LITERATURE REVIEW 1

Understanding the relationship between stress, distress and healthy lifestyle behaviour: A
qualitative study of patients and general practitioners

Authors Suzanne H McKenzie1,2* and Mark F Harris2

(Year)

(2013)
Population General Practice Patient aged 40 – 69 years in NSW and Sixteen General
Country (Westren & Asia) Practitioners (GPs)

Australia
Age (Mean) Mean Age : 56 Years
Gender (%)
Gender :
Patients : Female : 50 % Male : 50 %

GPs : Female : 40 %, Male : 60 %

Measurement Kessler Psychological Distress Scale (K10)

For Distress
Outcome the Kessler Psychological Distress Scale (K10) as part of their baseline
Measurement questionnaire for the HIPS study. Using this scale, patients were stratified as Low
(K10 score, 10–15), Medium (K10 score, 16–29) and High (K10 score, 30–50)
Distress [10] and then gender.

Results Participants were motivated to maintain a healthy lifestyle however they described
a range of external factors that impacted on behaviour in both positive and
negative ways, either directly or via their impact on psychological distress. The
impact of external factors was moderated by coping strategies, beliefs, habits and
social support. In some cases the process of changing or maintaining healthy
behaviour also caused distress. The concept of a threshold level of distress was
evident in the data with patients and GPs describing a certain level of distress
required before it negatively influenced behaviour.

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 LITERATURE REVIEW 2

Psychological distress in Ghana: associations with employment and lost productivity

Authors Maureen E Canavan1*, Heather L Sipsma1, Achyuta Adhvaryu1, Angela Ofori-

(Year) Atta3, Helen Jack1, Christopher Udry2, Isaac Osei-Akoto4 and Elizabeth H
Bradley1

(2013)
Population Adults from the Ghana Socioeconomic Panel Survey
Country (Westren & Asia)
Africa
Age (Mean) Mean Age : 42,5
Gender (%)
Men : 54 %
Women : 46 %

Measurement Kessler Psychological Distress Scale (K10)

For Distress

Outcome The K10 has been used to assess mental health in several countries, has been
Measurement validated in low-income countries [13], has been shown to be associated with the
Composite International Diagnostic Interview (CIDI), and indicates a high
probability of meeting criteria for a DSM-IV mental disorder [15]. The K10, a 10-
item questionnaire, asks the frequency with which respondents have experienced
specific feelings, including tired out, nervous or hopeless, over the past four weeks
on a 5-point Likert scale ranging from “none of the time” (scored as 1) to “all of
the time” (scored as 5).

We summed responses to each item for a total possible range of 10 to 50. For
analysis, we created 3 categories based on scores consistent with K10 categories in
previous studies [16,17]: 10–24, indicating likely to be well or have mild
psychological distress; 25–29 for likely to have moderate psychological distress;
and 30–50 for likely to have severe psychological distress.

Results Approximately 21% of adults surveyed had moderate or severe psychological

distress. Increased psychological distress was associated with increased odds of
being unemployed. Men and women with moderate versus mild or no
psychological distress had more than twice the odds of being unemployed. The
association of severe versus mild or no distress with unemployment differed
significantly by sex (P-value for interaction 0.004).

Among men, the adjusted OR was 12.4 (95% CI: 7.2, 21.3), whereas the
association was much smaller for women (adjusted OR = 3.8, 95% CI: 2.5, 6.0).
Extrapolating these figures to the country, the lost productivity associated with
moderate or severe distress translates to approximately 7% of the gross domestic
product of Ghana.

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 LITERATURE REVIEW 3

Psychological distress and mental health of Thai caregivers

Authors Vasoontara Yiengprugsawan1*, Sam-ang Seubsman2 and Adrian C Sleigh1

(Year)
(2013)

Population National Cohort Study of 60.569 Thai adults.

Country (Westren & Asia) Asia

Age (Mean) Mean age :

Gender (%) 20 – 29 : 27,4 %
30 – 39 : 42,6%
40+ : 30,0%

Men : 45,2 %
Women : 54,8%

Measurement Psychological distress was measured using the standard Kessler 6 instrument
For Distress

Outcome Kessler 6 instrument which included the following questions “In the past 4 weeks,
Measurement how often did you feel: 1) so sad nothing could cheer you up, 2) nervous, 3)
restless or fidgety, 4) hopeless, 5) everything was an effort, 6) worthless?”
Responses were scored from 0 to 4 (‘none’, ‘a little’, ‘some’, ‘most’, or ‘all the
time’) (Kessler et al. 2003). Scores for the six questions were then totaled and
those scoring 13 or higher were dichotomized into having ‘high psychological
distress’; these are consistent with relevant recent Asian literature (Fushimi et al.
2011; Hozawa et al. 2009).

Results Among cohort members, 27.5% were part-time caregivers and 6.6% were full-time
caregivers. Compared to non-caregivers, full-time caregivers tended to be older, to
be married, to be in the lowest household income group, to be unpaid family
members, and to reside in rural areas. We noted the seeming contradiction that
when compared to non-caregivers, the caregivers reported higher psychological
distress but higher positive mental health (i.e., self-esteem and content with life),
higher positive mental capacity (i.e., coping with crises), and higher positive
mental quality (i.e., helping others).

After adjusting for possible covariates, part-time and full-time caregivers were
more likely to report high psychological distress (Adjusted Odds Ratios, AOR 1.33
and 1.78 among males and 1.32 and 1.45 among females). Less contact with
colleagues was associated with high psychological distress both in males and
females (AOR 1.36 and 1.33). Less contact with friends was also associated with
high psychological distress, especially among females (AOR 1.27 and 1.42).
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LITERATURE REVIEW 4

Gender differences in the age-cohort distribution of psychological distress in Canadian

adults: findings from a national longitudinal survey

Authors Aline Drapeau1,2,3*, Alain Marchand4,5 and Charlotte Forest1,6

(Year)
(2014)

Population Data from the National Population Health Survey, a longitudinal population survey conducted in
Country (Westren & Asia) Canada from 1994–1995 to 2010–2011. Growth curve analyses were performed separately in
women (n = 9062) and in men (n = 7877) to examine the distribution of psychological distress by
age group and birth cohort in Canadians aged 18 years and older

Westren

Age (Mean) Mean age (SD) :

Gender (%)
Men :
Women :

Measurement Psychological distress was assessed with the K6, a scale developed by Kessler and
For Distress his colleagues and used in several population surveys (Kessler et al. 2002; Kessler
et al. 2003; Furukawa et al. 2003; Baillie 200
Outcome The K6 is a unidimensional scale comprising 6 items asking respondents how
Measurement often during the preceding 30 days they felt: so sad that nothing could cheer them
up; nervous; restless
or fidgety; hopeless; worthless; that everything was an effort. Each item is scaled
from 0 (none of the time) to 4 (all of the time). The total score of psychological
distress is computed by summing the six items scores and ranges from 0 to 24.

Results The mean level of psychological distress is higher in women than in men in all age
groups and all birth cohorts, and in the 18-29 age group than in older adults. Minor
gender differences are found in the distribution of distress when age and birth
cohort are examined jointly.
In women, the mean level of distress decreases steadily beginning at age 18,
reaches its lowest point in the 60-69 age group and rises thereafter without ever
reaching the level observed in young adults. In men, it remains stable in the
 twenties and then follows a pattern similar to that observed in women. This age
pattern is more apparent in more recent than in earlier cohorts and is related to
variations in employment status, marital status and education during adulthood.

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LITERATURE REVIEW 5

Identifying factors of psychological distress on the experience of pain and symptom

management among cancer patients

Authors Tamara A. Baker1*, Jessica L. Krok-Schoen2 and Susan C. McMillan3

(Year)
(2016)

Population Patients receiving outpatient services from a National Cancer Institute (NCI)-
Country (Westren & Asia) Designated Comprehensive Cancer Center.

American

Age (Mean) Mean age (SD) : 55.6

Gender (%)
Men : 50 %
Women : 50%

Measurement The MSAS-PSYCH subscale

For Distress

Outcome The MSAS-PSYCH subscale was used to measure the frequency, presence, and
Measurement distress associated with six psychological symptoms (difficulty concentrating,
feeling nervous, difficulty sleeping, feeling sad, worry, feeling irritable). Symptom
frequency was measured on a five-point Likert scale (0 = not at all to 4 = very
severe), with a higher score endorsing more of the symptom.

Presence of the symptom was assessed as a dichotomous variable, with response

choices as either yes or no (experiencing the symptom or not). Symptom-related
distress was similarly rated on a five-point Likert scale (how much does the
symptom distress or bother you; 0 = not at all to 4 = very much), with higher
scores denoting more distress related to the symptom

Results Patients reporting functional limitations were more likely to report pain.
Specifically, those reporting difficulty sleeping and feeling irritable were similarly
likely to report pain. Data further showed age and feeling irritable as significant
indicators of pain-related distress, with younger adults reporting more distress.
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