Severe Psychosocial Distress Research Articles

Community interpreting in Germany: results of a nationwide cross-sectional study among interpreters

BackgroundCommunity interpreters (CIPs) play a crucial role in various community services, including healthcare, when service providers and users do not share a common language. However, there is a lack of evidence-based data on this population globally. This explorative cross-sectional study aims to gain a better understanding of CIPs and their work in Germany.MethodsA nationwide online survey was conducted among CIPs in Germany to collect data on their qualification background, working conditions, mental health, interpreting-related psychosocial distress and sociodemographics. Participants were recruited through interpreting pools, training institutions and migrant organizations. Data were analyzed descriptively, dependent t-test, multiple logistic and hierarchical stepwise regression analyses were performed to predict participation in interpreting-specific training, interpreting competence and interpreting-related psychosocial distress.ResultsAcross all 16 federal states, N = 873 responses were used for analysis. Most participants are female (74%), born abroad (77%) and have a high level of education (69%). The vast majority interpret occasionally in their leisure time (44%) and are self-employed/freelance (51%). 34% interpret solely or additional on a voluntary basis (unpaid). The median hours of interpreting per month are 10 h, 75% do not exceed 30 h. On average interpreters work in four different settings. 69% attended any kind of interpreting training with a median of 25 h in total. Interpreting in more settings emerged as an associated factor with participation in training. Of those who have never attended any training, 69% consider themselves as rather/very competent in interpreting. Interpreting more frequently, having less severe anxiety symptoms, getting higher and more often paid and being less satisfied with the payment is associated with self-reported interpreting competence. In total, 36% reported moderate or severe psychosocial distress regarding interpreting. Higher general psychosocial distress and depressive symptoms, higher interpreting frequency and lower payment satisfaction were found to be associated with higher distress regarding interpreting. Additionally, factors such as precarious work conditions, lack of recognition and discrimination (e.g. racism and sexism) were reported as distressing.ConclusionThis study provides a first comprehensive evidence-based national database on CIPs in Germany. The findings can be valuable for the development of qualifications, guidelines, policies and the process of professionalizing the field of CIPs.

An assessment of the psychosocial distress and problems faced by street children living in Kolkata city: a cross-sectional study

Background: Street children constitute a marginalized group in most societies. These children experience social and behavioural problems resulting from their environmental influences, school and peer interactions, home and family settings, or any combination of these. Keeping in view the prevalence of psychosocial distress among street children, this study was undertaken to assess the levels of psychosocial distress and problems faced by orphan and vulnerable children (OVC) living in Kolkata city. Methods: This was a cross sectional analytical study. A total of 127 children were interviewed with the help of pre-validated semi-structured questionnaire. GHQ-12 scale was used to measure the symptoms of the psychosocial distress. Bivariate analysis with the help of Chi-square test was done to determine variations in the psychosocial distress experienced by OVC by age, gender, duration of stay on streets, education. Results: The mean age of the study participants was 15±2 years. About one third of the children showed symptoms of severe psycho-social distress with 30% of children showing signs of intentional self-harm. Age, education and duration of living on the streets were some of the factors that showed significant correlation with the levels of psychosocial distress. Conclusions: The study concludes that although institutional care and support from NGOs takes care of basic amenities such as shelter, food and education, there is a need to address the psychological needs of the children through teacher sensitization programmes. A well-informed caregiver would be able to address the needs of children under his supervision and care.

Psychosocial distress, perceived social support, and coping in women survivors of domestic violence seeking help from a women's helpline in urban India.

Domestic violence against women is a worldwide phenomenon and a major public health concern. The adverse effects on the physical and mental health of the women survivors of domestic violence are influenced by various psychosocial factors. This study aimed to understand psychological distress, perceived social support, and coping strategies among women survivors of domestic violence and its implications. It is a cross-sectional study conducted with 30 women survivors of domestic violence from urban Bengaluru who were registered with a women's helpline. Data were collected using a socio-demographic schedule, a self-reporting questionnaire assessing psychological distress, perceived social support scale, and ways of coping scale. Descriptive and inferential statistics were used to analyze the data. Psychological distress was the highest among participants facing violence due to perpetrator using alcohol (M = 11.6, SD = 3.9) and (M = 11.73, SD = 3.5) dowry harassment. Perceived social support from family (M = 14.76, SD = 4.54) and friends (M = 11.85, SD = 4.7) was the highest among participants who reported that alcohol use was not a reason for violence. It can be noticed that alcohol use, dowry harassment, and poor coping strategies were the main reasons for domestic violence, which has led to severe psychosocial distress among the women survivors.

The Worsening Outcomes of the COVID-19 Lockdowns on Patients with a History of Alcoholism

ABSTRACT The COVID-19 pandemic has caused severe psychosocial distress, anxiety, and fear on a global and national level. Implementing quarantines by applying nationwide lockdowns had its effect on increasing mental health disorders, such as anxiety, depression, and substance use disorders, particularly alcohol use disorder (AUD). Lockdowns had difficult psychosocial consequences, such as isolation and separation from loved ones and loss of freedom. AUD is considered one of the leading causes of preventable death. Alcohol dependence is associated with psychiatric conditions, such as anxiety disorders, depression, panic attacks, mania, hypomania, personality disorders, schizophrenia, and suicide. The stress–alcohol relationship is bidirectional, stress exacerbates alcohol consumption and alcohol intake leads to additional stress. Alcohol use had additional negative consequences of the COVID-19 pandemic. Cancellations of in-person support groups during COVID-19 pandemic have made it difficult for those who are recovering from AUD to stay sober. The double effect of the disruption of social support networks and the stresses of the pandemic has caused relapse to alcohol use. In some countries, heavy drinkers were not able to access their daily dose of alcohol which led to the development of sudden withdrawal symptoms and sudden rise in hospitalization. In this literature, we review some of the deliberating consequences of COVID-19 and AUD on social, mental, and physical health.

Understanding the Perceptions of Omani Women Regarding Life After a Breast Cancer Diagnosis.

ObjectivesThere is a rising burden of breast cancer (BC) in the Eastern Mediterranean Region (EMR), and its sociopsychological impact is a quickly growing health concern in this region. Because understanding cancer patients’ perceptions of life is integral to their treatment, they are also a concern for healthcare providers. This qualitative study, therefore, explored changes in Omani women’s perceptions of life after a BC diagnosis.MethodsSemi-structured interviews were conducted individually with 21 Omani women undergoing treatment for BC at the Oncology Ward of Muscat’s Royal Hospital from March to May 2017. The collected data were subjected to qualitative content analysis.ResultsAfter their cancer diagnosis, the women appeared to pass through three main stages in their coping processes. First, they passed through a stage of severe psychosocial distress and diminishment in personal identity. Next, they evolved strategies for coping based on cultural, religious and family resources. Finally, the women experienced acceptance and submission to the reality of the cancer as God’s will with changes in attitudes and perceptions of the meaning of life.ConclusionA BC diagnosis impacts Omani women severely, affecting their lives dramatically. They adopt coping strategies based on cultural, religious and spiritual beliefs. Healthcare providers need to acknowledge and facilitate women’s spiritual and cultural coping strategies as an integral part of their treatment which holds potential to improve their prognosis. Such strategies should be individualised to suit each woman’s experiences, perceptions and needs.

Psychological characteristics and childhood adversity of adolescents with atypical anorexia nervosa versus anorexia nervosa

ABSTRACT The assessment and diagnosis of atypical anorexia nervosa (AAN) is an ongoing challenge for clinicians. This study aims to examine psychological morbidity and exposure to childhood adversity in adolescents with AAN compared to adolescents with anorexia nervosa, restricting type (AN-R). This registry-based study compared 42 adolescents with AAN to 79 adolescents with AN-R on a variety of psychosocial measures at the time of presentation to a specialized eating disorder program. In contrast to AN-R, adolescents with AAN had more severe drive for thinness (p =.011), body dissatisfaction (p =.038), and lower quality of life (p =.047), but had better global functioning (p =.032). Adolescents who had high Adverse Childhood Experiences (ACE) Questionnaire scores (ACE score ≥ 4) had over 5 times higher odds of having AAN than those who did not have high ACE scores (p =.008). There was no significant difference between groups on measures of low self-esteem and non-accidental self-injury. Adolescents with AAN presented with similar or more severe psychosocial distress compared to their peers with AN-R across a majority of the measures. The findings highlight the need to address trauma, body-related difficulties, and quality of life in the assessment and treatment of adolescents with AAN.

Psychosocial distress among oncology patients in the safety net.

Psychosocial distress among cancer patients leads to poor health outcomes and lower satisfaction. However, little is known about psychosocial distress among disadvantaged populations. We examined the prevalence, predictors, and follow-up experience of psychosocial distress among cancer patients within a diverse, urban, and multi-lingual safety-net setting. We conducted a retrospective cohort study of cancer patients undergoing psychosocial distress screening at initial medical oncology visits from 2014-2016. The primary outcome was self-reported moderate to severe psychosocial distress, defined by the NCCN as a Distress Thermometer score ≥ 4. Predictors of distress were assessed using logistic regression. Patients reporting distress were contacted by telephone 1-12 months later to reassess distress and assess completion of supportive service referrals. Among 200 screened patients, 61% had moderate to severe psychosocial distress. African-American race, psychiatric illness, greater number of emotional problems, and reported problems with housing, money, worry, sleep, memory or homelessness were associated with psychosocial distress. Among 39 patients with moderate to severe psychosocial distress who completed follow-up (42% of eligible patients), mean distress scores decreased from 6.5 at screening to 4.5 at follow-up (P < .02). 56% of the supportive service referrals made at the initial visit were not completed. Cancer patients in the safety-net experience more psychosocial distress than other populations, with persistently elevated distress levels and difficulty accessing supportive services. We identified subgroups that may be at higher risk for psychosocial distress. Closer follow-up and assistance for patients who report high distress levels may be needed.

The meaning and consequences of amputation and mastectomy from the perspective of pain and suffering

BackgroundThe concepts ‘pain’ and ‘suffering’ are frequently treated as synonymous. However, they are clearly distinct phenomena. Phantom phenomena including pain and sensory disturbances are still recognized as long-lasting problems after limb amputation and after mastectomy. The complex nature of phantom phenomena makes the interpretation of its results ambiguous, regarding the prevalence of pain, sensory disturbances and the accompanying suffering. There is clinical experience that suffering is a great burden for the individual but there is a lack of systematic studies of patients’ own evaluations of the suffering caused by their phantom phenomena. ObjectivesThe overall aim of this study was to identify and describe patients’ suffering related to, and as a part, of their post-amputation situation. MethodsThe present study constitutes a part of a prospective, two-year follow up project investigating interviews of 28 men and women in different ages and who have undergone a limb amputation or mastectomy. The reason for amputation or mastectomy varied among the patients and included vascular diseases, cancer (sarcoma and breast-cancer) and trauma. Our ambition was to extract as much variations as possible in different, individualized aspects of the actual pain and suffering producing situation. The participants were, here, invited to open-ended, narrative-oriented interviews one month after the surgery. The interviews were transcribed verbatim and analyzed within qualitative methodology: thematic content analysis. ResultsTwenty-two of 28 interviewees experienced phantom pain and phantom sensations. The two surgical processes amputation and mastectomy meant for a majority of the interviewees a critical event with threatening consequences for everyday life such as loss of function and personal integrity. Nine interviewees felt even stigmatized as a result of their lost body part. Numerous inter-related factors following the amputation/mastectomy, which can inflict severe suffering on the amputee, were uncovered. The context in which the interviewees were informed about the decision to amputate proved to be one such critical and important factor. ConclusionTo understand potential suffering in relation to phantom phenomena, it will never be enough merely to have knowledge of the underlying physiological or neurological mechanisms and/or the intensity of phantom pain and phantom sensations. Rather, it is necessary to find out how the loss of the body part and its everyday consequences are experienced by patients. ImplicationsIt is important to create time for real dialogue with the patients both during pre-operative preparation and post-operative rehabilitation in order to clarify and verbalize elements that constitute the patients individual suffering. Hopefully this strategy can alleviate future chronic pain problems, severe psycho-social distress and suffering. Such an approach ought to have impact also for perceived suffering after other types of surgery or different invasive treatments.

Electronic real-time assessment of patient-reported outcomes in routine care-first findings and experiences from the implementation in a comprehensive cancer center.

Cancer patients suffer from a variety of physical and mental complaints. Since physician assessment of symptoms seems insufficient to reveal the complete range of patients' ailments, patient-reported outcomes (PRO) have become of key importance in modern cancer treatment. The implementation and first results of a systematic electronic real-time assessment of PRO in routine care is described. Consecutive patients presenting for the first time to a German comprehensive cancer center were asked to fill in an adaptive self-administered electronic questionnaire consisting of standardized PRO measures. After completion, patient-reported data was linked to the patients' medical files for discussion in the first consultation with the treating physician. Interviews with staff were conducted to identify barriers in implementation. Out of 160 cancer patients, 126 (79%; mean age 63years, 67% males) agreed to participate. The number of recruited patients increased over time. Of participating patients, 67% provided complete information on all PRO-related scales. On average, 31min (range 3-140) were required to fill in the questionnaire. Of participating patients, 53.0% comprised need for psychooncological support and 62% revealed moderate to severe psychosocial distress. The mean score for global quality of life according to the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30) was 55.2 (SD ±25.6). Comprehensive oncological treatment needs to consider disease symptoms, quality of life, preferences, and comorbidities of individual patients in a structured, standardized, and transparent way. Our findings indicate that an adaptive, self-administered electronic assessment tool for cancer patients to report a broad set of PRO can be feasibly implemented and is well accepted by patients in a realistic setting.

Clinical profile and quality of life of patients with occupational contact dermatitis from New Delhi, India

Data regarding occupational contact dermatitis (OCD) and its effect on quality of life (QOL) in India are limited. To evaluate patients with OCD and record the outcome of treatment. All patients with OCD were evaluated for severity of disease (by the use of physician global assessment) and its effect on QOL (by use of the Dermatology Life Quality Index) questionnaire) at the first visit and after 3 months of treatment. Among 117 patients with OCD, hand eczema was present in 81.2%. Positive patch test reactions were found in 76%. The most common allergens were Parthenium hysterophorus and potassium dichromate. The most frequent diagnosis was occupational allergic contact dermatitis (OACD) (57%), caused by farming and construction work, followed by occupational irritant contact dermatitis (OICD) (24%), caused by wet work. Severe psychosocial distress was recorded in 62.5% of patients. After 3 months of treatment, 83% improved significantly, and 54% had improvement in QOL. Farmers were most frequently affected, followed by construction workers and housewives. OACD was found at a higher frequency than OICD. The most frequent allergens were Parthenium hysterophorus in farmers, potassium dichromate in construction workers, and vegetables in housewives. OCD has a significant impact on QOL. Patch testing, in addition to standard treatment, improves the outcome considerably.

Postsurgical screening for psychosocial disorders in neurooncological patients

The diagnosis of a brain tumor can cause severe psychosocial distress, which can have a variety of negative consequences on patients' physical and mental well-being. The detection of psychosocial distress in daily clinical routine is difficult and subsequent referral to mental health professionals is rare. The aim of this study was to determine the incidence of psychological disorders of patients early postoperatively and to investigate both the Hornheide Screening Instrument (HSI) and Distress Thermometer (DT) as screening tools in neurooncological practice. One hundred and thirty-four patients with brain tumors of different histology were postoperatively evaluated by the Distress Thermometer and Hornheide Screening Instrument. Additionally, correlation to gender, age, localization of the tumor, Karnofsky performance score and tumor entity were analyzed. After initial surgery 36 patients (26.9 %) showed pathologic results in the HSI and 50 patients (36.7 %) were severely distressed (DT Score≥6). Women had the highest rate of psychological disorders, followed by patients suffering from gliomas and meningiomas. Further highlighting the results of both tests, over 80 % of those patients who scored pathologically in both tests were in need of professional psychiatric help due to depression. Both the DT and HSI are suitable instruments for identifying patients in psychological distress after brain tumor surgery in neurooncological routine. Our results confirm that nearly one third of patients are unable to overcome the difficulties facing the diagnosis of a brain tumor in this early situation and should be supported by mental health professionals.

Unrelieved Pain and Suffering in Patients With Advanced Cancer

Even with specialist-level palliative care, cancer pain can be difficult to treat especially when the pain is complicated by profound suffering. It is paramount to consider not only the patients' biochemical factors but also their psychosocial and spiritual/existential influences. A multidimensional approach with knowledge of the risk factors for poor pain control is important to prevent, detect, and manage risk factors for intractable pain, including psychosocial distress, addictive behavior, and delirium in patients with terminal cancer. We present 3 cases of patients with advanced cancer with intractable bone pain whose hospital courses were complicated by severe psychosocial distress and delirium. We also propose an algorithm of multidimensional approach to unrelieved pain and suffering in patients with advanced cancer.

Comments on the Recent Clinical Guidance Statement on HIV Screening

Although we agree in principle with the guidelines setforth by Qaseem and colleagues (1) regarding HIV screening and havegenerally adopted similar practices in our clinics, we are concerned thatsome consequences of universal screening were not addressed in thisarticle. Specifically, assuming the sensitivity and specificity to be greaterthan 99% and greater than 99.99%, respectively, for the sequentialscreening test (initial enzyme immunoassay followed by either confirma-tory Western blot or immunofluorescent assay) and the U.S. populationestimate for number of persons older than 13 years to be 244 926 386persons (2), then applying sequential universal screening to this popula-tion would result in 24 393 false-positive HIV test results. This is anunfortunate consequence of universal screening, and no mention ismade of the cost of misdiagnosis, which could involve unnecessary med-ical intervention and squandering of limited health care resources (3).In addition, persons with false-positive results may develop se-vere psychosocial distress (4) and be unable to obtain health insur-ance. These cases may result in substantial financial cost to the healthcare system with respect to litigation (5). Furthermore, many thou-sands of persons would test positive on the initial enzyme immuno-assay before testing negative on a confirmatory test, which wouldresult in psychosocial stress for these persons as well. Therefore, al-though broader screening approaches are warranted, medical practi-tioners who initiate HIV screening must be educated on the poten-tial of false-positive test results before future guideline statements areconstructed for universal HIV screening.

Die Erfassung psychosozialer Belastungen und Ressourcen in der Onkologie - Ein Literaturüberblick zu Screeningmethoden und Entwicklungstrends

A substantial percentage of cancer patients suffers from psychosocial distress to severe mental disorders and psychosocial crisis during the course of the illness and cancer treatment. However, only a small percentage of patients with severe psychosocial distress and mental disorders in the present oncological practice is accurately identified, diagnosed, and appropriately treated. Therefore, sufficient knowledge about psychosocial distress and mental disorders as well as screening procedures are urgent concerns to improve psychosocial care for cancer patients. First, the article provides an overview of psychosocial distress and the epidemiology of mental disorders in cancer patients. Then a few of the most important objectives and problems of psychosocial assessment in cancer patients will be explained. The following part will offer an overview of questionnaires and screening procedures that are frequently used to assess psychosocial distress, mental disorders, personal and social resources, and health related quality of life in cancer patients.

Severe opioid toxicity and somatizationof psychosocial distress in a cancer patient with a background of chemical dependence

A case of severe opioid toxicity is described in a 52-year-old cancer patient. The patientpresented with classical clinical features of central hyperexcitability associated with opioid toxicity: delirium, myoclonus, hallucinations, hyperalgesia, and a possible seizure. This patient had a background of severe psychosocial distress and somatization in addition to a history of benzodiazepine dependence and alcohol abuse. The occurrence of opioid toxicity in this patient highlights the risks of a unidimensional approach to cancer pain, which ignores the non-organic components of pain, such as psychosocial distress, which will not respond to escalating doses of opioid medication.

Rehabilitation outcomes of long‐term survivors treated for head and neck cancer

Little is known about the rehabilitation outcomes of long-term survivors following treatment for head and neck cancer. There are, for example, no studies on physical and psychosocial rehabilitation outcomes of T1 glottic larynx carcinoma, despite the fact that these form the majority of head and neck cancer sites. Thus, this investigation afforded a unique opportunity for examining similarities and differences among T1 glottic larynx patients, laryngectomy patients, and those who had surgery for cancer of the oral cavity and/or oropharynx along a variety of physical and psychosocial dimensions. To describe the impact of these three types of head and neck cancer and their treatment on the physical and psychosocial functioning of long-term survivors, a self-report questionnaire was completed by 110 patients treated between 2 and 6 years previously in a major cancer center. Data indicate that a higher percentage of patients treated with laryngectomy or commando procedures still experience severe psychosocial distress between 2 and 6 years after their last treatment than do patients treated with radiotherapy for a T1 carcinoma of the glottic larynx. Psychosocial and physical complaints are still reported by many laryngectomy patients, apparently the result of problems in effective communication with others. Many commando procedure patients experience problems with respect to food intake, and with disfigurement and its consequences. T1 larynx patients mainly experience a considerable number of physical complaints. The greater the time that had elapsed since treatment, the fewer the psychosocial problems associated with head and neck tumors. Open discussion of the illness in the family, social support, and perceptions of adequate information from the specialist are the most important predictors of positive rehabilitation outcomes. This study indicates that T1 larynx patients report many physical complaints even though several years had elapsed since treatment. Also, laryngectomy patients may need psychosocial guidance for a longer posttreatment period and that health care personnel must involve the partner as much as possible in all communications. Commando procedure patients in particular feel hindered by their disfigurement and its consequences. Future research with respect to validation of the specific head and neck modules is needed.