Distress Symptoms In Patients Research Articles

Risk and Protective Factors of Psychological Distress in Patients Who Recovered From COVID-19: The Role of Cognitive Reserve.

Recent studies reported the development of psychological distress symptoms in patients who recovered from COVID-19. However, evidence is still scarce and new data are needed to define the exact risk and protective factors that can explain the variability in symptoms manifestation. In this study, we enrolled 257 patients who recovered from COVID-19 and we evaluated the levels of psychological distress through the Symptoms Checklist-90-R scale. Data concerning illness-related variables were collected from medical records, while the presence of subjective cognitive difficulties, both before and after the illness, as well as the level of the cognitive reserve (CR), were assessed over a clinical interview. Results revealed that being female and reporting the presence of subjective cognitive difficulties after COVID-19 were associated with higher levels of psychological distress. At the same time, being admitted to the hospital and having a high CR were protective factors. Adding new information to this emerging research field, our results highlight the importance of a complete psychological and cognitive assessment in patients with COVID-19.

Serum 25-hydroxyvitamin D levels and psychological distress symptoms in patients with affective disorders during the COVID-19 pandemic

Background. The COVID-19 pandemic has given rise to stress worldwide, especially in vulnerable people like those suffering from mental illness. This study aims to investigate the psychological distress perceived by a cohort of patients with Major Depressive Disorder (MDD) or Bipolar Disorder (BD) after a seven-week period of lockdown measures, and to analyze serum 25-hydroxyvitamin D [25(OH)D] levels as a potential predictor of distress severity.Methods. Fifty-nine remitted MDD and fifty-three euthymic BD patients were enrolled. An online dedicated survey was administered to obtain lockdown-related information and to evaluate COVID-19 related distress by using the Kessler 10 Psychological Distress Scale (K10). Patients’ medical records were reviewed to collect sociodemographic and clinical data, including serum 25(OH)D levels dosed in the three months preceding the outbreak. A multivariate general linear model was adopted to test the effect of factors of interest on psychological distress.Results. In our sample (n = 112), 29 subjects (25.9 %) reported no likelihood of psychological distress, whereas 35 (31.2 %) and 48 (42.9 %) displayed mild and moderate-to-severe likelihood of psychological distress, respectively. Low serum 25(OH)D levels (p = 0.005) and MDD diagnosis (p = 0.001) specifically predicted the severity of psychological distress. Living alone during the lockdown, a longer duration of illness, and smoking habits were more frequently detected in subjects with COVID-19 related distress.Conclusions. Low serum 25(OH)D levels and MDD diagnosis predicted an increased vulnerability to the stressful impact of the COVID-19 outbreak. Our results suggest that vitamin D may represent a biological factor mediating the psychological response to stress in individuals with affective disorders and provide further insight into tailoring intervention strategies.

Use of Mental Health Apps by Patients With Breast Cancer in the United States: Pilot Pre-Post Study.

BackgroundNearly half of the patients with breast cancer experience clinically significant mental distress within the first year of receiving their cancer diagnosis. There is an urgent need to identify scalable and cost-efficient ways of delivering empirically supported mental health interventions to patients with breast cancer.ObjectiveThe aim of this study was to evaluate the feasibility of in-clinic recruitment for a mobile phone app study and to evaluate the usability and preliminary impact of a suite of mental health apps (IntelliCare) with phone coaching on psychosocial distress symptoms in patients recently diagnosed with breast cancer.MethodsThis pilot study adopted a within-subject, 7-week pre-post study design. A total of 40 patients with breast cancer were recruited at a US National Cancer Institute–designated clinical cancer center. Self-reported distress (Patient Health Questionnaire-4) and mood symptoms (Patient-Reported Outcomes Measurement Information System depression and anxiety scales) were assessed at baseline and postintervention. App usability was assessed at postintervention.ResultsThe minimum recruitment threshold was met. There was a significant decrease in general distress symptoms, as well as symptoms of depression and anxiety, from baseline to postintervention. Overall, participants reported high levels of ease of app use and learning. Scores for app usefulness and satisfaction were reinforced by some qualitative feedback suggesting that tailoring the apps more for patients with breast cancer could enhance engagement.ConclusionsThere is a dire need for scalable, supportive interventions in cancer. The results from this study inform how scalable mobile phone–delivered programs with additional phone support can be used to support patients with breast cancer.International Registered Report Identifier (IRRID)RR2-10.2196/11452

Effects of a Mindfulness Intervention on Hospitalized Patients With Hematologic Malignancies and Their Caregivers.

To examine the effects of a mind-body intervention on the psychological distress of hospitalized patients with hematologic malignancies and their caregivers. 29 patients with hematologic malignancies and 5 caregivers were recruited from the bone marrow transplantation unit at Barnes-Jewish Hospital in St. Louis, Missouri. After completing the Rotterdam Symptom Checklist (RSCL) to rate their levels of psychological and physiologic distress and quality of life, participants were taught a mindfulness activity. Two weeks postintervention, participants completed the RSCL again, reported how often they practiced the activity, and answered qualitative questions regarding their experience. Participants reported increased relaxation and improved sleep and showed interest in practicing mindfulness as a part of their treatment plan. Nurses can help to alleviate symptoms of distress in patients with hematologic malignancies by integrating education on how to perform short and simple mindfulness activities into the care plan.

Validation of the HADS and PSS-10 and psychological status in patients with oral lichen planus.

To validate the Hospital Anxiety and Depression Scale (HADS) and the 10-item Perceived Stress Scale (PSS-10) for use in patients with oral lichen planus (OLP) and to provide cross-sectional analysis of anxiety, depressive and distress symptoms in patients with OLP. Validity and reliability of both instruments were assessed in 260 participants with OLP in one tertiary oral medicine centre through confirmatory factor analysis and calculation of reliability coefficients. Prevalence, clinical and demographic predictors of the presence of psychological symptoms in OLP were calculated and identified using multivariated logistic regression. Factor analysis results demonstrated that a bifactor model described the underlying structure of both scales better than other models. Values of omega indicated adequate reliability of total HADS and PSS-10 score while low coefficient omega hierarchical values limit clinical applicability of their subscale scores. The prevalence of anxiety, depressive and distress symptoms in OLP was 39.23%, 20.77% and 27.69%, respectively. Pain intensity, disease comorbidities, age, smoking and alcohol consumption were found to be independent predictors of the presence of psychological symptoms in OLP. The HADS and PSS-10 are appropriate to use as general measures of psychological distress and perceived stress in patients with OLP.

852-P: Reduction in Emotional Burden in Type 2 Diabetes Is Associated with Improved Medication Adherence: Results from COMRADE

The presence of distress symptoms in patients with uncontrolled type 2 diabetes (T2D) negatively influences diabetes management behaviors (DMB) and increases the risk of co-morbid complications. Cognitive behavioral interventions (CBI) are successful at reducing these symptoms, but the role of reducing Emotional Burden (EB) on diabetes behaviors is poorly understood. A prospective randomized trial involving 139 patients (mean age = 52.6 +/- 9.5 years; 27% black; 78% female; BMI = 37.0 +/- 9.0) with uncontrolled T2D (mean A1c = 9.6 +/-2) compared the effectiveness of a 16-week severity-tailored CBI plus lifestyle coaching (n=67; IG=intervention group) to usual care (n=72; CG=control group) on reducing EB and its impact on DMB such as self-care behaviors and medication adherence. Trained staff at a rural primary care clinic measured EB (subscore of Diabetes Distress Scale-17), self-care behaviors (Summary of Diabetes Self-Care Activities, SDSCA), and medication adherence (ModMAS) at baseline and 12-months follow-up using validated instruments. There were no differences between groups at baseline in mean age, race, or gender. The average reduction in EB, average improvement in ModMAS, and average improvement in self-care (SDSCA) were all significantly greater in the IG (-1.00 +/- 1.17; +1.0 ± 2.0; +1.1 ± 1.3) than in the CG (-.06 +/- 1.38; + 0.17 ± 1.9; +0.58 ± 1.4) (p=0.0001; p = 0.02; p = 0.027, respectively). Mean improvement in ModMAS was significantly and progressively related to improvements in EB in the IG (worse/same EB = -0.25 ±0.96; moderately improved EB = +0.79 ± 1.9; markedly improved EB = +1.6 ± 2.2; p = 0.045). A linear regression model showed that EB remained significantly associated with ModMAS even when controlling for age, race, and treatment group (β = -0.55; 95% CI: -0.8 to -0.3; p = 0.0001). A severity-tailored CBI plus lifestyle coaching significantly improves EB in T2D patients which is associated with significantly improved medication adherence. Disclosure D.M. Cummings: None. M. Brown: None. L. Lutes: None. B. Hambidge: None. M.A. Carraway: None. S.P. Patil: Research Support; Self; Novo Nordisk Inc. A. Adams: None. K. Littlewood: None. S.B. Edwards: None. P. Gatlin: None. Funding Bristol-Myers Squibb Foundation

Screening for distress in patients with primary brain tumor using distress thermometer: a systematic review and meta-analysis

BackgroundPatients with primary brain tumors are reported to have an elevated level of distress prevalence, due to the functional sequelae and the unfavorable prognosis, but the estimated prevalence of this disorder varies among studies. The Distress Thermometer (DT) is widely used distress screening tools to identify patients suffering from elevated psychosocial distress. The objective of this meta-analysis is to get a summarized estimate of distress prevalence in adult primary brain tumor patients screened by the DT instrument to identify distress in brain tumor patients.MethodWe searched studies published in PubMed, PsycINFO, and Cochrane library through August 2017 and checked related reviews and meta-analyses for eligible studies. Studies were eligible if they were published in the peer-reviewed literature and evaluated distress level by Distress Thermometer. The prevalence of distress symptoms in patients with the intracranial tumor was estimated by study-level characteristics using stratified meta-analysis. The prevalence of distress level or symptoms during the follow-up examination at different time points was detected by secondary analysis of the longitudinal studies included.ResultsTwelve studies including a total of 2145 brain tumor patients were included in this analysis. Eight used a cross-sectional design and four were longitudinal. The pooled prevalence of distress was 38.2% (95% confidence interval (CI) 28.7%–47.7%) for the overall sample. The pooled prevalence of distress DT ≥4 was 41.1% (642/1686, 95% CI 28.6%–53.5%) and the pooled prevalence of distress by DT ≥6 was 29.7% (137/459, 95% CI 19.5%–39.9%). The distress symptom did not decrease in follow-up studies (Relative Increase Ratio:1.02, 95% CI, (0.78, 1.35)). A huge heterogeneity in different studies was detected, and different screening scales were not compared.ConclusionThe high prevalence of distress becomes an enormous challenge for primary brain tumor patients. Routine screening and evaluation of distress in brain tumor patients may assist medical workers to develop proper interventions, which may lead to better quality of life and oncology management.

COMT Val158Met Polymorphism and Symptom Improvement Following a Cognitively Focused Intervention for Irritable Bowel Syndrome.

Our nurse-delivered comprehensive self-management (CSM) program, a cognitive behavioral therapy intervention, is effective in reducing gastrointestinal and psychological distress symptoms in patients with irritable bowel syndrome (IBS). Findings from non-IBS studies indicate that the catechol-O-methyltransferase (COMT) Val158Met polymorphism may moderate the efficacy of cognitive behavioral therapy. It is unknown whether this COMT polymorphism is associated with symptom improvements in patients with IBS. We tested whether this COMT Val158Met polymorphism influences the efficacy of our 2-month CSM intervention. We analyzed data from two published randomized controlled trials of CSM. The combined European American sample included 149 women and 23 men with IBS (CSM, n = 111; usual care [UC], n = 61). The primary outcomes were daily reports of abdominal pain, depression, anxiety, and feeling stressed measured 3 and 6 months after randomization. Secondary outcomes were additional daily symptoms, retrospective psychological distress, IBS quality of life, and cognitive beliefs about IBS. The interaction between COMT Val158Met polymorphism and treatment group (CSM vs. UC) in a generalized estimating equation model tested the main objective. At 3 months, participants with at least one Val allele benefited more from CSM than did those with the Met/Met genotype (p = .01 for anxiety and feeling stressed, and p < .16 for abdominal pain and depression). The moderating effect of genotype was weaker at 6 months. Persons with at least one Val allele may benefit more from CSM than those homozygous for the Met allele. Future studies with larger and more racially diverse samples are needed to confirm these findings. Parent studies were registered at ClinicalTrials.gov (NCT00167635 and NCT00907790).

Patient reported distress symptoms in patients undergoing palliative radiotherapy.

Patient reported distress symptoms in patients undergoing palliative radiotherapy.

Patient-reported distress symptoms in patients undergoing palliative radiotherapy.

75 Background: The focus of palliative radiotherapy (RT) is on improving quality of life (QOL) for patients with serious illnesses by eliminating or decreasing physical symptoms. The importance of assessing distress levels in palliative care patients is recognized due to the relevance of QOL, as treatment is given to provide symptom-relief rather than curative results. We sought to identify the most common causes of patient reported distress during palliative RT. Methods: Retrospective review was performed for patients who received palliative RT from 11/1/2012 to 6/4/2015 for various types of metastatic cancer at our institution. All patients completed a Patient Reported Distress (PRD) questionnaire with 30 specific questions and an overall distress thermometer prior to beginning treatment. The PRD survey quantified 30 areas of current concern ranging in patient-reported values from 1 to 5 in addition to a linear analog measure from 0 to 10 of overall reported distress in the last month. Results: Completed PRD surveys were available for a total of 297 patients, 149 (50.2%) female and 148 (49.8%) male. All patients were undergoing external beam radiation therapy for treatment of metastatic disease. 49 (16%) received chemotherapy and 46 (9%) underwent surgery. Overall distress ranged from 0 to 10, with a median of 5.0. The mean distress scores for the top five concerns ranged from 1.4 to 2.7. Top distresses were “Fatigue” (2.7), “Pain that affects daily functioning” (2.6), “How will I feel during treatment” (2.5), “Sleep difficulties” (2.4), and “Out of pocket medical costs” (2.3). Least troubling symptoms were “Transportation” (1.4), “A loved one relying on me for their physical care” (1.5), “My job” (1.5), “Housing during treatment” (1.5), “Spirituality” (1.5), and “Anger” (1.5). Conclusions: Patients demonstrated concern for distress related to interruption of activities of normal life, such as tiredness and insomnia, pain, and overall burdens from treatment. Medical costs were also a major concern. Importantly, housing and transportation were not issues in the current study but could be of concern in other regions. Providers should be aware that patients’ primary concerns may not be directly related to the symptom being palliated.

Emotional Distress in Patients with Advanced Heart Failure

Chronic heart failure (CHF) is a leading cause of death, with a rising prevalence. The disease has a high symptom burden and a negative impact on patients’ quality of life. However, as a result of difficulties in prognostication in relation to CHF, palliative care services do not always become involved in the care of patients with CHF. Emotional distress is especially common in the advanced stages of disease, including CHF. The term ‘emotional distress’ encompasses psychiatric symptoms such as depression and anxiety, as well as the wider spectrum of entities such as low mood. Emotional distress is a less stigmatising term than the more psychiatric-based terms. This article provides an overview of the prevalence, pathophysiology and symptoms of emotional distress in patients in the advanced stages of CHF. It summarises evidence on the psychological needs of patients and provides recommendations regarding the assessment of emotional distress at the end of life. It is hoped that the article will increase understanding of the psychological symptom burden in patients with advanced heart failure. Conflicts of interest: none