Interaction of Stress, Lead Burden, and Age on Cognition in Older Men: The VA Normative Aging Study

BACKGROUND. Low-level exposure to lead and to chronic stress may independently influence cognition. However, the modifying potential of psychosocial stress on the neurotoxicity of lead and their combined relationship to aging-associated decline have not been fully examined. OBJECTIVES. We examined the cross-sectional interaction between stress and lead exposure on Mini-Mental State Examination (MMSE) scores among 811 participants in the Normative Aging Study, a cohort of older U.S. men. METHODS. We used two self-reported measures of stress appraisal-a self-report of stress related to their most severe problem and the Perceived Stress Scale (PSS). Indices of lead exposure were blood lead and bone (tibia and patella) lead. RESULTS. Participants with higher self-reported stress had lower MMSE scores, which were adjusted for age, education, computer experience, English as a first language, smoking, and alcohol intake. In multivariable-adjusted tests for interaction, those with higher PSS scores had a 0.57-point lower (95% confidence interval, -0.90 to 0.24) MMSE score for a 2-fold increase in blood lead than did those with lower PSS scores. In addition, the combination of high PSS scores and high blood lead categories on one or both was associated with a 0.05-0.08 reduction on the MMSE for each year of age compared with those with low PSS score and blood lead level (p < 0.05). CONCLUSIONS. Psychological stress had an independent inverse association with cognition and also modified the relationship between lead exposure and cognitive performance among older men. Furthermore, high stress and lead together modified the association between age and cognition.National Institutes of Health (R01ES07821, R01HL080674, R01HL080674-02S1, R01ES013744, ES05257-06A1, P20MD000501, P42ES05947, ES03918-02); National Center for Research Resources General Clinical Research Center (M01RR02635); Leaves of Grass Foundation; United States Department of Veterans Affair

The reliability and validity of a Japanese version of symptom checklist 90 revised

<p>Abstract</p> <p>Objective</p> <p>To examine the validity and reliability of a Japanese version of the Symptom Checklist 90 Revised (SCL-90-R (J)).</p> <p>Methods</p> <p>The English SCL-90-R was translated to Japanese and the Japanese version confirmed by back-translation. To determine the factor validity and internal consistency of the nine primary subscales, 460 people from the community completed SCL-90-R(J). Test-retest reliability was examined for 104 outpatients and 124 healthy undergraduate students. The convergent-discriminant validity was determined for 80 inpatients who replied to both SCL-90-R(J) and the Minnesota Multiphasic Personality Inventory (MMPI).</p> <p>Results</p> <p>The correlation coefficients between the nine primary subscales and items were .26 to .78. Cronbach's alpha coefficients were from .76 (Phobic Anxiety) to .86 (Interpersonal Sensitivity). Pearson's correlation coefficients between test-retest scores were from .81 (Psychoticism) to .90 (Somatization) for the outpatients and were from .64 (Phobic Anxiety) to .78 (Paranoid Ideation) for the students. Each of the nine primary subscales correlated well with their corresponding constructs in the MMPI.</p> <p>Conclusion</p> <p>We confirmed the validity and reliability of SCL-90-R(J) for the measurement of individual distress. The nine primary subscales were consistent with the items of the original English version.</p

The dose-response effect in routinely delivered psychological therapies: A systematic review

The dose-response effect refers to the relationship between the dose (e.g., length, frequency) of treatment and the subsequent probability of improvement. This systematic review aimed to synthesise the literature on the dose-response effect in routine psychological therapies delivered to adult patients with mental health problems. Twenty-six studies were eligible for inclusion. Different methodological approaches have been used to examine the dose-response effect; including survival analysis, multilevel modelling and descriptive cluster analyses. Replicated and consistent support was found for a curvilinear (log-linear or cubic) relationship between treatment length and outcomes, with few exceptions such as eating disorders and severe psychiatric populations. Optimal doses of psychotherapy in routine settings range between 4 – 26 sessions (4 – 6 for low intensity guided self-help) and vary according to setting, clinical population and outcome measures. Weekly therapy appears to accelerate the rate of improvement compared to less frequent schedules. Most of the reviewed evidence is from university counselling centres and outpatient psychotherapy clinics for common mental health problems. There is scarce and inconclusive evidence in clinical samples with chronic and severe mental disorders

High levels of untreated distress and fatigue in cancer patients

The purpose of the study was to assess a large representative sample of cancer patients on distress levels, common psychosocial problems, and awareness and use of psychosocial support services. A total of 3095 patients were assessed over a 4-week period with the Brief Symptom Inventory-18 (BSI-18), a common problems checklist, and on awareness and use of psychosocial resources. Full data was available on 2776 patients. On average, patients were 60 years old, Caucasian (78.3%), and middle class. Approximately, half were attending for follow-up care. Types of cancer varied, with the largest groups being breast (23.5%), prostate (16.9%), colorectal (7.5%), and lung (5.8%) cancer patients. Overall, 37.8% of all patients met criteria for general distress in the clinical range. A higher proportion of men met case criteria for somatisation, and more women for depression. There were no gender differences in anxiety or overall distress severity. Minority patients were more likely to be distressed, as were those with lower income, cancers other than prostate, and those currently on active treatment. Lung, pancreatic, head and neck, Hodgkin's disease, and brain cancer patients were the most distressed. Almost half of all patients who met distress criteria had not sought professional psychosocial support nor did they intend to in the future. In conclusion, distress is very common in cancer patients across diagnoses and across the disease trajectory. Many patients who report high levels of distress are not taking advantage of available supportive resources. Barriers to such use, and factors predicting distress and use of psychosocial care, require further exploration

Client and therapist views of contextual factors related to termination from psychotherapy: A comparison between unilateral and mutual terminators

Contextual variables potentially influencing premature termination were examined. Clients (n = 83) and therapists (n = 35) provided parallel data on early working alliance, psychotherapy termination decision (unilateral vs. mutual), clients’ reasons for termination, and barriers to treatment participation. When clients unilaterally ended therapy, therapists were only partially aware of either the extent of clients’ perceived improvements or their dissatisfaction. When termination was mutually determined, there were no differences between client and therapist ratings of termination reasons. Although working alliance and barriers to treatment participation were rated as lower in the context of unilateral termination by clients and therapists, all clients rated the early alliance and barriers to treatment more highly than did therapists. Results have implications for understanding premature termination and suggest future research examining the utility of therapist feedback regarding contextual variables in terms of retaining clients in therapy

Evaluating the quality of interaction between medical students and nurses in a large teaching hospital

BACKGROUND: Effective health care depends on multidisciplinary collaboration and teamwork, yet little is known about how well medical students and nurses interact in the hospital environment, where physicians-in-training acquire their first experiences as members of the health care team. The objective of this study was to evaluate the quality of interaction between third-year medical students and nurses during clinical rotations. METHODS: We surveyed 268 Indiana University medical students and 175 nurses who worked at Indiana University Hospital, the School's chief clinical training site. The students had just completed their third year of training. The survey instrument consisted of 7 items that measured "relational coordination" among members of the health care team, and 9 items that measured psychological distress. RESULTS: Sixty-eight medical students (25.4%) and 99 nurses (56.6%) completed the survey. The relational coordination score (ranked 1 to 5, low to high), which provides an overall measure of interaction quality, showed that medical students interacted with residents the best (4.16) and with nurses the worst (2.98; p < 0.01). Conversely, nurses interacted with other nurses the best (4.36) and with medical students the worst (2.68; p < 0.01). Regarding measures of psychological distress (ranked 0 to 4, low to high), the interpersonal sensitivity score of medical students (1.56) was significantly greater than that of nurses (1.03; p < 0.01), whereas the hostility score of nurses (0.59) was significantly greater than that of medical students (0.39; p < 0.01). CONCLUSION: The quality of interaction between medical students and nurses during third-year clinical rotations is poor, which suggests that medical students are not receiving the sorts of educational experiences that promote optimal physician-nurse collaboration. Medical students and nurses experience different levels of psychological distress, which may adversely impact the quality of their interaction

Flow on the Internet: a longitudinal study of Internet addiction symptoms during adolescence

Internet Addiction (IA) constitutes an excessive Internet use behavior with a significant impact on the user’s well-being. Online flow describes the users’ level of being absorbed by their online activity. The present study investigated age-related, gender, and flow effects on IA in adolescence. The sample comprised 648 adolescents who were assessed twice at age 16 and 18 years. IA was assessed using the Internet Addiction Test and online flow was assessed using the Online Flow Questionnaire. A three-level hierarchical model estimated age-related, gender, and online flow effects on IA symptoms and controlled for clustered random effects. IA symptoms decreased over time (for both genders) with a slower rate in males. Online flow was associated with IA symptoms and this remained consistent over time. Findings expand upon the available literature suggesting that IA symptoms could function as a development-related manifestation at the age of 16 years, while IA-related gender differences gradually increase between 16 and 18 years. Finally, the association between online flow and IA symptoms remained stable independent of age-related effects. The study highlights individual differences and provides directions for more targeted prevention and intervention initiatives for IA

Predicting sexual risk behavior in British and European Union university students in the United Kingdom

Drawing on the Health Adversity Risk Model, this study examines the relationship between mental health and sexual risk behaviors in British and European Union (EU) university students in the United Kingdom. Four hundred and thirty-one undergraduate students completed a cross-sectional survey. Data were analyzed using independent samples t-tests, multiple regression and structural equation modeling. Results showed that female students and British students exhibited higher levels of psychological distress, self-harm and sexual risk behaviors than males and EU students; and that female and EU students were more likely to adopt adaptive coping styles than male and British students, respectively. The structural equation model suggests that the relationship between gender and citizenship and sexual risk-taking is mediated by identity threat, psychological distress, coping styles and self-harm. Adaptive coping styles are not necessarily protective against sexual risk-taking but rather determine the type of sexual risk behavior: re-thinking/planning is associated with volitional risk behaviors and social engagement with non-volitional behaviors. Social and cultural norms may shed light on mental health outcomes and sexual risk-taking in university students

Levels and variables associated with psychological distress during confinement due to the coronavirus pandemic in a community sample of Spanish adults

Due to the COVID-19 pandemic's consequences and the state of alarm, literature has shown that people worldwide have experienced severe stressors that have been associated with increased prevalence of emotional distress. In this study, we explored psychological distress (depression, anxiety, and somatization symptoms) using an online survey platform in a sample of 1,781 Spanish adults during the confinement due to COVID-19, relationships between distress and sleep problems, affect, pain, sleep, emotional regulation, gender, type of housing, history of psychopathology, and living alone during the confinement, and differences depending on demographic and psychological variables. Results showed that between 25% and 39% of the sample referred to clinically significant levels of distress. In addition, women showed higher levels of distress, negative affect, perception of pain, and cognitive reappraisal and lower levels of emotional suppression and sleep quality than men. A history of psychopathology, being younger, living alone or in a flat was associated with higher distress. Finally, the variables most strongly related to distress were negative and positive affect, levels of pain, sleep quality, and emotional suppression. Our results highlight the important role of emotional suppression, cognitive reappraisal, and loneliness and the impact of being a woman and younger in Spain during the COVID-19 pandemic. Therefore, it would be necessary to provide assessments of distress levels in these population groups and focus psychological preventive and therapeutic online interventions on expressing emotions and preventing loneliness