Psychological impact of predicting individuals’ risks of illness: a systematic review

The aim of this review is to determine the frequency and circumstances under which predicting individuals’ risk of illness has adverse psychological effects. Using systematic review methodology, the literature was searched for studies that had assessed the adverse psychological outcomes of risk assessment programmes. The outcomes investigated are emotional (anxiety, depression, distress) cognitive (intrusive thoughts, perceptions of health) and behaviour (work absenteeism). The impact of both positive and negative test results are summarised in terms of the number of studies showing significant effects between and within groups in the short (one month or less) and longer term (more than one month). Where sufficient data were available, a meta-analysis was conducted to assess effect size. Fifty-four studies met the criteria for inclusion. The studies assessed the impact of informing individuals about cardiovascular risk (21), risk of AIDS (eight), risk of cancer (10), risk of Huntington’s disease (10), risk of diabetes (two), risk of spinocerebellar ataxia (one) and risk of osteoporosis (two). Overall, the quality of studies assessed was limited, with only two using a randomised design to determine the psychological impact of risk assessment. Receiving a positive test result was associated in the short term in the great majority of studies with depression, anxiety, poorer perceptions of health and psychological distress. Data were available for a quantitative synthesis of results on three outcomes, anxiety, depression and distress. Anxiety and depression were significantly higher in those tested positive compared with those tested negative in the short term but not the longer term. Distress could only be assessed in the longer term: there was no evidence of an increase for those receiving positive test results. The five experimental studies that reported interventions aimed at preventing some of these adverse effects all reported favourable results. There was little evidence of any adverse psychological effects of receiving an unfavourable test result. Adverse psychological effects are a common immediate consequence of positive test results following risk assessment. Results from the few experimental studies reviewed suggest that these adverse outcomes should not be seen as inevitable.     

Maternal psychological distress during pregnancy does not increase the risk for adverse birth outcomes

ABSTRACT

Maternal psychological distress during pregnancy is a potential risk factor for various birth complications. This study aimed to explore psychological factors associated with adverse birth outcomes. Symptoms of psychological distress, individual characteristics, and medical complications were assessed at two time points antenatally in 285 women from Australia and New Zealand; birth outcomes were assessed postpartum, between January 2014 and September 2015. Hierarchical multiple regression analyses were conducted to examine the relation of psychological distress to adverse birth outcomes. Medical complications during pregnancy, such as serious infections, placental problems and preeclampsia, and antenatal cannabis use, were the factors most strongly associated with adverse birth outcomes, accounting for 22 percent of the total variance (p < .001). Symptoms of depression and/or anxiety, low social support, and low sense of coherence were not associated with birth complications. In unadjusted analyses, self-reported diagnosis of anxiety disorder during pregnancy and an orientation toward a Regulator mothering style were associated with adverse birth outcomes; however, after controlling for medical complications, these were no longer associated. Our study results indicate that antenatal depressive and/or anxiety symptoms were not independently associated with adverse birth outcomes, a reassuring finding for women who are already psychologically vulnerable during pregnancy.     

What is the impact of genetic counselling in women at increased risk of developing hereditary breast cancer? A meta-analytic review

Meta-analytic methods were used to determine the impact of genetic counselling on women with a family history of breast cancer. Published studies with prospective designs and randomized controlled trials were included in the review, and the psychological outcomes assessed were generalized psychological distress, generalized anxiety, depression, and breast cancer anxiety. Other outcomes investigated were the accuracy of perceived risk of developing breast cancer, breast cancer genetics knowledge and breast cancer screening uptake. A meta-analysis was performed to estimate effect size, where sufficient data were available. A total of 12 studies, most of which measured several outcomes, met at least one of the inclusion criteria. A sufficiently large number of studies were available to assess the magnitude of effects on three outcomes: generalized psychological distress, generalized anxiety and accuracy of perceived risk of developing breast cancer. The quantitative synthesis showed that genetic counselling leads to statistically significant decreases in generalized anxiety, with an average weighted effect sizes of r = - 0.17 (p<0.01). In contrast, the reduction in psychological distress exhibited a trend towards statistical significance only, with r = -0.074 (p = 0.052). The impact of genetic counselling on the accuracy of perceived risk was associated with an effect size of r = 0.56 (p<0.01). Thus in this meta-analysis, we demonstrated the efficacy of genetic counselling in meeting two of its objectives: reducing women's anxiety levels and improving the accuracy of their perceived risk. This review highlighted that most research so far focused on generalized distress and anxiety and accuracy of perceived risk, to the exclusion of other, perhaps equally important, types of outcomes. Future studies are likely to lead to more comprehensive assessments if additional emotional, cognitive and behavioural outcomes are included in the assessment.     

Prevalence of psychological distress, anxiety and depression in rural communities in Australia

OBJECTIVE: To describe the prevalence of psychological distress, depression and anxiety in three Australian rural settings and to identify the levels of risk by gender and age. DESIGN AND SETTING: Three cross-sectional surveys in the Greater Green Triangle area covering the south-east of South Australia (Limestone Coast), and south-west (Corangamite Shire) and north-west (Wimmera) of Victoria. PARTICIPANTS: A total of 1563 people, aged 25-74 years, randomly selected from the electoral roll. MAIN OUTCOME MEASURES: Psychological distress assessed by the Kessler 10, and anxiety and depression assessed by the Hospital Anxiety and Depression Scale. RESULTS: The prevalence of psychological distress was 31% for both men and women with two-thirds reporting moderate and one-third high levels of psychological distress. The prevalence of depression and anxiety was approximately 10%. The highest rate of psychological distress, anxiety and depression occurred in the 45-54 years age group. There were no consistent gender or area differences in the prevalence of psychological distress, depression or anxiety. CONCLUSIONS: A third of the rural population reported psychological distress, with the highest prevalence observed in middle-aged men and women. Thus, health professionals should attend not only to physical health, but also to mental health status in this age group. It is also important to target prevention strategies at the 20% who reported moderate levels of psychological distress in order to prevent the development of more serious conditions.     

Distressed or relieved? Psychological side effects of breast cancer screening in The Netherlands.

STUDY OBJECTIVES: To assess the psychological impact of mammographic screening on women with non-malignant outcomes after attending the Netherlands' National Breast Cancer Screening Programme. DESIGN: During one year all women with false positive test results (95) in a screening area were invited for the study. Each false positive was matched with two women with normal mammograms with respect to age and municipality. A random reference group of 400 was drawn from the female population in an area not yet included in the screening programme. Experiences with screening and psychological status of subjects were assessed 8-10 weeks after screening (T1) and again after six months (T2), by interviews as well as questionnaires. References completed two questionnaires with a six months' interval. PARTICIPANTS: 74 (78%) women with false positive outcomes and 113 (59%) women with negative outcomes participated at T1, of these 65 (88%) and 105 (93%) at T2, respectively; 238 references returned questionnaires at T1 (59%), of these 143 (60%) at T2. MAIN RESULTS: At 8-10 weeks after the screening, the women who received false positive test results scored higher on most of the variables indicating psychological disfunctioning than women with normal mammograms, but did not notably differ on the same variables from the non-screened reference group. Women with normal mammograms had the lowest scores on all the variables in the study at both assessments. The same situation was observed six months later. Although 61% of the women who received false positive mammograms reported that they had experienced the "false alarm" as a stressful event, this experience had apparently no adverse effects on their psychological functioning, as assessed 8-10 weeks after screening. CONCLUSIONS: Overall, breast screening is not likely to generate adverse psychological effects in "healthy" women, even if the outcome is false positive. Differences in psychological functioning between false positives and negatives are more likely ascribable to feelings of relief in the negative group than to raised anxiety and distress in the false positive group.     

社会及心理因素与脑卒中发病关系的流行病学研究进展

脑卒中在全球范围内造成了严重的疾病负担，已成为全球重大的公共卫生问题。目前，已有研究评估了社会、心理因素与脑卒中发病之间的联系。本文综述了国内外心理因素（抑郁、心理社会压力、心理应激、焦虑、孤独感）及社会因素（社会支持、社会隔离、社会网络）与脑卒中发病风险关系的流行病学研究进展，发现研究结果存在不一致性，多数研究显示这些因素与脑卒中发病之间存在关联，但也有研究显示没有关联。     

The psychological consequences of violence against people with disabilities

Background

People with disabilities experience mental health disparities and higher rates of violence compared to people without disabilities. Few studies have examined the psychological consequences of violence against people with disabilities, and whether they differ from those experienced by people without disabilities.

Social and psychological characteristics of Kuwaiti children and adolescents with type 1 diabetes

Type 1 diabetes mellitus is a chronic disease that may have an impact on children's psychosocial adjustment. This study aimed to investigate the psychosocial characteristics of Kuwaiti children with type 1 diabetes as compared to healthy children without diabetes, and assess the impact of glycaemic control on psychosocial variables. A total of 349 school children aged 6-18 years with type 1 diabetes, and 409 children without diabetes having comparable age, gender, and social class were included in the study. Data were obtained by interviewing children and parents using a questionnaire. Psychological distress was measured by the Hopkins symptoms checklist-25 scale including anxiety and depression. Glycaemic control was assessed by glycosylated haemoglobin, HbA(IC) level. Glycaemic control was considered 'good to excellent' at HbA(IC)<8.0%, 'fair' at HbA(IC) 8.1 to 10.0%, and 'poor' at HbA(IC)>10.0%. Median scores of anxiety, depression, and total distress were significantly higher in children with diabetes indicating worse psychological adjustment. There was also significant difference between children with diabetes and those without diabetes in social aspects and school absence days. There was significant positive correlation between HbA(IC) concentration and scores of the psychological functioning indices. Children with poor glycaemic control had worse psychological adjustment. After controlling the variance accounted by gender and age, stepwise multiple regression analysis showed that girls, older children, children in need of emotional support, and those with higher HbA(IC) were at higher risk for psychological maladjustment. These variables explained 47.9% of the variation in total distress. In conclusion, the study supported our hypotheses. Children with diabetes had worse psychological adjustment, and distress was related to glycaemic control. Since psychological distress increases the risk for future complications due to its relation with glycaemic control, longitudinal studies are recommended to identify children with diabetes having distress at an early stage when preventive interventions are effective.     

Cardiovascular disease risk factors and psychological distress among Hispanics/Latinos: The Hispanic Community Health Study/Study of Latinos (HCHS/SOL)

Studies show that cardiovascular disease (CVD) risk factors are correlated with psychological distress, yet research examining these relationships among Hispanic/Latinos is lacking. The population-based Hispanic Community Health Study/Study of Latinos enrolled a cohort of Hispanic/Latino adults (N = 16,415) 18–74 years of age at the time of recruitment, from four US metropolitan areas, between March 2008 and June 2011. Psychological distress (i.e., 10-item Center for Epidemiological Studies Depression Scale, 10 item Spielberger Trait Anxiety Scale, and a combined depression/anxiety score), socio-demographics (i.e., age, education, income, insurance, sex, and Hispanic/Latino background), acculturation (i.e., country of birth and language preference), and traditional CVD risk factors (i.e., dyslipidemia, obesity, current cigarette smoking, diabetes, and hypertension) were assessed at baseline. Associations between CVD risk factors and psychological distress measures by sex were examined using multiple linear regression models, accounting for complex survey design and sampling weights and controlling for socio-demographic and acculturation covariates. In adjusted analyses, all three psychological distress measures were significantly related to smoking. For females, greater psychological distress was significantly related to obesity and current smoking. For males, diabetes and current smoking were associated with psychological distress. For males and females, dyslipidemia and hypertension were not associated with psychological distress after adjusting for other factors. Elevated depression and anxiety symptoms were associated with CVD risk factors for Hispanic/Latino men and women. However, these results were not consistent across Hispanic/Latino groups. As promoted by the integrative care model, psychosocial concerns should be considered in research on CVD risk and chronic disease prevention.     

A Randomized Controlled Trial of Fasting and Lifestyle Modification in Patients with Metabolic Syndrome: Effects on Patient-Reported Outcomes

Lifestyle interventions can have a positive impact on quality of life and psychological parameters in patients with metabolic syndrome (MetS). In this randomized controlled trial, 145 participants with MetS (62.8% women; 59.7 ± 9.3 years) were randomized to (1) 5-day fasting followed by 10 weeks of lifestyle modification (F + LM; modified DASH diet, exercise, mindfulness; n = 73) or (2) 10 weeks of lifestyle modification only (LM; n = 72). Outcomes were assessed at weeks 0, 1, 12, and 24, and included quality of life (Short-Form 36 Health Survey Questionnaire, SF-36), anxiety/depression (Hospital Anxiety and Depression Scale, HADS), stress (Cohen Perceived Stress Scale, CPSS), mood (Profile of Mood States, POMS), self-efficacy (General Self-Efficacy Scale, GSE), mindfulness (Mindfulness Attention Awareness Scale, MAAS), and self-compassion (Self-Compassion Scale, SCS). At week 1, POMS depression and fatigue scores were significantly lower in F + LM compared to LM. At week 12, most self-report outcomes improved in both groups—only POMS vigor was significantly higher in F + LM than in LM. Most of the beneficial effects within the groups persisted at week 24. Fasting can induce mood-modulating effects in the short term. LM induced several positive effects on quality of life and psychological parameters in patients with MetS.     

学龄期矮小儿童焦虑抑郁状况及其与心理弹性的关系

目的 探讨学龄期矮小儿童焦虑、抑郁状况及其与心理弹性的关系,为进一步进行心理干预提供依据.方法 选用儿童焦虑性情绪障碍筛查表、儿童抑郁障碍自评量表和(或)心理弹性量表(RS)个性问卷,对2008年8月-2011年8月扬州大学临床医学院儿科矮小门诊确诊为矮小症的82例9 ～ 14岁身材矮小儿童和78名正常对照儿童进行问卷调查.结果 矮小儿童有焦虑障碍的比例(43.90％)与对照组( 16.70％)差异有统计学意义(x2=13.96,P＜0.01);有抑郁障碍的比例(18.30％)高于对照组(12.80％),差异无统计学意义(x2=0.91,P＞0.05);两组儿童焦虑总分以及躯体化/惊恐、广泛性焦虑、社交恐怖、学校恐怖分量表评分差异有统计学意义(P值均＜0.05);矮小儿童抑郁评分与正常对照组差异无统计学意义(P＞0.05).矮小儿童心理弹性评分焦虑组与非焦虑组、抑郁组与非抑郁组差异均有统计学意义(P值均＜0.05).矮小儿童焦虑各因子及总分,抑郁评分与心理弹性总分及各因子评分均呈显著负相关(r=-0.10～-0.33,P值均＜0.05).结论 学龄期矮小儿童较正常儿童有更多的焦虑等情绪,心理弹性好的学生焦虑抑郁症状较轻.应注重儿童心理弹性的培养.     

Generational Differences in Psychosocial Adaptation and Predictors of Psychological Distress in a Population of Recent Vietnamese Immigrants

While first-wave Vietnamese immigrants adapted well to life in the United States, subsequent immigrants have had greater adjustment difficulties, including more evidence of psychological distress. This study aimed to analyze psychosocial adaptation differences among three generations of recent Vietnamese immigrants, as well as to examine predictors of mental distress in the sample as a whole. A community sample of 184 recent Vietnamese immigrants, categorized as either elderly, middle-aged, or young adults, was assessed for levels of psychological distress, including depression, anxiety, and PTSD, as well as family conflict, dissatisfaction with life in the U.S., acculturation and biculturalism, social support, coping, and premigratory stressors. Young Vietnamese adults were most acculturated, most bicultural, and reported themselves as healthiest and least depressed. They were most often working, least often on welfare, and had the highest family income. However, they also reported most dissatisfaction with their current lives in the U.S. and most family conflict. Regression analysis explaining approximately one-quarter of the variance in mental distress implicated current dissatisfaction with and lack of adjustment to life in the United States, as well as greater acculturation and increased family conflict. Although young adults scored significantly higher than other generations on most of the risk factors for psychological distress, they appeared to be buffered against poorer mental health outcomes by factors of generation and perceived positive overall well-being. In terms of testing a predictive model of psychological distress, this study found current adjustment factors significantly more important in determining mental health outcomes than premigratory stressors such as war-related traumas.     

Peer-group support intervention improves the psychosocial well-being of AIDS orphans: Cluster randomized trial

Accumulating evidence suggests that AIDS orphanhood status is accompanied by increased levels of psychological distress such as anxiety, depression, intense guilt, shame, and anger. However, few studies have examined the possible reduction of psychological distress in AIDS orphans through the help of interventions that promote well-being. The objective of the study was to evaluate the effects of a school-based peer-group support intervention combined with periodic somatic health assessments and treatment on the psychosocial well-being of AIDS orphans in the Mbarara District of southwestern Uganda. In a cluster randomized controlled design, 326 AIDS orphans aged 10–15 years were assigned to either peer-group support intervention combined with monthly somatic healthcare (n = 159) or control group (n = 167) for follow-up assessment. Baseline and 10 week follow-up psychological assessments were conducted in both groups using self-administered Beck Youth Inventories. Complete data were available for 298 orphans. After adjusting for baseline scores, follow-up scores for the intervention group in comparison with controls showed significant improvement in depression, anger, and anxiety but not for self-concept. This study demonstrated that peer-group support intervention decreased psychological distress, particularly symptoms of depression, anxiety and anger. Thus, the use of peer-group support interventions should be incorporated into existing school health programs.     

被动性社交媒体使用对青少年心理影响的研究进展

通过系统分析国内外有关被动性社交媒体使用的研究成果,揭示被动性社交媒体使用对青少年用户的心理影响。结果显示,被动性社交媒体使用对青少年和大学生用户的心理影响主要有认知性影响(如自我概念清晰性、自尊)、情绪性影响(如抑郁、焦虑、妒忌、孤独)和主观幸福感(如生活满意度)等。建议未来的研究者采用更多样的研究方法(如纵向研究法、扎根理论方法等),针对更多种类的社交媒体(如新兴的社交短视频)以及进一步细分的被动性使用形式展开研究,更加深入地探讨被动性社交媒体使用对青少年和大学生用户的心理性、行为性和社会性影响后果。     

A Review of Interventions that Promote Eating by Internal Cues

Traditional diet programs that encourage individuals to consciously restrict their dietary intake have not only been ineffective in terms of weight outcomes, but have also been counterproductive, promoting psychological distress and unhealthy eating behaviors. Nondiet approaches shift the focus away from weight outcomes to the improvement of health outcomes and psychological well-being. One such approach, intuitive eating, promotes dietary intake based on internal cues of hunger and fullness, body acceptance, and making behavior choices based on health as well as enjoyment. Several studies have implemented such ideas into intervention programs. The purpose of our review was to examine the physical and psychological effects of these programs. Twenty interventions were identified. Overall, studies had positive results, demonstrating improvements in eating habits, lifestyle, and body image as measured by dietary restraint, restrictive dieting, physical activity, body satisfaction, and drive for thinness. Participants also experienced improved psychological health as measured by depression, ineffectiveness, anxiety, self-esteem, negative affect, and quality of life. Several improvements were sustained through follow-up periods as long as 2 years. Completion rates were as high as 92% in nondieting groups. In addition, improvements in eating behaviors and maintaining a nondiet approach, increased self-esteem, and decreased body dissatisfaction were sustained long-term. Overall, studies that encourage individuals to eat intuitively help participants abandon unhealthy weight control behaviors, improve metabolic fitness, increase body satisfaction, and improve psychological distress. Results from our review favor the promotion of programs that emphasize a nonrestrictive pattern of eating, body acceptance, and health rather than weight loss.     

Outcomes associated with participation in a therapeutic recreation camping programme for children from 15 European countries: Data from the 'Barretstown Studies'

In recent years, specialised camping programmes, based largely on the premise of therapeutic recreation, have emerged as a form of intervention for children with chronic illnesses, and their siblings. Although these programmes are proliferating, little systematic evaluation of their outcomes has been undertaken, particularly within a European context. The aim of this research was to investigate the symptom and psychosocial outcomes of The Barretstown Gang Camp therapeutic recreation programme in Ireland, a programme aimed at European children with chronic illnesses and their siblings, in the short and longer term. Measures assessing children's physical, psychological and social functioning, specifically their self-reported physical symptoms, affect, self-esteem and quality of life, were translated into 12 European languages and administered at 3 time periods: 2 weeks before each child participated in the programme (Time 1), 2 weeks after participation (Time 2) and at 6 months following participation (Time 3). Benefits were noted in their experience of physical symptoms, affect pertaining to physiological hyperarousal and quality of life in the short and longer term. Positive changes were also noted in relation to self-esteem as it pertains to global self-worth and physical attractiveness though these were, for the most part, in the longer term only and were preceded by adverse effects in the short term. While some of these positive changes were global, there were group differences based mostly on children's age, and patient/sibling status and to a lesser extent on their nationality. However, no benefits were evident in many aspects of children's functioning, either at a global or a group level, in the short and longer term. These findings clarify previous research and suggest that camping programmes have an important role to play as a complementary intervention in facilitating adjustment to chronic illness.     

Testing the effectiveness of a mindfulness-based intervention to reduce emotional distress in outpatients with diabetes (DiaMind): design of a randomized controlled trial

Background  

Approximately 20-40% of outpatients with diabetes experience elevated levels of emotional distress, varying from disease-specific distress to general symptoms of anxiety and depression. The patient's emotional well-being is related to other unfavorable outcomes, like reduced quality of life, sub-optimal self-care, impaired glycemic control, higher risk of complications, and increased mortality rates. The purpose of this study is to test the effectiveness of a new diabetes-specific, mindfulness-based psychological intervention. First, with regard to reducing emotional distress; second, with respect to improving quality of life, dispositional mindfulness, and self-esteem of patients with diabetes; third, with regard to self-care and clinical outcomes; finally, a potential effect modification by clinical and personality characteristics will be explored.