Worse Psychological Well-being Research Articles

Financial-related discrimination and socioeconomic inequalities in psychological well-being related measures: a longitudinal study

BackgroundThis study examined the prospective association between financial-related discrimination and psychological well-being related measures and assessed the role of financial-related discrimination in explaining socioeconomic inequalities in psychological well-being related measures.MethodsData of UK older adults (≥ 50 years) from the English Longitudinal Study of Ageing were used (baseline: Wave 5, 2010/2011; n = 8,988). The baseline total non-pension wealth (in tertiles: poorest, middle, richest) was used as a socioeconomic status (SES) measure. Financial-related discrimination at baseline was defined as participants who reported they had been discriminated against due to their financial status. Five psychological well-being related measures (depressive symptoms, enjoyment of life, eudemonic well-being, life satisfaction and loneliness) were examined prospectively across different follow-up periods (Waves 6, 2012/2013, 2-year follow-up; and 7, 2014/2015, 4-year follow-up). Regression models assessed associations between wealth, financial-related discrimination, and follow-up psychological measures, controlling for sociodemographic covariates and baseline psychological measures (for longitudinal associations). Mediation analysis informed how much (%) the association between wealth and psychological well-being related measures was explained by financial-related discrimination.ResultsParticipants from the poorest, but not middle, (vs. richest) wealth groups were more likely to experience financial-related discrimination (OR = 1.97; 95%CI = 1.49, 2.59). The poorest (vs. richest) wealth was also longitudinally associated with increased depressive symptoms and decreased enjoyment of life, eudemonic well-being and life satisfaction in both 2-year and 4-year follow-ups, and increased loneliness at 4-year follow-up. Experiencing financial-related discrimination was longitudinally associated with greater depressive symptoms and loneliness, and lower enjoyment of life across follow-up periods. Findings from mediation analysis indicated that financial-related discrimination explained 3–8% of the longitudinal associations between wealth (poorest vs. richest) and psychological well-being related measures.ConclusionsFinancial-related discrimination is associated with worse psychological well-being and explains a small proportion of socioeconomic inequalities in psychological well-being.

A Brief Group Social-Belonging Intervention to Improve Mental-Health and Academic Outcomes in BIPOC and First-Generation-to-College Students

Despite greater emphasis on diversity and inclusion on college and university campuses, inequities persist. Awareness of structural and social threats to success can lead students from underrepresented identities to question whether they will fully belong at a given institution, which jeopardizes their psychological well-being and academic performance. This study tested a brief social-belonging intervention, delivered in a group format, that emphasized that first-year challenges are normative and that, over time, students develop relationships that deepen their sense of belonging. Participants ( N = 122) who reported poorer belonging at baseline experienced greater depressive symptoms, greater worry, and worse psychological well-being over the 14-month follow-up period. The intervention significantly reduced risk for major depression during the first 2 years of college and specifically reduced risk for participants experiencing more discrimination. Hypotheses that the intervention would improve psychosocial or academic outcomes specifically for Black, Indigenous, and people of color and first-generation-to-college students were not supported.

Teacher Stress and Mental Health During the COVID-19 Pandemic: Differences by Teaching Modality

This study examines stress, mental health, and well-being in K-12 teachers during the COVID-19 pandemic Fall 2020 school restart and assesses differences in mental health and well-being by mode of instruction: online, in-person, or a hybrid. K-12 teachers (n = 5856) across three states completed an online survey with questions pertaining to teacher’s experiences surrounding COVID during the Fall 2020 school restart. Using OLS regression, we found that teachers who engaged in dual modalities (both online and in-person and online and in the school building on a regular basis) reported greater levels of perceived stress, anxiety and depression, and lower levels of well-being than those who engaged in “single” modalities (online but not in the building and in-person). This study highlights the additional demands and challenges of balancing two modes of instruction during the pandemic and the toll it took on teacher’s mental health and well-being. Impact Statement Teachers commonly report high levels of occupational stress, and the challenges and demands that resulted from the COVID-19 pandemic have only increased. Results from this study found that teachers who juggle both in-person and online instruction had significantly higher levels of stress, greater levels of depression and anxiety symptoms, and worse psychological well-being than teachers who taught only in-person or online. Examining factors that contribute to high levels of stress and mental health challenges in teachers is necessary for creating school contexts that foster both teachers’ and students’ health and well-being as well as academic performance. The development of robust support systems designed to reduce teacher stress and workload will be of paramount importance to combat teacher burnout and attrition in the face of continuing and future challenges.

The COVID-19 pandemic as an existential threat: Evidence on young people's psychological vulnerability using a Multifaceted Threat Scale.

Research offers evidence that younger generations suffered the most psychologically from the COVID-19 crisis. In this article, we look at the onset of the pandemic to understand the reasons for this increased vulnerability. We use the COVID-19 Multifaceted Threat Scale to explore potential mechanisms underlying generational differences in psychological well-being. In a sample of 994 individuals (+18) obtained in the USA and India, we first assess levels of perceived psychological well-being across the generations. Thus, we measure cross-generational differences in the perceived levels of financial, relational, existential, health and lifestyle threats experienced by respondents seven months after the pandemic broke out. In accordance with earlier findings, the results confirm that people from Generation Z and Generation Y reported worse levels of psychological well-being than older adults. Our results suggest that the heightened existential threat, as reflected in a loss of meaning and feelings of being "trapped", mediate the association between younger generations and worse psychological well-being. No substantial intergenerational differences were found for other threat dimensions. The observed effects were consistent across both national contexts, hence stressing the importance of existential concerns as a mechanism underlying the psychological vulnerability of younger people in the historical contingencies of the COVID-19 pandemic.

Persistent pain and long-term physical and mental conditions and their association with psychological well-being; data from 10,744 individuals from the Lolland-Falster health study.

Persistent pain (PP) and long-term conditions are all associated with psychological well-being. Less is known about their associations with reduced psychological well-being when co-occurring. We investigated how PP and long-term physical and mental conditions relate to psychological well-being when occurring together. Data collected in the Danish population-based Lolland-Falster Health study were used in this cross-sectional study. Participants aged ≥18years completing questions concerning PP, long-term conditions and psychological well-being were included. PP and long-term conditions were defined as conditions lasting 6months or longer. Psychological well-being was assessed by the World Health Organization Well-Being Index (WHO-5). Multiple linear regression investigated combinations of PP and physical and mental long-term conditions and their associations with WHO-5. Of 11,711 participants, 10,744 had available data. One third had PP (n = 3250), while 6144 (57%), 213 (2%) and 946 (9%) reported having only physical conditions, only mental conditions or both, respectively. All combinations of PP and long-term conditions were negatively associated with WHO-5. PP in combination with mental (-23.1 (95% CI -28.3 to -17.8)) or both physical and mental conditions (-25.1 (-26.7 to -23.52) yielded the strongest negative associations. Two or more pain sites together with long-term physical and mental conditions was associated with a lower WHO-5 score (-6.2 (-8.9 to -3.5) compared to none or one pain site. The presence of PP and long-term conditions, in particular mental conditions, were strongly associated with worse psychological well-being. This highlights the importance of assessing psychological well-being in individuals with PP and long-term conditions.

Area Deprivation Index Is Associated with Quality of Life and Psychosocial Well-being after Breast Cancer Surgery

INTRODUCTION: Neighborhood-level factors have been shown to influence operative outcomes. To date, no study has been conducted to examine the relationship between area-level deprivation (ADI) and postmastectomy outcomes. METHODS: We conducted a cross-sectional survey of all adult female breast cancer patients who underwent lumpectomy or mastectomy between January 2018 and June 2019. Patient-specific demographics, clinical history, and ADI information were abstracted and correlated with postoperative global- (SF-12) and condition-specific (Breast-Q) quality-of-life performance via multivariable regression. Patients were classified into 3 groups based on their ADI scores: 0–39 (prosperous/comfortable), 40–59 (mid-tier), and 60–100 (at risk/distressed). RESULTS: A total of 564 consecutive patients were identified; mostly White (75%) with a mean age of 60.2 ± 12.4 years, mean BMI of 28.8±7.1, mean Charlson Comorbidity Index of 3.5±2.0, and mean ADI of 42.3±25.7. Minority patients and those with high BMI were more likely to reside in highly deprived neighborhoods (p = 0.003 and p < 0.001). In adjusted models, patients at risk/distressed had significantly lower mean SF-12 physical (44.9 [95% CI 43.8–46.0] vs 44.9 [95% CI 43.7–46.1] vs 46.3 [95% CI, 45.3-47.3], p = 0.03) and BREAST-Q psychosocial well-being scores (63.5 [95% CI 59.32–67.8] vs 69.3 [95% CI 65.1–73.6] vs 69.7 [95% CI 66.4–73.1], p = 0.01) than the mid-tier and prosperous/comfortable groups. CONCLUSION: Patients residing in deprived neighborhoods were more likely to have worse psychological well-being and quality of life. ADI should be incorporated in the shared-decision making process and perioperative counseling to engender value-based and personalized care, especially for vulnerable populations.

Area Deprivation Index is Associated with Variation in Quality of Life and Psychosocial Well-being Following Breast Cancer Surgery.

Neighborhood-level factors have been shown to influence surgical outcomes through material deprivation, psychosocial mechanisms, health behaviors, and access to resources. To date, no study has examined the relationship between area-level deprivation (ADI) and post-mastectomy outcomes. A cross-sectional survey of adult female breast cancer patients who underwent lumpectomy or mastectomy between January 2018 to June 2019 was carried out. Patient-specific characteristics and ADI information were abstracted and correlated with postoperative global- (SF-12) and condition-specific (BREAST-Q) quality-of-life performance via multivariable regression. Patients were classified into three ADI terciles: 0-39 (low deprivation), 40-59 (moderate deprivation), and 60-100 (high deprivation). A total of 564 consecutive patients were identified, being mostly white (75%) with mean age of 60.2 ± 12.4 years, median body mass index of 27.8 [interquartile range (IQR) 24.3-32.2) kg/m2, median Charlson Comorbidity Index of 3 (IQR 2-5), and mean ADI of 42.3 ± 25.7. African American and Hispanic patients and those with high BMI were more likely to reside in highly deprived neighborhoods (p = 0.003 and p < 0.001). In adjusted models, patients in highly deprived neighborhoods had significantly lower mean SF-12 physical (44.9 [95% CI, 43.8-46.0] versus 44.9 [95% CI, 43.7-46.1] versus 46.3 [95% CI, 45.3-47.3], p = 0.03) and BREAST-Q psychosocial well-being scores (63.5 [95% CI, 59.32-67.8] versus 69.3 [95% CI, 65.1-73.6] versus 69.7 [95% CI, 66.4-73.1], p = 0.01) relative to moderate- and low-deprivation groups. Patients residing in the most deprived neighborhoods were identified to have worse psychological well-being and quality-of-life. The ADI should be incorporated into the shared decision-making process and perioperative counseling to engender value-based and personalized care, especially for vulnerable populations.

Working conditions and well-being in UK social care and social work during COVID-19.

Summary Stress and mental health are among the biggest causes of sickness absence in the UK, with the Social Work and Social Care sectors having among the highest levels of stress and mental health sickness absence of all professions in the UK. Chronically poor working conditions are known to impact employees' psychological and physiological health. The spread of the COVID-19 pandemic has affected both the mode and method of work in Social Care and Social Work. Through a series of cross-sectional online surveys, completed by a total of 4,950 UK Social Care and Social Workers, this study reports the changing working conditions and well-being of UK Social Care and Social Workers at two time points (phases) during the COVID-19 pandemic. Findings All working conditions and well-being measures were found to be significantly worse during Phase 2 (November–January 2021) than Phase 1 (May–July 2020), with worse psychological well-being than the UK average in Phase 2. Furthermore, our findings indicate that in January 2021, feelings about general well-being, control at work, and working conditions predicted worsened psychological well-being. Applications Our findings highlight the importance of understanding and addressing the impact of the pandemic on the Social Care and Social Work workforce, thus highlighting that individuals, organizations, and governments need to develop mechanisms to support these employees during and beyond the pandemic.

Association between area deprivation index and quality of life and psychosocial well-being following breast cancer surgery.

e18612 Background: Neighborhood-level factors have been shown to influence surgical outcomes through material deprivation, psychosocial mechanisms, health behaviors, and access to resources. To date, no study has been conducted to examine the relationship between area-level deprivation (ADI) and post-mastectomy outcomes. Methods: We conducted a cross-sectional survey of all adult female breast cancer patients who underwent lumpectomy or mastectomy between January 2018 to June 2019. Patient-specific demographics, clinical history and ADI information were abstracted and correlated with post-operative global- (SF-12) and condition-specific (Breast-Q) quality-of-life performance via multivariable regression. Patients were classified into three groups based on their ADI scores: 0–39 (prosperous/comfortable), 40–59 (mid-tier), and 60–100 (at risk/distressed). Results: A total of 564 consecutive patients were identified; mostly white (75%) with a mean age of 60.2±12.4, mean body mass index (BMI) of 28.8±7.1, mean Charlson Comorbidity Index of 3.5±2.0, and mean ADI of 42.3±25.7. Minority patients and those with high BMI were more likely to reside in highly-deprived neighborhoods (p = 0.003 and p &lt; 0.001). In adjusted models, Patients at risk/distressed had significantly lower mean SF-12 physical (44.9 [95%CI, 43.8-46.0] vs. 44.9 [95%CI, 43.7-46.1] vs. 46.3 [95%CI, 45.3-47.3], p = 0.03) and BREAST-Q psychosocial well-being scores (63.5 [95%CI, 59.32-67.8] vs. 69.3 [95%CI, 65.1-73.6] vs. 69.7 [95%CI, 66.4-73.1], p = 0.01) than the mid-tier and prosperous/comfortable groups. Conclusions: Patients residing in deprived neighborhoods were more likely to have worse psychological well-being and quality of life. ADI should be incorporated in the shared-decision making process and perioperative counselling to engender value-based and personalized care, especially for vulnerable populations.

Early Evidence of the Interplay between Separation Anxiety Symptoms and COVID-19-Related Worries in a Group of Children Diagnosed with Cancer and Their Mothers.

Having cancer in childhood is a risk factor for separation anxiety symptoms, with negative effects on the disease and psychological wellbeing. The Covid-19-pandemic-related concerns could have a negative effect. The present study explores the interplay between separation anxiety symptoms and COVID-19-related worries in pediatric cancer patients and their mothers, compared to a group of healthy children and their mothers, during the pandemic. Thirty-three subjects with cancer, aged 7–15 years, and their mothers were compared to a control sample of 36 healthy children and caregivers. They were administered a pandemic-related psychological experience survey and standardized questionnaires assessing psychological wellbeing, anxiety, and separation anxiety symptoms. Children with cancer reported significantly higher prosocial behaviors, fear of being alone, and fear of abandonment. Their mothers had worse psychological wellbeing, higher COVID-19 concerns, anxiety, and separation anxiety symptoms. The multiple linear regression model showed that an increase in children’s separation anxiety symptoms was associated with younger age, more recent diagnosis, more mother-child time, lower mothers’ worry for children’s contagion, and higher mothers’ and children’s anxiety. COVID-19-related worries of clinical children’s mothers seem to be protective for children’s psychological wellbeing. Early psychosocial support interventions for mothers are essential in health services for cancer.

Emotional characteristics of socially isolated older adults with MCI using tablet administered NIH toolbox: I-CONECT study.

Examining the emotional functioning of individuals with mild cognitive impairment (MCI) could help describe their cognitive status and inform the development of interventions. This study compared the emotional characteristics of socially isolated older adults with and without MCI. We used baseline data from the Internet-based Conversational Engagement Clinical Trial. Emotional characteristics were assessed with the National Institutes of Health Toolbox Emotion Battery (NIHTB-EB). MCI status was determined with a consensus clinical diagnosis. This study included 163 participants (mean age=81.2 years, non-Hispanic Black=20.7%, MCI=52.8%). MCI was associated with higher negative affect and lower psychological well-being. Non-Hispanic Black participants scored lower in sadness, higher in positive affect, and higher in meaning and purpose than non-Hispanic White participants. Older adults with MCI experience more negative emotions and worse psychological well-being than those with normal cognition. The NIHTB-EB appears to be a sensitive tool to detect emotional characteristics associated with cognitive decline.

Impact of Housing and Neighborhood on Depression Among Older Adults in the Health and Retirement Study

Prior research has suggested that poor neighborhood and housing conditions can lead to worse psychological wellbeing. Most studies examine either neighborhood or housing conditions, but not both. Since neighborhood and housing conditions may be correlated it raises the question of whether one is a proxy for the other. We use data from the 2006 and 2008 waves of the Health and Retirement Study to examine associations between perceived neighborhood and housing conditions in 2006 and depressive symptoms (CES-D 8) score in 2008. We find that worse housing conditions and neighborhood safety are associated with more depressive symptoms two years later, even when controlling for prior depressive symptoms. Furthermore, housing and neighborhood conditions are independently related to increased depression symptoms over time. Our research contributes to a deeper understanding of the relationship between home and neighborhood environments and psychological wellbeing in older adults.

Caregiving in quarantine: Humor styles, reframing, and psychological well-being among parents of children with disabilities

Prior research links adaptive humor styles (affiliative and self-enhancing) with enhanced psychological well-being and maladaptive humor styles (aggressive and self-defeating) with worse psychological well-being, primarily through humor styles’ influence on individuals’ social interactions and efforts to positively reframe stressors. The present study examined the unique relation of each humor style with psychological well-being with a focus on understanding mechanisms of adjustment under highly stressful conditions. Ninety-nine parents of children with disabilities were surveyed at the beginning of the COVID-19 pandemic in the United States in March 2020, and 79 parents completed follow-up surveys in July 2020. As predicted, at T1, self-enhancing humor was associated with less psychological distress and greater family satisfaction, self-defeating humor was associated with greater distress, and aggressive humor was associated with lower family satisfaction. Moreover, affiliative humor predicted decreased psychological distress over time, whereas self-defeating humor predicted increased psychological distress and decreased family satisfaction over time. Relations were largely mediated by caregiver positive reappraisal, family efforts to reframe daily disability-related challenges, and negative social interactions. Future research should further examine the influence of caregiver humor styles on family dynamics, family reframing norms, and caregiving efficacy.

Surgical Performance Anxiety and Wellbeing Among Surgeons

Objective: This national cross-sectional study aims to establish the prevalence and potential impact of performance anxiety among surgeons and investigate its association with psychological traits and wellbeing. Summary and Background Data: Despite a growing awareness that human factors, non-technical skills and wellbeing in healthcare affect patient outcomes, an area that has remained unexplored is surgical performance anxiety (SPA). Methods: A prospectively registered, cross-sectional study using mixed methods was conducted across the United Kingdom. Data captured included demographics, surgical specialty, trait anxiety, trait perfectionism, SPA, and surgical perfectionism scores. Wellbeing was assessed using The Short Warwick-Edinburgh Mental Wellbeing Scale, whereas qualitative data were collected regarding surgeons’ experiences of SPA. Results: A total of 631 responses were collected. Mean age was 41·2 years and mean surgical experience 15·3 years. A total of 62% were male and 52% of consultant/attending grade. A total of 100% felt that SPA affected surgeons, with 87% having experienced it themselves. A total of 65% reported SPA negatively impacted surgical performance and 96% felt SPA negatively impacted surgeons’ wellbeing. Male surgeons reported significantly better wellbeing than female surgeons. Surgeons with SPA reported significantly worse wellbeing compared with surgeons who did not experience SPA. Surgeons in general experienced significantly lower mental wellbeing compared with population norms. Thematic analysis highlighted a reticence to share SPA openly and need for cultural change. Conclusions: Surgical performance anxiety is a very common and significant challenge among surgeons across all specialties at all levels of experience in the United Kingdom. It is perceived by surgeons to affect surgical performance adversely and is associated with worse psychological wellbeing. A more open culture of sharing and acknowledgment has been identified to be beneficial.

Course of social support and associations with distress after partial laryngectomy

Purpose Social support has been shown to be positively associated with quality of life and adjustment after a cancer diagnosis. The present study investigates the course of social support up to one year after partial laryngectomy and its association with distress. Design Longitudinal questionnaire study. Sample A total of 428 patients after partial laryngectomy (mean age: 64, SD = 11, 91% male). Methods Patients completed questionnaires before treatment (t1), one week after a partial laryngectomy (t2), 3 months (t3), and one year (t4) thereafter. Social support was evaluated at t2, t3, and t4 using a brief version of the Social Support Questionnaire. Distress was measured at t2, t3, and t4 using the HADS. Descriptive statistics for social support were computed across the three measurement points. Changes were analyzed by Wilcoxon signed-rank tests. Associations with distress were identified using linear regression analyses. Findings Social support increased between t2 and t3 and decreased to baseline level between t3 and t4. Distress at t2 was associated with social support at t2 (B = −0.15, p < 0.01) and distress at t3 with social support at t3 (B = −0.19, p < 0.01). Distress at t4 was related to social support at t2 (B = −0.10, p = 0.05). Conclusions Although perceived social support increases after partial laryngectomy, it decreases again during the course of aftercare. Implications for Psychosocial Providers or Policy Social support resources should be assessed to identify patients at risk for worse psychological well-being.

Mindful larks and lonely owls: The relationship between chronotype, mental health, sleep quality, and social support in young adults.

Chronotype is related to mental health, with evening chronotypes being more susceptible to psychological disorders than intermediate and morning types. The present study investigated the relationship between chronotype, mental health, sleep quality, and social support in Canadian young adults. We surveyed 3160 university students aged 18-35years. Participants completed the Morningness-Eveningness Questionnaire, the Hospital Anxiety and Depression Scale, the Mindful Attention Awareness Scale, the Pittsburgh Sleep Quality Index, and the Medical Outcomes Study - Social Support Survey. We conducted Bonferroni-corrected one-way analyses of covariance with post hoc paired comparisons to determine the relationship between the aforementioned variables, with age and sex as covariates. We further looked at the moderation of social support on the relationship between chronotype and sleep quality. Overall, 55%, 36% and 9% of participants were classified as intermediate, evening and morning types, respectively. There was a significant difference between chronotype on levels of depression, anxiety, and sleep quality, with evening types reporting more severe symptomology than morning-types and intermediate types. Morning types reported greater levels of overall social support and mindfulness. Evening types reported the lowest levels of all types of social support. Social support did not moderate the relationship between chronotype and sleep quality. This study further demonstrates the association between worse psychological well-being and eveningness and between more social support, and mindfulness in morning chronotype young adults. Education and intervention are warranted to help evening chronotypes manage the potential negative features of their circadian rhythm, as well as to cultivate a greater sense of social support and mindfulness.

The Influence of Self-Efficacy and Locus of Control on Body Image: A Path-Analysis in Aspiring Fashion Models, Athletes and Students.

It is widely documented that negative body image is a significant public health concern due to its association with symptoms of disordered eating and worse psychological well-being. The purpose of the study was to develop a path model of intrapersonal dimensions (self-efficacy and internal locus of control) as antecedents of perceived stress toward females’ body dissatisfaction and eating attitude disorders. A total of 300 females, including 100 aspiring fashion models, 100 athletes and 100 students (controls), between 15 and 24 years of age (M = 19.6, SD = 1.85) participated in the study. Measures included level of psychological stress, self-efficacy and locus of control dimensions, body dissatisfaction and eating attitude disorder indices. A path analysis confirmed our research hypothesis. Comparing the three subsamples, we found better fit indexes in the two subgroups with elevated investment on their body image with respect the control group. More specifically, the model in the group of aspiring fashion models showed the best fit index. These results indicated that aspiring fashion models have a strong desire to maintain their low body mass or to become thinner. For this reason, a suitable involvement of expert health workers in the nutritional and psychological field could be extremely essential in the fashion world to maintain a healthier well-being.

Measuring financial toxicity in Australian cancer patients - Validation of the COmprehensive Score for financial Toxicity (FACT COST) measuring financial toxicity in Australian cancer patients.

The FACT COST is a patient-rated measure of financial toxicity, developed and validated in a North American population. We aimed to confirm the validity and reliability of the FACT COST in Australian cancer patients, because the Australian healthcare funding structure is different to that in North America. A single center, cross-sectional study design investigated financial toxicity in oncology outpatients. Eligible adults had current malignancy, with or without active cancer treatment. The primary endpoint was the degree of financial toxicity experienced via the COST questionnaire; secondary endpoints included health-related quality of life (Functional Assessment of Cancer Therapy-General), anxiety, and depression (Hospital Anxiety and Depression Scale). Clinical and demographic data were recorded. Statistical analysis determined the internal consistency, test-retest reliability and validity of COST, and correlations between COST score and secondary endpoints. A total of 257 patients participated (79% response rate). Fifty-three percent were female; median age 63 years (range 19-88). COST scores were skewed toward less financial toxicity, median 26 (SD 10.3, range 1-43), lower scores indicating higher toxicity. High internal consistency (Cronbach's α=0.884), test-retest reliability (ICC=0.801), and convergent validity were demonstrated. Financial toxicity was greatest in younger participants, those with more inpatient admissions, those with a change in employment status following diagnosis, and those in the lowest income quintile. Financial toxicity was associated with worse health-related quality of life, and greater depression and anxiety. The COST measure of financial toxicity demonstrated acceptable validity parameters in an Australian outpatient population. Greater financial toxicity was associated with worse psychological well-being and with certain patient demographics.

Using REGARDS to Study Family Caregiver Well-Being, Health, and Mortality

The REGARDS study has provided a unique opportunity to study both disease-specific (stroke) and broader samples of family caregivers, and to examine the effect of transitions to caregiving over time. Using REGARDS has afforded many advantages over conventional caregiving research, including the availability of biomarker and mortality data, a large sample of non-caregiving controls who can be carefully matched to caregivers, and ability to track onset of caregiving over time. Our findings illustrate the complex nature of caregiving-related effects. While caregiving leads to worse psychological well-being, we have found minimal physical health decreases and reduced mortality rates compared to matched non-caregiving samples. These findings have policy implications and have challenged the conventional beliefs about caregiving based on previous studies of convenience samples. Diverse students and junior faculty members from multiple universities have also gained experience and contributed to high impact papers from this work.

Psychosocial outcomes following surgery in women with unilateral, nonhereditary breast cancer.

570 Background: Rates of bilateral mastectomy continue to rise in average-risk women with unilateral breast cancer. We aim to characterize psychosocial predictors of surgical procedure and how psychosocial outcomes change over time after surgery for breast cancer. Methods: A prospective cohort of women with unilateral, nonhereditary breast cancer were recruited at University Health Network in Toronto, Canada between 2014-2017. Women completed validated psychosocial questionnaires (BREAST-Q) pre-operatively, and 6 and 12 months after surgery. Outcomes were assessed between three surgical groups (unilateral lumpectomy, unilateral mastectomy, bilateral mastectomy). Predictors of surgical procedure were identified using a multinomial logistic regression model. Change in psychosocial scores over time according to procedure was assessed using linear mixed models. All models control for age, stage, reconstruction and treatment. P values &lt; .05 were considered statistically significant. Results: 506 women underwent surgery as follows: 216 unilateral lumpectomy (43%), 181 unilateral mastectomy (36%) and 109 bilateral mastectomy (22%). In the multinomial regression model, younger age (p &lt; .01), and lower chest physical (p = .03) and sexual well-being (p = .02) predicted having bilateral mastectomy over unilateral lumpectomy while younger age (p &lt; .01) and lower disease stage (p = .02) predicted bilateral mastectomy over unilateral mastectomy. The mixed model demonstrates that breast satisfaction follows a non-linear pattern of change over time, with 6- but not 12-month scores being significantly different from baseline (p = .015). Procedure predicts baseline satisfaction (p = .016), with bilateral mastectomy having worse satisfaction than unilateral lumpectomy. Procedure also predicts change in satisfaction, with unilateral and bilateral mastectomy having lower scores across time than lumpectomy. While a significant improvement in psychological well-being is detected by 12 months (p = .02), those with unilateral and bilateral mastectomy have worse psychological well-being over time compared to lumpectomy. Women having mastectomy start with worse physical well-being than those in the lumpectomy group, but their physical well-being does not decline as much as the lumpectomy group over time (p &lt; .01). Conclusions: Definitive surgical procedure affects the trajectory of psychosocial functioning over time. This emerging data may be used to further facilitate surgical decision-making in women considering contralateral prophylactic mastectomy.