Search

Background: Symptoms of psychological distress such as depression and anxiety as well as gender are known to be associated with sleep quality in middle-aged and older adults. However, little is known about the effect on sleep quality of interactions among these factors., Purpose: This study was developed to investigate the moderating effect of gender on the relationship between psychological distress and sleep quality in middle-aged and older adults., Methods: A cross-sectional design, secondary data analysis of data on 5,590 individuals aged ≥ 45 years from the Taiwan Biobank database (2009-2018) was used. In this database, psychological distress was assessed using the Patient Health Questionnaire-4, and sleep quality was assessed using a self-report, one-question scale. Demographic data and health-related variables were evaluated as potential confounding factors. A hierarchical regression was conducted to examine the moderating effect of gender on the relationship between psychological distress and sleep quality after adjusting for potential confounders., Results: The participants with severe psychological distress were found to have a lower mean quality of sleep than those without ( p < .01), and males returned a better mean quality of sleep score than females ( p < .01). Moreover, a significant interaction effect between psychological distress and gender on sleep quality score was found ( b = 0.123, SE = 0.022, p = .03). In terms of participants with severe psychological distress, males reported significantly poorer sleep quality than females., Conclusions: The findings provide evidence that gender moderates the relationship between sleep quality and psychological distress. Also, in terms of individuals with severe psychological distress, males reported worse sleep quality than women, indicating psychological distress impacts sleep quality in men more than women. Nurses should be aware of these findings when working with clinical professionals to tailor gender-specific education interventions to improve sleep quality and psychological health., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2025 The Authors. Published by Wolters Kluwer Health, Inc.)

Objective: Previous studies implied detrimental effects of adverse childhood experiences (ACE) on cardiovascular disease and mental health. Still, data on the influence of ACE on psychological distress in patients with an implantable cardioverter-defibrillator (ICD) are lacking., Methods: We prospectively recruited 423 patients with an ICD. To determine associations between ACE (ACE questionnaire, cut-off ≥4), depression (Patient Health Questionnaire-8), anxiety (Generalized Anxiety Disorder-7 scale), and post-traumatic stress disorder (PTSD) symptoms (Post-Traumatic Stress Diagnostic Scale), we conducted a binary logistic regression analysis. Regression models were adjusted for conventional risk factors of psychological distress in ICD patients. To identify indirect mediating effects of resilience (Resilience Scale) on ACE and psychological distress, we applied the PROCESS regression path analysis modeling tool., Results: 49.1 % of all patients reported at least one ACE, and 9.7 % experienced even four or more ACE. A high-risk ACE profile (≥ 4) was associated with higher levels of anxiety (OR 3.68, 95 % CI 1.37-9.84, p = 0.009), depression (OR 4.08, 95 % CI 1.67-9.97, p = 0.002), and PTSD symptoms (OR 2.20, 95 % CI 1.03-5.21, p = 0.041). Greater resilience partially mediated the relationship between ACE and depression (indirect effect 0.11, 95 % CI 0.01-0.26) as well as anxiety (indirect effect 0.08, 95 % CI 0.008-0.19)., Conclusions: The current study suggests an association between ACE and psychological distress in patients with an ICD. However, resilience could mitigate the adverse effects of ACE. Future studies should strive to unravel the complex mechanisms of ACE and its effects on cardiovascular and mental health in ICD patients., Competing Interests: Declaration of competing interest The authors declare no conflict of interest., (Copyright © 2024. Published by Elsevier Inc.)

Background: Mass disasters, whether natural or human-made, pose significant public health challenges, with some individuals demonstrating resilience, whereas others experience persistent emotional distress that may meet diagnostic criteria for mental health disorders. We explored key risk factors for distress following the October 7, 2023, Hamas attacks on Israel, focusing on trauma exposure, gender, and event centrality., Method: A longitudinal study design was used, assessing posttraumatic distress (PTSD), depression, generalized anxiety, event centrality, and functioning at approximately three (T1; n=858) and seven (T2, n=509) months post-attack., Results: Replicating findings from war trauma literature, we documented a high comorbidity among PTSD, depression, and anxiety; greater distress in women; and a dose-response relationship between exposure and distress. Event centrality was consistently linked to distress at both time points. Extending the literature, we found that gender, exposure, and event centrality contributed to distress at each time point. Moreover, important gender-specific patterns of risk and distress were revealed. In addition, distress at T1, event centrality at T1, gender, and continuous exposure contributed to distress at T2. Whereas distress and event centrality remained stable, functioning improved significantly from T1 to T2, highlighting the different trajectories of distress and recovery., Conclusions: Personalized approaches and continuous monitoring of individuals exposed to cumulative trauma are highlighted. The importance of assessing multiple indices of trauma - distress, functioning, and meaning -to address mental health needs in the wake of mass disasters is emphasized., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2025 The Authors. Published by Elsevier B.V. All rights reserved.)

Introduction: Today, dying by suicide is one of the most important mental health challenges in the world, and proper planning and using various preventive methods play an important role in this field. The present research aimed to study comparatively the effectiveness of text-based intervention in reducing emotional distress of people involved in psychosocial crises, comparing it with phone-based intervention., Methods: In this study, the Distress Thermometer, assessing emotional distress, was used at the start and end of both text and phone-based interventions to explore their effectiveness in crisis de-escalation and management. This study comprises two samples within an overarching study, with 700 clients receiving text-based intervention and 737 clients receiving phone-based intervention., Results: The research findings indicate the effectiveness of both methods in reducing emotional distress among individuals in crisis. The mean emotional distress significantly differed between pre-and post-tests. Importantly, prior to controlling for baseline distress levels, text-based intervention demonstrated particularly strong efficacy in reducing emotional distress, showing a statistically significant difference., Conclusion: Recognizing the effectiveness of both intervention methods and particularly the favorable response of young people with immediate suicide risk to text-based intervention, prioritizing the implementation of text-based systems is recommended in the national suicide prevention programs of developing countries., (© 2025 American Association of Suicidology.)

Migrant populations - including labour migrants, undocumented migrants, asylum seekers, refugees, internationally displaced persons, and other populations on the move - are exposed to a variety of stressors that affect their mental health. We designed and tested the effectiveness of a stepped-care programme consisting of two scalable psychological interventions developed by the World Health Organization (WHO) and locally adapted for migrant populations. A parallel-group randomized controlled trial was conducted in Italy. We recruited migrant adults (≥18 years) with psychological distress (score of at least 16 on the Kessler Psychological Distress Scale, K10). The experimental arm received psychological first aid (PFA) and a stepped-care programme consisting of two WHO interventions adapted for this population group: first, Doing What Matters in Times of Stress (DWM) and, for participants who still reported significant levels of psychological distress after DWM, Problem Management Plus (PM+). Each intervention lasted 5-6 weeks and was delivered remotely by lay facilitators. The control arm received PFA and care as usual (CAU). The primary outcome was the change in symptoms of depression and anxiety from baseline to week 21 after randomization, measured by the Patient Health Questionnaire Anxiety and Depression Scale (PHQ-ADS). Between December 14, 2021 and April 18, 2023, 108 migrants were randomized to the stepped-care intervention and 109 to CAU. Analysis of the primary outcome revealed that participants receiving the stepped-care programme showed a greater reduction in anxiety and depression symptoms compared to those receiving CAU (coefficient: -3.460, standard error, SE: 1.050, p=0.001) at week 21. The same difference was observed at week 7 (coefficient: -3.742, SE=1.008, p<0.001) and week 14 (coefficient: -6.381, SE=1.039, p<0.001). The stepped-care programme was also associated with a greater improvement of depression and anxiety symptoms assessed separately at all timepoints, of post-traumatic stress disorder symptoms at weeks 14 and 21, and of self-assessed problems, function and well-being at all timepoints. No serious adverse events occurred. This study provides evidence supporting the stepped-care delivery of DWM and PM+ for migrant population groups with elevated distress. As these interventions are low-intensity, transdiagnostic and task-shifting, they are highly scalable. Existing evidence-based guidelines and implementation packages should be updated accordingly., (© 2025 World Psychiatric Association.)

Background: Early maladaptive schemas are well-established mechanisms between childhood maltreatment (i.e., abuse and neglect) and psychopathology in adulthood. However, research has not yet examined the unique contribution of childhood maltreatment, while controlling for the family dysfunction-related experiences, in shaping specific EMS domains and their associations with distinct psychopathological outcomes., Objective: Our aim was to examine the unique role of childhood maltreatment, while controlling for the effects of family dysfunction on early maladaptive schemas and subsequently on personality disorders and psychological distress using structural equation modelling and network analysis., Methods: A total of 2,011 unique inpatients aged 18 to 80 years (M = 39.7, SD = 14.18; 53.4% women) admitted to the Alexianen Zorggroep Tienen Psychiatric Hospital between 2011 and 2021 were included in this study. Self-report questionnaires were completed as part of the hospital admission process. Data were analyzed using structural equation modeling and network analysis., Results: The results showed positive associations between childhood maltreatment, family dysfunction, early maladaptive schema domains, symptoms of personality disorders, and psychological distress. Accounting for the effects of family dysfunction-related experiences, early maladaptive schema played a significant mediating role in the association between childhood maltreatment and psychopathological outcomes. The results highlighted the central role of the domains disconnection/rejection and impaired autonomy/performance for personality disorders and psychological distress. There were no significant gender-specific differences in the network of relationships between the variables., Conclusions: These results demonstrate the key role of EMS in the domains of disconnection/rejection and impaired autonomy/performance in the association between childhood maltreatment and personality pathology and psychological distress in psychiatric inpatients. Clinical implications, study limitations, and recommendations for future research are discussed., Competing Interests: Declaration of competing interest On behalf of all authors, the corresponding author declares that there are no conflicts of interest related to this manuscript., (Copyright © 2025 Elsevier Ltd. All rights reserved.)

In Italy, breast cancer survivors are increasing. Body image is a complex posttreatment concern for breast cancer survivors, particularly younger women. This population reports higher levels of body-image concerns associated with higher psychological distress and lower quality of life. Body image concerns and factors that can impact the body image of older breast cancer survivors remain an important but under-explored research area. The purpose of this study is to examine the association of negative and positive body image with both well-being and psychological inflexibility in a sample of breast cancer survivors. 114 women who have completed breast cancer treatment (±5 years) completed a questionnaire to measure the research variables. Hierarchical regressions and indirect effects were performed. Functionality appreciation and body compassion accounted for a significant percentage of the variance of well-being (34%) and psychological inflexibility (50%) of the participants. The indirect effect of body dissatisfaction on well-being and psychological inflexibility through body compassion was significant. The results emphasise the relevance of the positive aspect of body image on well-being and psychological inflexibility. Functionality appreciation and body compassion contribute to understanding the health-status description of these women and could be considered in future health-promotion interventions aimed at reducing psychological distress associated with body image concerns in older breast cancer survivors.

Introduction: Solitude represents an important context for emerging adults' well-being; but to date, little is known about how emerging adults spend their time alone. The goals of this study were to: (1) describe and characterize solitary activities among emerging adults attending university; (2) examine links between solitary activities and indices of adjustment; and (3) explore the moderating role of affinity for solitude in these associations., Methods: Participants were N = 1798 university students aged 18-25 years (M age  = 19.73, SD = 1.46; 59.7% female) who completed assessments of how/why they spend time alone and indices of psychosocial adjustment (e.g., well-being, psychological distress, loneliness, and aloneliness)., Results: Emerging adults who spent time alone predominantly thinking reported poor adjustment outcomes (i.e., higher loneliness and psychological distress, and lower well-being) and dissatisfaction with solitude, whereas those who engaged in active leisure activities or passive technology use while alone reported lower psychological distress and higher satisfaction with solitude. The negative implications of doing nothing were not attenuated at higher levels of affinity for solitude., Discussion: These findings suggest that some solitary activities are more beneficial than others., (© 2023 The Authors. Journal of Personality published by Wiley Periodicals LLC.)

Introduction: Firearms account for more than half of suicide deaths in the United States (US) and both ownership and access are associated with increased risk of intentional and unintentional injury. Despite evidence linking ownership and access to suicide risk, individuals may be reticent to answer questionnaire items assessing ownership. The current study examined characteristics of individuals who do not provide a response (nonresponders) to a firearm ownership item in a community sample., Methods: Data were collected from a cross-sectional online survey of 10,625 US adults. Univariate and multivariate analyses were conducted to examine demographic, emotional distress, and suicide risk differences across three groups (firearm owners, nonowners, and nonresponders)., Results: Nonresponders were significantly younger, more likely to be female and non-White than firearm owners and nonowners. Nonresponders were less likely to endorse recent suicidal ideation and probable PTSD than firearm owners, but more likely to endorse probable PTSD than nonowners. Firearm owners were significantly more likely to report several correlates of suicide risk than nonowners., Conclusions: Nonresponders may be a unique subgroup with distinct demographic, emotional distress, and suicide risk profiles compared to both firearm owners and nonowners. Implications of these findings for future directions are discussed., (© 2024 The Author(s). Suicide and Life‐Threatening Behavior published by Wiley Periodicals LLC on behalf of American Association of Suicidology.)

Rationale: Anecdotal reports suggest that psychedelic drugs can improve psychological wellbeing and social engagement in autistic people. However, there are few contemporary studies on this topic., Objectives: To examine autistic participants' experiences with psychedelic drugs and the extent to which they attributed changes in mental health and social engagement to their most 'impactful' psychedelic experience. We also explored associations between these changes and mechanistically important variables (e.g., aspects of the acute psychedelic experience and changes in 'psychological flexibility')., Methods: Self-selecting autistic participants (n = 233) with high autism quotient scores completed an online survey relating to their most impactful psychedelic experience. Questionnaires assessed the acute psychedelic experience and perceived psychedelic-induced changes in distress, social engagement and psychological flexibility, among other relevant variables., Results: The majority of participants attributed reductions in psychological distress (82%) and social anxiety (78%) and increases in social engagement (70%) to their most 'impactful' psychedelic experience. A substantial minority (20%) also reported undesirable effects such as increases in anxiety with some describing their psychedelic experience as among the most negatively impactful experiences of their lives. The only substantial predictor of reductions in psychological distress was increased psychological flexibility., Conclusion: Autistic people attributed changes in mental health and social engagement to a single highly impactful psychedelic experience. The results and their implications are discussed with caution considering the use of a non-experimental design and biased sampling., Competing Interests: Declarations. Conflict of interest: On behalf of all the authors, the corresponding author states there are no conflicts of interest., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

The global pandemic has intensified the risk of moral distress due to increased demands on already limited human resources and uncertainty of the pandemic's trajectory. Nurses commonly experience moral distress: a conflict between the morally correct action and what they are required or capable of doing. Effective moral distress interventions are rare. For this reason, our team conducted a multi-phase research study to develop a moral distress intervention for pediatric critical care nurses. In this article, we discuss our multi-phase approach to develop a moral distress intervention-proactive, interdisciplinary meeting. Our proposed intervention is a sequential compilation of empirical work couched within a relational ethics lens thus should point to enhanced potential for intervention effectiveness., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Although system justification-believing that the societal status quo is legitimate and desirable-is positively associated with subjective well-being and mental health outcomes for members of advantaged groups, the picture is more complicated for members of disadvantaged minority groups. According to system justification theory, believing that the social system is legitimate and desirable is a way of coping with one's own and fellow in-group members' state of disadvantage. At the same time, it is also a potential stressor, insofar as it implies that there are deficiencies of the individuals and groups who "fail" to succeed in a fair system. In this article, we quantitatively summarize the results of 34 articles (and 65 effect sizes) identified through computerized searches of scientific databases. Meta-analytic results revealed that system justification among members of disadvantaged minority groups was associated with lower levels of psychological distress (r = -0.131, k = 22, N = 25,506) and higher levels of subjective well-being (r = 0.190, k = 31, N = 172,075) and self-esteem (r = 0.106, k = 12, N = 4,839). These findings are consistent with the notion that, in general, system justification serves the palliative function of reducing distress and improving subjective well-being, most likely by increasing perceptions of personal control and individual mobility and decreasing perceptions of discrimination. At the same time, system justification can come at the expense of mental health when associated with the internalization of inferiority. Suggestions for future research are provided., Competing Interests: Declaration of competing interest None., (Copyright © 2024. Published by Elsevier Ltd.)

This article examines for the first-time prevalence and factors associated with psychological distress among Ebola survivors and healthcare workers (HCWs). A representative sample of 563 participants completed the survey (309 survivors; 202 HCWs; 52 survivors/HCWs). Prevalence of psychological distress was higher among survivors (85.25 %) compared to HCWs (51.24 %), and combined group (73.08 %), χ2=69.32, p<.001. Logistic regression models showed that COVID-19 (OR=1.02, 95 %CI: [1.01-1.03], p=.005) and Ebola stigmatization (OR=1.06, 95 %CI: [1.04-1.07], p<.001) were the most important predictors of psychological distress. Significant main effects of social support (B=-.05, p=.001) was observed. This study shows the need of implementing culturally adapted trauma-informed prevention and intervention programs among survivors and HCWs., Competing Interests: Declaration of competing interest No conflict of interest for any author., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: Distal radius fractures have a psychological impact on patients, with the pain and disability caused by these injuries potentially leading to psychological distress. It is not known whether dominant-side and nondominant-side distal radius fractures cause more psychological distress in patients., Questions/purposes: (1) Compared with patients who have distal radius fractures on the nondominant side, do patients with dominant-side fractures experience greater pain? (2) Do patients with dominant-side distal radius fractures have greater disability? (3) Do patients with dominant-side distal radius fractures have worse psychological adjustment? (4) What factors are associated with a worse quality of life mental component measure?, Methods: This retrospective study was conducted by the departments of orthopaedics-traumatology and psychiatry in a multidisciplinary manner at our university hospital, which is a public hospital. The study included 172 patients with distal radius fractures who were treated nonoperatively. We excluded 2% (3 of 172) of patients who underwent surgery because of loss of reduction, 1% (2 of 172) of patients with bilateral distal radius fractures, and 9% (16 of 172) of patients who did not consent to participate in the study. After the exclusion of 12% (21 of 172) of ineligible patients, the study continued with 88% (151 of 172) of patients. Forty-six percent (70 of 151) of patients had dominant distal radius fractures and 54% (81 of 151) of patients had nondominant distal radius fractures. The evaluation was carried out face-to-face at the end of the sixth week of treatment in the orthopaedic outpatient clinic. The VAS score was used to assess pain (this score ranges from 0 to 10, where 0 represents no pain and 10 represents the worst pain, with a minimum clinically important difference [MCID] of 2), the QuickDASH was used to assess disability (ranges from 0 to 100, representing best to worst, with an MCID of 15.9), the Brief Adjustment Scale-6 (BASE-6) was used to assess psychological adjustment (ranges from 6 to 42, lower scores indicate better outcomes), and the SF-12 was used to assess quality of life (ranges from 0 to 100, representing worst to best, with an MCID of 5)., Results: At cast removal, patients with dominant-side distal radius fractures had higher levels of pain (dominant VAS median [IQR] 4 [4], nondominant VAS median 2 [3], median difference 2; p = 0.005), but the difference was not clinically important. There were no differences in disability (dominant QuickDASH median 63.6 [21], nondominant Quick DASH median 59.1 [25], median difference 4.5; p = 0.20). Psychological adjustment was worse in patients with dominant-side fractures (dominant BASE-6 median 22.5 [24.3], nondominant BASE-6 median 15 [23.5], median difference 7.5; p = 0.004). After accounting for variables such as age, occupation, and gender, a better quality of life mental component (SF-12 MCS) was associated with a lower BASE-6 (β = -0.67; p < 0.001) and nondominant fracture (β = -0.16; p = 0.006)., Conclusion: Dominant-side distal radius fractures have a negative impact on the psychological adjustment and quality of life of patients. Patients with dominant distal radius fractures are more susceptible to the development of psychological disorders. Future studies should assess whether providing appropriate counsel at the time of fracture may alleviate the psychological disorders experienced by patients with dominant-side distal radius fractures., Level of Evidence: Level III, therapeutic study., Competing Interests: Each author certifies that there are no funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article related to the author or any immediate family members. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request., (Copyright © 2024 by the Association of Bone and Joint Surgeons.)

Objective: This proof-of-concept study aimed to explore the acceptability and potential benefit of a self-guided online self-compassion intervention to aid resilient coping and reduce emotional distress among patients and caregivers living with ALS., Methods: A single-arm pilot study was conducted in 20 adults living with ALS either as a patient or as a caregiver. Acceptability was examined using questionnaires ( n  = 20) and semi-structured interviews ( n  = 9). Potential benefit was assessed as changes in self-compassion, self-criticism and emotional distress, determined using psychological questionnaires at 3 and 6 weeks. Questionnaires were analyzed using linear mixed-effects models and interview data using inductive thematic analysis., Results: Out of 20 participants who started the intervention, 16 completed the study (80%). The majority of study completers (12/16) were satisfied with the intervention, but the data suggest room for improvement in terms of personalization. Qualitative data revealed multiple psychological benefits of using the intervention, including self-kindness, emotional self-awareness and savoring. Although not statistically significant, quantitative data showed positive trends with increased self-compassion (mean difference: 2.07; 95% CI: -.5.76 - 1.63) and reduced self-criticism (mean difference: -2.62; 95% CI: -.1.97 - 7.23) and emotional distress (mean difference: -2.49; 95% CI: -.51 - 5.50) at week 6 compared to baseline., Conclusions: The findings suggest that a self-compassion intervention is acceptable to people living with ALS, but its beneficial effects and the mechanisms involved have yet to be established in larger and more diverse samples, using controlled designs.

Community-based youth mental health (YMH) platforms are challenging to evaluate. Using a multi-method approach, we examined the efficacy of an integrated YMH program in Hong Kong. The real-world outcomes of 1047 participants were compared with a propensity score (PS) matched control group randomly selected from the community (study 1). In a separate prospective 12-month study, a sample of up to 133 matched pairs of YMH and controls were compared for more detailed symptomatic and functional outcomes (study 2). Study 1 revealed that the YMH program was associated with a significant reduction in distress. A higher proportion of YMH participants improved, and fewer deteriorated compared with controls. The YMH program also translated into a net reduction of 1.28 % in the risk of common disorders. Study 2 revealed that the YMH program showed significant reductions in depressive symptoms, anxiety symptoms, distress, and functioning after 12 months. The two complementary studies, using PS-matched controlled comparisons, enabled the sample representativeness and the comprehensive examination of the longitudinal impact. This YMH program reduces current distress, symptoms, and functional impairment, and prevents the emergence of probable mental disorder. Findings have significant implications for developing and evaluating future YMH services., Competing Interests: Declaration of competing interest Professor Eric Yu-Hai Chen has participated in the paid advisory board for Otsuka and received educational grant support from Janssen-Cilag. The remaining authors declare no competing interests., (Copyright © 2024 Elsevier B.V. All rights reserved.)

The emerging difficulties and tensions in establishing inclusive and multicultural societies in the contemporary globalised world have necessitated the generation of ample empirical evidence in support of the socioeconomic and health benefits of racial diversity. This study contributes to the scholarly and policy discourses by examining the effect of racial diversity on mental distress in post-apartheid South Africa after several decades of racial segregation. We used all five waves (2008, 2010, 2012, 2014, and 2017) of the National Income Dynamics Survey (NIDS). After addressing the endogeneity problem in the racial diversity-mental distress nexus, our findings show that an increase in racial diversity is associated with a decrease in mental distress across the 52 districts of South Africa. This finding is consistently established when different quasi-experimental methods and alternative conceptualisations of racial diversity are employed to generate the results. We also found that racial diversity decreases mental distress more among females and urban residents. Further analyses revealed that interracial trust serves as a potential pathway through which racial diversity transmits to mental distress. We argue that people living in highly racially diverse neighbourhoods have the potential to experience a decrease in their mental distress through improved interracial trust.

Background: All health professionals have a role in suicide prevention, although little is known about physiotherapists' contact with clients experiencing suicidal thoughts and behaviors., Objective: The aims of this study were to investigate physiotherapists' self-reported frequency of contact with clients who disclose suicidal thoughts and behaviors and to identify potential factors associated with frequency of contact., Methods: Three-hundred and thirty-eight Australian physiotherapists were surveyed using an online questionnaire, with an estimated response rate of 6.1%. Data were analyzed using descriptive analysis and logistic regression., Results: Over half the respondents (52.1%) reported encountering clients at least once a year who disclosed suicidal thoughts, and nearly half (49.4%) reported having received at least one disclosure of a suicide plan at some point in their career. Among those working in the public sector, 67.5% of respondents reported having received a disclosure of a suicide plan, and almost all physiotherapists working in pain management reported having received such a disclosure (93.8%). The binary logistic regression model explained approximately 39.7% of the variance in whether a physiotherapist had a client disclose a plan for suicide at some point in their career or not., Conclusion: The results highlight that all physiotherapists should receive training in suicide prevention.

Objective: This cross-sectional study demonstrates the differences in the dimensions of musculoskeletal (MSK) pain between participants with mental distress and/or insomnia among general population with MSK pain within the past 12 months., Methods: Participants of Northern Finland Birth Cohort 1966 (NFBC1966) were studied (n = 4316). They were divided into groups based on their mental distress and insomnia status (co-occurring mental distress and insomnia [CMI], isolated mental distress [M] and insomnia [I], and absence of both [AMI]). The AMI group was used as a reference for the main analyses. The dimensions of MSK pain included frequency, bothersomeness (Numerical Rating Scale [NRS] 0-10), intensity of pain (NRS), and number of pain sites (1-8). Multinomial and general linear regression analyses were used to study the associations, and adjustments were made for sex, education, number of somatic diseases, and physical activity., Results: The CMI group was associated with more severe pain in every dimension when contrasted to all other groups (daily pain adjusted OR 5.08, 95 % CI 3.43-7.51; bothersomeness adjusted β 1.7, 95 % CI 1.5-2.0; intensity adjusted β 1.4, 95 % CI 1.2-1.7; number of pain sites adjusted β 1.2, 95 % CI 1.0-1.4). Compared to AMI, I and M groups also had relationships with all pain dimensions, but with lower magnitude compared to the CMI group., Conclusions: The results suggest that insomnia and mental distress co-exist with more severe MSK pain, and when co-occurring, MSK pain severity tends to increase. Therefore, contemplating insomnia and mental distress are important to consider when comprehensively evaluating MSK pain symptoms., Competing Interests: Declaration of competing interest The authors have no conflicts of interest to declare. NFBC1966 46y follow-up study received financial support from the University of Oulu Grant no. 24000692, Oulu University Hospital Grant no. 24301140, ERDF European Regional Development Fund Grant no. 539/2010 A31592. The funders played no role in the study design, data collection or interpretation, nor in the decision to submit the study for publication. The authors did not receive any external funding., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Objective: Cancer- and cancer treatment-related cognitive impairment (CRCI) is reported by many women with breast cancer (BC). Distress tolerance (DT) refers to both the perceived capacity and behavioral act of withstanding uncomfortable/aversive/negative emotional and/or physical experiences. Poor DT has been associated with worse cognitive performance, including executive dysfunction. Importantly, DT can be improved through psychological interventions. However, DT research in cancer has been limited. This study aimed to examine the relationship between DT and CRCI in women with BC., Method: Women with nonmetastatic BC ( n = 107, age ≥ 50 years) were recruited between 2016 and 2023, post BC surgery (54.2% lumpectomy and 38.3% mastectomy) but prior to adjuvant therapy, completed the Distress Tolerance Scale and the Functional Assessment of Cancer Therapy-Cognitive Scale, self-report measures of DT and CRCI, respectively. Hierarchical linear regression was used to test the associations between the DTS-Total Score (DTS-T) and CRCI on the Functional Assessment of Cancer Therapy-Cognitive subscales., Results: DTS-T was significantly associated with perceived cognitive impairment (CogPCI, p = .015), perceived cognitive abilities (CogPCA, p < .001), and quality of life impact (CogQOL, p = .010), after controlling for age and days since surgery. DTS-T explained 12%, 27%, and 12% of the variance in CogPCI, CogPCA, and CogQOL, respectively., Conclusion: Women with BC with greater ability to tolerate distress reported less CRCI, including less CogPCI, less CogQOL, and better CogPCA. Future directions should involve the use of objective measures of CRCI and longitudinal testing of its association with DT. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Objective: The bidirectional relationship between disease activity and mental health in inflammatory bowel disease (IBD) has prompted investigations into the efficacy of psychotherapies, such as mindfulness-based interventions (MBI), for improving biopsychosocial outcomes. Therefore, the aim is to examine the feasibility, acceptability, and preliminary efficacy of an online-delivered, self-directed MBI, adapted to individuals with IBD and psychological distress, in comparison to wait-list control (WLC)., Methods: 50 adults with IBD were randomized to WLC (N = 25) or intervention (N = 25) groups. The intervention (MIND4IBD program) consisted of six, weekly, 15-min videos (with guided meditations). Feasibility was examined through recruitment and retention rates, while acceptability was examined through intervention satisfaction ratings and qualitative feedback. Preliminary efficacy was examined using linear mixed models for group differences in outcomes between baseline and post-intervention., Results: Primary Outcomes. The retention rate for the WLC group was 92 %, while the retention rate for the intervention group was 48 %. However, 16 % of participants allocated to the intervention group never began the intervention, therefore this resulted in a retention rate of 71 % of participants who began the intervention. Acceptability was high with an average intervention satisfaction rating of 83/100., Secondary Outcomes: When compared with the WLC, the MIND4IBD program improved total mindfulness levels (b = 0.29, 95 %CI [0.11,0.47], p = 0.004) with a large effect size (β = 0.54, b = 0.19, 95 %CI [0.04,0.34], p = 0.014). Themes based on participants' intervention feedback included: 1) beginning of journey with mindfulness, 2) the beneficial impact of mindfulness, 3) why adapting the intervention to IBD is important, 4) views on program delivery, and 5) mixed reactions to AI generated presenters., Conclusion: MIND4IBD is feasible and acceptable for individuals with IBD and psychological distress. Participants' total mindfulness levels increased significantly in the intervention group compared to WLC. Most participants provided positive intervention feedback. These findings warrant a full-scale RCT to determine MIND4IBD's efficacy for IBD., Competing Interests: Declaration of competing interest We declare no competing interests., (Copyright © 2024. Published by Elsevier Inc.)

Background: Many studies have reported that electronic health (e-health) care helps health professionals manage patients undergoing assisted reproductive technology (ART) and improves their reproductive outcomes and psychological distress. However, little is known about the effectiveness of e-health care on the health outcomes of patients undergoing ART., Objectives: This study aimed to evaluate the effectiveness of e-health care on patient-centered health outcomes, such as live birth rate, pregnancy rate, time to pregnancy, etc. as well as psychological distress (i.e., infertility distress and anxiety) among individuals undergoing ART., Design: A systematic review with random-effects or fixed-effects meta-analysis was conducted to compare e-health interventions with usual care in patients undergoing ART., Method: Electronic database, including Medline, EMBASE, Web of Science, CINHAL, and CENTRAL, were systematically searched from the inception to December 01, 2023. The authors independently reviewed the articles based on inclusion and exclusion criteria, extracted data, and assessed risk of bias used the Cochrane Risk of Bias tool version 2.0. Heterogeneity was evaluated with I 2 and Chi-square. We pooled data from each study using fixed-effects meta-analysis if heterogeneity was low. Random-effects meta-analysis was used to pool data with high heterogeneity. Subgroup analysis (i.e., data collection time point) and sensitivity analysis was performed., Result: Data were synthesized from 21 articles covering a total of 6,749 participants (female:6,227; male:522). Pooled analysis showed that e-health care may not increase live birth rate (RR 1.44 95 %CI0.78-2.67, P = 0.25). The clinical pregnancy rate was increased to 1.57 times in the e-health care group compared with the control group (Z = 2.19, P = 0.03) and the e-health care group had an increase in time to pregnancy by 17.40 days than that of the control group (Z = 2.13, P = 0.03). Lower score of Fertility Problem Inventory-social subscale was found in the e-health care group. Subgroup analysis showed that the risk ratio of clinical pregnancy was 3.07 (95 %CI 1.60-5.89) in < 3 months group, 1.21 (95 %CI 0.93-1.59) in ≥3 months group. The fertility-related knowledge level in e-health group was higher than that of the control group (Z = 2.01, P = 0.04)., Conclusion: Low certainty evidence suggests that e-health care increases the clinical pregnancy rate after the intervention. Additionally, e-health care benefits in improving perceived infertility-related stress specific to social and the level of infertility-related knowledge. Future studies are needed to establish core outcome measures for e-health intervention targeting infertile individuals., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier B.V.)

Objective: Neighborhood characteristics can influence cardiometabolic health, including during the perinatal period. However, maternal health research has largely examined the influence of objective neighborhood measures, limiting insights into psychological and social processes. We examined associations of perceived neighborhood disorder and social cohesion with maternal cardiometabolic risk 1 year postpartum and explored potential pathways of psychological distress and physical activity., Methods: A predominantly low-income sample of Black, Latina, and White postpartum women (n = 987) were participants in the Community Child Health Network study. Women reported on neighborhood characteristics at 1 month postpartum and on symptoms of depression, anxiety, and posttraumatic stress disorder and physical activity at 6 months postpartum. Biometrics and biological samples were collected at 1 year postpartum, including blood pressure, height, weight, and dried blood spots for cardiometabolic biomarkers (e.g., C-reactive protein, glycosylated hemoglobin). In this pre-registered study, we used structural equation modeling to estimate latent variables for disorder, social cohesion, distress, physical activity, and cardiometabolic risk. We fit a parallel mediation model to test associations between latent neighborhood factors at 1 month postpartum, distress and physical activity at 6 months postpartum, and cardiometabolic risk at 1 year postpartum., Results: Greater social cohesion, but not disorder, was significantly associated with lower distress and greater physical activity. However, there were no significant associations between disorder or social cohesion with subsequent cardiometabolic risk nor evidence for indirect effects of distress or physical activity., Conclusion: Results suggest that social cohesion may be more pertinent than disorder for health-relevant behavioral mechanisms in postpartum women., Competing Interests: Declaration of competing interest The authors report no financial interests or potential conflicts of interest., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Postpartum women experience multiple, co-occurring postpartum symptoms. It is unknown if social determinants of health (SDOH) influence postpartum symptom typologies. This secondary analysis used the Community and Child Health Network study data. Participants included for analysis varied depending on the availability of the SDOH data (N = 851 to 1784). Bivariate and multiple regression analyses were conducted to examine the association between SDOH and previously identified postpartum symptom typologies. Area under the receiver operating characteristics curve (AUROC) was calculated to examine if adding SDOH variables contributes to predicting postpartum symptom typologies. The adjusted odds (aOR) of being in high symptom severity or occurrence typologies were greater for participants who had less than high school education (aOR = 2.29), experienced healthcare discrimination (aOR = 2.21), used governmental aid (aOR = 2.11), or were food insecure (aOR = 2.04). AUROC improved after adding SDOH. Considering experiences of different social-economic hardships influence postpartum symptom typologies, future practice and research should address SDOH to improve postpartum symptom experiences., Competing Interests: Declarations. Ethics Approval: Duke University Institutional Review Board declaration of research not involving human subjects was obtained (Pro00108330). Competing Interests: Dr. Tully is one of the inventors of a patented medical device. The University of North Carolina at Chapel Hill technology is licensed. The device is not referenced or otherwise related to the content of this manuscript. The other authors report no conflicts of interest. Disclaimer: The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health., (© 2024. W. Montague Cobb-NMA Health Institute.)

Purpose: This study aims to identify specific sub-types of hope levels in breast cancer (BC) patients and explore the influencing factors., Methods: Between August and December 2023, 528 BC patients took part in this study. Latent Profile Analysis (LPA) was employed using the Herth Hope Index, Distress Thermometer, Hospital Anxiety and Depression Scale, Social Support Rating Scale, BC survivors' self-efficacy scale and Functional Assessment of Cancer Therapy-Breast to identify clusters of hope levels., Results: Three potential categories of hope levels were identified: Low Hope Level-Harmonious-Calm Type (33.71%); Moderate Hope Level-Isolation Fear Type (37.12%); and High Hope Level-Optimistic Coping Type (29.17%). The study established that social support, quality of life, psychological distress, self-efficacy, occupation, income, education and type of surgery are factors influencing hope levels., Conclusion: Hope levels within BC patients exhibit identifiable heterogeneity. By discerning the features associated with hope levels, the focus extends beyond patients' occupations, income, education and surgical procedures. It also underscores the importance of enhancing social support, quality of life and self-efficacy while mitigating psychological distress. This targeted approach aims to formulate interventions specifically designed to effectively elevate hope levels in BC patients., (© 2024 British Psychological Society.)

Objective: Stress processes have long been of interest to researchers. A growing body of research explores the bidirectional relations between stressors, psychological and physical states. However, research on stress processes and their individual differences from a dynamic systems perspective is still lacking. This study examined dynamic feedback loops between stressors, psychological distress, and physical symptoms simultaneously using ecological momentary assessment., Method: Three hundred and fifty-six participants completed five momentary assessments on stressors, psychological distress, and physical symptoms per day for 7 days in 2023. They also completed measures of their Big Five personality traits, depressive symptoms, and anxiety symptoms., Results: Dynamic structural equation models showed positive cross-lagged and feedback effects of stressors with psychological distress and physical symptoms, suggesting their self-perpetuating loops. Agreeableness and conscientiousness were protective factors, and neuroticism was a risk factor for the stressor-psychological loop. Individuals with depressive and/or anxiety symptoms were characterized by (a) greater inertia of psychological distress and physical symptoms, (b) stronger reverse effects of psychological distress and physical symptoms on subsequent stressors, (c) significant reciprocal effects between psychological distress and physical symptoms, and (d) stronger self-perpetuating loops of stressors with psychological distress and physical symptoms., Conclusions: Our findings highlight the importance of analyzing feedback loops to understand bidirectional relations and individual differences in dynamic stress processes, providing insights for relevant personalized interventions. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

WHAT IS KNOWN ON THE SUBJECT?: Suicide is an important health problem that has been common all over the world in recent years. Nursing students are a high-risk group for suicide. Factors affecting suicide risk should be investigated and included in psychiatric nursing interventions. Psychological pain is a predisposing condition for suicide risk. Studies focus on the relationship between suicide risk and psychological pain. Studies examining the moderator factors affecting this relationship are limited. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: By means of the structural equation model, the effect of resilience mediation on the relationship of suicide risk and psychological pain has been shown. In the process of going from psychological pain to suicide, resilience takes on a buffer function with its mediating effect, and this process can be prevented by the development of resilience. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Resilience can be added as a protective factor for suicide to the practices of psychiatric nursing. Initiatives to strengthen resilience can be added to psychiatric nursing practices. In this way, psychological pain and the risk of suicide can be reduced by strengthening resilience. Psychological pain can be added as a risk factor for suicide to the practices of psychiatric nursing. Within the scope of psychiatric nursing practices, nursing interventions can be structured to assess and reduce psychological pain. Interventions on strategies to manage and cope with psychological pain and initiatives to strengthen resilience can be added to suicide prevention programs created for nursing students., Abstract: INTRODUCTION: Nursing students are a high-risk group for suicide. Psychiatric nurses should investigate risk factors for suicide., Aim: The aim of this study was to examine the resilience mediation effect in the relationship of suicide risk and psychological pain in nursing students., Materials and Methods: This cross-sectional study was conducted between March and May 2021 with 619 students in the Akdeniz University Faculty of Nursing. A Descriptive Information Form, the Suicide Probability Scale, the Psychache Scale and the Brief Resilience Scale were used to collect data. The structural equation model approach was used to examine the resilience mediating effect on the relation between suicide risk and psychological pain, and Path Analysis was performed. The reporting of the study was conducted according to STROBE., Results: A semi-mediatory effect of resilience was found between psychological pain and the risk of suicide, and the effect size was determined to be broad (0.57)., Discussion: Resilience can be considered as a protective factor for suicide prevention in psychiatric nursing practices., Conclusion: Resilience has an effect on the relationship between psychological pain and suicide risk., Implications for Practices: The results of this study may guide psychiatric nursing practices in reducing and preventing suicide risk., (© 2024 The Author(s). Journal of Psychiatric and Mental Health Nursing published by John Wiley & Sons Ltd.)

This study aimed to understand long-term coping responses of mothers ( N  = 287) receiving genetic counseling and testing (GCT) for hereditary breast/ovarian cancer (HBOC) syndrome. Psychological characteristics, including cancer-specific distress (Impact of Events Scale-Revised, α = .85) and coping (Brief COPE, α = .93) were assessed via structured personal communication, along with epidemiologic items assessing personal and family history of cancer. Genetic risk was determined by BRCA1/2 carriage. A principal component analysis was conducted on the coping measure to reduce its summary score to active coping (α = .91) with nine approach-oriented strategies responsive to stress. A multivariable regression model examined the main and interacting effects of clinical and psychological characteristics on maternal coping. Personal cancer history (F = 4.99, df = 1, p  = .026), BRCA test result (F = 22.20, df = 1, p  < .001), and cancer-specific distress (F = 17.80, df = 1, p  < .001) were associated with greater engagement in active coping strategies. When controlling for cancer-specific distress, the interaction between personal cancer history and genetic test results was significant, such that women previously unaffected by cancer who received positive BRCA results reported the greatest levels of active coping (F = 7.92, p  < .001). These findings indicate that previous cancer history, genetic risk, and psychological distress independently and jointly impact how women adapt to the threat of cancer over time.

This study focuses on two groups: evacuees from Israel's southern and northern frontline communities following the October 7th Hamas attack, and individuals from regions not directly threatened. Using network analysis, we identified key associations and central nodes related to stress indicators (i.e., exposure to traumatic life events, physical health-related quality of life, anxiety, and depression) as well as personal resources (i.e., self-mastery and meaning in life), and coping strategies. The study included 221 evacuees and 145 non-evacuees (controls), recruited via iPanel, Israel's leading online research panel. Participants completed standardised self-report questionnaires. Evacuees exhibited higher levels of anxiety, depression, and traumatic life events, than did controls. Additionally, evacuees showed higher levels of problem-focused coping and a greater sense of meaning in life, along with lower physical health-related quality of life. Network analysis revealed that both groups had four sub-networks: 'personal state', 'psychological distress', 'resources', and 'coping'. However, the sub-networks' composition varied. Both groups shared similar sub-networks for 'coping' and 'personal state', but differed in 'psychological distress' and 'resources'. For the controls, dysfunctional coping strategies were part of 'psychological distress', whereas for evacuees, they were included in 'resources'. Additionally, meaning in life was more central among the controls, influencing the interaction between coping mechanisms, personal states, and psychological distress. For evacuees, physical health-related quality of life was more closely associated with the absence of negative factors-(i.e., anxiety, depression, traumatic experiences, and lower self-mastery)-rather than the presence of adaptive coping strategies and meaning in life. These differences highlight the vulnerability of evacuees and the central role of personal resources. Targeted interventions that foster resources such as self-mastery and meaning in life are vital for coping with the psychological distress associated with forced displacement., (© 2024 The Author(s). Stress and Health published by John Wiley & Sons Ltd.)

Background: Despite Asians being the fastest-growing ethnic group in the US, most studies have focused on Asian Americans as an aggregate racial/ethnic group. The burden of mental health problems is increasing among caregivers due to population aging, yet little is known about the distress experienced by Asian caregivers when examined by disaggregated ethnic groups., Methods: Using 2019-2020 California Health Interview Survey data, we examined disparities in psychological well-beings between non-Hispanic White and Asian American adult caregivers, with an emphasis on understudied Asian ethnic groups. Psychological distress was measured using the Kessler 6 scale, with scores ≥6 indicating mental distress and ≥13 indicating serious mental illness. Multivariable logistic regression adjusted for socio-demographics, physical health, caregiving relationship, intensity of care, and care recipients' characteristics., Results: The study included 8,722 caregivers (mean age, 58.7 years; 61.3% women; 14.1% Asian [379 Chinese, 260 Filipino, 167 Japanese, 138 South Asian, 105 Korean, 101 Vietnamese, 78 other Asian], 85.9% White). Overall, 26.8% had mental distress, and 8.5% had serious mental illness. Compared to White caregivers, Korean American caregivers had higher odds of mental distress (Odds Ratio [OR], 2.37; 95% CI, 1.47-3.82) and serious mental illness (OR, 2.15; 95% CI, 1.17-3.92), while Chinese (OR, 0.72; 95% CI, 0.55-0.95) and Japanese (OR, 0.67; 95% CI, 0.45-0.99) American caregivers had lower odds of mental distress. Korean American caregivers had the highest prevalence of mental distress (43.1%) and serious mental illness (15.3%), compared with White and other Asian American caregivers., Conclusion: Disaggregating data reveals significant mental health disparities among ethnic subgroups of Asian American caregivers. Tailored resources should address the distinct needs of ethnic subgroups of Asian American caregivers, considering language barriers, acculturation, and cultural norms that may exacerbate psychological distress.

Significant links exist between one's perception of available social support and mental health outcomes, including during the transition to motherhood. Yet, attachment theory posits that individuals do not benefit equally from social support. As such, we examined the influence of attachment representations (i.e., secure base script knowledge) as they potentially moderate links between social support and psychological distress in a 1-year longitudinal study of an ethnically diverse (56% White) sample of infant-mother dyads. We hypothesized that higher social support would predict lower maternal psychological distress and this relation would be strongest in those with higher secure base script knowledge. Results indicated that maternal perceptions of social support were significantly negatively correlated with psychological distress. Analyses revealed that secure base script scores significantly moderated these associations. Interestingly, for those high in script knowledge, low social support predicted greater psychological distress. For those low in script knowledge, social support was unrelated to psychological distress. This pattern suggested that those who expect care (i.e., high secure base script knowledge) but receive minimal support (i.e., low perceived social support) find motherhood uniquely dysregulating. Practitioners may do well to examine individuals' attachment expectations in relation to their current social support.

Background: Despite the use of Patient-Drawn Pain Drawings (PDPDs) in clinical settings, their validity as indicators of psychological distress remains debated. We aimed to assess the association between PDPD areas and physical health and psychological variables., Methods: This study analysed digitally-drawn PDPDs from 15,345 chronic low back pain (LBP) patients at a Danish outpatient hospital unit. We employed a novel quantitative approach to calculate four log-transformed geometric pain areas for each PDPD. We assessed six psychological constructs and seven physical health variables. Associations were modelled using multivariable linear regression., Results: Increasing leg pain intensity (estimates from 0.12 to 0.25), disability (estimates from 0.3 to 0.14), and pain duration (estimates from 0.10 to 0.33) had the strongest associations with increasing pain areas. Conversely, increasing fear of movement (estimates from -0.02 to -0.05) and catastrophizing (estimates from -0.02 to -0.03) were associated with slight reductions in pain areas. Anxiety and depression had the weakest and most uncertain relationships to pain area size., Conclusions: Increasing levels of leg pain intensity, pain duration, and pain-related disability were consistently associated with larger geometric pain areas in PDPDs. Conversely, the associations between the psychological constructs and the geometric pain areas exhibited varying directions and were notably weaker. Clinicians are encouraged to focus on the association of PDPDs with physical symptoms rather than psychological conditions during clinical assessments., Significance Statement: This large-scale study demonstrates that extensive pain areas in pain drawings drawn by LBP patients do not signify psychological distress. Our findings reveal that these pain representations are more closely linked to increased pain intensity, pain duration, and disability rather than being independently associated with psychological factors. Clinicians are encouraged to focus on the association of extensive pain areas with physical symptoms rather than psychological distress during clinical assessments., (© 2024 The Author(s). European Journal of Pain published by John Wiley & Sons Ltd on behalf of European Pain Federation ‐ EFIC ®.)

Background: Cancer patients experience substantial psychological distress which causes the reduction of the quality of life. However, the risk of psychological distress has not been well predicted especially in young- and middle-aged gynaecological cancer patients. This study aimed to develop a prediction model for psychological distress in young- and middle-aged gynaecological cancer patients using the artificial neural network (ANN)., Methods: A cross-sectional study of young- and middle-aged gynaecological cancer patients (n = 368) was conducted between March and December 2022. We used the univariate analysis to determine the factors affecting psychological distress. ANN was used for psychological distress prediction in young- and middle-aged gynaecological cancer patients. Also, a traditional logistic regression (LR) model was constructed for comparison. The area under the receiver's operating characteristic curve (AUC) was used to evaluate the model's predictive performance., Results: ANN and LR showed that self-efficacy, economic income and sleep duration were the top risk variables for psychological distress in young- and middle-aged gynaecological cancer patients. The AUC of the ANN was 0.977, the sensitivity was 94.83% and the specificity was 86.44%, whereas logistic regression's were 0.920, 85.57% and 82.76%, respectively., Conclusion: Compared with the LR model, the ANN model shows obvious superiority across all assessment index outcomes, and it may be used as a decision-support tool for early identification of young- and middle-aged gynaecological cancer patients suffering from psychological distress., (© 2024 John Wiley & Sons Ltd.)

Firearm-related injuries are a major public health concern in the USA. Given the increased racism endured by Asian Americans during the COVID-19 pandemic, the current study aims to investigate the direct and indirect effects of racism, mental distress, and substance use on firearm purchase among Asian Americans. To fulfill this purpose, we collected data from a national sample of 916 Asian Americans in 2021. The study results showed that Asian Americans' racism experience is directly related to increased mental distress, substance abuse, and firearm purchase. Both mental distress and alcohol use were also linked to firearm purchase. It was found that racism links to more mental distress and increased alcohol use, which in turn link to increased firearm purchases. The findings add new information on how racism can have compounded effects on mental distress and alcohol use in addition to firearm-related risk behavior among Asian Americans and posing serious public health concerns., Competing Interests: Declarations. Ethics Approval: This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Institutional Review Board of Eastern Michigan University. Informed consent was provided by all participants. Consent to Participate: Participants provided informed consent. Consent for Publication: All authors agreed to publication. Participants provided consent for nonidentifiable data to be reported. Conflict of Interest: The authors declare no competing interests., (© 2023. W. Montague Cobb-NMA Health Institute.)

Introduction: High tobacco smoking prevalence in people with low SES or serious psychological distress in the U.S. may increase cardiovascular disease risk among these marginalized subpopulations. The authors estimate how smoking disparities contribute to cardiovascular disease disparities., Methods: Using the Simulation of Tobacco and Nicotine Outcomes and Policy model, a validated microsimulation model of tobacco use and clinical outcomes, the authors used 2004-2019 data from the National Health Interview Survey to first compare 20-year cumulative cardiovascular disease incidence for people aged 40 years by sex, smoking status, and marginalized subpopulation membership. Second, the authors simulated the marginalized subpopulations with representative age, sex, and smoking status distributions to estimate 20-year cumulative cardiovascular disease incidence under status quo and counterfactual scenarios. In the counterfactual scenario, smoking prevalence and trends in the low SES and serious psychological distress subpopulations match those in the higher SES and non-SPD subpopulations, respectively., Results: The model-projected impact of smoking on 20-year cumulative cardiovascular disease incidence is considerably larger than the impact of low SES or serious psychological distress; for example, among males aged 40 years, cumulative cardiovascular disease incidence is 28.3% for low SES people who currently smoke, 13.0% for low SES people who never smoke, and 26.2% for higher SES people who currently smoke. In the second analysis, in the status quo scenario, model-projected 20-year cumulative cardiovascular disease incidence is 19.3% for low SES and 22.1% for serious psychological distress; in the counterfactual scenario, it is 18.1% for low SES and 19.6% for serious psychological distress., Conclusions: Interventions focused on reducing smoking disparities could substantially reduce cardiovascular disease in marginalized subpopulations., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Context: The Bereaved Family Survey is an important method for evaluating the quality of palliative care., Objectives: To examine the distress and benefits of bereaved families of patients with or without cancer, who participated in a Bereaved Family Survey, and identify factors associated with distress and benefits., Methods: We conducted a nationwide cross-sectional, self-reported questionnaire mail survey among the bereaved families of patients who died of cancer, heart disease, cerebrovascular disease, pneumonia, or kidney failure. Participants answered questions on a four-point Likert scale measuring the distress and benefit associated with participating in the Bereaved Family Survey. We conducted a qualitative analysis of responses to open-ended questions about the distress and benefits of participating in the survey to comprehensively examine the distress and benefits of participating in the survey., Results: Questionnaires were distributed to 115,816 eligible bereaved family members between February 2019 and February 2020; 62,576 (54.0%) family members returned valid responses. Distress and benefits accounted for 51.4% and 49.3%, respectively. The results of the binomial logistic analysis for distress were significantly higher among cancer patients (P < 0.001-0.003), 20-39-year-old patients (P < 0.001), female bereaved family members (P < 0.001), and bereaved family members with poor mental health statuses (P < 0.001). Factors related to "benefit" were significantly higher among over-80-year-old bereaved family members (P < 0.001), higher care evaluation scale (CES) scores (P < 0.001), and higher good death inventory (GDI) scores (P < 0.001)., Conclusion: Bereaved family members experience both distress and benefits. There is need to devise ways to reduce distress and increase its benefits to continue assessing the quality of palliative care., (Copyright © 2024 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.)

Objectives: Self-compassion is a positive psychological factor linked to improved physical and psychological outcomes across different chronic illness populations. However, the extent to which self-compassion contributes to reduced distress across different conditions or as a function of participant factors is not clear. The current meta-analysis aimed to quantify the association between self-compassion and psychological distress in different chronic illness populations and evaluate the factors that moderate this association., Methods: A systematic search of three electronic databases identified research reporting associations between self-compassion and psychological distress in chronic illness. A random effects meta-analysis was conducted to evaluate the association between self-compassion and psychological distress. Moderator analyses were conducted for sample characteristics and distress types. A bespoke tool evaluated study quality., Results: Searches yielded 51 eligible studies with 57 effect sizes. Meta-analysis revealed that self-compassion was negatively associated with psychological distress (r = -.516; 95% CIs [-.55, -.48]; p = .000). Moderator analyses were significant for distress type and chronic illness group, with effects being largest for stress and neurological conditions. Effects did not vary by sex, age or illness duration., Conclusions: Findings from this first comprehensive investigation of the link between self-compassion and distress in chronic illness highlight the protective role of self-compassion for chronic illness populations. These results lay the foundation for further research into understanding the processes that link self-compassion to lower psychological distress, and that examine the effectiveness of self-compassion interventions in chronic illness populations, to further advance knowledge and inform practice in this area., (© 2024 The Author(s). British Journal of Health Psychology published by John Wiley & Sons Ltd on behalf of British Psychological Society.)

Background: Many cancer patients experience psychological distress and/or poor quality of life during or after their cancer treatment, yet they face multiple barriers to accessing psychological support. Digital psychological interventions represent a promising approach for addressing these barriers, however their comparative effectiveness remains uncertain., Methods: Nine databases were searched for randomized controlled trials (RCTs) from inception to July 2024. The primary outcomes were psychological distress and quality of life, and the secondary outcomes were measures of depression, anxiety, insomnia, fatigue, and fear of cancer recurrence in this study., Results: One hundred and thirty-six RCTs with 23,154 participants were identified. Of these interventions, three types-digitally-delivered cognitive behavioral therapy (CBT), health education, and virtual reality therapy (VRT)-demonstrated significant reductions in psychological distress compared to non-active controls. Digital CBT, narrative interventions, and VRT significantly improved quality of life compared to non-active controls. For depression, both digital CBT and VRT were superior to the non-active control group. Regarding anxiety, CBT, psychoeducation, and VRT outperformed the non-active control group. In terms of fatigue, CBT, psychoeducation, VRT, and multi-component interventions all showed enhanced efficacy compared to the non-active control group. However, only CBT exhibited significantly superior effectiveness in alleviating insomnia compared to non-active controls. Similarly, only mindfulness-based interventions significantly reduced fear of cancer recurrence compared to the non-active control condition., Conclusions: Our results suggest that digital CBT and VRT are highly promising options for reducing psychological distress and enhancing the quality of life among cancer patients; further high-quality randomized controlled trials involving diverse populations are essential to validate these findings., Competing Interests: Declaration of competing interest There are no conflicts of interest by any author., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: COVID-19 is a transmissible and infectious disease with symptoms similar to pneumonia, ranging from moderate to severe. This study investigated the psychological experiences of patients both during their illness and after their recovery., Methods: The study employed purposive sampling and semi-structured interviews to gather insights from 13 COVID-19 survivors (7 women and 6 men). Interpretive Phenomenological Analysis was used to analyze the interview transcripts. Participants ranged in age from 22 to 62 years., Results: The analysis identified seven main themes of psychological experiences during the illness, each with several sub-themes. Key themes included denial of the disease, uncertainty about the illness, and psychological distress, which had sub-themes of depression and stress. Other themes included death anxiety, perceived social stigma (with loneliness as a sub-theme), exposure to infection (with restrictions as a sub-theme), and coping strategies (which encompassed active coping and avoidant coping). For experiences post-recovery, two main themes emerged, with eight sub-themes. The first was post-traumatic growth, which included attachment to God, acceptance of death, gratitude (toward God), trust in interpersonal relationships, gratitude toward people, and the significance of life. The second theme was delayed resilience, which involved recovery from insomnia and post-COVID psychological distress., Conclusion: The study concluded that surviving COVID-19 involves significant psychological challenges both during the illness and after recovery. These insights are valuable for psychologists and counselors in addressing the emotional and mental health needs of COVID-19 patients., Competing Interests: Declarations. Ethics approval and consent to participate: An ethical approval letter was obtained from the ethical review committee of the University to conduct the study (SU/PSY/1475); Date of Approval: 20 October 2020). All participants were fully informed about the nature of the study beforehand and then they provided informed consent. Informed consent was obtained from all subjects and/or their legal guardian(s). Consent for publication: Not applicable. Author information: FA is Associate Professor of Anthropology at the Islamia University of Bahawalpur. RB is Professor of Information management at the Islamia University of Bahawalpur. NIM is a Professor of Psychology University of Sargodha, Punjab, Pakistan. MSH is from the United Nations Children’s Fund (UNICEF), Punjab, Pakatan. AR & AY are Lecturers of Psychology University of Sargodha, Punjab, Pakistan. MS is Professor of Psychology at the Islamia University of Bahawalpur. NK is a PhD scholar at Xian Jiaotong University, China. SG is a vice president and RN is an Associate Professor at Luohe Medical College, Henan Province, China. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Aim: To analyse and synthesise current evidence on the effectiveness of cancer rehabilitation interventions in increasing physical activity, increasing healthy dietary habits, alleviating psychological distress, and increasing health-related quality of life (HRQoL) in women treated for gynaecological cancers (GCs)., Design: A meta-analysis of randomised controlled trials (RCTs)., Data Sources: A systematic search was conducted in 12 databases from inception to 31 May 2024., Review Methods: The quantitative results from comparable RCTs were pooled and meta-analysed using Review Manager 5.4 software. The results from non-comparable (i.e., clinically heterogeneous) RCTs were narratively summarised. The methodological quality of all RCTs was assessed using Version 2 of the Cochrane risk of bias tool for randomised trials., Results: Nine RCTs reported in a total of 12 articles met the inclusion criteria and comprised a total of 418 patients. The interventions had significant effects on total physical activity levels at post-intervention, 6-month follow-up, and 12-month follow-up, and on self-efficacy in physical activity at post-intervention and 3-month follow-up. However, the interventions did not significantly improve overall HRQoL or healthy dietary habits and did not significantly alleviate anxiety and depression. The key intervention components were information provision on health-promoting behaviours; adoption of behavioural change techniques (goal setting, action planning, relapse prevention, problem-solving, self-monitoring, and social support); and stress and emotion management., Conclusion: Rehabilitation interventions effectively increase physical activity in women treated for GCs, leading to sustainable effects. However, there is limited evidence on the effectiveness of such interventions in improving overall HRQoL, encouraging healthy eating, and alleviating psychological distress in women treated for GCs., Relevance to Clinical Practice: This review found that rehabilitation interventions can increase physical activity levels among women treated for GCs. It also identified the key effective components of such interventions., Reporting Method: This review is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement., Patient or Public Contribution: None., Trial Registration: International Prospective Register of Systematic Reviews registration number: CRD42023442877., (© 2025 The Author(s). Journal of Clinical Nursing published by John Wiley & Sons Ltd.)

Objectives: Preliminary examination of emotional awareness/expression relationships with pain in people with traumatic brain injury (TBI) and chronic pain (CP) and exploration of psychological factors as mediators or moderators of these relationships., Methods: Cross-sectional study in adults ( N  = 59) with chronic TBI and CP using Toronto Alexithymia Scale-20 Difficulty Identifying and Describing Feelings subscales; Ambivalence over Emotional Expressiveness Questionnaire; Emotional Approach Coping Scale; PROMIS Pain Intensity and Pain Interference scales, Michigan Body Map (pain widespreadness); headache frequency; Pain Catastrophizing Scale; Brief Symptom Inventory-18 (psychological distress), and Post-traumatic Stress Checklist-Civilian., Results: Difficulty Identifying Feelings was positively associated with pain intensity, pain interference, and headache frequency. Difficulty Describing Feelings was positively correlated with pain interference and headache frequency. Emotional Approach Coping was inversely correlated with headache frequency. Emotional awareness/expression relationships with pain outcomes were mediated by Pain Catastrophizing; Difficulty Describing Feelings relationships with Pain Interference and headache frequency were mediated by psychological distress; and Difficulty Describing Feelings associations with Pain Interference were mediated by post-traumatic stress. No moderators were identified., Conclusion: These preliminary findings suggest that emotional awareness/expression is linked to pain in adults with TBI and CP, which may be connected via pain catastrophizing and psychological distress. If longitudinal studies with larger samples produce similar findings, researchers should explore training emotional awareness/expression for possible pain management after TBI.

Background: Psychologists play a crucial role in providing essential psychological aid to individuals navigating the challenges posed by the COVID-19 pandemic. However, studies focusing on the mental health of psychologists during the COVID-19 pandemic remain scarce. This study investigates the interaction between coping strategies and psychological distress among a group of Indonesian psychologists., Methods: This longitudinal study was conducted over two-time points in 2021, with data collected from April 29 to June 23 and again from September 1 to October 23. A total of ninety-seven psychologists, predominantly female (91 out of 97), participated. The data was collected through an online survey, where participants completed the Indonesian version of the Depression, Anxiety, and Stress Scale-21 (DASS-21) and the Brief COPE questionnaire. Multiple regression analysis was used to perform cross-lag analyses on the data., Results: The findings revealed that adaptive coping strategies were strong predictors of continued use of adaptive coping strategies six months later, while existing psychological distress strongly predicted future distress. Notably, maladaptive coping strategies demonstrated a similar pattern, predicting the continued use of maladaptive coping techniques over time, but they were also consistently associated with psychological distress across both time points, though they did not significantly predict future psychological distress., Discussion: These findings shed light on the dynamic nature of coping strategies and psychological distress among psychologists, presenting significant implications for their support systems and mental health during the challenges posed by the pandemic. Future studies should focus on how psychologists can reduce maladaptive coping strategies to be better equipped to handle very stressful situations such as a pandemic. Additionally, researchers should explore effective interventions and programs that can be implemented to enhance adaptive coping mechanisms, ultimately improving overall psychological resilience and well-being during crises., Competing Interests: No potential conflict of interest was reported by the author(s)., (© 2025 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.)

Background: Triple-negative breast cancer (TNBC) is a subtype of breast cancer clinically defined as lacking expression of Estrogen receptor (ER), Progesterone receptor (PR), and Human Epidermal growth factor Receptor (HER2). Psychological distress is a major risk factor of TNBC, patients diagnosed with TNBC are under tremendous stress due to the aggressive nature of the disease. Stress hormones decrease the efficacy of therapeutics. These facts underscore the need for mind relaxation treatment for TNBC patients., Objectives: To find out the anti-anxiety activity of the Jatamansi Taila in TNBC patients., Material and Methods: This was a two-arm, open-labelled, parallel, prospective controlled clinical study, conducted on 70 patients of TNBC in the age group of 20-70 years who have completed conventional therapy and opted for Ayurvedic Treatment. Patients were divided into 2 groups. Thirty-five patients in Group A were treated with Oral Ayurvedic Medicines (Shamana Chikitsa) and Jatamansi Taila Shirodhara; whereas 35 patients in Group B were treated with only Oral Ayurvedic Medicines., Results: Jatamansi Taila Shirodhara was found to be effective in relieving symptoms of Anxiety and Psychological distress (Chittodvega) immediately after the procedure, viz. sleep disturbance, difficulty in concentration, and fearfulness. Jatamansi Taila Shirodhara was found to be highly effective in improving Quality of Life (QoL), especially in improving functional ability, well-being and reducing symptomatology related to breast cancer, measured by scores of QLQ C30 and symptom score of QLQ BR23., Conclusion: This study emphasizes the role of Jatamansi Taila Shirodhara therapy for mind and body relaxation in psychological distress seen in breast cancer especially, in TNBC patients., Competing Interests: Conflict of interest Jatamansi Taila has been partly included along with the mentioned Shamana Chikitsa as “A Herbo-Mineral Metallic Pharmaceutical Kit” application no. 202121011657 for an Indian patent and published as well as in PCT application no. PCT/IB2022/052192 for Triple Negative Breast Cancer patients., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: Digital addictions are a major problem worldwide, which has increased considerably during the COVID-19 pandemic. In this scenario, two important impact factors to explain this problem are stress and anxiety because of COVID-19. The objective of this research was to determine the impact of distress and anxiety due to COVID-19 on digital addictions., Methods: cross-sectional, explanatory study. A total of 802 students from public and private universities residing in the city of Lima and Callao (Peru), with a mean age of 21.68 (SD = 3.11), selected by convenience sampling, participated in the study. The MULTICAGE CAD-4 questionnaire, the distress scale, and the anxiety scale by COVID-19 were applied., Results: two models examined with structural equation modeling showed good fit indices (CFI and TLI > .95, RMSEA and SRMR < .06). The first model shows that the latent variables distress and anxiety due to COVID-19 have direct effects on digital addictions as a general construct (R 2 = 22%). The second model shows that the exogenous latent variables (stress and anxiety) have direct effects of different magnitudes on each digital technology, so the variance explained on smartphone addiction was higher (R 2 = 25%) with respect to internet (R 2 = 19%) and video game addiction (R 2 = 6%). It was also found that for every male, there are two females with high levels of distress and anxiety. Regarding the problematic use of smartphones and internet, there is a prevalence of 40% regardless of sex; but as for the problematic use of video games, there is a marked difference between males (18.8%) and females (2.7%)., Conclusion: the distress and anxiety caused by COVID-19 have a direct impact in aggravating digital addictions., Competing Interests: No competing interests were disclosed., (Copyright: © 2025 Capa-Luque W et al.)

Introduction: To target psychological support to cancer patients most in need of support, screening for psychological distress has been advocated and, in some settings, also implemented. Still, no prior studies have examined the appropriate 'dosage' and whether screening for distress before cancer treatment may be sufficient or if further screenings during treatment are necessary. We examined the development in symptom trajectories for breast cancer patients with low distress before surgery and explored potential risk factors for developing burdensome symptoms at a later point in time., Methods: In total, 299 patients newly diagnosed with breast cancer who scored < 7 on the distress thermometer were included between August 2017 and October 2019 at the Department of Breast Surgery, Rigshospitalet, Copenhagen. Patients were followed through electronic questionnaires at baseline before surgery and after 6, 12, and 18 months. We used latent class mixed models to identify sub-groups of patients with similar development in distress, anxiety, depression, breast cancer-specific health-related quality of life, self-efficacy, and fear of recurrence over time. Logistic and multinomial regression analyses were applied to examine clinical and sociodemographic factors associated with specific symptom trajectories., Results: We did not identify any sub-groups of women with low distress at diagnosis who developed disabling psychological symptoms up to 18 months after diagnosis. However, we did identify a sub-group of 52% of the women who experienced persistent mild anxiety (Generalised Anxiety Disorder [GAD]-7 score 5-9). Adjusted for baseline treatment modalities and sociodemographic characteristics, women having low social support (odds ratio [OR]: 2.90; 95% confidence interval [CI]: 1.07-7.87) or living with a partner (OR: 3.18; 95% CI: 1.38-7.34) were more likely to experience persistent mild anxiety., Interpretation: The results show that the majority of women with low distress at breast cancer diagnosis do not experience an increase in psychological symptoms over time. Screening for distress at cancer diagnosis may be an essential step to identify most breast cancer patients in need of professional support for psychological symptoms.

The COVID-19 pandemic may have exacerbated mental health conditions by introducing and/or modifying stressors, particularly in university populations. We examined longitudinal patterns, time-varying predictors, and contemporaneous correlates of moderate-severe psychological distress (MS-PD) among college students. During 2020-2021, participants completed self-administered questionnaires quarterly (T1 = 562, T2 = 334, T3 = 221, and T4 = 169). MS-PD reflected Kessler-6 scores ≥ 8. At T1 (baseline), most participants were cisgender women [96% vs. 4% transgender/gender non-conforming (TGNC)]. MS-PD prevalence was over 50% at all timepoints. MS-PD predictors included low self-rated health and perceptions of local pandemic control, verbal/physical violence experience, food insecurity, cohabitation dynamics, geographic location, and loneliness. Unique MS-PD correlates encompassed drug use and TGNC identity. Trajectories comprised Persistently (40%), Highly (24% MS-PD twice/thrice), Minimally (15% MS-PD once), and Never (21%) Distressed. Persistently Distressed students had low social support and self-rated health; high food insecurity, drug use, physical/verbal violence experience, need-based financial aid, and TGNC representation; and fluctuating self-rated health amid increasing COVID-19 symptomatology. In this sample, MS-PD prevalence was high, persistent, and associated with financial, behavioral, structural, experiential, and intra- and inter-personal factors. Given its complexity, improving and preserving college students' mental health necessitates comprehensive, multi-component activities to change adjustable stressors while attenuating the adverse effects of immutable influences., Competing Interests: Declarations. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Purpose: Mental health is a global public health challenge, with mental disorders being a major cause of morbidity. Particularly, taxi drivers face unique challenges related to long working hours, economic instability, and hazardous working conditions. To summarise the existing scientific literature on mental disorders in taxi drivers and identify associated variables., Methods: PubMed, Scopus and Web of Science databases were examined from inception to April 2024 following the PRISMA guidelines. Two authors independently selected original studies. We included observational studies published in English or Spanish or Portuguese, which assessed the mental health of taxi drivers. The Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies of the National Heart, Lung, and Blood Institute (NHBLI) was used to assess the quality of the articles., Results: From an initial pool of 618 studies, eleven met the inclusion criteria and were included in the present systematic review. The findings indicate a considerable prevalence of mental health issues among taxi drivers in comparison to the general population. The prevalence of depression ranged from 14.3 to 60.5% and were driven by a number of factors, including perceived mental strain, lack of respect from operators, a stressful personal life, insufficient sleep, poor working conditions, work-family conflict and low work engagement. Anxiety was reported by 24.1-47% of drivers, with a lack of sufficient sleep being identified as a primary contributing factor. The prevalence of stress ranged from 19 to 55%, with key contributing factors including discrimination, smoking, limited language proficiency, sleep disorders and younger age. Furthermore, 33% of drivers displayed elevated levels of psychological distress, frequently linked to traumatic experiences and occupational hazards., Conclusions: Rates of depression, anxiety, stress and psychological distress are higher in taxi drivers than in general population, therefore prevention strategies should target this group., Systematic Review Registration: PROSPERO registration no. CRD42023360073., (© 2024. The Author(s).)

This research investigated if dispositional mindfulness, resilience, and self-efficacy affect quality of life (QoL) and distress in a sample of patients with stoma. Further, it tested if body image distress and post-traumatic growth mediate these associations. A total of 102 patients with a stoma (mean age: 60.37 ± 12.79 years; 60 females, 52 males) volunteered for this cross-sectional study. The results revealed that mindful attention and resilience were direct, significant negative predictors of psychological distress. On the contrary, body image distress was directly and positively associated with psychological distress and significantly mediated the association between resilience and the dependent variable. The results emphasize the importance of interventions aimed at enhancing dispositional mindfulness and resilience as well as reducing body image-related distress to improve the QoL of patients with a stoma. Additional longitudinal and cross-cultural studies are needed to confirm these findings., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Aims: Although individuals with lower socio-economic position (SEP) have a higher prevalence of mental health problems than others, there is no conclusive evidence on whether mental healthcare (MHC) is provided equitably. We investigated inequalities in MHC use among adults in Stockholm County (Sweden), and whether inequalities were moderated by self-reported psychological distress., Methods: MHC use was examined in 31,433 individuals aged 18-64 years over a 6-month follow-up period, after responding to the General Health Questionnaire-12 (GHQ-12) in 2014 or the Kessler Six (K6) in 2021. Information on their MHC use and SEP indicators, education, and household income, were sourced from administrative registries. Logistic and negative binomial regression analyses were used to estimate inequalities in gained MHC access and frequency of outpatient visits, with psychological distress as a moderating variable., Results: Individuals with lower education or income levels were more likely to gain access to MHC than those with high SEP, irrespective of distress levels. Education-related differences in gained MHC access diminished with increasing distress, from a 74% higher likelihood when reporting no distress (odds ratio, OR = 1.74 [95% confidence interval, 95% CI: 1.43-2.12]) to 30% when reporting severe distress (OR = 1.30 [0.98-1.72]). Comparable results were found for secondary care but not primary care i.e., lower education predicted reduced access to primary care in moderate-to-severe distress groups (e.g., OR = 0.63 [0.45-0.90]), and for physical but not digital services. Income-related differences in gained MHC access remained stable or increased with distress, especially for secondary care and physical services., Conclusions: Overall, individuals with lower education and income used MHC services more than their counterparts with higher socio-economic status; however, low-educated individuals faced inequities in primary care and underutilized non-physician services such as visits to psychologists.

Background: This study sought to explore the interrelationship between diabetes-related distress, patient evaluations of chronic illness management, and self-management practices among older adults diagnosed with T2DM and associated chronic complications., Methods: This was a cross-sectional study including 264 older adults with T2DM in Shanghai, China. Chinese version of Problem Areas in Diabetes Scale (PAID-C), Patient Assessment of Chronic Illness Care (PACIC) and Diabetes Self-Management Behaviour for Older (DSMB-O) were employed. Student's t -test, one-way ANOVA or the nonparametric analysis (Mann-Whitney U -test), Pearson correlation coefficient and structural equation model (SEM) were used to analyse the data., Results: A total of 264 participants (157 males [59.47%], with an average age of 71.07±6.47 years) were included in the study; their duration of T2DM ranged from 5 to 30 years, with a mean duration of 11.19±6.96 years. The DSMB-O scores exhibited a negative correlation with the PAID-C scores (r=-0.250, p<0.01), while showing a positive correlation with PACIC scores (r=0.348, p<0.01). Additionally, PAID-C scores demonstrated a negative correlation with PACIC scores (r=-0.182, p<0.01). The indirect effect of PAID-C on DSMB-O through PACIC was calculated as (-0.70*-0.39=0.27). Furthermore, the total effect of PAID-C on DSMB-O via PACIC was determined to be (0.27+0.22=0.49). Notably, the mediating effect accounted for 54.99%., Conclusion: Psychological distress is intricately linked to self-management behaviour among elderly patients suffering from T2DM and chronic complications. Our findings carry significant implications for T2DM healthcare, indicating that addressing psychological distress may enhance the quality of chronic illnesses, ultimately fostering improved self-management practices and yielding better health outcomes., Competing Interests: The authors report no conflicts of interest in this work., (© 2025 Sun et al.)