Perceptions of stressful life events as turning points are associated with self-rated health and psychological distress

Abstract

We test the hypothesis that changes in physical and psychological health are associated with construals of stressful life events. At two points in time, approximately 10 years apart, participants (n=1038) rated their physical health and psychological distress. At the second assessment, participants also reported their most stressful life event since the first assessment and indicated whether they considered the event a turning point and/or lesson learned. Lower self-ratings of health and higher ratings of psychological distress, controlling for baseline health and distress, and relevant demographic factors, were associated with perceiving the stressful life event as a turning point, particularly a negative turning point. The two health measures were primarily unrelated to lessons learned. How individuals construe the most stressful events in their lives are associated with changes in self-rated health and distress.     

Differential outcomes of skill training,group counseling,and individual cognitive therapy for persons with acquired visual impairment

As part of the Living Skills Training Program, group counseling and individual cognitive therapy were implemented to decrease psychological distress for adults with acquired visual impairment. This quasi‐experimental design study compared the outcomes of a 6‐month skill training program combined with a group counseling program (n = 37), with (n = 9) or without (n = 10) individual cognitive therapy, and with a control group (n = 42). The outcome measures were the Profile of Mood States and the Nottingham Adjustment Scale Japanese Version. The results showed that participants with low psychological distress decreased anxiety and increased acceptance of disability, even when they did not participate in group counseling. However, among the participants with high distress, they did not show any improvement without group counseling or individual therapy. The participants with high distress who engaged in group counseling showed an improving trend in attitudes toward others. Moreover, the participants who chose to engage in individual therapy in addition to group counseling showed decreased tension‐anxiety, depression, and fatigue, and significantly improved acceptance of disability. These results suggest that group counseling, combined with individual cognitive therapy, can be an effective part of rehabilitation treatment for clients who have high psychological distress.     

Seeking help when transgender: Exploring the difference in mental and physical health seeking behaviors between transgender and cisgender individuals in Ireland

Abstract

Background: While there is growing awareness of the need to support the physical and mental wellbeing of transgender people, some may be reluctant to seek help from healthcare professionals. Little is understood about the mechanisms that influence help-seeking behavior in this group.

Aims: This study aimed to compare transgender and cisgender participants in their likelihood to seek help for both physical and mental health conditions, and to explore whether this help-seeking behavior is predicted by a range of sociodemographic and psychological variables.

Methods: 123 participants living in Ireland (cisgender= 67; transgender= 56) completed a questionnaire which included demographic questions, as well as measures of optimism (LOT-R), self-esteem (RSES), psychological distress (GHQ-12), attitudes towards seeking psychological help (ATSPPH-SF), and attitudes towards seeking help for a physical health problem (Attitudes Towards Seeking Medical Help Scale- Action/Intervention subscale). Associations between predictor variables and mental and physical health seeking were explored using correlation analysis and stepwise regressions.

Results: Transgender participants were less likely to seek help for a physical health issue than cisgender participants, but did not differ in mental health help-seeking behaviors. Results suggest that this may be due to differences in optimism, self-esteem and psychological distress. Transgender participants had significantly lower optimism and self-esteem, which were two factors linked to poorer physical health seeking behaviors. Optimism also emerged as a significant predictor in mental health seeking behaviors.

Discussion: The lack of a significant difference for mental health help-seeking between the transgender and cisgender participants is encouraging, as it suggests that there is less stigma surrounding mental illness than expected, however findings also contradict previous findings suggesting that physical health is less stigmatized. This could be due to stigma relating to gender-specific healthcare and suggests that healthcare professionals should acknowledge the specific healthcare needs and concerns among transgender individuals.     

Health Risk Behaviors and Their Relationships to Health Care Utilization Among Veterans Receiving Primary Medical Care

This paper reports the findings of a behavioral health risk screening form and examines the interrelationships among behavioral risk factors and health care utilization. Participants were 1,000 veterans who completed a brief self-report questionnaire assessing affective distress and behavioral health risk factors while they waited to see their primary care provider. Participants reported a mean level of affective distress in the mild range on a scale of 0 to 20 (M = 6.4, SD = 4.95), and 22.4% reported moderate or high levels of affective distress. Fifty percent of the sample denied alcohol use; 5% of the men and none of the women reported a pattern of use that met established criteria for at-risk drinking. Twenty-six percent of the sample reported current tobacco use, 45% acknowledged concerns about diet and/or weight, and 54% reported concern about pain. These factors were largely significantly intercorrelated and several were related to indices of health care utilization. It was concluded that veterans receiving health care in primary care settings report significant levels of affective distress and other health risk behaviors and that the presence of these factors is associated with increased use of the health care system. These data encourage increased efforts to identify these factors and to develop behavior change interventions.     

Psychological distress with relationship satisfaction is moderated by anticipatory relational savoring among non-deployed military partners

This study recruited participants whose partners were deployed for active-duty military service to examine whether anticipatory relational savoring moderated the association of psychological distress with relationship satisfaction. Two weeks prior to their partner's deployment (T1), participants (N = 73) completed a self-report measure of relationship satisfaction. Then, 2 weeks into their partner's deployment (T2), participants completed self-report measures of stress, loneliness, and depression (combined into a composite index of psychological distress), and relationship satisfaction. Participants also completed a stream-of-consciousness task at T2 in which they imagined and discussed their partner's return from deployment. We coded the stream-of-consciousness task for anticipatory relational savoring regarding their upcoming reunion with their deployed partner. We found that anticipatory relational savoring moderated the association of psychological distress with during-deployment relationship satisfaction after adjusting for demographics, interpersonal variables, and deployment-specific variables; the association did not hold after adjusting for pre-deployment relationship satisfaction, and thus was robust when considering the distress-satisfaction association during the deployment but was not when considering changes in relationship satisfaction from pre- to during-deployment. We discuss the potential importance of anticipatory relational savoring for this unique population.     

A Mixed‐Methods Evaluation of Intensive Trauma‐Focused Programming

This study investigated the magnitude of treatment effect and clients' perceptions of change during a 10‐week intensive outpatient program (IOP) for individuals with posttraumatic stress disorder. Participants were 48 adults (30 women, 18 men) with a mean age of 43.48 years (SD = 12.16) who were predominantly European American (72.9%, n = 35). Results of a mixed‐methods sequential explanatory design indicated that the IOP was strongly associated with decreased psychological symptom severity and increased relational health among participants over time.     

Intelligence in childhood and risk of psychological distress in adulthood: The 1958 National Child Development Survey and the 1970 British Cohort Study

Lower cognitive ability is a risk factor for some forms of severe psychiatric disorder, but it is unclear whether it influences risk of psychological distress due to anxiety or the milder forms of depression. The participants in the present study were members of two British birth national birth cohorts, the 1958 National Child Development Survey (n = 6369) and the 1970 British Cohort Study (n = 6074). We examined the association between general cognitive ability (intelligence) measured at age 10 (1970 cohort) and 11 years (1958 cohort) and high levels of psychological distress at age 30 (1970 cohort) or 33 years (1958 cohort), defined as a score of 7 or more on the Malaise Inventory. In both cohorts, participants with higher intelligence in childhood had a reduced risk of psychological distress. In sex-adjusted analyses, a standard deviation (15 points) increase in IQ score was associated with a 39% reduction in psychological distress in the 1958 cohort and a 23% reduction in the 1970 cohort [odds ratios (95% confidence intervals) were 0.61 (0.56, 0.68) and 0.77 (0.72, 0.83), respectively]. These associations were only slightly attenuated by further adjustment for potential confounding factors in childhood, including birth weight, parental social class, material circumstances, parental death, separation or divorce, and behaviour problems, and for potential mediating factors in adulthood, educational attainment and current social class. Intelligence in childhood is a risk factor for psychological distress due to anxiety and the milder forms of depression in young adults. Understanding the mechanisms underlying this association may help inform methods of prevention.     

Caution or Warning? A Validity Study of the MAYSI‐2 with Juvenile Offenders

Given the high prevalence of mental health and substance use disorders in the juvenile justice system and the emphasis on efficient screening and referrals, the current study sought to further validate the use of the Massachusetts Youth Screening Instrument version 2 (MAYSI‐2). Using data from institutionalized delinquents (N = 836) committed to the California Youth Authority, finite mixture modeling was employed to identify distinct latent classes based on MAYSI‐2 scale scores. Identified classes were then compared across a range of covariates, including prior offenses, official records of misconduct, and multiple measures of mental health and psychological well‐being. Findings revealed a three‐class, gradient‐based structure: low distress (n = 380), moderate distress (n = 327), and high distress (n = 129). Overall, the MAYSI‐2 identified juvenile offenders with mental health and substance use issues, but it did not differentiate youths with respect to offending patterns. Copyright © 2014 John Wiley & Sons, Ltd.     

Measuring the phenomenology of autobiographical memory: A short form of the Memory Experiences Questionnaire

The Memory Experiences Questionnaire (MEQ) is a theoretically driven and empirically validated 63-item self-report scale designed to measure 10 phenomenological qualities of autobiographical memories: Vividness, Coherence, Accessibility, Time Perspective, Sensory Details, Visual Perspective, Emotional Intensity, Sharing, Distancing and Valence. To develop a short form of the MEQ to use when time is limited, participants from two samples (N = 719; N = 352) retrieved autobiographical memories, rated the phenomenological experience of each memory and completed several scales measuring psychological distress. For each MEQ dimension, the number of items was reduced by one-half based on item content and item-total correlations. Each short-form scale had acceptable internal consistency (median alpha = .79), and, similar to the long-form version of the scales, the new short scales correlated with psychological distress in theoretically meaningful ways. The new short form of the MEQ has similar psychometric proprieties as the original long form and can be used when time is limited.     

How Much Distress Is Too Much on Deployed Operations? Validation of the Kessler Psychological Distress Scale (K10) for Application in Military Operational Settings

The aim of this study was threefold: (a) to assess the factor structure of the Kessler Psychological Distress Scale (K10) to determine whether interpreting the scale as a single dimensional measure of psychological distress is justified in military operational setting; (b) to validate the K10 for mental health surveillance in operational settings against self-reported occupational impairment; (c) to evaluate whether the K10 has better discriminatory power than de facto standards for mental health surveillance on deployment, namely the Patient Health Questionnaire and the Posttraumatic Stress Disorder Checklist, Civilian version. A convenience sample of Canadian Armed Forces personnel serving in Afghanistan (N = 1,264) completed self-report measures of psychological distress and occupational impairment. On examination of 6 competing models, the authors determined that interpreting the K10 as a measure of unspecified psychological distress is justified. Using receiver operating characteristic (ROC) curve analysis, they identified new cutoff values for dichotomous and polychotomous scoring methods. After comparing the area beneath the ROC curves for each of the 3 mental health surveillance questionnaires, the authors determined that all measures perform well as predictors of self-rated occupational impairment, with values ranging from .86 to .90. These results highlight the importance of cross-setting validation and demonstrate that validating psychological screening questionnaires against self-report measures of occupational impairment can be a useful strategy for understanding the manifestation of psychological distress on deployed military operations.     

Internet-based acceptance and commitment therapy for psychological distress experienced by people with hearing problems: a pilot randomized controlled trial

Psychological distress is common among people with hearing problems, but treatments that specifically target this aspect have been almost non-existent. In this pilot randomized controlled trial, an eight-week long Internet-based treatment, informed by Acceptance and Commitment Therapy, was administered to explore the feasibility and efficacy of such a treatment. Included participants were randomized to either treatment (n = 31) or wait-list control (n = 30) condition. All participants were measured prior to randomization and immediately after treatment ended using standardized self-report instruments measuring hearing-related emotional and social adjustment (Hearing Handicap Inventory for the Elderly – S, HHIE-S), quality of life (Quality of Life Inventory, QOLI), and symptoms of depression and anxiety (Patient health Questionnaire, PHQ-9 and Generalized Anxiety Disorder scale, GAD-7). Linear mixed effects regression analysis using the full intention-to-treat sample demonstrated that the treatment had superior outcomes on the main outcome measure as compared with the control group, Cohen’s d = 0.93, 95% CI [0.24, 1.63]. The benefits of treatment over control were also evident in scores of depression, Cohen’s d = 0.61, 95% CI [0.04, 1.19], and quality of life, Cohen’s d = 0.88, 95% CI [0.14, 1.61]. The results provide preliminary support for Internet-delivered acceptance and commitment therapy as a potentially effective treatment of psychological symptoms associated with hearing problems.     

The Development of a Brief Distress Reduction Intervention for Individuals Recently Diagnosed With HIV in China

In China, where there are few mental health resources, the majority of HIV-related efforts have focused on medical treatment and transmission prevention rather than psychosocial support. Yet people living with HIV/AIDS (PLWHA) report high levels of psychological distress, especially upon first receiving their HIV diagnosis. We conducted mixed methods research of a qualitative study with (N = 31) individual interviews and 3 focus groups (n = 6 in each group) of HIV-affected participants, and a quantitative survey (N = 200) with individuals living with HIV in Shanghai and Beijing, China. Our qualitative data revealed themes of forms of distress experienced and types of psychosocial support that our participants wished they could have accessed upon diagnosis as well as suggestions for intervention structure that would be most feasible and acceptable. Our quantitative surveys provided further evidence of the high degree of psychosocial distress among recently diagnosed PLWHA. Our findings informed the development of the Psychology Toolbox intervention, a brief CBT skills-based intervention comprising cognitive restructuring, behavioral activation, and paced breathing, designed to be integrated into primary care for recently diagnosed PLWHA. This study describes the intervention development process and contents of each session. Future research should evaluate the intervention for efficacy as well as examine best strategies for eventual implementation and dissemination.     

Illness disclosure and mental health among women with HIV/AIDS

The current study examines two contrasting models of the relationship between illness disclosure and mental health among an ethnically‐diverse group of women with HIV/AIDS. In the first, and commonly accepted model, illness disclosure predicts enhanced mental health status. In the second or alternate model, based on the stigmatization that accompanies HIV/AIDS infection, illness disclosure predicts poorer mental health. We also explore an alternate interpretation for this second model, namely that the mental health status of participants is predictive of their levels of disclosure. A total of 176 women from three major ethnic groups were interviewed and assessed during the baseline visit for a comprehensive longitudinal study. Results showed that these women constituted a highly‐disclosed population; over one‐third of them had disclosed their HIV status to their entire social networks. Contrary to expectation, disclosure was unrelated to mental health among the African‐American (n = 72) and European‐American (n = 47) women. Among the Latina women (n = 57), however, greater disclosure was related to higher levels of depression, psychological distress, and reported pain. Regression analyses controlling for age, education, and illness severity showed that disclosure makes a small but independent contribution to the prediction of mental health status. Thus, among the Latinas, the data were consistent with both the stigma model and the hypothesis that greater distress predicts wider disclosure. General patterns of disclosure are described and possible explanations for the inconsistent relationships found between disclosure and mental health among the three ethnic groups are considered. Copyright © 2000 John Wiley & Sons, Ltd.     

Unanswered Prayers: Religiosity and the God-Serving Bias

Two self-report experiments examined how religiosity affects attributions made for a target person’s death. Online adults (Study 1, N = 427) and undergraduate students (Study 2, N = 326) read about Chris who had a heart attack, used religious or health behaviors, and lived or died. Participants made attributions to Chris and God (both studies), and reported their emotions (Study 2). Participants made more attributions to Chris when he lived than when he died, but only when he used health behaviors. The highly religious made more attributions to God, but not when Chris used religious behaviors and died (the God-serving bias); they reported the most positive emotions when Chris lived after using religious behaviors (the Hallelujah effect). Directions for future research in terms of implicit religious beliefs and normative evaluations of religion are discussed.     

An open trial of mindfulness‐based stress reduction for young adults with social anxiety disorder

The present study investigated mindfulness‐based stress reduction (MBSR) for young adults with a social anxiety disorder (SAD) in an open trial. Fifty‐three young adults in a higher education setting underwent a standard eight‐week MBSR program. Eight participants (15%) did not complete the program. Participants reported significant reductions in SAD symptoms and global psychological distress, as well as increases in mindfulness, self‐compassion, and self‐esteem. Using intention‐to‐treat (ITT) analyses, effect sizes ranged from large to moderate for SAD symptoms (Cohen's d = 0.80) and global psychological distress (d = 0.61). Completer analyses yielded large effect sizes for SAD symptoms (d = 0.96) and global psychological distress (d = 0.81). The largest effect sizes were found for self‐compassion (d = 1.49) and mindfulness (d = 1.35). Two thirds of the participants who were in the clinical range at pretreatment reported either clinically significant change (37%) or reliable improvement (31%) on SAD symptoms after completing the MBSR program, and almost two thirds reported either clinically significant change (37%) or reliable improvement (26%) on global psychological distress. MBSR may be a beneficial intervention for young adults in higher education with SAD, and there is a need for more research on mindfulness and acceptance‐based interventions for SAD.     

Predicting the Performance of Dental Hygiene Behaviors: An Examination of the Fishbein and Ajzen Model and Self-Efficacy Expectations1

This study examined the value of the Fishbein and Ajzen model of behavioral intentions and Bandura's concept of self-efficacy expectations as prospective predictors of the dental hygiene behaviors of young adults. All participants (73 males and 58 females) completed self-report measures of the predictor variables and 60% of that group (N = 77) then recorded brushing and flossing behaviors over a four-week period. The Fishbein and Ajzen model accounted for a significant proportion of the variance in intentions to brush (R²= .32) and intentions to floss (R²= .30). Intentions were in turn related to self-monitoring records of brushing and flossing frequency (rs= .52 and .61). Introducing self-efficacy expectations into the Fishbein and Ajzen model failed to improve the prediction of brushing and flossing frequency. However, self-efficacy was predictive of behavioral intentions, adding significantly to the variance accounted for by the attitudinal and subjective norm components of the Fishbein and Ajzen model. These data suggest that self-efficacy expectations are important in understanding protective health behaviors and that the inclusion of a self-efficacy component in the Fishbein and Ajzen model deserves consideration.     

Characteristics of intrusive memories in a community sample of depressed, recovered depressed and never-depressed individuals

An accumulating body of evidence has revealed that intrusive autobiographical memories of negative events play a role in depression. Despite increasing understanding of the phenomenological experience of these memories, previous research in this area has been conducted in either nonclinical samples, or in clinical samples without an adequate control group. This study aimed to replicate and extend findings with dysphoric samples by comparing the content and characteristics of intrusive memories in clinically depressed (n = 25), recovered (n = 30) and never-depressed (n = 30) participants. Participants completed mood measures, and a battery of self-report questionnaires that indexed intrusive memory frequency, avoidance and characteristics. Intrusive memories were common and shared strikingly similar characteristics across the three groups. The key finding was that depressed participants reported higher levels of intrusion-related distress, associated emotions (especially sadness and helplessness), interference as a result of the memories and memory vividness compared to the never-depressed group. Despite similar levels of intrusion, there were group differences in avoidance such that depressed participants reported higher levels of avoidance than the never-depressed group. These results provide further support for the proposal that clinical interventions for depression could usefully incorporate components that aim to reduce intrusive autobiographical memories and target avoidance strategies.     

Psychosocial Predictors of Psychological Distress in Taiwanese Secondary School Boys and Girls

This study was designed to investigate predictors of psychological distress in secondary school boys (n =779) and girls (n = 893) in Taiwan. Participants completed anxiety and depression scales as part of a larger study. Gender, GPA, parenting practices, self-esteem, and personality/satisfaction were significantly correlated with psychological distress. Significant gender differences were found in students' psychological distress, GPA, stereotyped thinking, academic self-expectations, parental expectations, parenting practices, and mother's education level. Stepwise regressions revealed that self-esteem was the only significant predictor for boys; it accounted for 40.9% of the variance in their psychological distress. GPA, family income, self-esteem, and parenting practices were significant predictors for girls; they accounted for 42.6% of the variance in girls' psychological distress. Research recommendations and educational implications are discussed.     

Incorporating a Psychological Counselor in a Cancer Risk Assessment Program: Necessity, Acceptability, and Potential Roles

Evidence suggests that cancer risk assessment may be associated with increased psychological distress. This exploratory study assessed the necessity and acceptability of incorporating psychological counseling into routine clinic procedures at a cancer risk program. Following a visit to a university-based cancer risk clinic, patients (N = 102) completed an anonymous self-report instrument. Participants reported experiencing current stress and anxiety (41%), depression (29%), and suicidal ideation (2%). Patients with a history of cancer were more likely to be experiencing current emotional difficulties. Sixty-nine percent of the participants found the visit with the psychological counselor to be helpful, while 41% of the participants reported interest in follow-up psychological services. Interest in receiving future psychological services was positively correlated with levels of anxiety, depression, and cancer worry. This pilot study demonstrates the acceptability and potential role for psychological counselors in increasing adjustment in high-risk patients undergoing genetic counseling for inherited cancers.