Self-reported Distress Research Articles

Mental distress and associated factors among undergraduate students: evidence from a cross-sectional study at the University of Dodoma, Tanzania

Mental distress is a common health problem facing university students worldwide. It manifests with varying levels of depression, anxiety, and somatic symptoms such as headache, backache, sleeping problems, and fatigue. University students are a high-risk group for mental distress than the general population. This study aimed to assess knowledge, the prevalence of mental distress, and its associated factors among undergraduate students. A cross-sectional study was conducted among undergraduate students at the University of Dodoma in Tanzania. Data were collected using pre-tested and self-administered questionnaires. Bivariate and multivariable logistic regression models were used to identify factors associated with mental distress. A total of 224 undergraduate students gave a complete response, of which the majority were aware of the common symptoms of mental distress. Self-reported mental distress experience was reported among 116/224 (51.8%) students. Multivariable logistic analysis showed that only alcohol consumption (aPR = 1.61, 95% CI 1.22–2.11, p = 0.001) was independently associated with mental distress among students. The findings of this study revealed that undergraduate students had adequate knowledge of the symptoms of mental distress. Our results show that the prevalence of self-reported mental distress was moderately high among undergraduate students. Furthermore, the study indicates a significant association between alcohol consumption and self-reported mental distress among these students. These results suggest that interventions aimed at reducing alcohol consumption may be beneficial in mitigating mental health issues among undergraduate students in Tanzania.

Population Health Implications of Medicaid Prerelease and Transition Services for Incarcerated Populations.

As states expand prerelease and transition services for incarcerated individuals under the Medicaid Reentry Section 1115 Demonstration Opportunity, we sought to systematically inform Medicaid state and plan administrators regarding the population size and burden of disease data available on incarcerated populations in both jails and prisons in the United States. We analyzed data on eligibility criteria for new Medicaid prerelease and transition services based on incarceration length and health conditions across states. We estimated the potentially eligible populations in prisons and jails, considering various incarceration lengths and health status requirements. We also compared disease prevalence in the incarcerated population with that of the existing civilian Medicaid population. We found that rural and smaller states would experience a disproportionately large proportion of their Medicaid populations to be eligible for prerelease and transition services if new Medicaid eligibility rules were broadly applied. Self-reported psychological distress was notably higher among incarcerated individuals compared with those currently on Medicaid. The prevalence rates of previously diagnosed chronic hepatitis C and kidney disease were also much higher in the incarcerated population than the existing civilian Medicaid population. We estimated large volumes of potentially Medicaid-eligible entrants as coverage policy changes take effect over the coming years, particularly impacting smaller and more rural states. Our findings reveal very high disease prevalence rates among the incarcerated population subject to new Medicaid coverage, including specific chronic, infectious, and behavioral health conditions that state Medicaid programs, health plans, and providers may benefit from advanced planning to address.

The changing impacts of social determinants on youth mental health in Australia.

Most lifetime mental health disorders begin by age 25 years, and the prevalence among young people has been increasing over recent years. We sought to understand what impact, if any, social determinants have had on this increase through the analysis of an Australian longitudinal dataset (with data from 2007 to 2021). The analysis focused on five social determinants: loneliness and lack of social support, family relationships, participation in education and employment, receipt of government benefits and relative socio-economic status. We analysed cross-sectional changes in self-reported psychological distress between 2007 and 2021 (using the Kessler-10 item; K10 scores) and examined the effects of these five social determinants on psychological distress using weighted linear regression models. We identified a significant increase in psychological distress among Australians from 2007 to 2021, with the sharpest rise among those aged 15 to 25 years, who saw more than doubling in the percentage of high and very high K10. This period also saw an increase in the prevalence of social determinants such as loneliness and lack of social support, as well as poor family relationships, particularly in 2021 post COVID-19 pandemic. Regression models suggest loneliness and lack of social support had the most pronounced and increasing impact on psychological distress, followed by poor family relationships. The observed significant and steady increases in psychological distress and related social determinant factors, particularly loneliness and lack of social support among young people, highlight the urgent need for comprehensive actions. Coordinated research and community-based initiatives are needed to deliver intrapersonal, interpersonal and socially-focused interventions with a holistic approach to support psychosocial wellbeing. Policymakers must adopt a comprehensive shift in political commitment and a whole-of-government approach to address these challenges.

Beyond presence of symptoms: Self-reported psychosocial distress interference among outpatient youth with cancer and other life-limiting conditions.

Youth with life-limiting conditions face significant psychosocial challenges (e.g., symptoms of anxiety, depression, and pain) throughout illness and treatment. Without appropriate intervention, this can negatively affect long-term outcomes (e.g., disease management, health-related quality of life). Prompt identification and appropriate attention to distress can mitigate these effects. We aimed to determine the prevalence and severity of distress interference among outpatient youth with cancer and other life-limiting conditions, using the Checking IN screener. Within a larger study across four hospital centers, English-speaking pediatric outpatients aged 8-21, and a caregiver-proxy-reporter, completed a brief distress screener. Descriptive analyses were used to characterize the sample and evaluate reported distress symptoms. Checking IN was completed by 100 participants, aged 8-21 (M=14.27, SD=3.81); caregivers completed an equivalent proxy screener. Youth most frequently endorsed fatigue (moderate: n=50, 50.0%; high: n=21, 21.0%), paying attention (moderate: n=45, 45.0%; high: n=16, 16.0%), and sleep difficulty (moderate: n=46, 46.0%; high: n=13; 13.0%) as problematic. Caregivers proxy reported fatigue (moderate: n=46, 46.0%; high: n=32, 32.0%), worry (moderate: n=56, 56.0%; high: n=10, 10.0%), and sleep difficulty (moderate: n=47, 47.0%; high: n=14; 14.0%) as most problematic. Group differences between youth and caregiver responses were not significant. Youth self-report via Checking IN can detect psychosocial distress interference. By directing resources based on real-time assessment of symptom interference, there is potential to simplify outpatient psychosocial screening and improve referral timeliness and specificity, thus allowing for more effective attention to evolving symptoms of distress.

Abstract B141 Self-reported distress in multiple myeloma patients at first consultation at a transplant referral center

Abstract The National Comprehensive Cancer Network (NCCN) recommends screening all cancer patients for distress to facilitate psychosocial support and referrals. This distress is associated with treatment delays and other obstacles that may affect patient outcomes. The prevalence of distress in patients with multiple myeloma (MM) and its variation among underrepresented minorities and vulnerable groups is unknown. We hypothesized that patients with advanced disease, racial minorities, and vulnerable individuals would report higher distress levels. New patients with MM seen between 1/1/2015-12/31/2022 at a tertiary medical center were identified. All patients receive the NCCN Distress Thermometer (DT) survey for completion at initial consultation as standard of care. Baseline characteristics of patients who completed the survey were compared with those of patients who did not. Among those with survey data, DT score was categorized as <4 (low), 4–6 (moderate), and >6 (high). DT score was analyzed by sociodemographic and disease-related factors. The 2020 Social Vulnerability Index (SVI) at the county level was calculated using Zip codes and categorized as less vulnerable (score <50) or more vulnerable (>=50). Of 1,011 new MM patient consultations, 683 patients had an available DT survey at initial consultation. In patients without the survey (N=328), a higher proportion was older than 75 years (21% vs 16% P=0.04), non-Hispanic Black (NHB) [22% vs. 9%, P<0.01], and with more advanced disease (ISS III 20% vs 14%, P<0.01). There was lower autologous stem cell transplant utilization in the group with missing survey data (71% vs 79%, P<0.01). Among those with DT survey, younger age, female sex, advanced stage, and shorter time from diagnosis to consult was associated with higher distress. In patients with DT survey data and SVI (N=683), the mean SVI was 0.37 (std dev 0.31) and 166 (28%) had more vulnerability. Younger age and NHB race were associated with more vulnerability. The more vulnerable group also had a shorter time from diagnosis to consult (1.2 vs 1.8 months, P<0.01). In the more vulnerable group, high DT score was seen with younger age and NHB race. There was no difference in transplant utilization by SVI group. No significant differences were found in the proportion of patients reporting concerns for physical, practical, emotional, social concerns by vulnerability. In this tertiary referral center study, we observed the greatest disparity by the completion of the NCCN DT survey highlighting a missed opportunity to identify individuals who may benefit from additional services. Among those who completed the survey, patient-reported distress was influenced by age, sex, and MM stage. Younger age was associated with more vulnerability. This may be due to minority status as a theme in the SVI calculator and the known association of younger age at MM onset in NHB individuals. Next steps including an adjusted analysis will be shown in the final presentation. Citation Format: Noel Estrada-Merly, James F Wu, Anita D'Souza. Self-reported distress in multiple myeloma patients at first consultation at a transplant referral center [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B141.

The Role of Social Determinants of Health in Self-Reported Psychological Distress among United States Adults Post-COVID-19 Pandemic.

Psychological distress, an emotional condition with symptoms of anxiety and depression, leads to impaired function, behavior, and personal traits. The current study examined the association between social determinants of health and the severity of psychological distress among adults in the United States after the COVID-19 pandemic. Using multinomial multivariable logistic regression, we analyzed data from 5106 (n = 5106) participants in the Health Information National Trends Survey (HINTS) 6. Compared to non-Hispanic Whites, African Americans (AOR = 0.62, CI = 0.42-0.93) had lower odds of reporting mild psychological distress rather than no stress. Other variables associated with a higher likelihood of reporting moderate to severe psychological distress, rather than no distress, are being in the 50-64 years age group (AOR = 2.77, CI = 1.45-5.28), divorced (AOR = 2.50, CI = 1.70-3.69), and widowed (AOR = 3.78, CI = 2.15-6.64). Respondents living in an urban area had lower odds of reporting moderate to severe psychological distress (AOR = 0.56, CI = 0.39-0.80) compared to those living in rural areas. Our findings identify several risk factors for psychological distress by sociodemographic characteristics such as age, race, marital status, and urban living, providing empirical evidence for interventions in behavioral health. These findings suggest there is an utmost need for a multi-sectoral approach to address the social determinants of health associated with psychological distress post-COVID-19 pandemic.

Assessment of the Mental and Physical Health Problems of Clients Undergoing Opioid Substitution Therapy: A Hospital-based Cross-sectional Study

Background: Opioid substitution therapy (OST) is one of the most effective treatment options for opioid dependence. However, there are not enough credible studies available on the health-care problems of clients undergoing OST. Materials and Methods: The study recruited 100 patients undergoing OST on an outpatient basis using a consecutive sampling technique. The mental and physical health problems were evaluated using the Patient Health Questionnaire-9, General Anxiety Disorder Scale 7, and a self-reported physical symptom checklist. Results: The estimates of depression and anxiety were 52% and 39%, respectively. The general physical ailments were more often reported by the subjects followed by musculoskeletal problems and neurological problems. A significant correlation was observed between physical health problems with anxiety (r = 0.40, P < 0.01) and depression (r = 0.37, P < 0.01). Conclusion: The clients undergoing OST have a high degree of self-reported health problems and psychological distress in this setting.

Technology-facilitated sexual harassment and mental health symptoms among young-adult female student sample in Bangladesh.

To assess the prevalence of technology-facilitated sexual harassment (TFSH) and its relationships to adverse mental health issues among young adult female students in Bangladesh. We collected data for this cross-sectional study from July to September 2022 from 455 female students at a large university in Bangladesh. The prevalence of TFSH, self-reported distress, stress, anxiety, depression, and suicidal thoughts was assessed. Multivariable logistic regressions were used to assess the identified relationships. This study found that nearly half of the respondents (46.1%) reported having experienced TFSH. The prevalence of suicidal thoughts, moderate to severe distress, stress, anxiety, and depression was 34.9%, 47.7%, 78.2%, 36.9%, and 59.8%, respectively. Results also reported that, compared to the respondents who did not experience TFSH, those who experienced it were more likely to report adverse mental health issues with higher odds. For example, after controlling for sociodemographic variables, the odds of moderate to severe distress (Adjusted odds ratio [AOR]: 3.70; 95% confidence interval [CI]: 2.36-5.78), stress (AOR: 2.09; 95% CI: 1.25-3.49), anxiety (AOR: 3.80; 95% CI: 2.40-6.03), depression (AOR: 3.32; 95% CI: 2.12-5.18), and having suicidal thoughts (AOR: 4.86; 95% CI: 2.29-7.89) were higher among female students experiencing TFSH than those who did not experience it. TFSH harassment among young adult female students is common and significantly associated with different adverse mental health issues. Attempts at primary intervention for improving mental health status are required to take TFSH into consideration.

Are protected characteristics associated with mental health care inequalities in the adult UK general population? a cross-sectional study.

This study investigates the association between protected characteristics and inequalities in mental health care in the UK. Multinomial regression was used to model the association between protected characteristics and self-reported distress. Data was extracted from waves 6-10 (2014-2019) of the UK Household Longitudinal Study. Two risk categories were constructed: "undiagnosed distress" referred to a General Health Questionnaire-12 (GHQ-12) score above "caseness" along with no history of mental health diagnosis; "diagnosis without self-report symptoms" referred to a GHQ-12 score consistently below "caseness" within the study time frame but having received a mental health diagnosis. Compared to people without a disability, people with a disability are at considerably greater risk of both undiagnosed distress (Relative risk ratios (RRR) 2.76; Confidence Interval (CI): 2.55, 2.99) and diagnosis without self-reported symptoms (RRR 3.61; CI: 2.80, 4.66). Likewise, women were more likely than men to report undiagnosed distress (RRR = 1.49; CI: 1.38,1.61) or a diagnosis without self-reported symptoms (RRR = 1.38; CI: 1.08, 1.76. Lesbian, gay, and bisexual people are at greater risk of undiagnosed distress compared with heterosexual people (RRR 1.42; CI: 1.19, 1.70). Adults aged 16-24 years were at greatest risk compared to all other age groups. People from a minority ethnic background had a reduced risk of diagnosis without self-report symptoms compared with people from a White ethnic background (RRR 0.34; CI: 0.20, 0.61). Education, employment and income variables moderated some of these associations. This is the first study to examine diagnosis without self-report symptoms alongside undiagnosed distress. Findings suggest that addressing inequality in mental health care requires increased understanding of the needs and strengths within different groups and to provide appropriate forms of social, medical or psychosocial intervention rather than a singular focus on increasing detection, diagnosis and treatment. People with a disability appear to be at greatest disadvantage, requiring greater attention in policy and practice.

State Abortion Policy and Moral Distress Among Clinicians Providing Abortion After the Dobbs Decision

Moral distress occurs when individuals feel powerless to do what they think is right, including when clinicians are prevented from providing health care they deem necessary. The loss of federal protections for abortion following the Dobbs v Jackson Women's Health Organization Supreme Court decision may place clinicians providing abortion at risk of experiencing moral distress, as many could face new legal and civil penalties for providing care in line with professional standards and that they perceive as necessary. To assess self-reported moral distress scores among abortion-providing clinicians following the Dobbs decision overall and by state-level abortion policy. This survey study, conducted from May to December 2023, included US abortion-providing clinicians (physicians, advanced practice clinicians, and nurses). A purposive electronic survey was disseminated nationally through professional listservs and snowball sampling. Abortion policy in each respondent's state of practice (restrictive vs protective using classifications from the Guttmacher Institute). Using descriptive statistics and unadjusted and adjusted negative binomial regression models, the association between self-reported moral distress on the Moral Distress Thermometer (MDT), a validated psychometric tool that scores moral distress from 0 (none) to 10 (worst possible), and state abortion policy was examined. Overall, 310 clinicians (271 [87.7%] women; mean [SD] age, 41.4 [9.7] years) completed 352 MDTs, with 206 responses (58.5%) from protective states and 146 (41.5%) from restrictive states. Reported moral distress scores ranged from 0 to 10 (median, 5) and were more than double for clinicians in restrictive compared with protective states (median, 8 [IQR, 6-9] vs 3 [IQR, 1-6]; P < .001). Respondents with higher moral distress scores included physicians compared with advanced practice clinicians (median, 6 [IQR, 3-8] vs 4 [IQR, 2-7]; P = .005), those practicing in free-standing abortion clinics compared with those practicing in hospitals (median, 6 [IQR, 3-8] vs 4 [IQR, 2-7]; P < .001), those no longer providing abortion care compared with those still providing abortion care (median, 8 [IQR, 4-9] vs 5 [IQR, 2-8]; P = .004), those practicing in loss states (states with the greatest decline in abortion volume since the Dobbs decision) compared with those in stable states (unadjusted incidence rate [IRR], 1.72 [95% CI, 1.55-1.92]; P < .001; adjusted IRR, 1.59 [95% CI, 1.40-1.79]; P < .001), and those practicing in surge states (states with the greatest increase in abortion volume since the Dobbs decision) compared with those in stable states (unadjusted IRR, 1.27 [95% CI, 1.11-1.46]; P < .001; adjusted IRR, 1.24 [95% CI, 1.09-1.41]; P = .001). In this purposive national survey study of clinicians providing abortion, moral distress was elevated among all clinicians and more than twice as high among those practicing in states that restrict abortion compared with those in states that protect abortion. The findings suggest that structural changes addressing bans on necessary health care, such as federal protections for abortion, are needed at institutional, state, and federal policy levels to combat widespread moral distress.

An emotional distress biomarker in pregnant women: Ultra-short-term heart rate variability

Prenatal emotional distress is common in pregnant women. Altered emotional distress can occur from the very beginning to the end of pregnancy. Heart rate variability (HRV) has recently become considered to be a potentially reliable psychophysiological stress biomarker in adults. In the current study, we evaluated ultra-short-term HRV (1-minute measurement) as a psychophysiological biomarker by examining the association between HRV parameters and self-reported prenatal emotional distress among pregnant women (N = 230) across three trimesters of pregnancy. ResultsPrenatal emotional distress was associated with a lower root mean square of successive differences between normal heartbeats (RMSSD), NN50, and SDNN Index among pregnant women who are in the second trimester. For women in the first and third trimester of pregnancy, prenatal emotional distress was not significantly correlated with any HRV indicators. LimitationsThe cross-sectional nature of our results limits the directional expression and assessment of the relationships, and longitudinal studies that target the recruitment of more pregnant women with subtypes of emotional distress issues are also needed. ConclusionsTime-domain parameters of low HRV (associated with reduced parasympathetic activity) can potentially serve as an efficient psychophysiological biomarker for prenatal emotional distress in the second trimester of pregnancy. However, the time-domain HRV indicators in pregnant women in the first and third trimesters may be affected by other physiological and psychological fluctuations, thus decreasing the HRV biomarker’s efficiency in predicting their prenatal emotional distress.

The Effect of Oncology Nurse Navigation on Mental Health in Patients with Cancer in Taiwan: A Randomized Controlled Clinical Trial.

In this study, we investigated the prevalence of mental health problems among patients with cancer and whether oncology nurse navigation improved their mental health outcomes and medical experience. In this randomized controlled clinical trial, we recruited 128 outpatients with cancer via purposive sampling from a teaching hospital in northern Taiwan. Participants were randomly assigned to the navigation group (N = 61) or the usual care group (N = 67). Data were collected from January 2019 to July 2020 using questionnaires, including the self-reported Distress Thermometer, Hospital Anxiety and Depression Scale, Demoralization Scale, and Patient Assessment of Chronic Illness Care. Data were collected at baseline and after three and six months of the intervention. Descriptive and analytical statistical analyses were performed. The prevalence rates of anxiety, depression, distress, and demoralization were 17.9%, 15.7%, 29.7%, and 29.7%, respectively. After three months, the participants in the navigation group exhibited significantly reduced levels of anxiety, demoralization, and emotional distress (reduced by 92%, 75%, and 58%, respectively) and reported a better medical experience (odds ratio = 1.40) than those in the usual care group.

A Preliminary Analysis of Stress Burden and Cognitive Function and Clinically Adjudicated Cognitive Outcomes in Black American Adults.

The combination of exposure to multiple stressors and psychological distress may contribute to the disproportionate burden of dementia risk among Black Americans. This study estimates the effect of an index of stress and psychological distress (ie, "stress burden") on cognitive function and clinically adjudicated cognitive outcomes among older Black American adults, and examines sleep as a mediator. The sample included 204 Black adults (79% female; mean age = 64 years) from Pittsburgh, PA, USA. Stress burden comprised 3 self-reported stress and distress measures assessed in 2016: discrimination, psychological distress, and posttraumatic stress. Potential mediators included actigraphy-assessed sleep duration and efficiency from 2018. Cognitive battery and clinical adjudication in 2019 assessed cognitive function and clinically adjudicated outcomes. Causal mediation analysis estimated the direct effect between stress burden and cognitive outcomes, and indirect effects through sleep, after adjusting for sociodemographics and hypertension. Higher stress burden had a significant direct effect on lower executive functioning and visuospatial performance. However, there were no significant indirect effects (ie, mediation) by sleep disturbances on any domain of cognitive function assessed. Also, there were no significant direct or indirect effects on clinically adjudicated outcomes. Multiple stressors often co-occur and may contribute to racial disparities in cognitive health. Findings suggest that higher stress burden had negative effects on functioning in executive and visuospatial domains in this community-based sample of older Black American adults. However, there was no evidence of mediation by sleep. Findings highlight the importance of continued work to identify modifiable pathways between stress burden and cognitive health disparities.

Psychological distress among Canadian postsecondary students: a repeated cross-sectional analysis of the Canadian Campus Wellbeing Survey (CCWS) between spring 2020–2023

Objective: To examine trends in self-reported psychological distress among Canadian postsecondary students between 2020 and 2023. Participants and Methods: Using data collected from postsecondary students (n = 103,936) through the Canadian Campus Wellbeing Survey (CCWS), multilevel regression models were fitted to determine how distress levels, as measured by the Kessler Psychological Distress Scale, differed across six-time points of the CCWS. Results: Across the cycles, students reported high levels of distress (mean across cycles = 26.16, SD = 8.61). Considering the impact of time on distress, when compared to pre-COVID-19 pandemic, Fall 2020 (β = 1.4, p < .001), Spring 2021 (β = 1.2, p < .001), Spring 2022 (β = 1.6, p < .001), and Spring 2023 (β = 0.80, p < .017) had significantly higher levels of distress. Distress levels were associated with ancestry, age, gender, and sexual orientation. Conclusion: It is imperative to develop strategies and allocate resources to address the high levels of psychological distress among Canadian postsecondary students.

Self-reported cognitive function and its relationship with self-reported health, psychological distress, and life satisfaction among cardiac arrest survivors - a nationwide register study

Abstract Introduction Cognitive problems in terms of memory, executive function, information retrieval, perception, and attention are common in cardiac arrest (CA) survivors. Studies show that cognitive impairment are associated with important outcomes such as lower quality of life, social function, and ability to work. However, cognitive function is commonly assessed by performance-based or observer-reported outcome measures that do not reflect the person’s own experience. To offer a person-centred CA care, this knowledge is of high importance. Purpose To describe self-reported cognitive function and its relationship with self-reported health, psychological distress, and life satisfaction among CA survivors. Methods This nationwide register study utilized data from the (Country) Register of Cardiopulmonary Resuscitation, encompassing survivors of both in-hospital and out-of-hospital CA. Inclusion criteria comprised survivors with a Cerebral Performance Category (CPC) scale score ≤3 at hospital discharge who underwent a follow-up phone interview with a registered nurse 3-6 months post CA. Health status was measured using the EQ-5D Visual Analogue Scale (EQ VAS), psychological distress with the Hospital Anxiety and Depression Scale (HADS), and life satisfaction with a global question about overall satisfaction from the Life Satisfaction Questionnaire (LiSat-11). Self-reported cognitive function was measured by a single question: ‘How do you experience your memory, concentration, and/or planning abilities today compared to before the cardiac arrest?’ Data was analysed using multiple linear regression and multiple binary logistic regression models. Results The sample consisted of 1,254 CA survivors, 32% females. The mean age was 66 (SD=13.4) years. Most of the CAs occurred in-hospital (74%) and were witnessed (93%). A cardiac aetiology (55%) and a shockable initial rhythm (57%) were most common. In total, 68% reported an unchanged cognitive function while 27% reported worse cognitive function. Better cognitive function was reported by 5%. Experiencing a worse cognitive function in relation to unchanged or better cognitive function was associated with worse self-reported health measured using the EQ VAS (p&amp;lt;0.001), higher levels of symptom of anxiety and depression measured with the HADS (p&amp;lt;0.001 and p&amp;lt;0.001 respectively), and a lower life satisfaction measured by the LiSat-11 (p&amp;lt;0.001). The significant associations remained after the regression models were adjusted for age, sex, place, aetiology, initial rhythm, and witnessed status. Conclusions As CA survivors with worse cognitive function reported poorer health, more psychological distress, and reduced life satisfaction, this study points out the importance to screen for self-reported cognitive function. Using a single question may facilitate the ability to identify survivors with a perceived worse cognitive function in need of support.

Symptom Distress Before and After Heart Transplantation - A Longitudinal 5-Year Follow-Up.

Symptom distress after heart transplantation (HTx) is a significant problem causing uncertainty, low self-efficacy, and psychological distress. Few studies have addressed self-reported symptoms. The aim was to explore self-reported symptom distress from time on the waiting list to 5years after HTx and its association with self-reported psychological well-being, chronic pain, and fatigue in order to identify possible predictors of psychological or transplant specific well-being. This multicenter, longitudinal cohort study includes 48 heart recipients (HTRs), 12 women, and 36 men, with a median age of 57years followed from pretransplant to 5years post-transplant. Symptom distress was explored by means of four instruments measuring psychological general wellbeing, transplant specific wellbeing, pain, and fatigue. Transplant specific well-being for the whole improved in a stepwise manner during the first 5years compared to pretransplant. Heart transplant recipients with poor psychological wellbeing were significantly more burdened by symptom distress, in particular sleep problems and fatigue, for up to 5years after HTx, and their transplant-specific well-being never improved compared to baseline. The prevalence of pain varied from 40% to 60% and explained a significant proportion of the variance in transplant-specific well-being, while psychological general well-being was mainly predicted by overall symptom distress. The presence of distressing symptoms explains a significant proportion of poor psychological wellbeing both among HTRs reporting chronic pain and those without pain.

Digital cognitive behavioral therapy for insomnia for people with comorbid psychological distress: A large scale randomized controlled trial

Study objectivesTo examine if comorbid anxiety and depression symptoms (psychological distress) moderate intervention effect in participants receiving digital Cognitive Behavioral Therapy for Insomnia (dCBT-I) in a large-scale randomized controlled trial (RCT), compared to a patient education (PE) control condition. Further, we investigate if dCBT-I reduced levels of psychological distress for those with insomnia and comorbid psychological distress. Methods1721 participants with insomnia completed online assessments of sleep, fatigue and psychological distress, at baseline and at nine-week follow-up. Primary outcome was Insomnia Severity Index (ISI), and secondary outcomes included self-reported sleep (diary), cognition, fatigue, and psychological distress. Participants with psychological distress (HADS>16) were separated from participants without psychological distress. Linear mixed models in SPSS were conducted to test the effects of the intervention. ResultsAt nine-week follow-up we found no difference in effect of the intervention between those who had comorbid psychological distress vs. those without psychological distress in terms of insomnia severity (p = 0.552) and fatigue (p = 0.744). Both groups had large effect size improvements on insomnia severity (p < 0.001=), small to medium (Cohen d < 0.08) improvements on fatigue (p < 0.01=) and sleep efficiency (p < 0.001), and small improvement on other sleep diary measures, compared to their respective control group. The psychological distress group showed a small, but statistically significant decrease in psychological distress (d = 0.2, p < 0.05) with dCBT-I compared to PE. ConclusiondCBT-I is a viable treatment for Insomnia also for those who have comorbid psychological distress.

The influence of President Trump's micro-expressions during his COVID-19 national address on viewers' emotional response.

This preregistered study replicates and extends studies concerning emotional response to wartime rally speeches and applies it to U.S. President Donald Trump's first national address regarding the COVID-19 pandemic on March 11, 2020. We experimentally test the effect of a micro-expression (ME) by Trump associated with appraised threat on change in participant self-reported distress, sadness, anger, affinity, and reassurance while controlling for followership. We find that polarization is perpetuated in emotional response to the address which focused on portraying the COVID-19 threat as being of Chinese provenance. We also find a significant, albeit slight, effect by Trump's ME on self-reported sadness, suggesting that this facial behavior served did not diminish his speech, instead serving as a form of nonverbal punctuation. Further exploration of participant response using the Linguistic Inventory and Word Count software reinforces and extends these findings.

Effects of cardiac radiation on sleep and psychological distress in adult survivors of pediatric Hodgkin lymphoma without breathing sleep disorders.

10068 Background: Adult survivors of childhood Hodgkin lymphoma (HL) are at higher risk for excessive sleepiness, fatigue, and other morbidities that affect long-term quality of life (QoL). The relationship between radiation dose to the heart delivered during treatment and self-reported sleep quality, fatigue, QoL, and psychological distress in survivors of HL has not been explored. This study examines clusters of cardiac dosimetry and sleep quality and associated symptoms of insomnia, fatigue, QoL, and psychological distress in a subset of adult survivors of pediatric HL without breathing sleep disorders. Methods: Survivors completed standardized surveys of sleep quality (Pittsburg Sleep Quality Index, PSQI), insomnia (Insomnia Severity Index), fatigue (FACIT-F), QoL (SF36 short survey), and psychological distress (BS18). Two consecutive nights of in-home polysomnography were completed with at least 4 hours of recorded sleep in one night. Analyses were conducted on 95 survivors (mean[SD] age=36[7.2] years, 55 female) who demonstrated at least average sleep efficiency (&gt;85%) and demonstrated no evidence of sleep apnea (Apnea-Hypopnea Index &lt;5, or AHI &gt;5 and &lt;15 with no daytime sleepiness as defined by the American Society of Sleep Medicine). Radiation dose to the heart was estimated using dose reconstruction methods for therapeutic radiation exposure developed by the MD Anderson Cancer Center. Radiation/Sleep clusters were found using a silhouette analysis and K-means algorithm. Linear regression associations between clusters and outcomes were adjusted by age and body mass index. Statistical analyses were computed in the statsmodels toolbox for Python3. Results: Sleep and radiation were not correlated (ρ=0.03, p=0.67). Considering good sleep as PSQI&lt;5, three main Radiation/Sleep clusters were found indicating a low-radiation/middling-sleep group (22%; RT = 251[250.7] cGy, PSQI = 7[2.7]), a high- radiation/better-sleep group (46%; RT = 2012[406.8] cGy, PSQI = 4[1.5]), and a high- radiation/worst-sleep group (32%; RT = 2072[472.3] cGy, PSQI = 11[2.5]). Survivors in high-radiation/worst-sleep group demonstrated worse fatigue ( β=-12.3, p=0.001) and insomnia ( β=9.52, p&lt;0.001). This group was associated with poor Mental Health ( β=-2.1, p&lt;0.001) but not Physical Health QoL ( β=-0.4, p=0.154). This latter group also indicated more psychological distress (depression β=11.6, p=0.001, somatization β=11.8, p&lt;0.001), but not anxiety ( β=4.6, p=0.241). Conclusions: Our results highlight the burden of symptoms associated with higher radiation dosimetry in the heart including poor sleep quality, insomnia, fatigue, and increased psychological distress. Understanding the mechanisms of sleep quality and fatigue in HL survivors is warranted as some survivors demonstrate poor sleep quality and fatigue due to factors other than clinical sleep disorders.

Smile, You’re on Camera: Investigating the Relationship between Selfie Smiles and Distress

Background: This study examined the relationship between (1) participant smiling in daily “selfie” videos and (2) self-reported distress. Given the extensive use of digital devices for sharing expressions of non-verbal behavior, and some speculation that these expressions may reveal psychological states—including emotional distress—we wanted to understand whether facial expression in these TikTok-like videos were correlated with standardized measures of psychological distress. Based on the work of Paul Ekman and others, which posits that facial expressions are universal reflections of people’s inner states, we predicted that smiling would be inversely related to psychological distress. Method: Twenty-four undergraduate students, aged 18+ years (M = 18.35, SD = 2.75), were prompted to record a two-minute selfie video each evening during two weeks of data collection (i.e., 14 total days). They were instructed to describe various aspects of their day. They also completed self-report questionnaires at the end of each assessment week, including the Depression Anxiety Stress Scale (DASS), Perceived Stress Scale (PSS), and the Pittsburgh Sleep Quality Index (PSQI). Results: A counterintuitive effect was observed whereby smiling intensity during selfie videos was positively correlated with individual differences in anxiety, depression, and stress. Discussion: This study challenges the common view that facial expressions necessarily reflect our inner emotions. It provides preliminary evidence that a mobile sensing app that captures selfies—along with other naturalistic data—may help elucidate the relationship between facial expressions and emotions.