the relationship of self-critical rumination and somatic symptom distress.

Internal Control Sebagai Moderasi Dalam Hubungan Financial Distress Dengan Accrual Earnings Management

The purpose of this study is to obtain empirical evidence on the influence of financial distress on earnings management as well as the moderation effect of internal control in the relationship of financial distress with earnings management in manufacturing firms listed on the Indonesia Stock Exchange during the period 2017-2019. The research design used to test the influence of independent variables on dependent variables and the influence of moderation variables in the relationship is a descriptive research with purposive sampling method, and obtained as many as 105 samples of companies. Then, the hypothesis testing is done by panel data regression model and moderation regression model. This research was conducted using EViews (Econometrical Views) 11 application. This study obtained the results that financial distress has a significant positive influence on accrual earnings management, and there is a moderation effect of internal control that weakens the relationship of financial distress with accrual earnings management. The implication of this study is firms with greater financial distress have a higher level of accrual earnings management and the need to increase firms’ internal control to restrict firms’ accrual earnings management.

On–Off Relationship Instability and Distress Over Time in Same‐ and Different‐Sex Relationships

AbstractObjectiveWe sought to test the association between on‐again/off‐again relationship cycling and mental health over time.BackgroundTemporary distress following relationship dissolution is normative, yet a prolonged history of terminating a relationship and then reconciling (i.e., on–off relationship cycling) may facilitate more pervasive symptomology.MethodWe used data from 545 individuals in same‐ and different‐sex relationships to assess the association between on–off cycling and symptoms of depression and anxiety across 15 months.ResultsRelationship cycling was associated with psychological distress and change in distress over time.ConclusionThis study supports existing theories of family change and highlights the importance of focusing on relationship transitions and well‐being over time.ImplicationsPractitioners can help partners navigate unpredictability during transitions by helping them make deliberate decisions either to stay and stabilize their relationships or permanently leave depending on the circumstances underlying relationship cycling and the level of distress associated with any lingering interpersonal turmoil.

Extracorporeal membrane oxygenation and inhaled sedation in coronavirus disease 2019-related acute respiratory distress syndrome.

Coronavirus disease 2019 (COVID-19) related acute respiratory distress syndrome (ARDS) is a severe complication of infection with severe acute respiratory syndrome coronavirus 2, and the primary cause of death in the current pandemic. Critically ill patients often undergo extracorporeal membrane oxygenation (ECMO) therapy as the last resort over an extended period. ECMO therapy requires sedation of the patient, which is usually achieved by intravenous administration of sedatives. The shortage of intravenous sedative drugs due to the ongoing pandemic, and attempts to improve treatment outcome for COVID-19 patients, drove the application of inhaled sedation as a promising alternative for sedation during ECMO therapy. Administration of volatile anesthetics requires an appropriate delivery. Commercially available ones are the anesthetic gas reflection systems AnaConDa® and MIRUSTM, and each should be combined with a gas scavenging system. In this review, we describe respiratory management in COVID-19 patients and the procedures for inhaled sedation during ECMO therapy of COVID-19 related ARDS. We focus particularly on the technical details of administration of volatile anesthetics. Furthermore, we describe the advantages of inhaled sedation and volatile anesthetics, and we discuss the limitations as well as the requirements for safe application in the clinical setting.

Clinical outcomes of intravenous immunoglobulin therapy in COVID-19 related acute respiratory distress syndrome: a retrospective cohort study

BackgroundIntravenous immunoglobulin (IVIG) has been used as an immunomodulatory therapy to counteract severe systemic inflammation in coronavirus disease 2019 (COVID-19). But its use in COVID-19 related acute respiratory distress syndrome (ARDS) is not well established.MethodsWe conducted a retrospective analysis of electronic health records of COVID-19 patients admitted to intensive care units (ICUs) at Hazm Mebaireek General Hospital, Qatar, between March 7, 2020 and September 9, 2020. Patients receiving invasive mechanical ventilation for moderate-to-severe ARDS were divided into two groups based on whether they received IVIG therapy or not. The primary outcome was all-cause ICU mortality. Secondary outcomes studied were ventilator-free days and ICU-free days at day-28, and incidence of acute kidney injury (AKI). Propensity score matching was used to adjust for confounders, and the primary outcome was compared using competing-risks survival analysis.ResultsAmong 590 patients included in the study, 400 received routine care, and 190 received IVIG therapy in addition to routine care. One hundred eighteen pairs were created after propensity score matching with no statistically significant differences between the groups. Overall ICU mortality in the study population was 27.1%, and in the matched cohort, it was 25.8%. Mortality was higher among IVIG-treated patients (36.4% vs. 15.3%; sHR 3.5; 95% CI 1.98–6.19; P < 0.001). Ventilator-free days and ICU-free days at day-28 were lower (P < 0.001 for both), and incidence of AKI was significantly higher (85.6% vs. 67.8%; P = 0.001) in the IVIG group.ConclusionIVIG therapy in mechanically ventilated patients with COVID-19 related moderate-to-severe ARDS was associated with higher ICU mortality. A randomized clinical trial is needed to confirm this observation further.

Why do people self-sacrifice for their country? The roles of identity fusion and empathic concern.

Identity fusion with a group, a feeling of connection with it, is a good predictor of extreme pro-group behavior, an action to favor or protect the group, including self-sacrifice. Relational ties and personal distress (self-oriented emotional reaction; e.g., anxiety, distress) toward ingroup members in need have been evaluated separately as mediators of the relationship between identity fusion and pro-group self-sacrifice. Another mediator could be empathic concern (other-oriented emotional reaction; e.g., compassion, sympathy), but it has not been considered in the literature. We related those three mediators in a model. The objective was to analyze whether relational ties mediate the relationship between identity fusion and pro-country self-sacrifice whereas both empathic concern and personal distress mediate the association between relational ties and pro-country self-sacrifice. We expected that identity fusion with the country leads to more relational ties, which in turn evokes both empathic concern and personal distress, and those emotional reactions promote more and less pro-country self-sacrifice, respectively, with more effect of empathic concern than personal distress. We considered the country as the group reference because it is the most used in identity fusion research. In a sample of university students (N=539), the results supported this model: Identity fusion promoted relational ties, which in turn evoked empathic concern and personal distress. Then, the last two variables predicted more and less self-sacrifice, respectively, with more effect of empathic concern than personal distress. We discussed the theoretical implications of the model, especially the relationship of identity fusion with empathic concern and personal distress-traditional explanations for pro-group behavior-considering the different motivations associated to both emotional reactions. Despite the limitations associated with the measurements, the data supported the model that relates variables not previously explored jointly.

Self-Efficacy for Symptom Management in Long-Term Adult Hematopoietic Stem Cell Survivors

Background: Hematopoietic cell transplantation (HCT) survivors have a complex and multiphase recovery period. Health care delivery and psychosocial interventions for HCT survivors are challenging as many HCT recipients live great distances from the facility where they had their HCT. Therefore, identifying factors associated with a patient's capability to self-manage symptoms is an important focus of survivorship research. A patient's self-efficacy may be important for the successful management of major stressors associated with treatments and recovery. Here, we aimed to evaluate the impact of perceived self-efficacy on distress, quality of life (QoL), depression, and fatigue, and identify the factors associated with lower self-efficacy.Methods: This cross-sectional study analyzed baseline data from a randomized controlled internet based self-management intervention trial (INSPIRE, NCT01602211) in adult (age 18 and older) survivors 2-10 years post HCT. Patients with recurrence or subsequent malignancy requiring cancer treatment during the two years prior to enrollment, inability to read and understand English and lack of access to email and the Internet were excluded. Data included medical records and patient-reported outcomes (PROs) including Cancer and Treatment Distress (CTXD) with 6 subscales, Patient Health Questionnaire depression scale (PHQ-8), Short Form 12 Health Survey (SF-12) physical function (PCS) and mental function (MCS) scores, Brief Fatigue Inventory (BFI) and Health Self-Efficacy. Pearson correlations were used to test bivariate associations for self-efficacy with CTXD, SF-12, BFI, and PHQ8. General linear models were used to test the independent association for CTXD and SF-12 outcomes with self-efficacy, controlling for selected sociodemographic and treatment covariates. Tenability of statistical model assumptions were examined, and no remediation was necessary.Results: Total of 1078 HCT survivors were included in the analysis. Participants were 18 to 76 years (mean age 51), 53% male, and over 90% white and non-Hispanic. Only 16% reported living in a rural area. A majority received an autologous HCT (55%) and were less than 5 years from their first HCT (54%). Among the allogeneic HCT recipients, more than half (60%) had active chronic Graft-versus-Host (cGVHD) and nearly 40% were on active systemic treatment. The mean self-efficacy score was 3.01 (SD 0.49). Female gender (p=0.014), younger age at HCT, younger age at cGVHD presentation, moderate to severe currently active cGVHD (p=0.003) and household income less than $40,000 (p < 0.001) were associated with lower self-efficacy. In bivariate analyses, self-efficacy was negatively correlated with mean total CTXD (r -0.5, p <0.001) and each of the CTXD subscales including family strain (r -0.41, p<0.0001), identity (r -0.37, p<0.0001), uncertainty (r -0.5, p<0.0001), interference (r -0.47, p<0.0001), medical (r -0.36, p<0.0001) and health burden (r -0.42, p<0.0001). HCT survivors with higher self-efficacy also reported better physical (r 0.48, p<0.001) and mental function on the SF-12 (r 0.57, p<0.001). Moreover, self-efficacy was negatively correlated with symptoms such as fatigue (r -0.44, p<0.001) and depression (r -0.48, p<0.001).In a regression model investigating the impact of self-efficacy on CTXD controlled for demographics and disease characteristics , lower self-efficacy was independently associated with higher CTXD (beta -0.232; 95% CI (-0.294, -0.169), p< 0.001) (Table 1). Moreover, there was a significant positive relationship between self-efficacy and both mental (beta 4.68; 95% CI (3.82, 5.54); p <0.001) (Table 2) and physical (beta 2.69; 95% CI (1.74, 3.64); p<0.001) (Table 3) components of QoL.Conclusion: Our study demonstrates that lower levels of self-efficacy reported by HCT survivors was independently associated with higher levels of symptoms such as fatigue and depression, lower QoL, and more cancer -related distress. Furthermore, self-efficacy is more likely to be impaired in females, younger adults, those with lower incomes, and survivors with active cGVHD. These findings support the value of self-management interventions focused on improving self-efficacy as having the potential to improve multiple symptoms and QoL in HCT survivors. [Display omitted] DisclosuresFarhadfar: Incyte: Consultancy. Jim: RedHill Biopharma: Consultancy; Janssen Scientific Affairs: Consultancy; Merck: Consultancy; Kite pharma: Research Funding. Majhail: Anthem, Inc: Consultancy; Incyte Corporation: Consultancy. Wingard: Merck: Consultancy; AlloVir: Consultancy; Celgene: Consultancy; Shire: Consultancy; Janssen: Consultancy; Cidara Therapeutics: Consultancy.

Couples' Experiences Managing Young-Onset Dementia Early in the COVID-19 Pandemic.

The coronavirus disease 2019 (COVID-19) pandemic created unexpected stressors for society and could disproportionately affect more vulnerable groups. One such group is couples facing young-onset dementias (YOD), who experience pandemic-induced stressors alongside ongoing YOD-related stressors (e.g., progressive symptoms, increased caregiving needs). Using a qualitative design, our objective was to characterize the experiences of couples living with YOD early in the COVID-19 pandemic and the impact on couples' 'relationships' and well-being. Couples (N = 23) of persons with YOD and their spousal caregivers participated in a 1 hour live video, joint interview during the early COVID-19 pandemic. We used a hybrid inductive-deductive coding approach to thematic analysis to extract findings within 2 a priori domains: (a) psychosocial stressors experienced during the early pandemic and (2) the impact of early pandemic stressors on couples' relationships and well-being. Thematic analyses revealed 6 main themes: (a) increased caregiving responsibilities, (b) increased uncertainty, (c) increased social isolation and disruptions in social support and medical care, (d) loss of meaningful activities and routines, (e) changes to the couple's relationship, and (f) heightened emotional distress. The COVID-19 pandemic exacerbated relationship strain and distress among couples managing YOD. This population may face negative outcomes due to the dual impact of YOD- and pandemic-related stressors. It is imperative to provide timely resources and psychosocial support to couples facing YOD to mitigate the negative impact of such stressors on individual health and well-being and the couples' relationship together.

Defibrotide Therapy for Sars CoV2 Acute Respiratory Distress Syndrome

Defibrotide Therapy for Sars CoV2 Acute Respiratory Distress Syndrome

Couplelinks online intervention for young couples facing breast cancer: A randomised controlled trial.

Young women with breast cancer and their partners are more distressed than couples who are affected later in life. While dyadic interventions in the context of cancer are promising, there are access barriers, particularly foryounger couples. This study evaluated Couplelinks, a professionally facilitated,web-based program designed to help couples improve their conjoint coping. This randomised controlled trial employed a waitlist control evaluation of the program. Outcomes included dyadic coping, relationship adjustment, depression, and anxiety. Seventy-five couples consented to participate and were randomised. The final analysis included 31 couples in the treatment group and 36 couples in the waitlist group. Modest improvements were found in positive dyadic coping but effects were not maintained at 3-month follow-up. No effect was seen on overall relationship adjustment. Our findings inform the rapidly expanding field of online programming for couples in general, and those affected by BC in particular. Intervention timing, 'dose', low overall relational distress, and the mainly enrichment rather than problem-focus of Couplelinks may help explain the lack of change on relationship adjustment.

Factors linking perceived discrimination and weight bias internalization to body appreciation and eating pathology: A moderated mediation analysis of self-compassion and psychological distress.

Stigma and recurrent discriminatory experiences can lead to distress and internalization of biases. Self-compassion is a widely-recognized resilience factor that may decrease the impact of discrimination on psychological well-being. Research highlights the potential utility of self-compassion in counteracting the harmful effects of discrimination, reducing psychological distress, and preventing the development of eating disorders. The current study examined the roles of self-compassion and psychological distress in perceived discrimination, internalized weight bias, body image, and eating pathology. Participants (N=694) living in the United States completed an online battery of measures assessing perceived discrimination, weight bias internalization, self-compassion, psychological distress, body appreciation, and eating pathology. Self-compassion was associated negatively with perceived discrimination, weight-bias internalization, psychological distress, and eating pathology and was associated positively with body appreciation. Moderated mediation analyses examined whether psychological distress statistically mediated the relationship between perceived discrimination (Model 1) or weight bias internalization (Model 2) on body appreciation, as well as between perceived discrimination (Model 3) or weight bias internalization (Model 4) on eating psychopathology. For all models, self-compassion was explored as a moderator of indirect and direct effects. Results revealed how psychological distress mediated the link between perceived discrimination and body appreciation/eating psychopathology, as well as between weight bias internalization and body appreciation, but not eating psychopathology. For weight bias internalization models only, the statistical links between psychological distress in relation to body appreciation/eating psychopathology were stronger for those with lower self-compassion. Self-compassion may promote more effective coping and outcomes for individuals who are subject to societal stigma.

The Use of Advanced Integrative Therapy with C-PTSD and Intergenerational Trauma Transmission

Complex posttraumatic stress disorder (C-PTSD) and adverse childhood experiences (ACEs) pose health problems in the United States, and intergenerational relational trauma plays a role in the continuation and transmission of these issues. Advanced Integrative Therapy (AIT), a novel treatment, was used to treat a case of C-PTSD. The client’s chief concern was a flare-up of anxiety, relational distress, and fibromyalgia that occurred when they (chosen pronoun) accepted custody of their nephew. Over a span of nine 90-minute sessions, the clinician assessed progress using the PTSD Checklist for DSM-5 (PCL-5; Weathers et al., 2013) to measure PTSD symptoms; the International Trauma Questionnaire (ITQ; Cloitre et al., 2018), which measures C-PTSD symptoms according to the criteria of the World Health Organization (WHO) International Classification of Diseases, 11th revision (ICD-11); the Child-Parent Relationship Scale (CPRS; Pianta, 1992), which measures connection and conflict in the caregiver-child relationship; and the Subjective Units of Distress (SUD) scale (Wolpe, 1969), which rates the client’s current level of distress or discomfort. The clinician also used the self-report questionnaire Helpful Aspects of Therapy (HAT; Llewelyn et al., 1988) and the Change Interview (CI) method (Elliott et al., 2001) to measure client experience and perspective. After treatment with AIT, the client no longer met criteria for C-PTSD and showed dramatic improvement in intergenerational relationship satisfaction. In addition, there was a rapid reduction of hard to eradicate C-PTSD symptoms as well as reduction in the quantity and intensity of fibromyalgia induced pain. Use of AIT with caregivers could interrupt the transmission of intergenerational trauma thereby reducing or preventing ACEs by increasing emotional regulation and resilience.

Increased Angiotensin-Converting Enzyme 2 and Loss of Alveolar Type II Cells in COVID-19-related Acute Respiratory Distress Syndrome.

Rationale: ACE2 (angiotensin-converting enzyme 2), the entry receptor for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is expressed in type 2 alveolar epithelial cells (AT2) that may play key roles in postinjury repair. An imbalance between ACE2 and ACE has also been hypothesized to contribute to lung injury.Objectives: To characterize the expression and distribution of ACE2 and ACE and to compare AT2 with endothelial cell expression in coronavirus disease (COVID-19)–related or –unrelated acute respiratory distress syndrome (ARDS) and controls.Methods: Lung tissue stainings (using multiplex immunofluorescence) and serum concentrations of ACEs were determined retrospectively in two different cohorts of patients. AT2 and endothelial cells were stained in lung tissue for ProSPC (pro-surfactant protein C) and CD31, respectively.Measurements and Main Results: Pulmonary ACE2 expression was increased in patients with COVID-19–related and –unrelated ARDS (0.06% of tissue area and 0.12% vs. 0.006% for control subjects; P = 0.013 and P < 0.0001, respectively). ACE2 was upregulated in endothelial cells (0.32% and 0.53% vs. 0.01%; P = 0.009 and P < 0.0001) but not in AT2 cells (0.13% and 0.08% vs. 0.03%; P = 0.94 and P = 0.44). Pulmonary expression of ACE was decreased in both COVID-19–related and –unrelated ARDS (P = 0.057 and P = 0.032). Similar increases in ACE2 and decreases in ACE were observed in sera of COVID-19 (P = 0.0054 and P < 0.0001) and non–COVID-19 ARDS (P < 0.0001 and P = 0.016). In addition, AT2 cells were decreased in patients with COVID-19–related ARDS compared with COVID-19–unrelated ARDS (1.395% vs. 2.94%, P = 0.0033).Conclusions: ACE2 is upregulated in lung tissue and serum of both COVID-19–related and –unrelated ARDS, whereas a loss of AT2 cells is selectively observed in COVID-19–related ARDS.

COVID-Related Victimization, Racial Bias and Employment and Housing Disruption Increase Mental Health Risk Among U.S. Asian, Black and Latinx Adults.

Background: The mental health of racial/ethnic minorities in the U.S. has been disproportionately impacted by the COVID-19 pandemic. This study examined the extent to which disruptions in employment and housing, coronavirus-specific forms of victimization and racial bias independently and conjointly contributed to mental health risk among Asian, Black, and Latinx adults in the United States during the pandemic.Methods: This study reports on data from 401 Asian, Black, and Latinx adults (age 18–72) who participated in a larger national online survey conducted from October 2020–June 2021, Measures included financial and health information, housing disruptions and distress in response to employment changes, coronavirus related victimization distress and perceived increases in racial bias, depression and anxiety.Results: Asian participants had significantly higher levels of COVID-related victimization distress and perceived increases in racial bias than Black and Latinx. Young adults (<26 years old) were more vulnerable to depression, anxiety, and coronavirus victimization distress than older respondents. Having at least one COVID-related health risk, distress in response to changes in employment and housing disruptions, pandemic related victimization distress and perceived increases in racial bias were positively and significantly related to depression and anxiety. Structural equation modeling indicated COVID-related increases in racial bias mediated the effect of COVID-19 related victimization distress on depression and anxiety.Conclusions: COVID-19 has created new pathways to mental health disparities among racial/ethnic minorities in the U.S. by exacerbating existing structural and societal inequities linked to race. Findings highlight the necessity of mental health services sensitive to specific challenges in employment and housing and social bias experienced by people of color during the current and future health crises.