Psychosocial distress refers to the unpleasant emotions or psychological symptoms an individual has when they are overwhelmed, which negatively impacts their quality of life. Psychosocial distress is most commonly used in medical care to refer to the emotional distress experienced by populations of patients and caregivers of patients with complex chronic conditions such as cancer, diabetes, and cardiovascular conditions, which confer heavy symptom burdens that are often overwhelming, due to the disease's association with death. Due to the significant history of psychosocial distress in cancer treatment, and a lack of reliable secondary resources documenting distress in other contexts, psychosocial distress will be mainly discussed in the context of oncology. Although the terms "psychological" and "psychosocial" are frequently used interchangeably, their definitions are different. While "Psychological" refers to an individual's mental and emotional state, "Psychosocial" refers to how one's ideas, feelings, and behaviors influence and are influenced by social circumstances. While psychological distress refers to the influence of internal processes on psychological wellbeing, psychosocial factors additionally include external, social, and interpersonal influences. Psychosocial distress is commonly caused by clinically related trauma, personal life changes, and extraneous stressors, which negatively influences the patient's mood, cognition, and interpersonal activity, eroding the patient's wellbeing and quality of life. Symptoms manifest as psychological disorders, decreased ability to work and communicate, and a range of health issues related to stress and metabolism. Distress management aims to improve the disease symptoms and wellbeing of patients, it involves the screening and triage of patients to optimal treatments and careful outcome monitoring. However, stigmatization of psychosocial distress is present in various sectors of society and cultures, causing many patients to avoid diagnosis and treatment, in which further action is required to ensure their safety. As an increasingly relevant field in medical care, further research is required for the development of better treatments for psychosocial distress, with relation to diverse demographics and advances in digital platforms.
Causes and Symptoms
Common causes of psychosocial distress include clinically related trauma, personal life changes, and extraneous stressors. The unsettling sensations experienced can cause individuals to respond to the stress in different ways, presenting psychological symptoms (e.g., excessive exhaustion, unhappiness, avoidance, dread and worry) that negative impacts an individual's well-being and quality of life. When in psychosocial anguish, an individual may appear detached and avoid interpersonal communication. In addition, the ability to perform up to standard in the workplace can be impacted due to psychosocial discomfort. For example, the patient may find it difficult to stay focused or manage responsibilities sustainably. Clinical presentations of health issues may be observed, particularly for heart function. As a result of the body's increased release of stress hormones (e.g., cortisol) due to prolonged stress, blood pressure and heart rate will jump significantly. Such histological responses are linked to an increase in:
bodily inflammation risk of stroke cancer progression cardiovascular disease insomnia injury and suicidal tendencies These clinical health issues often further exacerbate the original psychological symptoms. Furthermore, digestion, metabolism and other crucial bodily functions may be slowed down.
Screening/Diagnosis Prior to 2014, the implementation of evidence-based distress screening in the healthcare setting was scarce. In 2014, to increase objectivity in distress screening based on qualitative data, the American Psychosocial Oncology Society (APOS) and Yale School of Nursing (YSN) collaborated to publish the Screening for Psychosocial Distress program, outlining the five steps- Screen, Evaluation, Referral, Follow-up and Documentation/Quality Improvement- to be carried out in psychosocial distress screening.
1. Screening The Distress Thermometer (DT) is an established self-assessment tool that invites patients to score their perceived level of distress during the previous week on a scale from 0 (no distress) to 10 (severe, intolerable distress). 39 different prompts classified as "Practical", "Family", "Emotional", "Spiritual", and "Physical" categories are utilized to evaluate the wellbeing of patients experiencing psychosocial distress. An average rating of >=4 points is regarded as significant, necessitating additional medical evaluation to determine the best course of medical care.
2. Evaluation The recommended practice is to periodically assess ongoing and recovered cancer patients for anxiety and depressive symptoms during the course of their care, according to the Pan-Canadian Screening, Assessment and Care guideline that is sponsored by the American Society of Clinical Oncology (ASCO). The Generalized Anxiety Disorder Scale can be used to evaluate symptoms of anxiety: a score of 0-4 implicates no symptoms, 5-9 implicates clement symptoms, 10-13 implicates moderate symptoms and 15-21 implicates severe symptoms.
3. Referral With reference to cancer patients in particular, in the event that typical management and treatment does not improve psychosocial distress outcomes, medical care professionals should provide patients with targeted referrals to mental health and social work institutions.
4. Follow-up Providing patients with follow up information, discussion and communication with their healthcare providers enables for further reevaluation upon the course of management or treatment that will be followed. Such communication also allows the provision of detailed patient-specific care.
5. Documentation/Quality Improvement All distress related patient information should be recorded in detail to reliably evaluate the course of the further action, according to the APOS Guidelines.
… excerpt ends here. Continue reading the full article.
