Longitudinal changes of psychological distress among childhood cancer survivors: The Swiss Childhood Cancer Survivor Study.

BACKGROUND: Childhood cancer survivors may experience psychological distress due to the disease, cancer treatments, and potential late effects. Limited knowledge exists regarding longitudinal changes in psychological distress after childhood cancer. We aimed to determine changes in psychological distress over time and explore determinants of changes. METHODS: The Swiss Childhood Cancer Survivor Study collected data at baseline (2007-2009) and follow-up (2010-2012). Psychological distress was measured using the Brief Symptom Inventory 18 (BSI-18), including three symptom scales (somatization, depression, anxiety) and an overall distress index (Global Severity Index, GSI). Sum-scores were T-standardized (mean = 50; standard deviation [SD] = 10). Survivors with a score ≥57 on the GSI or two symptom scales were classified as cases with distress. We used linear mixed effects regression to identify potential sociodemographic and clinical determinants of change in psychological distress. RESULTS: We analyzed 696 survivors at baseline (mean age = 24 years [SD = 4], 49% females, mean time since diagnosis = 16 years [SD = 4]). On follow-up (2.4 years, SD = 1), 317 survivors were analyzed, including 302 participants with repeated measures. We found that 13% (39/302) were cases at baseline, and 25% (76/302) were cases on follow-up. Those older at study and longer since diagnosis, females, diagnosed with central nervous system (CNS) tumors, and those reporting late effects were more likely to experience higher levels of distress. Females and unemployed are at higher risk for developing or persisting psychological distress than males and those who are employed or in training. CONCLUSION: We observed an increase in psychological distress score over time, with higher proportion of psychological distress on follow-up. Anticipatory guidance and screening should be implemented in regular follow-up care.

Mental health disparities between German lesbian and bisexual women and a population-based sample.

Lesbians are at greater risk of mental health problems than heterosexual women, and bisexual individuals are even more likely to report mental health problems. No study has yet tested whether there are any mental health differences between German lesbians, bisexual women, and female controls. We tested for mental health differences between matched groups of 161 lesbian and bisexual women and 161 women in the general population, as well as between matched groups of 79 lesbians and 79 bisexual women. Lesbian and bisexual women reported more mental health problems than population-based women. In contrast, bisexual women did not differ in mental health from lesbians. Therefore, German lesbian and bisexual women constitute a risk group for mental health problems. To improve lesbian and bisexual women's mental health, attempts should be made to lower the frequency of minority stressors, and best-practice mental health interventions made available.

Psychiatric Distress and Suicidal Tendencies in Adult Cancer Survivors: Verifying the Validity of the Brief Symptom Inventory-18 for Identifying Suicidal Ideation in the Hospitalized Population of Mainland China.

The Brief Symptom Inventory-18 (BSI-18) is widely used to assess psychiatric distress but has not been verified in the Chinese population. From March to April 2019, 293 hospitalized cancer patients, aged 20-87, completed the cross-sectional survey with demographics questionnaire, BSI-18, and PHQ-9. We analyzed the single suicide-related item of PHQ-9 with the full score clinical outpoint for BSI-18 and PHQ-9 using SPSS 22.0 and R 2.15, including Pearson's χ2 test and ROC curve analyses. A Pearson's χ2 test was carried out to compare the three different methods with the gold screening criteria. The p-value was correspondingly to .006, .066, .838. When the PHQ-9 ≥ 10 criteria for the BSI-18, receiver operating characteristic analysis revealed that AUC values were 0.839, optimal cut-off points for both BSI-18 ≥ 50, the sensitivity of 85.8%, and 62.5%, respectively. The BSI-18 is suitable for a screening tool for psychological distress and could also be used in clinical settings for preliminary screening of hospitalized cancer patients.

The long-term impact of cancer: Evaluating psychological distress in adolescent and young adult cancer survivors in Switzerland.

OBJECTIVES: Adolescents and young adults (AYAs) are diagnosed with cancer during a critical life period full of psychosocial challenges. They may experience a significant impact of the cancer diagnosis on their psychological health, also in the long term. We aimed to (a) evaluate psychological distress in AYA cancer survivors and compare levels of distress with controls and (b) describe socio-demographic and cancer-related characteristics associated with psychological distress. METHODS: We sent a questionnaire to AYA cancer survivors (aged 16-25 y at diagnosis, survived ≥5 y) registered in the Cancer Registry Zurich and Zug, Switzerland. Psychological distress was measured using the Brief Symptom Inventory-18 (BSI-18) assessing anxiety, depression, and somatization and a global severity index (GSI) (cutoff score indicating psychological distress: T ≥ 57). Distress levels were compared between survivors and controls. We used logistic regression to determine associations of socio-demographic and cancer-related characteristics with distress. RESULTS: Of 160 AYA cancer survivors, 34 (21%) reported being distressed (27% in women, 17% in men; P = 0.129). Compared with controls, survivors did not report higher levels of distress (all P values > 0.05). Survivors with migration background and survivors with late effects reported higher levels on GSI, somatization, and anxiety. Higher levels of depression were associated with being female, not being in a partnership, and having late effects. CONCLUSIONS: A substantial subgroup of AYA cancer survivors reported psychological distress. Systematically screening for distress and providing psychological follow-up for survivors at risk may help to provide adequate psychological support.

Norm values and psychometric properties of the brief symptom inventory-18 regarding individuals between the ages of 60 and 95.

OBJECTIVE: The SCL-90 and the SCL-90-R are the most applied measures regarding psychological distress. To reduce and prevent an overload to of the individuals, the Brief Symptom Inventory with 18 items (BSI-18) was developed based on the SCL-90. Since psychological disorders more frequently occur at an older age, there is a growing need for efficient instruments to measure distress in the elderly. However, the BSI-18's psychometric properties, norm values, and factorial structure have not yet been investigated in this age group. METHODS: The aim of this study was to evaluate the BSI-18 in a sample of elderly people and to establish norm values for this specific population. Subsequently, demographic information and BSI-18 results were collected from a sample totaling 884 (55% female, mean age of 70.75 years, SD = 7.08, age range = 60-95 years). The questionnaire contains three six-item scales: somatization (SOMA), anxiety (ANX), and depression (DEPR), which form a general symptom index (GSI). RESULTS: We found an acceptable to good model fit for a three-factor-model with a general GSI factor. The BSI-18's psychometric properties were satisfactory. Strict measurement invariance was shown for age and gender. Additionally, we found differences in psychological distress based on sociodemographic variables. CONCLUSIONS: These findings underline the growing need for preventive mechanisms for elderly people such as, e.g., (re)activating their social networks and strengthening their physical and psychological well-being.

Psychometric analysis of the brief symptom inventory 18 (BSI-18) in a representative German sample.

BACKGROUND: The BSI-18 contains the three six-item scales somatization, depression, and anxiety as well as the Global Severity Index (GSI), including all 18 items. The BSI-18 is the latest and shortest of the multidimensional versions of the Symptom-Checklist 90-R, but its psychometric properties have not been sufficiently clarified yet. METHODS: Based on a representative sample of N = 2516 participants (aged 14-94 years), detailed psychometric analyses were carried out. RESULTS: The internal consistency was good: Somatization α = .82, Depression α = .87, Anxiety α = .84 and GSI α = .93. Confirmatory factor analysis supported the three scales as second-order and GSI as first-order factors. The model fit based on RMSEA is good but that model fit based on CFI and TLI are too low. CONCLUSIONS: Therefore, it is a very short, reliable instrument for the assessment of psychological distress. The BSI-18 can be used to reliably assess psychological distress in the general population. However, further studies need to evaluate the usefulness of standardization in clinical samples.

Gender-responsive Classification of Women in Prison: A Typology Based on Mental Health Symptoms and Coping Strategies.

Despite the increase in the incarceration rates of women, most correctional practices are still normed on male samples, including prison classification. Moreover, those classifications do not take into account women's particular experiences, needs, and unique pathways to criminality. The current research proposes a typology based on female prisoners' mental health symptoms and coping strategies. The data was derived from a survey conducted with 194 women housed in a Northeastern prison. A two-step clustering analysis was used to obtain three classification types-each with different symptomatology, coping mechanisms, demographic, and background characteristics. The results suggest that identifying and relying on needs-based typologies has important correctional policy implications in terms of the management and the treatment of incarcerated women.

Validation of the Brief Symptom Inventory-18 Among Low-Income African American Adolescents Exposed to Community Violence.

African American youth, especially those who reside in low resourced communities, are exposed to higher levels of exposure to community violence relative to their counterparts from other race/ethnic groups. However, appropriate measures for assessing psychological stress related to such exposures are underresearched in the extant literature for this population. The aim of the current study was to examine the reliability and validity of the Brief Symptom Inventory (BSI-18) scale among African American youth exposed to community violence through classical test theory and item response theory methods. Internal reliability and construct validity were examined. Results indicated good internal reliability (α = .93). Construct validity of the BSI-18 was established through confirmatory factor analysis with the three-factor somatic, depression, and anxiety model. Construct validity was also determined with all items indicating adequate fit. Our study indicates good reliability and validity of the BSI-18 to assess psychological distress among African American youth exposed to community violence.

Mental Health Determinants Among a Psychiatric Outpatient Sample of Vietnamese Migrants in Germany.

Background: Mental health risk-factors for Asian migrants have been studied almost exclusively in the US, Canada, and Australia but not in European countries. Therefore, we aimed to identify sociodemographic, clinical, and migration-surrounding factors associated with experienced mental distress among Vietnamese migrants in Germany. Method: 305 Vietnamese migrants utilizing Germany's first Vietnamese psychiatric outpatient clinic filled out at admission the Brief-Symptom-Inventory 18 (BSI-18) as well as a questionnaire on 22 potential mental health determinants. Using a multiple linear regression model, we identified those sociodemographic, clinical, and migration-surrounding factors that were significantly related to the Global Severity Index (GSI) of the BSI-18. Results: The factors unemployment (B = -6.32, p = 0.014), financial problems (B = -10.71, p < 0.001), no or only little religious involvement (B = -3.23, p = 0.002), no psychiatric precontact (B = -7.35, p = 0.004), previous migration experiences (B = 8.76, p = 0.002), and perceived discrimination (B = 6.58, p = 0.011) were found to significantly increase the level of mental distress according to the BSI-GSI. Conclusion: Based on these results, we were able to construct a mental health risk-profile for Vietnamese migrants in Germany, which aims to detect candidates for psychiatric problems earlier and supply them with customized prevention and therapy options.

Evaluation of Distress and Risk Perception Associated with COVID-19 in Vulnerable Groups.

Preventive behavior developed by the population is essential in the face of the risk of coronavirus infection (COVID-19). However, preventive measures will depend on the risk perception acquired. In addition, lockdown can directly affect mental health, provoking distress. Distress could affect risk perception. This study's objective was to analyze whether experiencing distress had an influence on risk perception with respect to vulnerable groups. The sample consisted of 806 participants. The study was conducted during the first week of lockdown declared by the Spanish Government. The Brief Symptom Inventory BSI-18 and a risk perception questionnaire about vulnerable groups was administered. The study revealed the appearance of distress in 9.6% of the sample (85.7% women). Experiencing distress influenced risk perception. This study's main contribution is the link between experiencing distress and the risk perception with respect to vulnerable groups. Risk perception is relevant since it can influence how the population faces the pandemic. Transmission of accurate information could help to minimize the effect of certain cognitive biases that affect risk perception and foster preventive behavior.

The prevalence of psychological distress in Parkinson's disease patients: The brief symptom inventory (BSI-18) versus the Hopkins symptom checklist (SCL-90-R).

The prevalence of psychological distress in Parkinson's disease (PD) patients has been evaluated by many different assessment instruments and with diverse control groups. The most frequently used distress symptom scale has been the Hopkins Symptom Checklist (SCL-90-R), although it contains many symptoms with problematic validity clinically. The 18-item subscale of the SCL-90-R, the Brief Symptom Inventory (BSI-18) has recently been shown to have a sufficient validity to screen for the prevalence of psychological distress (somatization) in PD patients. We have performed a clinimetric analysis by comparing the BSI-18 with SCL-90-R relevant subscales in PD patients. Our micro-analysis has focused on the Mokken model to test the scalability of the subscales. The macro-analysis has focused both on effect size statistics and the normative level of psychological distress with reference to the Italian general population data using T-score metric. The Mokken analysis indicated acceptable scalability for all the subscales of BSI-18. The effect size statistics identified somatization in both BSI-18 and SCL-90-R as the most prevalent and intense symptom of psychological distress. The T-score metric identified the phobic anxiety subscale of SCL-90-R to be clinically much more important than the BSI-18 anxiety subscale in the PD patients. We have found the SCL-90-R subscale of phobic anxiety and the BSI-18 somatization subscale most clinically valid when measuring psychological distress in PD patients.

Risk of malnutrition and emotional distress as factors affecting health-related quality of life in patients with resected cancer.

INTRODUCTION: This study analyzes the prevalence of malnutrition, depression, anxiety, and somatization and which factor has the biggest effect on quality of life (QoL) in individuals with resected cancer. METHODS: A prospective study was conducted among 747 participants. Participants completed the EORTC-QLQ30, MST, and BSI-18 questionnaires. RESULTS: Prevalence for risk of malnutrition, depression, anxiety, and somatization were 36.4%, 35.5%, 35.2%, and 48.8%, respectively. Hierarchical multiple regression analyses revealed that malnutrition risk, somatization, depression, and anxiety accounted for 50.8% of the variance in functional scale, 45.3% in symptom scale, and 52.2% in global health. Malnutrition, somatization, depression, and anxiety displayed high explanatory power on all health-related QoL (HRQoL) scales. CONCLUSION: The risk of malnutrition and psychological symptoms is strongly associated with HRQoL in cancer patients; thus, medical oncologists should develop effective interventions that contribute to lowering the risk of malnutrition and psychological distress, thereby improving subjects' HRQoL before initiating adjuvant chemotherapy.

Behavioral Activation Augmented With Mobile Technology for Depression and Anxiety in Chronic Moderate-Severe Traumatic Brain Injury: Protocol for a Randomized Controlled Trial.

OBJECTIVE: To describe and provide the rationale for a randomized controlled trial for depression or anxiety after moderate to severe traumatic brain injury (TBI), which will test 2 treatments based on behavioral activation (BA), a promising model to promote both positive mood and increased activity in this population. DESIGN: Randomized controlled trial with masked outcome assessment. SETTING: Outpatient catchment area of 1 TBI treatment center. PARTICIPANTS: Community-dwelling persons (N=60) with moderate-severe TBI at least 6 months prior to enrollment and greater than mild depression or anxiety. INTERVENTIONS: Participants will be randomized 2:1 into an 8-session treatment, behavioral activation with technology, consisting of 6 face-to-face sessions and 2 via phone, with mood and activity monitoring conducted via ecological momentary assessment on a smartphone; or a single session incorporating BA principles followed by 8 weeks of activity reminders in the form of implementation intentions, delivered as text messages. MAIN OUTCOME MEASURES: Brief Symptom Inventory-18 (primary outcome); Environmental Reward Observation Scale, Behavioral Activation for Depression Scale, Participation Assessment with Recombined Tools-Objective, Diener Satisfaction With Life Scale, Quality of Life after Brain Injury scale, Patient Global Impression of Change. Outcomes are measured midway through intervention, after treatment cessation (primary outcome), and at 2-month follow-up. A treatment enactment interview is administered after the follow-up to ascertain to what extent participants continue to engage in activities and use strategies promoted during trial participation. RESULTS: N/A. CONCLUSIONS: N/A.

The factor structure of the Brief Symptom Inventory-18 (BSI-18) in Parkinson disease patients.

OBJECTIVE: Psychological distress is common among Parkinson disease (PD) patients. Screening tools, such as the Brief Symptom Inventory-18 (BSI-18), help clinicians to identify and manage PD patients with psychiatric symptoms. The objective of this study is to test the factor structure of the BSI-18 in PD patients. METHODS: Analysis was conducted on PD patients who had initial visits at a movement disorders center from 2004 to 2015. Univariate analysis was used to describe the distribution of socio-demographic and clinical characteristics. The BSI-18 was used to determine the prevalence of clinically significant psychological distress. Confirmatory factor analyses (CFA) treating BSI-18 items as ordered categorical data were conducted. Five competing models were tested. Multiple fit indices, parsimony, and past theory were used to select the final model. RESULTS: In the study sample (n=1067), 18.7%, 22.5%, 15.4%, and 15.0% of patients had BSI-18 T-scores indicative of clinically significant global psychological distress, somatization, depression, and anxiety, respectively. Of the competing models, the final model chosen was the second-order three-factor structure with somatization, depression, and anxiety loaded on psychological distress. CONCLUSION: The original proposed factor structure of the BSI-18 was validated in this patient population. Consequently, this study confirms the construct validity of the BSI-18 for screening of psychological distress in PD patients. Findings highlight somatization as a particularly important component of psychological distress in PD patients.

Improving the Diagnostic Accuracy of the Distress Thermometer: A Potential Role for the Impact Thermometer.

CONTEXT: Screening for and management of distress in clinical practice is an important issue in the field of psycho-oncology. The Distress Thermometer (DT) is a common screening tool, but other methods recently have been proposed, with the aim of improving its diagnostic accuracy. OBJECTIVES: To investigate the diagnostic accuracy of the DT alone and combined with the Impact Thermometer (IT), via the use of two possible combination methods. METHODS: A heterogeneous sample of 385 adult patients with cancer completed the DT, the IT, and the Brief Symptom Inventory-18. RESULTS: The results of the DT were comparable with those found in previous studies, indicating that the DT was adequate for "screening" but had limited value for "case finding." The DT and the IT combined (summed or paired scores) showed minor differences in accuracy indexes compared with the DT alone. CONCLUSION: The results of this study suggest that the addition of the IT to the DT failed to improve its accuracy for identifying distress.

Factorial structure of the Brief Symptom Inventory (BSI)-18 among Chinese drug users.

BACKGROUND: Although the Brief Symptom Inventory-18 (BSI-18) has been widely used for mental health screenings in both clinical and non-clinical populations, the validation of its application to Chinese populations has been very limited. The objective of this research is to assess the factorial structure of the BSI-18 within a Chinese drug using population. METHODS AND RESULTS: A total sample of 303 drug users recruited via Respondent Driven Sampling (RDS) from Changsha, China was used for the study. Our results show: (1) The BSI-18 item scores are highly skewed; (2) With dichotomous items measures (1 - problem at least moderately caused respondent discomfort during the past week; 0 - otherwise), our findings support the designed 3 - factor solution of the BSI-18 (somatization, depression, and anxiety); (3) The BSI-18 has a hierarchical factorial structure with 3 first-order factors and an underlying second-order factor (general psychological distress); (4) Tentative support should also be given to a single dimension of general psychological distress in Chinese drug using populations. Our study recommends a useful alternative approach for evaluating the factorial structure of the BSI-18 - i.e. CFA with dichotomous item measures. Both the total BSI-18 score and the three subscales (SOM, DEP, and ANX) can be used in applications of the BSI-18. CONCLUSION: Overall, our findings suggest the BSI-18 is useful with Chinese drug users, and shows potential for use with non-Western and substance using populations more generally.

Depression in Homebound Older Adults: Recent Advances in Screening and Psychosocial Interventions.

Homebound older adults are more likely than their ambulatory peers to suffer from depression. Unfortunately, the effectiveness of antidepressant medications alone in such cases is limited. Greater benefits might be realized if patients received both pharmacotherapy and psychotherapy to enhance their skills to cope with their multiple chronic medical conditions, isolation, and mobility impairment; however, referrals to specialty mental health services seldom succeed due to inaccessibility, shortage of geriatric mental health providers, and cost. Since a large proportion of homebound older adults receive case management and other services from aging services network agencies, the integration of mental health services into these agencies is likely to be cost-efficient and effective. This review summarizes recent advances in home-based assessment and psychosocial treatment of depression in homebound recipients of aging services.