Peritraumatic distress fully mediates the relationship between posttraumatic stress symptoms preoperative and three months postoperative in patients undergoing spine surgery

The mental health impacts of receiving a breast cancer diagnosis: A meta-analysis

BACKGROUND

Receiving a breast cancer diagnosis can be a turning point with negative impacts on mental health, treatment and prognosis. This meta-analysis sought to determine the nature and prevalence of clinically significant psychological distress-related symptoms in the wake of a breast cancer diagnosis.

METHODS

Ten databases were searched between March and August 2020. Thirty-nine quantitative studies were meta-analysed.

RESULTS

The prevalence of clinically significant symptoms was 39% for non-specific distress (n = 13), 34% for anxiety (n = 19), 31% for post-traumatic stress (n = 7) and 20% for depression (n = 25). No studies reporting breast cancer patients' well-being in our specific time frame were found.

CONCLUSION

Mental health can be impacted in at least four domains following a diagnosis of breast cancer and such effects are commonplace. This study outlines a clear need for mitigating the impacts on mental health brought about by breast cancer diagnosis. CRD42020203990.

Peritraumatic Distress and Posttraumatic Stress Symptoms During the COVID-19 Pandemic: The Contributions of Psychosocial Factors and Pandemic-Related Stressors

The present study aimed to identify the contributions of sociodemographic factors, psychological hardiness, and pandemic-related stressors to the development of peritraumatic distress and posttraumatic stress symptoms (PTSS) during the peak of the COVID-19 pandemic. We also examined the mediating contribution of peritraumatic distress with respect to the associations between PTSS and (a) individual characteristics and (b) pandemic-related stressors. A total of 1,238 participants (82.1% women, 17.9% men) aged 18-75 years were included in the study. Participants completed the Dispositional Resilience Scale, Peritraumatic Distress Inventory, and Posttraumatic Stress Disorder (PTSD) Checklist. The results showed that 11.5% of participants scored above the clinical cutoff for peritraumatic distress, and 12.8% of participants scored above the clinical cutoff for PTSS. Regression models showed that higher levels of peritraumatic distress were statistically predicted by female gender, β = -.12, p < .001; exposure to more than one stressor, β = .21, p < .001; lower levels of commitment to people and activities, β = -.12, p = .002; and resistance to challenges, β = -.17, p < .001. Additionally, male gender, β = .05, p = .007; younger age, β = -.05, p = .005; lower levels of commitment to people and activities, β = -.11, p < .001; lower ratings of hardiness with regard to challenge, β = -.04, p = .043; and more severe peritraumatic distress, β = .75, p < .001, predicted more severe PTSS during the pandemic. Peritraumatic distress mediated the associations between PTSS and both the number of experienced stressors and psychological hardiness.

The distribution and psychological distress related to COVID-19 of spine patients in a Grade-A tertiary hospital in Anhui province, China

The COVID-19 pandemic may cause psychological distress, changes in numbers and distributions of patients in spine surgery patients, which all affect the strategies of spine surgery treatment. These changes may be related to the number of new COVID-19 cases per day since they are visual indicators of the changes in the epidemic and are of interest to the public. This descriptive research took the spine surgery department as an example in a Grade-A tertiary hospital in Anhui province, China. The number and distribution of patients from January 24 to April 2, 2020 was collected and compared with the past 5 years. A psychological scale was constructed to assess the psychological distress of patients and the number of new COVID-19 cases per day in Anhui, China was collected each day from January 24 to April 2, 2020. Also, this research compared these variables with the emergency response or the number of new COVID-19 cases per day. All distributions dropped dramatically during first-level emergency response and then back to normal. The psychological distress of patients was relatively higher at the beginning of the outbreak and then gradually returned to normal. The trends between the psychological distress of patients and the number of new COVID-19 cases per day were similar. The number of new COVID-19 cases per day could be used to predict psychological distress, changes in patient numbers and distributions, which was beneficial for the department of spine surgery to adjust its treatment strategy during the epidemic.

Validation of the Italian version of the peritraumatic distress inventory: validity, reliability and factor analysis in a sample of healthcare workers

Background: Peritraumatic distress as assessed by the Peritraumatic Distress Inventory (PDI), has been consistently shown to predict the development of Posttraumatic Stress Disorder (PTSD) after the exposure to a potentially traumatizing event. Objective: The present study aims to validate the Italian version of the PDI in a sample of Healthcare Workers (HCWs) exposed to COVID-19 related potentially traumatizing events. Method: N = 265 HCWs who repeatedly experienced the deaths of patients during COVID-19 emergency in Italy, were enrolled from the Azienda Ospedaliero-Universitaria Pisana (Pisa, Italy). They completed the PDI, Impact Event Scale - revised (IES-R) and the reactions to losses or upsetting events Trauma and Loss Spectrum - Self Report (TALS-SR) domain. Results: Internal consistency was good with a Cronbach's alpha coefficient was .874. The PDI correlated strongly with measures that was conceptually close (TALS-SR reactions to losses or upsetting events domain; r = .723, p < .001). Participants who scored above the cut-off for PTSD reported significantly higher PDI scores than those who did not (6.47 ± 5.25 vs. 19.11 ± 8.291, p < 0.001). The one-month test-retest reliability (n = 21) was excellent (ICC = .997). Finally, factor analyses revealed that the PDI exhibited a single-factor structure. Conclusions: the Italian version of the PDI showed good psychometric proprieties and may be used to detect those at risk for developing PTSD.

Unwillingly traumatizing: is there a psycho-traumatologic pathway from general surgery to postoperative maladaptation?

BACKGROUND

Surgery may possibly be undermined by psychologic, psychiatric and psychosomatic problems, as long as these problems interfere with a patient's capacity to cope with surgery adaptively. Recent studies have shown that interpersonal trauma, e.g. abuse or neglect, and its correlates are involved in the adaptation to surgery. This observation is heuristically coherent, given the respective traumatization is an interpersonal event occurring in a relationship. Notably, surgery inevitably leads to the violation of physical boundaries within a doctor-patient relationship. Based on the principles of psycho-traumatologic thinking, such a constellation is deemed qualified to activate posttraumatic symptoms in the traumatized.

METHOD

The present topical review summarizes the respective findings which point to a subgroup of patients undergoing surgery, in whom difficulty bearing tension and confiding in others may cause adaptive problems relevant to surgery. Although this theorizing is empirically substantiated primarily with respect to total knee arthroplasty (TKA), a pubmed-research reveals psychopathologic distress to occur prior to surgery beyond TKA. Likewise, posttraumatic distress occurs in large numbers in the context of several operations, including cardiac, cancer and hernia surgery.

CONCLUSION

Aspects of psychological trauma may be linked to the outcomes of general surgery, as well, e.g. biliary, hernia or appendix surgery. The mechanisms possibly involved in this process are outlined in terms of a hierarchical organization of specific anxiety and negative affect as well as in terms of psychodynamics which imply the unconscious action of psychologic defenses at their core.

IMPLICATIONS

Not least, we encourage the screening for trauma and its correlates including defenses prior to general surgery in order to identify surgical candidates at risk of, e.g. chronic postoperative pain, before the operation.

The relevant psychological burden of having a benign brain tumor: a prospective study of patients undergoing surgical treatment of cranial meningiomas

OBJECTIVE

Meningiomas are the most common intracranial neoplasm. Evidence concerning surgical management and outcome is abundant, while the implications for the quality of life (QOL) of a patient confronted with the diagnosis and undergoing surgery are unclear. The authors conducted a prospective study to evaluate QOL in relation to psychological comorbidities comorbidities.

METHODS

A prospective study of patients undergoing elective surgery for the removal of an intracranial meningioma was performed. The authors evaluated depression (Allgemeine Depressionsskala K score) and anxiety (Post-Traumatic Stress Scale-10 [PTSS-10]; State Trait Anxiety Inventory-State Anxiety and -Trait Anxiety [STAI-S and STAI-T]; and Anxiety Sensitivity Index-3 [ASI-3]) scores before surgery and at 3 and 12 months after surgery. The correlation between preoperative psychological burden and postoperative QOL as measured by the 36-Item Short Form Health Survey and EQ-5L questionnaires was analyzed. Incidence and influence of these psychiatric comorbidities on clinical outcome were examined.

RESULTS

A total of 78 patients undergoing resection of a meningioma between January 2013 and September 2017 participated in the preoperative psychological screening and 71 patients fully completed postoperative follow-up examination after 1 year of follow-up. At presentation, 48 patients (67.7%) had abnormal anxiety scores, which decreased to 29.6% (p = 0.003). On follow-up at 12 months, mean EQ-5L visual analog scale scores were significantly lower in patients with pathological scores on the PTSS-10 (0.84 vs 0.69; p = 0.004), STAI-S (0.86 vs 0.68; p = 0.001), and STAI-T (0.85 vs 0.71; p = 0.011). Neurological status (modified Rankin Scale) improved slightly and showed some correlation with psychological comorbidities QOL scores (p = 0.167). There was a nonsignificant increase of EQ-5L scores over the period of follow-up (p = 0.174) in the repeated-measures analysis. In the regression analysis, impaired QOL and physical disability on follow-up correlated with elevated preoperative anxiety and depression levels.

CONCLUSIONS

The QOL and physical disability of patients undergoing resection of an intracranial meningioma highly depend on preoperative anxiety and depression levels. Stress and anxiety scores generally decrease after the resection, which leads us to conclude that there is a tremendous emotional burden caused by an upcoming surgery, necessitating close psychooncological support in order to uphold functional outcome and health-related QOL in the postoperative course.