Risk Factors For Psychological Distress Research Articles

Low Subjective Wellbeing Is Associated with Psychological Distress in People Living with Inflammatory Bowel Disease.

Inflammatory bowel disease (IBD) is a common and debilitating disease of the gastrointestinal tract. Psychological distress is highly comorbid to IBD, especially during periods of active disease. However, a controversy exists on how to best manage its symptoms in the IBD population. This study aimed to explore protective and risk factors of psychological distress in IBD. A cross-sectional online survey was conducted via social media and online patient forums. Respondents (N = 235) filled out questionnaires on demographics, health characteristics and a range of psychological variables. Measures of pain, disease activity, comorbid functional symptom severity, social support, subjective wellbeing, sleep quality, fatigue, stress, age, BMI and gender were entered into the Classification and Regression Tree Analysis model. Overall, 87 participants (37%) reported distress. Self-reported stress significantly discriminated between cases of probable psychological distress. In those with high stress, patients with and without probable psychological distress were separated by subjective wellbeing. Among patients with low stress, fatigue was the primary discriminator. Monitoring patients for low subjective wellbeing and high stress in clinical settings could offer an opportunity to engage in early intervention to limit psychological distress development. Monitoring for fatigue in patients who seem otherwise psychologically well could offer preventative benefits.

Prevalence of Psychological Distress and Its Risk Factors in Patients with Primary Bone and Soft Tissue Tumors.

Psychological distress is common in patients with soft tissue and bone tumors. We first investigated its frequency and the associated risk factors in patients with pre-operative bone and soft tissue tumors. Participants included 298 patients with bone and soft tissue tumors who underwent surgery in our institution between 2015 and 2020. Psychological distress was evaluated by the Distress and Impact Thermometer (DIT) that consists of two types of questions (questions about the severity of the patient’s distress (DIT-D) and its impact (DIT-I)). We used a cut-off point of 4 on the DIT-D and 3 on the DIT-I for screening patients with psychological distress. We therefore investigated: (1) the prevalence of psychological distress as assessed with DIT or distress thermometer (DT), which can be decided by DIT-D ≥ 4, (2) what are the risk factors for the prevalence of psychological distress, and (3) what is the number of patients who consulted a psychiatrist for psychological distress in patients with pre-operative bone and soft tissue tumors. With DIT and DT, we identified 64 patients (21%) and 95 patients (32%), respectively, with psychological distress. Multivariate logistic regression revealed that older age, sex (female), malignancy (malignant or intermediate tumor), a lower Barthel Index, and higher numeric rating scale were risk factors for psychological distress. Two patients (3%) consulted a psychiatrist after surgery. In conclusion, careful attention to psychological distress is needed, especially for female patients, older patients, and those with malignant soft or bone tissue tumors who have more than moderate pain.

Stability and Change in Psychological Distress and Early Adverse Environments in Japanese Adults

Research has repeatedly shown that early adversities are a risk factor for psychological distress in adulthood. However, limited research has examined the association between early adversities and intraindividual changes in psychological distress among middle-aged adults. This study developed a self-report scale to retrospectively measure the level of adversity experienced in childhood (Early Environment Scale: EES) and investigated the association between the EES score and the change in psychological distress in middle-aged adults. Study 1 examined the reliability and validity of the nine-item EES using a sample of 337 Japanese adults (162 women; Meanage = 42.96, SDage = 10.55). In Study 2, a three-wave six-month longitudinal survey was conducted with a sample of 2000 Japanese adults (1000 women; Meanage = 40.94; SDage = 5.35). Psychological distress at all three waves was measured with the Kessler Psychological Distress Scale (K-6). The results from a latent growth analysis showed significant positive associations between early adversities and the intercept and slope factors of psychological distress. Specifically, individuals who reported more early adversity showed higher initial levels of psychological distress and a stronger increase in psychological distress among Japanese middle-aged adults. Early adversities might influence the development of dispositional sensitivity for psychological distress in adulthood.

The mental health and wellbeing survey of Australian optometrists.

To investigate the prevalence of mental health conditions and burnout among practising optometrists in Australia. A cross-sectional survey of registered practising Australian optometrists was undertaken over a three-week period from mid-November 2019. The survey comprised three well-established mental health scales (Kessler Psychological Distress Scale [K10], Depression Anxiety Stress Scales [DASS-21] and Maslach Burnout Inventory [MBI]) and an open-ended question inviting comments. Five hundred and five respondents completed the K10, representing 8.8% of registered optometrists in Australia; 466 completed all three scales. Prevalence of moderate to severe psychological distress (K10≥25) was 30.7% (95% CI 26.7%-34.7%), with similar findings for depression and anxiety (DASS-21). Prevalence of high burnout, as indicated by MBI-GS exhaustion was 56.1% (95% CI 51.7%-60.4%), cynicism 57.1% (95% CI 52.7%-61.5%) and professional efficacy 23.1% (95% CI 19.4%-26.8%). Optometrists aged≤30years were 3.5 times more likely to report moderate to severe psychological distress compared to optometrists aged >30years (OR=3.54, P<0.001, 95% CI 2.38-5.25). The most frequently mentioned work-related issues concerned retail pressures, workload and career dissatisfaction. The rates of mental health conditions and burnout reported by practising Australian optometrists were high compared with the general population and other health professionals. Younger age and burnout were significant risk factors for psychological distress. Interventions are required to address these issues, particularly for younger optometrists, and could include workplace modifications and building resilience to improve personal mental wellbeing and ensure patient safety.

Prevalence of stress, anxiety and depression in undergraduate medical students: a cross sectional study

Background: It is important to identify the prevalence and risk factors of psychological distress among medical students which not only affect their health but also the academic achievements at different points of time in their study period. In addition, the patient care is affected by psychological distress among physicians such as poor communication, diminished quality of care and medical errors have been found associated with physical stress.Methods: The present study was a descriptive type of cross-sectional study, which was conducted in a government medical college located in rural Haryana, India from June to July 2018 among 200 MBBS students after adopting inclusion and exclusion criteria. A pre-validated, pre-designed structured depression, anxiety and stress scale-21 items (DASS-21) (annexure 2) was used for obtaining information from the study subjects. The total score of the study subjects was computed and thereafter graded for levels of stress, anxiety and depression.Results: The response rate was 94.5%. The mean score for DASS 21 scale was found to be 16.13 (±11.27). Out of the total, 61.4% students are suffering from different levels of depression. About two-third of the study participants (69.8%) were suffering from different levels of anxiety. The prevalence of stress was about 46.6% in the study subjects.Conclusions: The study confirmed the general impression that there is considerable amount of stress, anxiety and depression in medical students.

Factors associated with psychological distress among patients with breast cancer during the COVID-19 pandemic: a cross-sectional study in Wuhan, China

PurposeThis study aimed to examine the prevalence of psychological distress and the corresponding risk factors among patients with breast cancer affected by the outbreak of coronavirus disease 2019 (COVID-19).MethodsThis cross-sectional, survey-based, region-stratified study was conducted from March 14 to March 21, 2020. An online survey was used to collect the basic characteristics of patients with breast cancer. The degree of depression, anxiety, and insomnia symptoms were assessed using the Patient Health Questionnaire (PHQ-9), the Generalized Anxiety Disorder (GAD-7), and the Insomnia Severity Index (ISI) questionnaires, respectively. Multivariate logistic analysis was performed to identify factors associated with psychological distress outcomes.ResultsAmong the 834 patients with breast cancer included in the study, the prevalence of depression, anxiety, and insomnia was 21.6%, 15.5%, and 14.7%, respectively. No statistically significant difference in the prevalence of these symptoms was observed between patients in Wuhan and those outside Wuhan. Multivariate logistic regression analyses revealed that comorbidity, living alone, deterioration of breast cancer, and affected treatment plan were risk factors for psychological distress including depression, anxiety, and insomnia. When stratified by location, living alone was associated with depression and insomnia only among patients in Wuhan, but not those outside Wuhan.ConclusionsThis study shows an elevated prevalence of depression, anxiety, and insomnia among patients with breast cancer during part of the COVID-19 pandemic. Patients with comorbidity, living alone, deterioration of breast cancer, and whose treatment plan was affected should be paid more attention to prevent mental disorders.

Associations between mentally-passive and mentally-active sedentary behaviours during adolescence and psychological distress during adulthood

It is unclear if different types of sedentary behaviour during the adolescence are differentially associated with psychological distress during adolescence and adulthood. It is also unknown what may mediate this potential proposed association. The current study aimed to analyse the association of mentally-active and mentally-passive sedentary behaviours during adolescence (16y) with subsequent psychological distress during adulthood (42y), and to examine the role of potential mediators (42y). Data from the 1970 British Cohort Study was used (N = 1787). At age 16y participants reported time and frequency in mentally-passive (TV-viewing and watching movies) and mentally-active (reading books, doing homework and playing computer games) sedentary behaviours, psychological distress and organized sports participation. At 42y, participants reported cognition (vocabulary test), TV-viewing, psychological distress, self-rated health, body mass index and employment status. Education was collected throughout the follow-up years. Logistic regression and mediation models assessed associations. Multiple imputation using chained equations was used to assess the impact of missing data. Mentally-passive sedentary behaviour in adolescence was a risk factor for psychological distress during adulthood in complete-cases analysis [OR:1.44(95%CI:1.09–1.90)], which was confirmed by the model with multiple imputation. Mentally-active sedentary behaviour at 16y was not associated with psychological distress at 42y. Adult TV-viewing during weekends (24.7%), and self-rated health (19.0%) mediated the association between mentally-passive sedentary behaviour during adolescence and psychological distress during adulthood. However, the mediation was not clear in the models with multiple imputation. Mentally-passive sedentary behaviour during adolescence was associated with elevated psychological distress during adulthood and this association was mediated TV-viewing and self-rated health in adulthood.

Assessment of Psychological Distress among Parents of Children with Cancer

Background and Aims: The diagnosis of pediatric cancer is a potentially traumatic event and a major source of psychological distress for parents. The aim of our study was to determine the prevalence and the risk factors of psychological distress among parents of children diagnosed with cancer. Methods: This is a descriptive study carried out on parents of children diagnosed with cancer and treated in the department of medical oncology at the Habib Bourguiba Hospital in Tunisia. Over a period of four months, from the beginning of December 2020 until the end of March 2021, forty-three parents (34 mothers and 9 fathers) were assessed, using psychometric scales of anxiety, depression and post-traumatic stress according to respectively to the Hamilton anxiety rating scale (HAM), the Beck Depression Inventory (BDI) and the Impact of Event Scale (IES-R). Results: Sixteen percent of the parents had scores indicating acute stress and 21% had scores indicating post-traumatic stress. Eighty six percent of the parents had mild to severe depression and 95% had minor to major anxiety. Post-traumatic stress and anxiety are significantly correlated with the female sex of parents. Significant correlations are also found between post-traumatic stress scores and symptoms of depression and anxiety. However, our study did not show a significant correlation between the others factors studied and the parents’ psychological distress. Conclusion: The prevalence of anxiety and depressive disorders was high among parents of children diagnosed with cancer and a significant correlation was found between stress and anxiety with the female sex of parents. Our results were similar to several studies although other risk factors for psychological distress in parents of children with cancer were described in the literature.

Younger, more senior, and most vulnerable? Interaction effects of age and job seniority on psychological distress and quality of life among firefighters.

Firefighters are exposed to repeated traumatic events while the robustness of cumulative effects of repeated exposure to trauma on psychological distress among them are inconsistent. Considering the length of service and seniority are risk factors, the purpose of this study was to examine the effects of the interaction between age and seniority on psychological distress and quality of life among firefighters. Participants were 229 firefighters of the Hualien County Fire Bureau in Taiwan who worked full time in response to emergency services and disaster rescues activities. Probable posttraumatic stress disorder (PTSD), depression, anxiety, agoraphobia, and quality of life were assessed among firefighters using psychodiagnostics questionnaires. Firefighters were stratified based on age into a young and a mature group, and based on length of service into a junior and a senior group, yielding four groups: "young-senior," "young-junior," "mature-senior," and "mature-junior." A majority of the firefighters were dissatisfied with their health condition. All the firefighters scored relatively lower at the social domain of their quality of life compared with physical, emotional, and environment domains. In the post hoc multiple comparison analysis, the young-senior firefighters were found to be most vulnerable to psychological distress, manifested in having a higher prevalence of, and suffering from more, severe probable PTSD, depression, anxiety, and agoraphobia symptoms than the other groups of firefighters. Age and job seniority have significant effects on psychological distress among firefighters. Being young and starting young to serve as a firefighter for a relatively long time is a significant risk factor for psychological distress. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Psychological Reactions of Turkish Healthcare Workers During Covid-19 Outbreak: The Impact of Stigmatization.

The Coronavirus Disease 2019 (COVID-19) outbreak has resulted in huge psychological distress, especially for people working under risky conditions, such as healthcare workers. We aimed to investigate the psychological challenges of Turkish healthcare workers during the outbreak and discuss the factors that increase their burden, including stigmatization. A cross-sectional online survey composed of sociodemographic data, questions about perceived stigma, and concerns about working conditions was completed. Depression Anxiety and Stress Scale-21 (DASS-21) was also used. 634 participants completed the survey and the prevalence of moderate to severe depression, anxiety, and stress-related symptoms were 36%, 35%, and 22%, respectively. Being female, working with close contact with patients with COVID-19 and having a psychiatric disorder history were risk factors for psychological distress. The healthcare workers with significantly higher depression, anxiety, and stress scores described having less amount of personal protective equipment, lower support from their supervisors, and more unsafe working conditions. Additionally, 7% of the participants stated that they perceived stigmatization by their families and close friends, 14% perceived stigmatization by their neighbours, relatives, and less intimate friends; and 7% perceived stigmatization by unfamiliar people. Healthcare workers who perceived other people as more dismissive had significantly higher depression and anxiety scores. Our study shows that healthcare workers are at risk of developing psychological disturbances during infectious outbreaks. To minimize the psychological impact, additional risk factors such as having a previous psychiatric disorder, working under unsafe conditions, and stigmatization should be taken into account and a more supportive and safer environment should be provided.

Risk Perception and Worries among Health Care Workers in the COVID-19 Pandemic: Findings from an Italian Survey.

The ongoing pandemic scenario, due to the coronavirus disease 2019 (COVID-19), has had a considerable impact on public health all over the world. Italy was one of the most affected countries, as the first European full-blown outbreak occurred there. The exposure of the Italian health care workers to COVID-19 may be an important risk factor for psychological distress. The aim of this cross-sectional study was to describe worries and risk perception of being infected among Italian Health Care Workers (HCWs) during the first wave of the pandemic. In total, 2078 HCWs participated in a web survey (78.8% were females). The highest percentage of respondents were physicians (40.75%) and nurses (32.15%), followed by medical (18.00%), health care support (4.50%) and administrative (4.60%) staff. In a score range between 0 (not worried) and 4 (very worried), our results showed that participants declared that they were worried about the Coronavirus infection with a median score of 3 (IQR 2-3) and for 59.19% the risk perception of being infected was very high. In addition, HCWs reported they suffered from sleep disturbances (63.43%). From the analysis of the psychological aspect, a possible divergence emerged between the perceived need for psychological support (83.85%) and the relative lack of this service among health care providers emerged (9.38%). Our findings highlight the importance of psychological and psychiatric support services not only during the COVID-19 pandemic, but also in other emerging infectious diseases (EIDs) scenarios. These services may be useful for health authorities and policymakers to ensure the psychological well-being of health care professionals and to promote precautionary behaviors among them.

Perioperative risk factors of psychological distress in patients undergoing treatment for esophageal cancer

BackgroundEsophageal cancer patients often feel depressed and are fearful of metastasis and death. The objective of this study was to clarify the characteristics of patients with psychological distress at all 5 time points compared with patients with no psychological distress especially from standpoints of personal coping styles and QOL.MethodsIn total, 102 of 152 consecutive patients who attended the outpatient clinic at Toranomon Hospital between April 2017 and April 2019 met eligibility criteria for inclusion in this study. Questionnaires designed to identify psychological distress (HADS-scores) and assess QOL (EORTC QLQ C-30/OES18) were administered at 5 time points from the time of the first outpatient consultation to 3 months after esophagectomy. The questionnaire of coping strategies (MAC-scales) was administered at only time 1 point.ResultsBased on the trends of HADS-scores, we defined two groups: “persistent high-HAD scores” and “persistent low-HADS scores.” There are strong relationships between psychological distress and coping strategy, and psychological distress and QOL. The possibility that there are relationships between stress coping strategies and some QOL status depending on some point of treatment.ConclusionsThe psychological distress during the treatment course of esophageal cancer is significantly associated with the coping strategies and QOL influenced by esophagectomy. This study can provide baseline information for identifying patients in need of psychological management and paves the way for larger clinical studies in the future.

Effects of COVID-19 Epidemic Lockdown on Postpartum Depressive Symptoms in a Sample of Italian Mothers.

The extraordinary health emergency of the COVID-19 pandemic represents a new challenge for mental health researchers and clinical practitioners. The related containment measures may be a risk factor for psychological distress and mood disorders, especially in at-risk populations. This study aims to explore the impact of COVID-19 on postpartum depressive symptoms in mothers with children below 1 year of age. An online questionnaire survey was therefore conducted in Italy between May and June 2020. The survey consisted of several self-administered questionnaires: besides some ad-hoc questionnaires, the Edinburgh Postnatal Depression Scale (EPDS), the Scale of Perceived Social Support (SPSS) and the Maternity Social Support Scale (MSSS) were used. Two hundred forty-three Italian women were included in the study. The prevalence of postpartum depression symptomatology among mothers was 44%, as measured through the EPDS (cut-off >12). Women who spent the isolation in northern Italy adopted maladaptive coping strategies significantly more than women living in areas at lower risk. The analysis highlighted a significant difference between the group that was not directly affected by the virus and women who have had a direct or indirect contact with it. Besides situational factors specific to the pandemic, the results show that there are some risk factors tied to the personal history of the mother (e.g., having had a previous abortion). These data should inform and enlighten future protocols of intervention.

Practice change: Social Media Screening Questionnaire to identify high-risk adult psychiatric patients.

Include social media screening during initial psychiatric examination with new adult patients to increase psychiatric providers' awareness of the rate and impact of social media use in their patients. Plan-Do-Study-Act cycles were implemented to evaluate the effectiveness of psychiatric provider 5-question social media screening during the initial evaluation. Screening for social medial usage (N = 136) improved providers' a wareness of the rate and impact of social media use on patients' distress levels. The process of screening influenced a conversation between provider and patient about healthy social media use. The inclusion of social media screening during initial psychiatric evaluation may aid in the assessment of risk factors for psychological distress.

Individual Perceived Stress Mediates Psychological Distress in Medical Workers During COVID-19 Epidemic Outbreak in Wuhan.

BackgroundSince the novel coronavirus disease (COVID-19) outbreak in Wuhan, thousands of medical workers have been dispatched to support Wuhan against the virus. The purpose of this study was to identify the independent risk factors for psychological distress in order to develop a more effective strategy and precise evidence-based psychological intervention for medical workers.MethodsThis multisite cross-sectional survey recruited doctors and nurses from local and nonlocal medical teams working at 16 hospitals in Wuhan to complete this online survey from February to March, 2020. Psychological status was evaluated through Perceived Stress Scales (PSS), Patient Health Questionnaire-9 (PHQ-9), General Anxiety Disorder Scale (GAD-7) and Acute Stress Disorder Scale (ASDS).ResultsOf 966 participants, the prevalence of stress (95.9%), depression (46.0%) and anxiety (39.3%) were high. Local medical workers exhibited even higher scores of PSS, PHQ-9, GAD-7 and ASDS than those from outside Hubei (P<0.001). Females had more severe perceived stress, depression and anxiety than males (P<0.001). Multiple logistic regression showed that perceived stress is associated with increased odds of depression (OR=1.413; 95% CI: 1.338–1.493; P<0.001) and anxiety (OR=1.515; 95% CI: 1.407–1.631; P<0.001).ConclusionOur findings demonstrated a high prevalence of stress, depression, anxiety and acute distress among medical workers on the front-line during the COVID-19 outbreak in Wuhan. The level of psychological impact may be mediated by individual perceptions of stressful events.

Differences Between Health Workers and General Population in Risk Perception, Behaviors, and Psychological Distress Related to COVID-19 Spread in Italy.

In this study, we investigated the perception of risk and the worries about COVID-19 infection in both healthcare workers and the general population in Italy. We studied the difference in risk perception in these two groups and how this related to demographic variables and psychological factors such as stress, anxiety, and death anxiety. To this aim, we administered an online questionnaire about COVID-19 together with other questionnaires assessing the psychological condition of participants. First, we found that the exposition to infection risk, due to living area or job, increased the perceived stress and anxiety (i.e., medical staff in North Italy was more stressed and anxious with respect to both medical- and non-medical participants from Center and South Italy). Then, we conducted hierarchical logistic regression models on our data to assess the response odds ratio relatively to each regressor on each dependent variable. We found that health workers reported higher risk perception, level of worry, and knowledge as related to COVID-19 infection compared to the general population. Psychological state, sex, and living area were less related to these factors. Instead, judgments about behaviors and containment rules were more linked to demographics, such as sex. We discussed these results in the light of risk factors for psychological distress and possible interventions to meet the psychological needs of healthcare workers.

Prevalence and risk factors of mental distress in China during the outbreak of COVID‐19: A national cross‐sectional survey

ObjectiveAs a result of the pandemic of COVID‐19, the public have been experiencing psychological distress. However, the prevalence of psychological distress during the COVID‐19 pandemic remains unknown. Our objective was to evaluate the prevalence of psychological distress during COVID‐19 outbreak and their risk factors, especially their internal paths and causality.MethodsA nationwide cross‐sectional survey of the prevalence of mental disorders was conducted. We used Hospital Anxiety and Depression Scale (HADS) to estimate the prevalence of anxiety and depression. The internal paths and the causality of the psychological health were analyzed using a structural equation modeling (SEM) approach.ResultsA total of 24,789 respondents completed the survey. We found that the overall prevalence of anxiety, depression, combination of anxiety, and depression were 51.6% (95% CI: 51.0–52.2), 47.5% (95% CI: 46.9–48.1), and 24.5% (95% CI: 24.0–25.0), respectively. The risk of psychological disorders in men was higher than that in women. The status of psychological health was different across different age groups, education levels, occupations, and income levels. The SEM analysis revealed that inadequate material supplies, low income, low education, lack of knowledge or confidence of the epidemic, and lack of exercise are major risk factors for psychological distress.ConclusionsThe evidence from this survey poses serious challenges related to the high prevalence of psychological distress, but also offers strategies to deal with the mental health problems caused by the COVID‐19 pandemic.

Psychological impact of COVID-19 outbreak on frontline nurses: A cross-sectional survey study.

Aims and objectivesThis study aimed to portray the prevalence and associated factors of psychological distress among frontline nurses during COVID‐19 outbreak.BackgroundThe COVID‐19 outbreak has posed great threat to public health worldwide. Nurses fighting against the epidemic on the frontline might be under great physical and psychological distress. This psychological distress was predominantly described as sleep disturbance, symptoms of anxiety and depression, post‐traumatic stress, inability to make decisions and even somatic symptoms.DesignCross‐sectional study.MethodsFrontline nurses from designated hospitals for COVID‐19 patients were invited to complete an online survey by convenience sampling, and the survey included six main sections: the General Health Questionnaire, the Perceived Social Support Scale, the Simplified Coping Style Scale, the Impact of Event Scale‐Revised, socio‐demographic, occupation and work history. Multiple logistic analysis was used to identify the potential risk factors of psychological distress. The study methods were compliant with the STROBE checklist.ResultsOf the 263 frontline nurses, 66 (25.1%) were identified as psychological distress. Multiple logistic analysis revealed that working in emergency department, concern for family, being treated differently, negative coping style and COVID‐19‐related stress symptom were positive related to psychological distress. Perceived more social support and effective precautionary measures were negatively associated with psychological distress.ConclusionsThe study demonstrated that COVID‐19 had a significant psychological impact on frontline nurses. Early detection of psychological distress and supportive intervention should be taken according to the associated factors to prevent more serious psychological impact on frontline nurses.Relevance to clinical practiceThis study highlighted that the frontline nurses were suffering from varying degrees of psychological distress, which needed early screening and supportive intervention for preventing more serious psychological impact on frontline nurses. Beside, more specific measurement should be combined with the GHQ‐12 to assess the varying degrees of psychological distress in frontline nurses.

Psychological distress and self-harm in a religiously diverse sample of Lebanese students

ABSTRACT Drawing on identity process theory, this study explores the protective and risk factors of psychological distress and self-harm in a religiously diverse sample of heterosexual and non-heterosexual students in Lebanon. A convenience sample of 209 undergraduate students participated in a cross-sectional survey and completed measures of religiosity, identity threat, psychological distress and self-harm. Results indicated that non-heterosexual participants exhibited higher levels of psychological distress, were more likely to report self-harm, and reported lower levels of religiosity than their heterosexual counterparts. It was shown that religiosity was protective against psychological distress, and that sexual orientation distress predicted self-harm. In order to reduce the risk of psychological distress and self-harm, it will be necessary to challenge stigma towards sexual minorities, to promote engagement with a broader range of social identity categories (other than just religion), and to ensure the availability of effective counselling support to all who need it.

Living Kidney Donors' Financial Expenses and Mental Health.

Living kidney donors incur donation-related expenses, but how these expenses impact postdonation mental health is unknown. In this prospective cohort study, the association between mental health and donor-incurred expenses (both out-of-pocket costs and lost wages) was examined in 821 people who donated a kidney at one of the 12 transplant centers in Canada between 2009 and 2014. Mental health was measured by the RAND Short Form-36 Health Survey along with Beck Anxiety Inventory and Beck Depression Inventory. A total of 209 donors (25%) reported expenses of >5500 Canadian dollars. Compared with donors who incurred lower expenses, those who incurred higher expenses demonstrated significantly worse mental health-related quality of life 3 months after donation, with a trend towards worse anxiety and depression, after controlling for predonation mental health-related quality of life and other risk factors for psychological distress. Between-group differences for donors with lower and higher expenses on these measures were no longer significant 12 months after donation. Living kidney donor transplant programs should ensure that adequate psychosocial support is available to all donors who need it, based on known and unknown risk factors. Efforts to minimize donor-incurred expenses and to better support the mental well-being of donors need to continue. Further research is needed to investigate the effect of donor reimbursement programs, which mitigate donor expenses, on postdonation mental health.