Severe Distress Research Articles

Relationships between personality factors and DC/TMD Axis II scores of psychosocial impairment among patients with pain related temporomandibular disorders

This cross-sectional analytical study aimed to assess the relationship between personality factors and the DC/TMD Axis II scores of psychosocial impairment among patients with pain related temporomandibular disorders (TMD). 120 participants (60 females and 60 males) who were diagnosed with pain related TMD according to the Axis I DC/TMD protocol were recruited. The participants were requested to complete four tests including the NEO Five Factor Inventory (NEO-FFI) to assess personality factors and three Axis II DC/TMD tools; the Graded Chronic Pain Scale (GCPS) Version 2.0 to assess TMD pain intensity and pain-related disability, Patient Health Questionnaire-4 (PHQ-4) to assess psychological distress due to TMD pain, and Generalized Anxiety Disorder-7 (GAD-7) to assess patients’ stress reactivity. Results showed that 49.2% of the participants experienced high intensity of characteristic pain, 14.2% reported pain related disability more than 30 days (grade 3 disability days) and had disability scores of 70 or above (grade 3 disability scores), 16.7% demonstrated severe distress, and 18.3% reported severe anxiety due to TMD pain. Females scored higher on all these variables than males (P < .05). Multiple regression analyses indicated that higher extraversion scores, higher agreeableness scores and being a female were associated with higher intensity of characteristic pain (p < .05). Also, higher neuroticism and agreeableness scores were associated with more disability days (p < .05). In addition, higher agreeableness scores were associated with higher disability scores and disability point values (p < .05). Furthermore, lower neuroticism scores and being a female were associated with higher PHQ total scores, while being a female and having a lower level of education were associated with higher GAD total scores (p < .05). In conclusion, personality profiles and gender significantly impact the DC/TMD Axis II scores of psychosocial impairment among patients with pain related TMD.

Bouncing back to the surface: Factors determining SME recovery

ABSTRACT Limited attention has been devoted to the key determinants of survival in situations of severe financial distress for small and medium-sized enterprises (SMEs). Against this backdrop, drawing from turnaround management literature, we develop hypotheses about SMEs investigating the importance of prior financial blockages, financial indicators, personnel characteristics, and the dynamics between SMEs and their personnel on recovery probability. By relying on advanced machine learning techniques, we analyze and select key predictors of recovery likelihood for SMEs in situations of severe distress. The results provide empirical support for our hypotheses, showing the significant roles of prior bank account blockages, creditworthiness, mean employee age, firing ratio, and the share of permanent work contracts in influencing recovery odds. The implications extend knowledge on SME turnaround strategies and offer practical suggestions for managers and policymakers in tailoring interventions.

Novel biomarkers of mitochondrial dysfunction in Long COVID patients.

Coronavirus disease 2019 (COVID-19) can lead to severe acute respiratory syndrome, and while most individuals recover within weeks, approximately 30-40% experience persistent symptoms collectively known as Long COVID, post-COVID-19 syndrome, or post-acute sequelae of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (PASC). These enduring symptoms, including fatigue, respiratory difficulties, body pain, short-term memory loss, concentration issues, and sleep disturbances, can persist for months. According to recent studies, SARS-CoV-2 infection causes prolonged disruptions in mitochondrial function, significantly altering cellular energy metabolism. Our research employed transmission electron microscopy to reveal distinct mitochondrial structural abnormalities in Long COVID patients, notably including significant swelling, disrupted cristae, and an overall irregular morphology, which collectively indicates severe mitochondrial distress. We noted increased levels of superoxide dismutase 1 which signals oxidative stress and elevated autophagy-related 4B cysteine peptidase levels, indicating disruptions in mitophagy. Importantly, our analysis also identified reduced levels of circulating cell-free mitochondrial DNA (ccf-mtDNA) in these patients, serving as a novel biomarker for the condition. These findings underscore the crucial role of persistent mitochondrial dysfunction in the pathogenesis of Long COVID. Further exploration of the cellular and molecular mechanisms underlying post-viral mitochondrial dysfunction is critical, particularly to understand the roles of autoimmune reactions and the reactivation of latent viruses in perpetuating these conditions. This comprehensive understanding could pave the way for targeted therapeutic interventions designed to alleviate the chronic impacts of Long COVID. By utilizing circulating ccf-mtDNA and other novel mitochondrial biomarkers, we can enhance our diagnostic capabilities and improve the management of this complex syndrome.

Adult Mental Health Associated with Adverse and Positive Childhood Experiences Among 1st and 2nd Generation Asian Americans.

Adverse childhood experiences (ACEs) and positive childhood experiences (PCEs) impact adult health. However, differences in ACEs, PCEs, and mental health have not been extensively studied among Asian Americans. To examine the association between childhood experiences and adult mental health in first and second generation Asian Americans. This study used data from the 2021-2022 California Health Interview Survey (CHIS), an address-based sampling of noninstitutionalized Californians conducted online or by phone. Asian American respondents aged 18-65 years. Fifteen different ACEs and seven different PCEs. Adjusted prevalence ratios (aPR) of severe psychological distress for each generation. Survey weights were applied to all analyses for population-based representation. 5,744 Asian Americans (48.0% male, 16.4% aged 18-25) were included in the current study. We found that second generation Asian Americans experienced a greater prevalence of ACEs (65.4% reported ≥1 ACE vs 47.5% in first generation Asian Americans) and lower prevalence of PCEs (32.1% reported ≤2 PCEs vs 22.6% in first generation Asian Americans). Second generation Asian Americans were more likely to report ≥4 ACEs (aPR, 1.46; 95% CI, 1.13 to 1.88) and ≤2 PCEs (aPR, 1.51; 95% CI, 1.29 to 1.78) relative to first generation Asian Americans. Second generation Asian Americans with ≥4 ACEs or ≤2 PCEs were more likely to report severe psychological distress (aPR, 2.54; 95% CI, 1.55 to 4.17 and aPR, 1.48; 95% CI, 1.03 to 2.13, respectively) relative to first generation Asian Americans. When examining ACEs and PCEs individually, domestic, physical, and verbal abuse; divorce; racism; and lacking support systems were significantly associated with severe psychological distress in second generation Asian Americans. Second generation Asian Americans are more likely to experience more ACEs, fewer PCEs, and poorer mental health as a result. Our study indicates that physicians should screen for childhood experiences and leverage trauma-informed care among Asian American subpopulations.

Impact of the COVID-19 pandemic on university students’ psychological distress, well-being, and utilization of mental health services in the United States: populations at greatest risk

IntroductionThe COVID-19 pandemic led to major disruptions in the lives of university students, which is a population that is already at a greater risk of mental health concerns. Little is known about how the pandemic impacted distress and mental health services utilization among university students across the United States.MethodsUsing survey data from the National College Health Assessment, both before the COVID-19 pandemic (pre-March 2020, n = 88,986) and during the pandemic (Spring 2021, n = 96,489), the present study examined mental health symptoms and utilization of mental health services among undergraduate students attending four-year universities in the United States.ResultsThere were notable increases in measures of psychological distress and reductions in well-being from before the pandemic to during the pandemic. However, overall utilization rates of mental health services slightly decreased from pre-pandemic to during the pandemic. Predictors of severe psychological distress included those who experienced loneliness, COVID-19 related stressors, and loss of a loved one from COVID-19. COVID-related stressors and loneliness were associated with higher utilization rates of mental health services, while well-being and resilience were associated with lower utilization rates.DiscussionAnalyses revealed that several demographic groups were at an elevated risk for severe psychological distress, including non-binary, female, and sexual minority students, and especially those who identify as both non-binary and non-heterosexual. Results indicated that students of color, especially female students of color, were less likely to receive mental health services. Future research is needed to increase our understanding of the barriers to mental health service use among high-risk university students.

Case report: Ketogenic diet alleviated anxiety and depression associated with insulin-dependent diabetes management

Differentiating between an irrational versus a rational fear of hypoglycemia has treatment implications and presents significant challenge for clinicians facing patients with type 1 diabetes, illustrated in this case. A 39-year-old woman with autoimmune-positive insulin-dependent diabetes sought help to alleviate severe diabetes distress, and symptoms of depression and anxiety, associated with unpredictable drastic blood glucose drops. After exhausting conventional methods, she adopted a ketogenic diet (KD). Her glucose values decreased from around 20 mmol/L to 12 mmol/L (360 mg/dL to 216 mg/dL) in the first days. Then, by combining a KD with an insulin pump, her time in optimal glucose range increased from 8 to 51% after 2 months, reducing her HbA1c with 25 mmol/mol (2.2%). This reduced biological and psychological stress, immediately improving her mental health and renewing her hope for the future. The main concerns regarding KD in patients with comorbid type 1 diabetes is the assumed increased risk of ketoacidosis, theoretical depletion of glycogen stores, and a potential adverse effect of saturated fat on cardiovascular risk factors. These concerns are evaluated against existing empirical evidence, suggesting instead that a KD may protect against acidosis, hypoglycemia, and cardiovascular risk. The present case, together with available data, indicate that patients with type 1 diabetes experiencing high levels of biological and psychological stress should be informed of the expected benefits and possible risks associated with a KD, to ensure their right to take informed decisions regarding their diabetes management.

The impact of heart failure caregiver burden and patient heart failure severity: analysis of the needs assessment tool: advanced heart failure (NAT: PD-HF)

Abstract Background Not only patients with heart failure (HF), but also their caregivers have reported experiencing distress, depression, anxiety, social isolation, and health problems related to caring for a patient. Needs assessment tools have been used in clinical practice to identify patients' problems and needs from an early stage, however, their relationship with caregiver burden and the severity of the HF patients they care for has not been well investigated. Purpose The purpose of this study is to examine the relationship between distress and HF severity in patients and their caregivers using the Needs Assessment Tool: Progressive Disease-Heart Failure (NAT: PD- HF). Methods We enrolled consecutive 106 chronic HF patients who were admitted to a university hospital and assessed needs by the NAT: PD-HF between February 2023 and July 2023. We also enrolled 95 of their caregivers. The NAT: PD-HF is administered by the health care provider in the form of an interview with the patient and their caregiver. The questionnaire consists of an assessment of the patient's well-being and an assessment of the caregiver's ability to care for the patient. The healthcare provider completes the tool by indicating the level of distress (none, mild, significant) for each section. The severity of the New York Heart Association (NYHA) functional classification is examined in each patient. Results The median age was 72 years (interquartile range 59-81), and 41% were in NYHA class III or IV. The most common relationship between patients and their primary caregivers was partners (53%), followed by children (26%), parents (8%), and siblings (5%). There were 100 patients (94%) with more than mild distress, 57 with NYHA I or II and 43 with NYHA III or IV (P = 0.037). There were also 84 (88%) caregivers with more than mild distress, 47 with NYHA I or II, and 37 with NYHA III or IV of the patients they cared for (P = 0.026). Twenty-four patients (22.6%) were in severe distress, of which 10 were NYHA I or II and 14 were NYHA III or IV (P = 0.044). Among caregivers, 18 (18.9%) were in severe distress, of whom 6 with NYHA I or II and 12 with NYHA III or IV for whom they are caring (P = 0.010). Conclusions Regardless of the severity of HF, caregivers were found to experience distress as similar rate as that in the HF patients they cared for. The proportion of patients and caregivers experiencing distress was found to increase with the severity of HF. It is important to introduce palliative care for HF from the early stage of the disease and to support not only the patient but also the caregivers by using screening tools to identify distress.

Factors Associated with Unmet Supportive Needs in Adult Cancer Survivors in South Korea

Abstract Purpose As the number of cancer survivors increases, addressing their unmet supportive care needs (USCNs) has become crucial. This study aimed to evaluate the influence of financial toxicity on USCNs and identify comprehensive factors associated with USCNs among adults’ cancer survivors. Methods A cross-sectional survey using convenience sampling from the 2022 Korean Population Census. Data were collected online between November 17 and December 15, 2022. The study included 1,038 cancer survivors aged 19 years or older who had completed primary treatment. Multivariable logistic regression was analyzed to identify factors associated with USCNs. Results Two-thirds (65.7%) of cancer survivors experienced severe financial toxicity, correlating with high unmet supportive care needs. Among those who reported a severe financial burden, a substantial 170 out of 187 respondents, or approximately 90.9%, were identified as having high unmet supportive care needs. Cancer survivors had the highest needs in the order of ‘management of psychological symptoms’ and ‘coping and emotional needs’. Cancer survivors diagnosed between 5 and 10 years ago were found to be less likely to report unmet supportive care needs compared to those diagnosed more recently, with an odds ratio of 0.14. Additionally, breast cancer survivors and individuals who were unemployed at the time of diagnosis had a higher likelihood of experiencing unmet supportive care needs, with adjusted odds ratios of 1.68 (95% confidence interval: 1.088-2.603) and 1.80 (95% CI: 1.125-2.891), respectively. Conclusions Cancer survivors with moderate to severe financial distress were more likely to be at risk of experiencing a high level of unmet supportive care needs. Coping and emotional needs are the most important concerns among the unmet needs of cancer survivors regardless of the time since cancer diagnosis. Key messages • Cancer survivors in South Korea with moderate to severe financial distress are twice as likely to face a high level of unmet supportive care needs. • The most significant unmet supportive care needs among South Korean cancer survivors relate to coping and emotional support, highlighting the need for enhanced mental health services.

Real-world predictors of severe psychological distress during the COVID-19 pandemic in Japan: Insights from a large-scale internet-based cohort study.

The COVID-19 pandemic has had negative physical and psychological impacts worldwide. However, there has been a lack of real-world evidence concerning the predictors of severe psychological distress (SPD) among the general population in Japan during the COVID-19 pandemic. The aim of this study was to examine predictors of SPD during the COVID-19 pandemic. We investigated the predictors of new-onset SPD in the general Japanese population using data from a large-scale internet-based cohort study. We included 16 489 study participants (age range = 16-81, mean age = 52.7, percentage of male = 50%) in the analysis. Over the course of 1 year from baseline, the estimated proportion of participants who experienced SPD was 5.2% with inverse probability weighting. The predictors of SPD included younger age, being never married, being unemployed, having a higher education background, scoring higher on the Fear of Coronavirus-19 Scale, experiencing more adverse childhood experiences, reporting poorer subjective health status, and COVID-19 with oxygen therapy. Our internet-based survey of the Japanese population may have selection bias, limiting the generalizability to other countries and cultures. This study revealed that being afflicted with COVID-19 requiring oxygen therapy is the most significant predictor of SPD. In addition, we found that vulnerability to social isolation, such as never being unmarried, anxiety toward COVID-19, and susceptibility to stress, are predictors of the emergence of SPD. Therefore, the implementation of online support systems and ensuring access to accurate information may protect against SPD during the COVID-19 pandemic in Japan.

Sexual identity differences in the association between psychological distress and cardiometabolic health among women: 2013-2018 National Health Interview Survey.

Poor psychological health has been consistently documented for sexually minoritized women. However, little is known about the association between poor psychological health and physical health. This study examined associations between psychological distress and cardiometabolic health, including cardiovascular disease risk conditions (hypertension, high cholesterol, and diabetes) and diagnoses (stroke, coronary heart disease, myocardial infarction, and angina), by sexual identity among women. Data are from the 2013-2018 National Health Interview Survey and included 102,279 women, who were straight (n = 97,909), lesbian/gay (n = 1,424), bisexual (n = 1,235), something else (n = 360), did not know (n = 712), and refused to disclose (n = 639). Multivariable multinomial logistic regression models were fit to estimate associations between psychological distress (measured with Kessler-6) and cardiometabolic health (self-reported diagnosis) and to examine sexual-identity differences in these associations. Covariates included sociodemographic characteristics. Overall, severe psychological distress was associated with significantly higher odds of having a cardiometabolic health condition (OR = 2.66). These associations generally did not statistically significantly differ based on sexual identity. However, potential substantive differences in the magnitude of the association existed among lesbian/gay (OR = 4.00) compared to straight women (OR = 2.73). Moreover, women who identified as gay/lesbian, bisexual, "something else," or "I don't know" all reported significantly higher prevalence of severe psychological distress than straight women. Given the overall positive association between psychological distress and cardiometabolic health as well as the higher prevalence of severe psychological distress among sexual minority women, more work is needed to longitudinally examine the effects of psychological distress on health among sexually minoritized women. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Longitudinal Study of Bereavement Outcomes Among Palliative Caregivers Mourners: Psychological Profiles in Prolonged Grief and Psychopathology.

Prolonged grief (PG) is a mental health condition characterized by severe distress following a loss. This study examines the roles of attachment styles, social support, stressful life events (SLEs), and pre-existing psychopathology in predicting PG and post-bereavement psychopathology among 74 caregivers of palliative patients. Using validated assessment tools, the study employed hierarchical regression and fuzzy-set qualitative comparative analysis (fsQCA) to identify predictors of prolonged grief and psychological outcomes over six months. Results showed that pre-existing psychopathology and PG risk predicted post-bereavement psychopathology, though not PG itself. Low social support and high SLEs were linked to worse outcomes, while strong social support and low stress predicted positive outcomes. These findings highlight the importance of multiple interacting factors in understanding grief and emphasize the need for interventions that enhance social support, manage stress, and address mental health conditions to reduce psychological distress in bereaved caregivers.

The Relationship Between Time-Related Characteristics of Visual Impairment and Psychological Symptoms in Adults Who Are Blind

Introduction The prevalence of depression among blind people is higher than in sighted populations. The purpose of this study was to investigate the associations between time-related characteristics of visual impairment (i.e., onset and duration), as well as depressive symptoms, fatigue, sleepiness, and stress, in the context of self-reported total blindness and the inability to perceive light exposure. Methods This study employed a cross-sectional design utilizing the combination of online survey and telephone survey. The Centre for Epidemiological Studies–Depression Inventory, the Fatigue Syndrome Inventory, the Epworth Sleepiness Scale, and the Perceived Stress Scale were selected for the self-reported questionnaires. For statistical analysis, independent t-tests, analysis of variance tests, Wilcoxon–Mann–Whitney tests, chi-square tests, multiple linear regression models, and multivariable ordinal logistic regressions were conducted using the R software program and its required packages. Results A total of 154 respondents completed the online and telephone surveys. Although the number of years of experiencing blindness showed negative correlations with the scores of fatigue ( r = −.16, p &lt; .05), stress ( r = −.18, p &lt; .05), and depressive feelings ( r = −.21, p &lt; .05) in Model 1, the impacts of the onset of blindness on the depressive symptoms (β = −.02, p = .570) and the presence of severe depressive symptoms, OR = 1.42, 95% CI [0.49, 4.19], p = .518, were insignificant in Model 2. Discussion Blindness seems to be regarded as a more severe chronic condition which affects individuals’ psychological status. Given the effects of the limited range of social activities and daily tasks and the dramatically reduced accessible visual information inputs, the severe depressive symptoms in this group can be understood. Implications for Practitioners Regular counseling and psychological services monitoring depressive symptoms, chronic fatigue, and severe distress should be continued even after the completion of rehabilitation programs.

Character strength patterns, social support and psychological distress in adolescents and young adults with cancer: A multicenter cross-sectional study

ObjectiveAdolescents and young adults with cancer (AYAC) experience severe psychological distress worldwide. Social support was associated with reduced distress among cancer patients, but the role of character strength patterns in this association is unexplored. This study explored whether character strength patterns influence the association between social support and psychological distress in AYAC. MethodsA multicenter cross-sectional study was conducted at four hospitals in Changsha, China. Participants completed questionnaires assessing sociodemographic, distress, social support, and character strengths. Latent profile analysis determined character strength patterns, and multiple linear regression models examined the association. Interaction terms tested moderation effects, and adjusted models examined confounding, all stratified by gender. ResultsAmong 728 participants, three character strength patterns emerged: low (LCS), moderate (MCS), and high (HCS). Across all patterns, higher social support was significantly associated with lower distress in AYAC (female: β ​= ​−0.124, 95% CI ​= ​−0.051 to −0.015; male: β ​= ​−0.180, 95% CI ​= ​−0.080 to −0.030; P ​< ​0.001). AYAC with MCS and HCS experienced significantly less distress than those with LCS, across both genders. However, the association between character strength patterns and lower distress was stronger in males (MCS: β ​= ​−0.384, 95% CI ​= ​−1.898 to −1.033; HCS: β ​= ​−0.777, 95% CI ​= ​−3.420 to −2.495; P ​< ​0.001) compared to females (MCS: β ​= ​−0.284, 95% CI ​= ​−1.215 to −0.700; HCS: β ​= ​−0.593, 95% CI ​= ​−2.776 to −2.102; P ​< ​0.001). ConclusionsCharacter strength patterns didn't moderate or confound the association between social support and psychological distress, but had stronger protective effects against psychological distress than social support. Higher character strength patterns showed a stronger association with lower psychological distress, especially for males.

An Evidence-Based Nurse-Led Intervention to Reduce Diabetes Distress Among Adults With Type 1 Diabetes and Diabetes Distress (REDUCE): Development of a Complex Intervention Using Qualitative Methods Informed by the Medical Research Council Framework.

Diabetes distress refers to the negative emotional reaction to living with the demands of diabetes; it occurs in >40% of adults with type 1 diabetes (T1D). However, no interventions to reduce diabetes distress are specifically designed to be an integral part of diabetes care. This study aims to modify and adapt existing evidence-based methods into a nurse-led group intervention to reduce diabetes distress among adults with T1D and moderate to severe diabetes distress. The overall framework of this study was informed by the initial phase of the Medical Research Council's complex intervention framework that focused on undertaking intervention identification and development to guide the adaptation of the intervention. This study took place at 2 specialized diabetes centers in Denmark from November 2019 to June 2021. A total of 36 adults with T1D participated in 10 parallel workshops. A total of 12 diabetes-specialized nurses were interviewed and participated in 1 cocreation workshop; 12 multidisciplinary specialists, including psychologists, educational specialists, and researchers, participated in 4 cocreation workshops and 14 feedback meetings. Data were analyzed by applying a deductive analytic approach. The intervention included 5 biweekly 2.5-hour small group sessions involving adults with T1D and diabetes distress. Guided by a detailed step-by-step manual, the intervention was delivered by 2 trained diabetes specialist nurses. The intervention material included visual conversation tools covering seven diabetes-specific sources derived from the 28-item Type 1 Diabetes Distress Scale for measuring diabetes distress: (1) powerlessness, (2) self-management, (3) fear of hypoglycemia, (4) food and eating, (5) friends and family, (6) negative social perception, and (7) physician distress. The tools are designed to kick-start awareness and sharing of diabetes-specific challenges and strengths, individual reflections, as well as plenary and peer-to-peer discussions about strategies to manage diabetes distress, providing new perspectives on diabetes worries and strategies to overcome negative emotions. Diabetes specialist nurses expressed a need for a manual with descriptions of methods and detailed guidelines for using the tools. To deliver the intervention, nurses need increased knowledge about diabetes distress, how to support diabetes distress reduction, and training and supervision to improve skills. This co-design study describes the adaptation of a complex intervention with a strong evidence base, including detailed reporting of the theoretical underpinnings and core mechanisms.

Social Determinants of Health Affect Psychological Distress among People with Disabilities

People with disabilities experience inequitable exposure to social determinants of health (SDOH) that contribute to disparate health outcomes, including psychological distress. There is little research examining which SDOH have the strongest effect on psychological distress among people with disabilities. This leaves healthcare providers and policy makers with insufficient information to make well-informed treatment decisions or allocate resources effectively. We explored the association between SDOH and disability and which factors may moderate the association between disability and psychological distress. Using data from the US Census Bureau’s Household Pulse Survey (Phase 3.5), we examined SDOH among people with and without disability (n = 26,354). Among people with disability, the odds of severe psychological distress were highest among those who had low incomes (OR = 4.41, 95% CI: 3.51–5.60), were food insecure (OR = 3.75, 95% CI: 3.43–4.10), housing insecure (OR = 3.17, 95% CI: 2.82–3.58), or were unable to work (OR = 1.98, 95% CI: 1.80–2.18). Only difficulty paying for household expenses moderated the association between disability and severe psychological distress (OR = 9.81, 95% CI: 7.11–13.64). These findings suggest that supporting employment and economic opportunities and improving access to safe and affordable housing and food may improve psychological well-being among people with disabilities.

Evaluation of Mental Health Status of Obstetrics and Gynecology Assistants during the COVID-19 Pandemic in Iran - A Cross-sectional Study

Background: Some evidence shows that the COVID-19 pandemic has had negative effects on the mental health status of different sections of society, including the medical staff. Aims: The current study was conducted with the aim of investigating the mental health status of obstetrics and gynecology (OB-GYN) assistants during the COVID-19 pandemic in Iran. Methods: The present cross-sectional study was conducted in 23 hospitals across Iran in 2021 (January- March). Four hundred OB-GYN assistants were randomly and voluntarily enrolled in the study. The instrument used in this study was the 28-item General Health Questionnaire (GHQ-28), which had four subscales, including somatic symptoms, anxiety/ insomnia, social dysfunction and severe depression. To collect data and to reach respondents in distant areas, the questionnaires were provided to the OB-GYN assistants by the online platform. Results: The mean age of the OB-GYN assistants was 32.3±2.6 years, and all were female. Of 400 OB-GYN assistants, 132 (33%) had no distress and 268 (67%) had psychiatric distress. According to subscales scoring, 72 (18%), 68 (17%), 92 (23%) and 64 (16%) had severe distress in somatic symptoms, anxiety/ insomnia, social dysfunction and severe depression, respectively. Conclusion: Considering that more than half of the Iranian OB-GYN assistants had poor mental health, it seems that the COVID-19 pandemic has had a negative and destructive effect on the mental health of OB-GYN assistants. In this situation, they need psychological support and appropriate intervention.

Psychological Well-Being and Quality of Life in Laryngeal Cancer Patients across Tumor.

Background/Objectives: Laryngeal cancer significantly impacts patients' psychological well-being and quality of life (QoL). This study aims to evaluate the psychological impact and QoL in patients with laryngeal cancer, focusing on differences based on tumor stage and treatment. Methods: This longitudinal study included 75 patients diagnosed with laryngeal cancer. Participants were assessed at diagnosis and 3 months post-treatment using validated tools such as the Hospital Anxiety and Depression Scale (HADS) and the EORTC QLQ-H&N35 questionnaire. This study analyzed the impact of tumor stage, treatment type, and demographic factors on psychological well-being and QoL. Results: Patients with early-stage tumors (Stage I) reported significantly better psychological well-being and QoL compared to those with more advanced tumors (Stages III and IV) both before and after treatment. The non-significant p-values in advanced stages suggest a uniformity of severe distress and poor QoL among these patients. Treatment led to significant reductions in anxiety and depression in early-stage patients, while those with advanced-stage disease showed less improvement. Conclusions: The findings highlight the critical need for early psychological intervention, particularly in advanced-stage laryngeal cancer patients who continue to experience substantial psychological distress and poor QoL despite treatment. Integrating comprehensive psychological support into standard care is essential to improve overall outcomes for these patients.

Biological aging analysis based on DNA methylation status for social anxiety disorder.

Social anxiety disorder (SAD) is a common disorder characterized by excessive fear of scrutiny and embarrassment, leading to severe distress and avoidance behaviors or dysfunctions. SAD and other relevant diseases have been reported to be associated with a higher risk of aging-related diseases, such as Alzheimer's disease, Parkinson's disease, and diabetes mellitus. Recently, epigenetic clock analysis, which measures biological aging based on comprehensive DNA methylation (DNAm) status, has been widely conducted. We conducted epigenetic clock analyses in patients with SAD and controls, examining various epigenetic age acceleration and DNAm-based predictive values of aging-related proteins (GrimAge components and GrimAge2 components), including leptin level. We used the publicly available DNAm dataset, GSE164056, which consists of 66 patients with SAD and 77 controls of Caucasian descent aged between 18 and 50 years. We conducted regression analyses investigating the association between SAD and various indices of epigenetic aging, using age and sex as covariates. None of the epigenetic clocks showed significant differences in age acceleration. Of the DNAm-based predictive values of aging-related proteins, leptin level in GrimAge components (q = 0.0123) and GrimAge2 components (q = 0.0123) were significantly lower in patients with SAD than in controls. The results of this study suggested that leptin may be involved in SAD pathogenesis as an aging-related protein. Therefore, further studies with different designs are required.

Depression, anxiety, psychological distress, and perceived social support among Ugandan palliative care providers during the COVID-19 pandemic.

To identify the prevalence of depression, anxiety, and psychosocial distress among Ugandan palliative care providers during the COVID-19 pandemic, measure providers' perceived levels of social support, and identify factors affecting a provider's likelihood of being depressed, anxious, distressed, or perceiving various levels of social support. Data was collected from 123 palliative care providers using an online survey. Depression, anxiety, and psychological distress were measured using the Patient Health Questionnaire-9, the Generalized Anxiety Disorder-7, and the Self-Reporting Questionnaire, respectively. Information on perceived level of social support was gathered through the Multidimensional Scale of Perceived Social Support. The survey also asked about mental health resources available to providers at their place of work and what resources are still needed. Participants ranged in age, gender, religion, marital status, clinical position, and years of experience in palliative care. Results indicate that 20% of respondents show signs of moderate to severe depression, 14% show signs of moderate to severe anxiety, and 33% show signs of psychological distress. Additionally, 50% of respondents reported a low total level of social support. Depression, anxiety, and psychological distress scores were all negatively correlated with perceived social support scores. Over 50% expressed a desire for additional mental health resources at their place of work. In 2021-2022, the severity of depression, anxiety, and psychological distress varied among palliative care providers in Uganda, with some experiencing moderate to severe mental health effects. Higher degrees of depression, anxiety, and psychological distress were correlated with lower levels of perceived social support, highlighting the importance of social support during times of crisis. The results highlight a desire for improved access to mental health resources and will help providers and organizations provide better support and better prepare for future crises.

More adverse childhood experiences are associated with increased social thinning and severe psychological distress

Adverse childhood experiences have been linked to psychopathology due to reduced social networks or social thinning. However, evidence of the temporal associations between adverse childhood experiences, social networks, and psychopathology was lacking, as few studies assessed social networks repeatedly. Further, their underlying neurocognitive and biological mechanisms related to hypervigilance and inflammation remain unclear. This study aimed to clarify these associations using a three-wave population-based cohort study during the COVID-19 pandemic (n = 465), where we leveraged repeated social network assessments. Self-reported questionnaires assessed adverse childhood experiences, social network size and diversity, psychological distress, and hypervigilance regarding COVID-19. Blood tests were conducted to measure inflammation markers. Individuals with more adverse childhood experiences demonstrated lesser increases in their social networks than those without adverse childhood experiences. Decreased network sizes were associated with severe psychological distress, but this association did not remain after adjusting for baseline distress. On the other hand, reduced network diversities were associated with increased psychological distress. We did not find any paths through hypervigilance regarding COVID-19 and inflammation that explain associations between adverse childhood experiences, social thinning, and psychological distress. These findings emphasize the significant social network changes in the associations between adverse childhood experiences and psychopathology.