Functional connectivity between the ventral anterior cingulate and amygdala during implicit emotional conflict regulation and daily-life emotion dysregulation

Emotional conflict adaptation involving ventral anterior cingulate cortex (ACC) suppression of the amygdala is thought to be important in emotion regulation, with evidence of impaired implicit emotion regulation in emotional distress disorders. However, it is unclear how this impairment is associated with daily-life emotion dysregulation in emotional distress disorders. In the current study, female participants with an emotional distress disorder (N = 27) were scanned with MRI while completing an implicit emotion conflict regulation task that involved identifying the facial expression of an image while ignoring an overlaid congruent or incongruent affect label. Participants then completed two weeks of ambulatory assessment of daily-life emotion dysregulation. Consistent with previous research on comorbid emotional distress disorders (Etkin and Schatzberg, 2011), there was no behavioral effect of emotional conflict adaptation (p = .701) but a significant effect of congruent adaptation (p = .006), suggesting impairment is specific to implicit emotional conflict regulation. Additionally, there was no neural evidence of emotional conflict adaptation in the ventral ACC and amygdala (ps > .766). Further, in our primary psychophysiological interactions analyses, we examined ventral ACC-amygdala functional connectivity. As hypothesized, increased ventral ACC-amygdala functional connectivity for emotional conflict adaptation was associated with increased daily-life affective instability (p = .022), but not mean daily-life negative affect (p = .372). Overall, results provide behavioral and neural evidence of impaired implicit emotional conflict adaptation in individuals with emotional distress disorders and suggests that this impairment is related to daily-life affective instability in these disorders.

Preoperative anxiety and its association with patients' desire for support - an observational study in adults

Background

Preoperative anxiety is prevalent and has harmful effects on postoperative outcomes. However, to date, it is still unclear (i) to what extent patients perceive preoperative anxiety as emotionally distressful, (ii) whether patients would welcome support from anesthesiologists in coping with their anxiety, and (iii) whether anxiety scores are useful for everyday clinical practice to determine patients’ need for support.

Methods:

1082 patients scheduled to undergo elective procedures under general anesthesia were eligible for this cross-sectional study carried out at a university hospital.

Preoperative anxiety, resulting in emotional distress, and patients’ desire for anesthesiologists’ support in coping with their anxiety were assessed dichotomously (no vs. yes) and analyzed descriptively. The intensity of anxiety was evaluated using the Amsterdam Preoperative Anxiety and Information Scale (range 4–20). Associations between the intensity of anxiety and the resulting desire for support were analyzed using logistic regression. Receiver operating characteristic analyses were performed to identify anxiety levels that best predict desire for support.

Results

Among the 1000 (537 female; M (SD) 57 (18) years) subjects evaluated, 493 (318 (65 %) female) reported anxiety. Anxiety was associated with emotional distress in 320 (65 %) and desire for support in 291 (59 %) patients. Increased preoperative anxiety levels were associated with higher rates of desire for support (B= 0.270; odds ratio 1.31 [95 % CI 1.22–1.41]). An anxiety score > 9 was best to predict a desire for support (sensitivity 0.861, specificity 0.724). However, desire for support was even present in some patients with lowest anxiety scores (5 or 6).

Conclusions

All patients undergoing surgery should be screened for preoperative anxiety and the resulting desire for support to be able to determine who would welcome support. Anxiety scoring tools do not seem to be useful to identify these patients. By helping patients experience less preoperative anxiety, anesthesiologists may not only reduce patients’ emotional distress but also have a positive impact on postoperative outcome.

Trial registration

German Clinical Trials Register (DRKS 00013319, 23 November 2017).

Supplementary Information

The online version contains supplementary material available at 10.1186/s12871-021-01361-2.

Psychosocial Wellbeing of Nigerian Teachers in Special Education Schools

While there is evidence that impaired psychosocial wellbeing can compromise the effective performance of work-related roles, little is known about the wellbeing of teachers working with children with developmental disabilities. We interviewed 68 special education schoolteachers (response rate = 70.8%) in a Nigerian state with 12-item General Health Questionnaire and an adapted Zarit Burden Interview. About four in every ten teachers had psychological distress, representing many-fold the rates reported in the general population, and significant burden was prevalent in 51.5%. Perceived burden correlated significantly with psychological distress, anxiety/depression and social dysfunction (rs = .3). While increased burden predicted psychological distress, longer teaching experience was protective against distress. These findings underscore the need for psychosocial support for special education schoolteachers to enhance their wellbeing and roles.

Preoperative detection and evaluation of the need for psychological intervention in cancer and non-cancer patients referred to thoracic surgery

OBJECTIVES

(a) to evaluate and compare the psychological treatment needs of patients with cancer and non-cancer, who are going to undergo scheduled thoracic surgery, and (b) evaluate and compare the diagnostic accuracy of the screening tests of psychological treatment needs for cancer and non-cancer patients.

METHOD

The need for psychological treatment was evaluated in a total of 169 patients prior to thoracic surgery, through a clinical interview. The screening tests used were: the physician's judgment (yes/no), the Hospital Anxiety and Depression Scale (HADS) and, the single-item interview to assess depression "Do you feel depressed?" (DEPQ).

RESULTS

The number of patients who needed psychological treatment in the total sample was 47 (27.81%), in non-cancer-patients: 22 (30.99%) and in cancer patients: 25 (25.51%). The participants with treatment needs were more often young women with primary education levels, with more fears and concerns regarding their disease. With respect to the screening tests, the HADS-T (cut-off point ≥13) obtained a sensitivity (SE) of 0.75 and Specificity (SP) of 0.81 in the total sample. In patients with cancer, the HADS total score (cut-off point ≥10) obtained an SE=0.84 and SP=0.80, and, in non-cancer patients, the HADS total score (cut-off point ≥13) showed an SE=0.59 and SP=0.84. The DEPQ and the physician's judgment did not achieve adequate levels of precision.

CONCLUSIONS

A high percentage of patients have psychological treatment needs before performing thoracic surgery, which are similar for cancer and non-cancer patients. Preoperative detection of patients who need psychological intervention is feasible with a simple screening test: HADS, which achieves greater precision in cancer patients.

Mental health problems in children admitted with physical symptoms

The aim of the study was to investigate the burden of mental health problems in children and adolescents admitted to a pediatric ward with physical complaints. We conducted a retrospective study, considering all patients admitted to the pediatric ward of the IRCCS Burlo Garofolo, Trieste, Italy, between January 2015 and September 2016. We selected all patients, from 5 to 17 years old, who were admitted with physical complaints and were discharged with a diagnosis suggestive of a mental health problem: somatic symptom disorder, anxiety disorder, depressive disorder, factious disorders. For every patient, we collected demographic features, medical characteristics, health care services utilization, length of hospital stay, and after discharge referral. We selected 1456 patients; of these, 101 (6.9%) revealed a mental health problem. The median duration of symptoms was 5 months (IQR 1.5-12), and pain was the main reported symptom (69%). Of the 101 patients, 23 (23%) were affected by a previously documented chronic organic disease. Somatic symptom disorder was the most common diagnosis. In 69/78 patients (88%), a loss of social contacts emerged; 49/95 patients frequenting school (51%) had chronic school absenteeism in the previous school year.Conclusion: A considerable proportion of patients admitted to a pediatric ward with physical complaints have mental health problems. What is Known: • It has been suggested that mental health problems in children and adolescents are increasing and frequently burden on pediatric healthcare services, but how they impact on a general pediatric ward is not clear. What is New: • Among 1456 patients admitted to a general pediatric ward with physical symptoms, 101 patients (6.9%) had a mental health problem. Among them, pain was the most commonly reported symptom and somatic symptom disorder was the commonly reported diagnosis.

Predicting decisional conflict: Anxiety and depression in shared decision making

OBJECTIVES

Emotional distress can be a potential barrier to shared decision making (SDM), yet affect is typically not systematically assessed in medical consultation. We examined whether urological patients report anxiety or depression prior to a consultation and if emotional distress predicts decisional conflict thereafter.

METHODS

We recruited a large sample of urological outpatients (N = 397) with a range of different diagnoses (42 % oncological). Prior to a medical consultation, patients filled in questionnaires, including the Hospital Anxiety and Depression Scale. After the consultation, patients completed the Decisional Conflict Scale. We scored the rate of anxiety and depression in our sample and conducted multiple regression analysis to examine if emotional distress before the consultation predicts decisional conflict thereafter.

RESULTS

About a quarter of patients reported values at or above cut-off for clinically relevant emotional distress. Emotional distress significantly predicted a higher degree of decisional conflict. There were no differences in emotional distress between patients with and without uro-oncological diagnosis.

CONCLUSIONS

Emotional distress is common in urology patients - oncological as well as non-oncological. It predicts decisional conflict after physician consultation.

PRACTICE IMPLICATIONS

Emotional distress should be systematically assessed in clinical consultations. This may improve the process and outcome of SDM.

A longitudinal study on emotional distress among local government staff seven years after the 2008 Wenchuan earthquake in China

BACKGROUND

The current study examined the change in local government staff's emotional distress over 7 years after the 2008 Wenchuan earthquake, and the influence of earthquake exposure and professional quality of life (ProQOL) on emotional distress.

METHODS

This longitudinal study assessed 250 participants at 1 year after the earthquake; 162 (64.8%) were followed up at 7 years. Emotional distress was assessed with the Self-Reporting Questionnaire (SRQ) at both time points. We assessed ProQOL, including compassion satisfaction, burnout, and secondary traumatic stress, and earthquake exposure at 1 year. Wilcoxon signed-rank tests were performed to test longitudinal changes in emotional distress. Hierarchical multiple regression was conducted to examine the effect of earthquake exposure and ProQOL.

RESULTS

The positive screening rate of emotional distress (SRQ ≥ 8) was 37.6 and 15.4% at one and 7 years, respectively. Emotional distress scores declined over time (p < 0.001). Earthquake exposure and ProQOL predicted one-year (ps < 0.05) but not seven-year emotional distress, whereas burnout predicted both one-year (p = 0.018) and seven-year (p = 0.047) emotional distress.

CONCLUSIONS

Although emotional distress can recover over time, it persists even 7 years later. Actions to reduce burnout during the early stage of post-disaster rescue have long-term benefits to staff's psychological outcomes.

Moral Distress Entangled: Patients and Providers in the COVID-19 Era

Moral distress is defined as the inability to act according to one’s own core values. During the COVID-19 pandemic, moral distress in medical personnel has gained attention, related to the impact of pandemic-associated factors, such as the uncertainty of treatment options for the virus and the accelerated pace of deaths. Measures to provide aid and mitigate the long-term pandemic effect on providers are starting to be designed. Yet, little has been said about the moral distress experienced by patients and the relational and additive effect on provider moral distress. Pandemic-associated factors affecting moral distress in patients include the constraining effects of isolation on spiritual and religious traditions as well as the intentional separation of patients from their families. This paper will explore the idea that patients are suffering their own moral distress and further how this impacts the intensity of moral distress experienced by the providers—nurses and physicians. The paucity of research in this area with the implications on patient’s distress, decision making, and distress experienced by providers compels further investigation and analysis.

Examining associations between smartphone use, smartphone addiction, and mental health outcomes: A cross-sectional study of college students

Background: Prior studies have indicated the complex relationships of smartphone use and smartphone addiction with mental health and life satisfaction. The purpose of this study was to investigate the structural relationships among smartphone use, smartphone addiction, mental health problems (e.g., depression, anxiety, stress [DAS] and satisfaction with life [SWL]).

Methods: Cross-sectional data were collected by convenience sampling via an online survey of undergraduate students at a Midwestern university in the United States. The sample size of601 collected from undergraduate students that owned a smartphone and completed responses to the variables was utilized in this study. We assessed the hypothesized variables, including smartphone use, smartphone addiction, and mental health outcomes variables on a Likert-type scale. Structural analysis was used to examine the relationships.

Results: Results suggested that smartphone use had a significant negative association with DAS symptoms (β = -.31, t = -3.81, P < .001) and was positively associated with SWL (β =.25, t = 3.41, P < .001). However, smartphone use had a significant positive relationship with smartphone addiction (β = .48, t = 5.51, P < .001). Smartphone addiction was positively related to DAS (β = .44, t = 6.33, P < .001), but it was not related to SWL (β = -.08, t = -1.26, P > .05).

Conclusion: This study enhances our understanding of the associations between smartphone use and the health and well-being of undergraduate students. Implications for supporting their psychological health are discussed.

Study of emotional distress in a comparative effectiveness trial of diabetes treatments: Rationale and design

Emotional distress, including depression and diabetes-specific distress (e.g., feeling overwhelmed by living with diabetes, feelings of failure related to diabetes self-care), is a significant and prevalent problem for patients with type 2 diabetes. Both depression and diabetes distress have been associated with metabolic/glycemic control, diabetes complications, mortality, and quality of life. Recent findings further suggest that risk for emotional distress is influenced by diabetes treatment. The GRADE Study (Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study) is generating prospective data that will provide a unique opportunity to examine the relationships between emotional distress, diabetes treatment, and outcomes in an experimental design. The GRADE study is a randomized clinical trial that will compare the metabolic effects of four common anti-hyperglycemic drugs when combined with metformin. This sub-study recruited a subset (n = 1739) of GRADE participants and will examine patient-level variation in baseline emotional distress as a predictor of glycemic control and other health outcomes, independent of treatment effects. The study will also provide an experimental examination of treatment regimen effects on emotional distress over time as part of the overall evaluation of comparative effectiveness. Evaluation of emotional distress using validated measures will allow us to disentangle the roles of depressive symptoms and diabetes distress, factors that share significant overlap but require distinct approaches to screening and treatment. Study findings may directly influence practice decisions regarding screening and treatment for emotional distress as part of diabetes care. ClinicalTrials.gov Identifier: NCT01794143.

Insights on emotional distress following cancer, sources of support and the unmet needs in a setting with limited supportive care services for people living with cancer

INTRODUCTION

Delivery of supportive cancer care is often deemed a low priority in resource-limited settings. We aimed to explore the sources of emotional distress, the related support and the unmet needs of cancer survivors in Malaysia, where cancer survivorship services are presently limited.

METHOD

Twenty focus group discussions were conducted with 102 cancer patients from diverse ethnic and socioeconomic backgrounds. Thematic analyses were performed.

RESULTS

Patient narratives suggested that emotional distress arose from direct and indirect stressors. Direct stressors comprised physical and cognitive side effects of cancer surgery and therapies, and fear of recurrence. Indirect stressors included worry over dependent family members, financial distress following cancer, working with cancer and lack of practical support at home. Distress from altered physical appearances, fear of recurrence and lack of practical support were mainly raised by women, implying that men and women may have disproportionate emotional needs. Emotional support largely came from informal sources including self, family, friends and religion. While formal emotional support from professional counsellors and cancer support groups was acknowledged as important, it appeared to be largely lacking. Unmet needs in coping with fear of recurrence, financial distress, workplace discrimination and household chores were particularly highlighted.

CONCLUSION

The unmet needs revealed in this study provide insights to initiate actionable changes to improve the emotional wellbeing of people living with cancer in settings where cancer survivorship services are still in its infancy.

Social support and strain and emotional distress among Latinos in the northeastern United States

Background

US Latinos report high levels of emotional distress. Having positive familial and friend social support buffers emotional distress among US Latinos, but thus far no research has been done on social support and ataque de nervios in that population, or on social strain and emotional distress.

Methods

This paper assesses social support and strain across three relationship types (partner, family, and friends) with three measures of emotional distress (depression, anxiety, and ataque de nervios). The sample for partner, family, and friend support included 508 Latino adults 21 and older. Multivariate logistic regression models were used to assess the association of social support and strain with each outcome.

Results

As all social support types increased, the odds of emotional distress symptoms decreased. Conversely, as each unit of partner and family strain increased, the odds of emotional distress symptoms increased. Increased friend strain was associated with greater odds of depressive and anxiety symptoms only.

Conclusion

Social support in all three network types (partner, family, and friend) was associated with a decrease in the odds of emotional distress, assessed as symptoms of depression, anxiety, and ataque de nervios.

Gut microbiota dysbiosis is associated with worse emotional states in HIV infection

The biological mechanisms underlying emotional distress in HIV infection are likely to be complex but remain understudied. We investigated whether dysbiotic signatures in the gut microbiome of persons living with HIV (PLWH) are associated with their emotional status. We retrospectively examined the gut microbiome and clinical evaluation of 129 adults (94 PLWH and 35 HIV-) enrolled at UC San Diego's HIV Neurobehavioral Research Program. A subset of participants (32 PLWH vs. 13 HIV-) underwent an emotional assessment using the NIH Toolbox Emotion Battery summarized by three composite scores (negative affect, social satisfaction, and psychological well-being). We then sequenced the 16S rDNA V3-V4 regions from stool and performed taxonomic assignment using CLC Microbial Genomics Module. The gut microbiota profiles were evaluated in relation to participants' emotional assessment. All analyses were done in R statistical software. We found that the relative abundance of aerotolerant bacteria was significantly higher in PLWH (p < 0.01) and was associated with a lifetime major depression diagnosis independently of HIV status (p = 0.05). Moreover, PLWH experienced significantly worse psychological well-being (p = 0.02), less social satisfaction (p = 0.03), and more negative affect (p = 0.02). Higher levels of aerotolerant bacteria were associated with worse psychological well-being (rho = -0.35, p = 0.02), less social satisfaction (r = - 0.42, p < 0.01), and more negative affect (rho = 0.46, p < 0.01). The association of aerotolerant bacteria with social satisfaction and negative affect was independent of HIV status (p < 0.05, for both). The over-representation of aerotolerant bacteria in the gut may reflect worse oxidative stress and barrier defects and may contribute to emotional distress during HIV infection.

Psychological stresses among Chinese university students during the COVID-19 epidemic: The effect of early life adversity on emotional distress

BACKGROUND

Coronavirus disease 2019 (COVID-19) is leading to numerous psychological outcomes, especially emotional distress. Individuals with early life adversity (ELA) may be more susceptible to those psychological stresses during this epidemic.

AIMS

To measure the effect of the ELA on acute stress reactions, anxiety and depression during the COVID-19 epidemic, and to examine whether specific trauma types and frequencies of exposure are associated with a more severe acute stress reaction and increased risk of anxiety and depressive symptoms.

METHOD

This investigation was performed at college students in a comprehensive University of China. The online self-report questionnaire included ELA experiences, exposure to epidemic-related events, acute stress reactions, and anxiety and depression symptoms during the COVID-19 epidemic. Logistic regression and stepwise regression were used to assess the associations and interactions among these variables.

RESULTS

Participants with ELA reported more exposure to epidemic-related events and more severe stress reactions during the epidemics than did those with no ELA. The experience of ELA is associated with acute stress reactions, anxiety and depression in early adulthood. Furthermore, experiencing more ELA during childhood may not only increase the risk of anxiety and depression episode in early adulthood but also lead to more severe acute stress reactions during the epidemic.

CONCLUSION

Regardless of specific ELA types, ELAs have longer time effects on individual's susceptibility to stress. Under this epidemic, the mental health in young adults with ELA needs more attention.

Psychological distress assessment among patients with suspected and confirmed COVID-19: A cohort study

BACKGROUND

Global pandemic resulted from the coronavirus disease-19 (COVID-19) demands mental health concerns on the affected population. We examine the time-course shift of psychological burden among suspected and confirmed COVID-19 patients.

METHODS

Participants with suspected or confirmed COVID-19 were included in the cohort. Consecutive surveys were conducted upon hospital admission, discharge, and during outpatient follow-up by adapting the 5-item brief symptom rating scale (BSRS-5) assessing psychological symptoms including anxiety, depression, hostility, interpersonal sensitivity, and insomnia. The sixth measure to observe suicidal ideation was also included.

RESULTS

A total of 109 eligible patients participated in the study, in which 83.49% reported no distress upon hospital admission, while 2.75%, 3.66%, and 10.1% patients were assessed as being with severe, moderate and mild psychological distress, respectively. Overall, age, sex, and history of contact did not significantly differ between patients with and without psychological distress. Multivariate logistic regression revealed that patients admitted during April-May (OR: 7.66, 95% CI: 1.46-40.28) and presented with symptoms including sore throat (OR: 4.24, 95% CI: 1.17-15.29) and malaise (OR: 5.24, 95% CI: 1.21-22.77) showed significantly higher risk of psychological distress. Cough symptom interestingly showed lower risk of emotional distress (OR: 0.25, 95% CI: 0.08-0.81). Subsequent surveys upon hospital discharge and during outpatient follow-up revealed steadily declining distress among all cohort.

CONCLUSION

At least 16.5% of our cohort reported psychological distress upon hospital admission, with distinct time-dependent decline. Access to mental health support, alongside with promoting positive activities for good mental health are pivotal for those directly affected.

Differences in Emotional Distress Among Black and White Breast Cancer Survivors During the Covid-19 Pandemic: a National Survey

The Covid-19 pandemic is straining US healthcare resources, causing significant disruptions in cancer care. Prior to the pandemic, Black cancer survivors experienced a disproportionate burden of delays in cancer treatment compared to White cancer survivors. As a result of the pandemic, disruptions in care are widespread and affect cancer survivors regardless of race. This shift presented an opportunity to investigate differences in how Black and White cancer survivors experience disruptions in cancer care due to the pandemic. We conducted a national survey of adult breast cancer survivors, distributed online from 4/2/20 to 4/27/20. We used t-tests to compare cancer and non-cancer-related worry during the Covid-19 pandemic between Black and White breast cancer survivors. Analysis of data from 570 respondents (106 Black and 464 White) indicated significantly higher levels of distress among White respondents compared to Black respondents. Our results point to the importance of assessing race differences in emotional response to disruptions in cancer care during the pandemic. We suggest that differences in emotional distress may reflect differences in previous experience of treatment delays and coping strategies between Black and White breast cancer survivors.

Longitudinal Changes in Sleep: Associations with Shifts in Circulating Cytokines and Emotional Distress in a Cancer Survivor Population

BACKGROUND

Sleep disturbances are associated with numerous mood disorders. Similarly, anxiety and depression are associated with modulation of the psychoneuroimmune (PNI) axis. This study hypothesized that changes in both monitored and self-reported measures of sleep would relate to changes in circulating cytokine levels in an emotionally distressed population of cervical cancer survivors.

METHODS

Biospecimens, patient-reported outcome (PRO) measures, and actigraphy were collected from cervical cancer survivors enrolled in a biobehavioral clinical trial. Longitudinal changes over a 4-month period were examined. Sleep time measured by actigraphy and PRO were analyzed for correlative changes with emotional distress and serum cytokines (n = 71).

RESULTS

Longitudinal change in the actigraph measure of sleep time was inversely associated with changes in depression and anxiety (test for linear trend, p = 0.02 and p = 0.05 respectively), as well as acute-phase response/pro-inflammatory cytokines (test for linear trend, p = 0.003, interleukin (IL)-2; 0.022, IL-1β; 0.0002, IL-6; and 0.049, tumor necrosis factor α). Conversely, changes in self-reported sleep problems were related to an increase in depression and anxiety (p = 0.001 and p = 0.01 respectively), the T helper 2 (Th2) cytokine IL-5 (p = 0.027), and the counter-regulatory cytokine IL-10 (0.016).

CONCLUSION

This study showed that an increase in sleep time or decrease in sleep problems corresponded with a reduction in self-reported emotional distress and attenuation of pro-inflammatory, Th2, and counter-regulatory cytokines. Our results support sleep measurement as a meaningful biobehavioral variable in cancer survivorship. This study also indicates that sleep investigators should be aware that choice of methodology might influence concordance with different classes of immune parameters.

Outdoor air pollution exposure and inter-relation of global cognitive performance and emotional distress in older women

The interrelationships among long-term ambient air pollution exposure, emotional distress and cognitive decline in older adulthood remain unclear. Long-term exposure may impact cognitive performance and subsequently impact emotional health. Conversely, exposure may initially be associated with emotional distress followed by declines in cognitive performance. Here we tested the inter-relationship between global cognitive ability, emotional distress, and exposure to PM2.5 (particulate matter with aerodynamic diameter <2.5 μm) and NO2 (nitrogen dioxide) in 6118 older women (aged 70.6 ± 3.8 years) from the Women's Health Initiative Memory Study. Annual exposure to PM2.5 (interquartile range [IQR] = 3.37 μg/m3) and NO2 (IQR = 9.00 ppb) was estimated at the participant's residence using regionalized national universal kriging models and averaged over the 3-year period before the baseline assessment. Using structural equation mediation models, a latent factor capturing emotional distress was constructed using item-level data from the 6-item Center for Epidemiological Studies Depression Scale and the Short Form Health Survey Emotional Well-Being scale at baseline and one-year follow-up. Trajectories of global cognitive performance, assessed by the Modified-Mini Mental State Examination (3MS) annually up to 12 years, were estimated. All effects reported were adjusted for important confounders. Increases in PM2.5 (β = -0.144 per IQR; 95% CI = -0.261; -0.028) and NO2 (β = -0.157 per IQR; 95% CI = -0.291; -0.022) were associated with lower initial 3MS performance. Lower 3MS performance was associated with increased emotional distress (β = -0.008; 95% CI = -0.015; -0.002) over the subsequent year. Significant indirect effect of both exposures on increases in emotional distress mediated by exposure effects on worse global cognitive performance were present. No statistically significant indirect associations were found between exposures and 3MS trajectories putatively mediated by baseline emotional distress. Our study findings support cognitive aging processes as a mediator of the association between PM2.5 and NO2 exposure and emotional distress in later-life.

The mediating role of social support in the relationship between stigma and emotional distress among homeless adolescents in Ghana

Research on youth homelessness has showed a link between emotional distress and social stigma. However, the mechanisms underlying this relationship have received little empirical attention. This study was conducted to examine the mediating effect of social support that accounts for the link. Standard questionnaires that assessed emotional distress, stigma and social support were interviewer-administered to 193 homeless adolescents (50.4% male; Mean = 13.21 (SD = 2.06). The Pearson product-moment correlation coefficient and mediation analyses were used to analyse the data. The study revealed that both self-blame and general stigma were positively related to emotional distress; but negatively related to social support. In the mediation analysis, general stigma significantly predicted decreased perceived social support and had a direct positive influence on emotional problems. However, the levels of self-blame was neither significantly associated with perceived social support nor had a significant indirect influence on the level of emotional problems. Both self-blame and general stigma also did not have a significant indirect influence on the level of emotional problems through perceived social support. These findings call for further research to examine the complex mechanism underlying stigma and mental health outcomes.

Hippocampal cerebral blood flow increased following low-pressure hyperbaric oxygenation in firefighters with mild traumatic brain injury and emotional distress

BACKGROUND

Recent evidence suggests that hyperbaric oxygenation (HBO), which has been used as an effective treatment for certain types of tissue injury, may change neural activities in the human brain and subsequently improve symptoms of psychiatric disorders. To scrutinize the neural mechanism of HBO in the human brain, we investigated whether 20 sessions of HBO changed regional cerebral blood flow (rCBF) of the limbic system in firefighters with mild traumatic brain injury (mTBI) and subjective emotional distress.

METHODS

Twenty firefighters with mTBI and mild emotional distress were treated with HBO at a relatively low pressure of 1.3 atmospheres absolute for 45 min a day for 20 consecutive days (the mild emotional distress group). The rCBF of the limbic system was measured using an arterial spin labeling perfusion magnetic resonance imaging before and after the HBO. Analyses were performed on the data from fourteen individuals who completed the study and 14 age- and sex-matched healthy firefighters (the comparison group).

RESULTS

Firefighters in the mild emotional distress group showed increase rCBF following HBO in a cluster encompassing the right hippocampal and parahippocampal regions (peak t = 4.31; cluster size = 248 mm³)(post-hoc analysis, z = 5.92, p < 0.001) that had lower rCBF relative to the comparison group at baseline (post-hoc analysis, t = -2.20, p = 0.04).

CONCLUSION

The current study demonstrated that low-pressure HBO might increase rCBF of the hippocampal and parahippocampal regions, suggesting a potential underpinning mechanism of HBO in the human brain.

Comparison of Patient-Led and Physician-Led Insulin Titration in Japanese Type 2 Diabetes Mellitus Patients Based on Treatment Distress, Satisfaction, and Self-Efficacy: The COMMIT-Patient Study

INTRODUCTION

In Japan, patient-led insulin titration is rare in type 2 diabetes mellitus (T2DM) patients. Few studies have compared the effects of patient-led versus physician-led insulin titration on patient-reported outcomes in Japanese T2DM patients. This study aimed to compare the effects of patient-led and physician-led insulin titration in Japanese insulin-naïve T2DM patients on safety, glycemic control, and patient-reported outcomes (emotional distress, treatment satisfaction, and self-efficacy).

METHODS

Ultimately, 125 insulin-naïve Japanese T2DM patients were randomly assigned to either a patient-led insulin self-titration group or a physician-led insulin titration group and monitored for 24 weeks. The primary endpoint was a change in emotional distress as measured using the Problem Areas in Diabetes scale (PAID). Secondary endpoints included treatment satisfaction, as measured with the Diabetes Treatment Satisfaction Questionnaire (DTSQ), self-efficacy as measured using the Insulin Therapy Self-Efficacy Scale (ITSS), glycated hemoglobin (HbA1c) levels, fasting plasma glucose levels, body weight, insulin daily dose, and frequency of hypoglycemia.

RESULTS

There was no significant difference between the groups in PAID and DTSQ scores. The results for the primary endpoint should be interpreted taking account that the sample size for the power calculation was not reached. ITSS scores were significantly higher in the patient-led self-titration group. HbA1c and fasting plasma glucose levels were significantly decreased in both groups, but the decrease was significantly larger in the patient-led self-titration group. Although the insulin daily dose was significantly higher in the patient-led self-titration group, severe hypoglycemia did not occur in either group, and the frequency of hypoglycemia was similar in both groups.

CONCLUSION

Self-measurement of blood glucose and self-titration of insulin enhanced the patients' self-efficacy without compromising their emotional distress or treatment satisfaction. Also, insulin self-titration was found to be safe and effective; it resulted in better glycemic control without severe hypoglycemia.

TRIAL REGISTRATION

University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR) (registration number: UMIN000020316).

Predictors of emotional distress during the COVID-19 pandemic; a Croatian study

The study aimed to assess relations between coronavirus-related psychological distress and its potentially predictive factors. An online sample of 2860 Croatian adults filled in questionnaires on socio-demographic characteristics, distress (the Depression, Anxiety and Stress Scale 21), coping (the Brief COPE), personality (the International Personality Item Pool), and social support (the Duke-UNC Functional Social Support Questionnaire) during the COVID-19 lockdown and after the capital was hit by an earthquake. Results indicated that 15.9% of the respondents experienced severe to extreme depression, 10.7% severe to extreme anxiety, and 26.2% severe to extreme stress. The hierarchical regressions analysis indicated that the considered variables explained a substantial percentage of the variance in depression (51.4%), anxiety (35.2%), and stress (45.5%). Main predictors of emotional distress were lower scores of Emotional Stability, higher scores of Agreeableness, avoidant coping, lack of active coping and perceived social support. The negative effect of the earthquake was weak. Results provide information on a broad range of potentially protective or vulnerability factors that could help identify those at risk for developing coronavirus-related psychological distress. Findings suggest that promoting active coping styles and social interactions could be preventive and potentially therapeutic in general populations.

The relationship between perceived stress and emotional distress during the COVID-19 outbreak: Effects of boredom proneness and coping style

The outbreak of a novel coronavirus (COVID-19) pandemic was a great threat to the physical and mental health of the general population. Our research aimed to investigate the relationship between perceived stress and emotional distress during the initial outbreak. Furthermore, potential risks and protective factors, i.e., coping and boredom proneness, of stress-related emotional distress were also explored. Data from 3233 participants in China were collected through an online survey platform during the initial outbreak of the COVID-19 from January 31 to February 9 in 2020. Results showed that higher perceived stress was associated with more emotional distress including depression, fear, compulsion-anxiety, neurasthenia, and hypochondria. Boredom proneness significantly and positively mediated the relationship between perceived stress and emotional distress. Moreover, coping style moderated the stress-emotional distress relationship, i.e., individuals who mainly adopted positive coping strategies suffered fewer symptoms of depression, compulsion-anxiety, and neurasthenia under stress, while negative coping strategies aggravated emotional distress. These results from the present study provide practical value for mental health intervention during the emergent public health events.

Emotional distress, psychosomatic symptoms and their relationship with institutional responses: A survey of Italian frontline medical staff during the Covid-19 pandemic

With the advent of Covid-19, health workers have been under constant physical and psychological pressure. Italy was among the first countries to face the health emergency in a period of great uncertainty about the virus and the ways to treat patients. The present study aims to analyse the levels of emotional distress (ED) and psychosomatic symptoms (PS) of Italian frontline health workers during the Covid-19 emergency, and their relationship with the evaluation of the institutional responses received. A survey was available online during the peak of health system overload. Health workers' ED, PS and perceived overall wellbeing were assessed, along with the perceived adequacy of the emotional support, hygiene and safety measures, and protection received from the national government, regional administration and local hospital. A total of 103 questionnaires were collected [Women: 51.5%; mean age, 41.8 years; SD: ±10,7; high-risk zone: 41.7%]. Correlation analyses were applied to investigate the relationship between the measures of emotional distress and psychosomatic symptoms; ANOVA was applied to compare these measures among groups from different risk zones and with different perceived emotional and safety protection. About half of the health workers showed medium or high scores on emotional exhaustion, exceeded the cut-off for medium, high or very high psychosomatic symptom burdens, felt they have never or rarely been protected by the institutional responses and judged the emotional support received as inadequate; 32% judged the safety and hygiene measures as insufficient. Significant associations were found between measures of ED, PS and perceived change in personal wellbeing. Differences in perceived institutional support and adequacy of hygiene and safety measures related to significant differences in PS and perceived change in personal wellbeing. ED and PS were widely experienced by frontline health workers. Physical and psychological symptoms were amplified by the perceived lack of institutional support. Ensuring PS and hygiene and safety measures is essential to prevent worsening of health and psychosomatic symptoms in frontline health workers.

Randomized controlled trial of a group intervention combining self-hypnosis and self-care: secondary results on self-esteem, emotional distress and regulation, and mindfulness in post-treatment cancer patients

PURPOSE

Cancer patients often report low self-esteem and high emotional distress. Two factors seem particularly linked to these symptoms: emotion regulation strategies and mindfulness. The interest of hypnosis and self-care to relieve these symptoms is not well documented. Our randomized controlled trial aimed at assessing the effect of a group intervention combining self-hypnosis and self-care on self-esteem, emotional distress, emotion regulation, and mindfulness abilities of post-treatment cancer patients, as well as investigating the links between these variables.

METHODS

One hundred and four patients who had suffered from cancer were randomized into the intervention group (N = 52) and the wait-list control group (N = 52). They had to answer questionnaires before (T1) and after the intervention (T2). Nine men were excluded from the analyses, leading to a final sample of 95 women with cancer. Group-by-time changes were assessed with MANOVA, and associations with self-esteem and emotional distress were investigated with hierarchical linear regression models.

RESULTS

Participants in the intervention group (mean age = 51.65; SD = 12.54) reported better self-esteem, lower emotional distress, a decreased use of maladaptive emotion regulation strategies, and more mindfulness abilities after the intervention, compared to the WLCG. This increase in mindfulness explained 33% of the improvement of self-esteem and 41.6% of the decrease of emotional distress in the intervention group. Self-esteem and emotional distress also predicted each other.

CONCLUSION

Our study showed the efficacy of our hypnosis-based intervention to improve all the investigated variables. Mindfulness predicted the improvement of self-esteem and emotional distress. The primary impact of our intervention on mindfulness abilities seems to explain, at least in part, its efficacy. Registration: ClinicalTrials.gov (NCT03144154). Retrospectively registered on the 1st of May, 2017.