Psychosocial distress refers to the unpleasant

emotion Emotions are physical and mental states brought on by neurophysiology, neurophysiological changes, variously associated with thoughts, feelings, behavior, behavioral responses, and a degree of pleasure or suffering, displeasure. There is ...

s or psychological symptoms an individual has when they are overwhelmed, which negatively impacts their

quality of life Quality of life (QOL) is defined by the World Health Organization as "an individual's perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards ...

Psychosocial The psychosocial approach looks at individuals in the context of the combined influence that psychological factors and the surrounding social environment have on their physical and mental wellness and their ability to function. This approach is ...

distress is most commonly used in

medical care Health care, or healthcare, is the improvement or maintenance of health via the prevention, diagnosis, treatment, amelioration or cure of disease, illness, injury, and other physical and mental impairments in people. Health care is deliver ...

to refer to the

emotional distress In medicine, distress is an aversive state in which a person is unable to completely adapt to difficult situations and their resulting effects and shows maladaptive behaviors. It can be evident in the presence of various phenomena, such as inapp ...

experienced by populations of patients and caregivers of patients with complex chronic conditions such as

cancer Cancer is a group of diseases involving Cell growth#Disorders, abnormal cell growth with the potential to Invasion (cancer), invade or Metastasis, spread to other parts of the body. These contrast with benign tumors, which do not spread. Po ...

diabetes Diabetes mellitus, commonly known as diabetes, is a group of common endocrine diseases characterized by sustained high blood sugar levels. Diabetes is due to either the pancreas not producing enough of the hormone insulin, or the cells of th ...

, and cardiovascular conditions, which confer heavy symptom burdens that are often overwhelming, due to the disease's association with

death Death is the end of life; the irreversible cessation of all biological functions that sustain a living organism. Death eventually and inevitably occurs in all organisms. The remains of a former organism normally begin to decompose sh ...

. Due to the significant history of psychosocial distress in

cancer treatment Cancer treatments are a wide range of treatments available for the many different types of cancer, with each cancer type needing its own specific treatment. Treatments can include surgery, chemotherapy, radiation therapy, hormonal therapy, targ ...

, and a lack of reliable

secondary resources Secondary may refer to: Science and nature * Secondary emission, of particles ** Secondary electrons, electrons generated as ionization products * The secondary winding, or the electrical or electronic circuit connected to the secondary winding i ...

documenting distress in other contexts, psychosocial distress will be mainly discussed in the context of

oncology Oncology is a branch of medicine that deals with the study, treatment, diagnosis, and prevention of cancer. A medical professional who practices oncology is an ''oncologist''. The name's Etymology, etymological origin is the Greek word ὄγ ...

Although the terms "

psychological Psychology is the scientific study of mind and behavior. Its subject matter includes the behavior of humans and nonhumans, both consciousness, conscious and Unconscious mind, unconscious phenomena, and mental processes such as thoughts, feel ...

" and "psychosocial" are frequently used interchangeably, their

definition A definition is a statement of the meaning of a term (a word, phrase, or other set of symbols). Definitions can be classified into two large categories: intensional definitions (which try to give the sense of a term), and extensional definitio ...

s are different. While "Psychological" refers to an individual’s

mental Mental may refer to: * of or relating to the mind Films * ''Mental'' (2012 film), an Australian comedy-drama film starring Toni Collette * ''Mental'' (2016 film), a Bangladeshi romantic-action film starring Shakib Khan * ''Mental'', a 2008 docu ...

and

al state, "Psychosocial" refers to how one's

idea In philosophy and in common usage, an idea (from the Greek word: ἰδέα (idea), meaning 'a form, or a pattern') is the results of thought. Also in philosophy, ideas can also be mental representational images of some object. Many philosophe ...

feeling According to the '' APA Dictionary of Psychology'', a feeling is "a self-contained phenomenal experience"; feelings are "subjective, evaluative, and independent of the sensations, thoughts, or images evoking them". The term ''feeling'' is closel ...

s, and

behavior Behavior (American English) or behaviour (British English) is the range of actions of Individual, individuals, organisms, systems or Artificial intelligence, artificial entities in some environment. These systems can include other systems or or ...

s influence and are influenced by social circumstances. While

psychological distress Mental distress or psychological distress encompasses the symptoms and experiences of a person's internal life that are commonly held to be troubling, confusing or out of the ordinary. Mental distress can potentially lead to a change of behavior, ...

refers to the influence of internal processes on psychological wellbeing, psychosocial factors additionally include external, social, and

interpersonal In social psychology, an interpersonal relation (or interpersonal relationship) describes a social association, connection, or affiliation between two or more people. It overlaps significantly with the concept of social relations, which are ...

influences. Psychosocial distress is commonly caused by clinically related trauma, personal life changes, and extraneous stressors, which negatively influences the patient's mood,

cognition Cognition is the "mental action or process of acquiring knowledge and understanding through thought, experience, and the senses". It encompasses all aspects of intellectual functions and processes such as: perception, attention, thought, ...

, and interpersonal activity, eroding the patient's

wellbeing Well-being is what is ultimately good for a person. Also called "welfare" and "quality of life", it is a measure of how well life is going for someone. It is a central goal of many individual and societal endeavors. Subjective well-being ref ...

and

. Symptoms manifest as

psychological disorders A mental disorder, also referred to as a mental illness, a mental health condition, or a psychiatric disability, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. A mental disorder is ...

, decreased ability to work and communicate, and a range of health issues related to stress and

metabolism Metabolism (, from ''metabolē'', "change") is the set of life-sustaining chemical reactions in organisms. The three main functions of metabolism are: the conversion of the energy in food to energy available to run cellular processes; the co ...

. Distress management aims to improve the disease symptoms and

of patients, it involves the screening and

triage In medicine, triage (, ; ) is a process by which care providers such as Health professional, medical professionals and those with first aid knowledge determine the order of priority for providing treatment to injured individuals and/or inform th ...

of patients to optimal treatments and careful outcome monitoring. However,

stigmatization Stigma, originally referring to the visible marking of people considered inferior, has evolved to mean a negative perception or sense of disapproval that a society places on a group or individual based on certain characteristics such as their ...

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 Worrying is the mental distress or agitation resulting from anxiety, usually coming from a place of anticipatory fear (terror) or fear coming from a present threat (horror). With more understanding of the situation, worry becomes concern, the ...

) that negative impacts an individual's well-being and quality of life. When in psychosocial

anguish Anguish (from the Latin ''angustia'' "distress") is "extreme unhappiness caused by physical or mental suffering." The feeling of anguish is typically preceded by a tragedy or event that has a profound meaning to the being in question. Anguish can ...

, an individual may appear detached and avoid

interpersonal communication Interpersonal communication is an exchange of information between two or more people. It is also an area of research that seeks to understand how humans use verbal and nonverbal cues to accomplish several personal and relational goals. Communica ...

. In addition, the ability to perform up to standard in the

workplace A workplace is a location where someone works, for their employer or themselves, a place of employment. Such a place can range from a home office to a large office building or factory. For industrialized societies, the workplace is one of the ...

can be impacted due to psychosocial

discomfort Comfort is a state of physical or psychological ease, often characterized by the absence of hardship. Individuals experiencing a lack of comfort are typically described as uncomfortable or in discomfort. A degree of psychological comfort can b ...

. 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 hormone Stress hormones are secreted by endocrine glands to modify one's internal environment during times of stress. By performing various functions such as mobilizing energy sources, increasing heart rate, and downregulating metabolic processes which ...

s (e.g.,

cortisol Cortisol is a steroid hormone in the glucocorticoid class of hormones and a stress hormone. When used as medication, it is known as hydrocortisone. Cortisol is produced in many animals, mainly by the ''zona fasciculata'' of the adrenal corte ...

) 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 Stroke is a medical condition in which poor cerebral circulation, blood flow to a part of the brain causes cell death. There are two main types of stroke: brain ischemia, ischemic, due to lack of blood flow, and intracranial hemorrhage, hemor ...

* cancer progression *

cardiovascular disease Cardiovascular disease (CVD) is any disease involving the heart or blood vessels. CVDs constitute a class of diseases that includes: coronary artery diseases (e.g. angina, heart attack), heart failure, hypertensive heart disease, rheumati ...

insomnia Insomnia, also known as sleeplessness, is a sleep disorder where people have difficulty sleeping. They may have difficulty falling asleep, or staying asleep for as long as desired. Insomnia is typically followed by daytime sleepiness, low ene ...

injury Injury is physiological damage to the living tissue of any organism, whether in humans, in other animals, or in plants. Injuries can be caused in many ways, including mechanically with penetration by sharp objects such as teeth or with ...

and

suicidal tendencies Suicidal Tendencies is an American crossover thrash band formed in 1980 in Venice, California, by vocalist Mike Muir. The band has undergone various lineup changes, with Muir as the only remaining original member. Their current lineup includes ...

These clinical health issues often further exacerbate the original psychological symptoms. Furthermore,

digestion Digestion is the breakdown of large insoluble food compounds into small water-soluble components so that they can be absorbed into the blood plasma. In certain organisms, these smaller substances are absorbed through the small intestine into th ...

, metabolism and other crucial bodily functions may be slowed down.

Screening/Diagnosis

Prior to 2014, the implementation of

evidence-based Evidence-based practice is the idea that occupational practices ought to be based on scientific evidence. The movement towards evidence-based practices attempts to encourage and, in some instances, require professionals and other decision-makers ...

distress screening in the healthcare setting was scarce. In 2014, to increase objectivity in distress screening based on

qualitative data Qualitative properties are properties that are observed and can generally not be measured with a numerical result, unlike Quantitative property, quantitative properties, which have numerical characteristics. Description Qualitative properties a ...

, 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 In common usage, evaluation is a systematic determination and assessment of a subject's merit, worth and significance, using criteria governed by a set of Standardization, standards. It can assist an organization, program, design, project or any o ...

, 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 Pragmatism is a philosophical tradition that views language and thought as tools for prediction, problem solving, and action, rather than describing, representing, or mirroring reality. Pragmatists contend that most philosophical topics� ...

", "

Family Family (from ) is a Social group, group of people related either by consanguinity (by recognized birth) or Affinity (law), affinity (by marriage or other relationship). It forms the basis for social order. Ideally, families offer predictabili ...

", "

Emotion Emotions are physical and mental states brought on by neurophysiology, neurophysiological changes, variously associated with thoughts, feelings, behavior, behavioral responses, and a degree of pleasure or suffering, displeasure. There is ...

al", " 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

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 Generalized anxiety disorder (GAD) is an anxiety disorder characterized by excessive, uncontrollable and often irrational worry about events or activities. Worry often interferes with daily functioning. Individuals with GAD are often overly con ...

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 Mental health is often mistakenly equated with the absence of mental illness. However, mental health refers to a person's overall emotional, psychological, and social well-being. It influences how individuals think, feel, and behave, and how t ...

and social work institutions.

4. Follow-up

Providing patients with follow up information,

discussion Conversation is interactive communication between two or more people. The development of conversational skills and etiquette is an important part of socialization. The development of conversational skills in a new language is a frequent focus ...

and

communication Communication is commonly defined as the transmission of information. Its precise definition is disputed and there are disagreements about whether Intention, unintentional or failed transmissions are included and whether communication not onl ...

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.

Distress Management (DM)

Psychosocial Distress Management (DM) is mandatory in oncology care for every phase of disease treatment, and it involves screening,

assessment Assessment may refer to: Healthcare * Health assessment, identifies needs of the patient and how those needs will be addressed *Nursing assessment, gathering information about a patient's physiological, psychological, sociological, and spiritual ...

, intervention and outcome monitoring. Each stage is personalized based on individual factors of age, race/

ethnicity An ethnicity or ethnic group is a group of people with shared attributes, which they Collective consciousness, collectively believe to have, and long-term endogamy. Ethnicities share attributes like language, culture, common sets of ancestry, ...

, sex,

LGBTQ LGBTQ people are individuals who are lesbian, Gay men, gay, bisexual, transgender, queer, or questioning (sexuality and gender), questioning. Many variants of the initialism are used; LGBTQIA+ people incorporates intersex, Asexuality, asexual, ...

socio-economic status Socioeconomic status (SES) is a measurement used by economists and sociologsts. The measurement combines a person's work experience and their or their family's access to economic resources and social position in relation to others. In commo ...

, physical/ cognitive limitations,

literacy Literacy is the ability to read and write, while illiteracy refers to an inability to read and write. Some researchers suggest that the study of "literacy" as a concept can be divided into two periods: the period before 1950, when literacy was ...

substance abuse Substance misuse, also known as drug misuse or, in older vernacular, substance abuse, is the use of a drug in amounts or by methods that are harmful to the individual or others. It is a form of substance-related disorder, differing definition ...

history, as recommended by the APOS and Association of Oncology Social Work's (AOSW) 2021 consensus panel. DM management steps

Patients and their

caregiver A caregiver, carer or support worker is a paid or unpaid person who helps an individual with activities of daily living. Caregivers who are members of a care recipient's family or social network, who may have specific professional training, are o ...

s are proactively screened for distress at regular intervals and (optimally) every medical visit, as early detection is essential for avoidance of severe distress symptoms.

Frequency Frequency is the number of occurrences of a repeating event per unit of time. Frequency is an important parameter used in science and engineering to specify the rate of oscillatory and vibratory phenomena, such as mechanical vibrations, audio ...

of screening increases with the stage of the disease, as the risk of distress increases with severity of disease symptoms. Positively assessed patients are triaged to optimal interventions, while their clinical contacts and referrals are tracked by the health institution to ensure treatment is received. These targeted referrals are made towards optimal evidence-based treatments based on the patient's specific psychosocial symptoms and individual factors, with adherence to the NCCN's 2020 guidelines.

Treatment/ Intervention

The

goal A goal or objective is an idea of the future or desired result that a person or a group of people envision, plan, and commit to achieve. People endeavour to reach goals within a finite time by setting deadlines. A goal is roughly similar to ...

of DM is to relieve mental distress, raise the wellbeing of patients, and improve cancer treatment outcomes. Evidence-based interventions are classified into 1st-line interventions and 2nd-line interventions, whose effectiveness vary depending on the patient's individual characteristics and symptoms. Fetzima 1

These interventions are often administered in combination, in which nonpharmacological psychosocial interventions are recommended over antidepressant medication due to its higher risk-benefit ratio. Development for the use of digital platforms (such as

mobile app A mobile application or app is a computer program or software application designed to run on a mobile device such as a smartphone, phone, tablet computer, tablet, or smartwatch, watch. Mobile applications often stand in contrast to desktop appli ...

lications, internet-based,

virtual reality Virtual reality (VR) is a Simulation, simulated experience that employs 3D near-eye displays and pose tracking to give the user an immersive feel of a virtual world. Applications of virtual reality include entertainment (particularly video gam ...

) in DM is still in its early stages. Outcome monitoring should be conducted to ensure treatment success.

Society & Culture

Stigma of Distress

Stigmatization of

mental distress Mental distress or psychological distress encompasses the symptoms and experiences of a person's internal life that are commonly held to be troubling, confusing or out of the ordinary. Mental distress can potentially lead to a change of behavior, ...

and

illnesses A disease is a particular abnormal condition that adversely affects the structure or function of all or part of an organism and is not immediately due to any external injury. Diseases are often known to be medical conditions that are asso ...

is prevalent across many sectors of

society A society () is a group of individuals involved in persistent social interaction or a large social group sharing the same spatial or social territory, typically subject to the same political authority and dominant cultural expectations. ...

. This stigma is driven by presumptions that the patient suffering is to blame for their mental disorder, the socioeconomic disadvantages brought by mental illness (e.g.,

insurance Insurance is a means of protection from financial loss in which, in exchange for a fee, a party agrees to compensate another party in the event of a certain loss, damage, or injury. It is a form of risk management, primarily used to protect ...

, hiring discrimination), and by

health professional A health professional, healthcare professional (HCP), or healthcare worker (sometimes abbreviated as HCW) is a provider of health care treatment and advice based on formal training and experience. The field includes those who work as a Nursing, nur ...

s reluctant to diagnose mental disorders due to such stigmatization, leading to a low level of development in psychiatric research and a low level of confidence in professional treatment effectiveness. Some cultures (e.g.,

rural In general, a rural area or a countryside is a geographic area that is located outside towns and cities. Typical rural areas have a low population density and small settlements. Agricultural areas and areas with forestry are typically desc ...

) promote

independence Independence is a condition of a nation, country, or state, in which residents and population, or some portion thereof, exercise self-government, and usually sovereignty, over its territory. The opposite of independence is the status of ...

and

self-affirmation Self-affirmation theory is a psychological theory that focuses on how individuals adapt to information or experiences that are threatening to their self-concept. Claude Steele originally popularized self-affirmation theory in the late 1980s,Stee ...

that deter patients from reporting symptoms and receiving treatment. Instead, alternatives such as

religion Religion is a range of social system, social-cultural systems, including designated religious behaviour, behaviors and practices, morals, beliefs, worldviews, religious text, texts, sanctified places, prophecies, ethics in religion, ethics, or ...

and

cognitive reframing Cognitive reframing is a psychological technique that consists of identifying and then changing the way situations, experiences, events, ideas and emotions are viewed. Cognitive reframing is the process by which such situations or thoughts are chal ...

(using

prayer File:Prayers-collage.png, 300px, alt=Collage of various religionists praying – Clickable Image, Collage of various religionists praying ''(Clickable image – use cursor to identify.)'' rect 0 0 1000 1000 Shinto festivalgoer praying in front ...

s and narrative construction to encourage

self-acceptance Self-acceptance is acceptance of self. Definition Self-acceptance can be defined as: * the awareness of one's strengths and weaknesses, * the realistic (yet subjective) appraisal of one's talents, capabilities, and general worth, and, * feeling ...

) are common

coping mechanisms Coping Mechanism(s) may refer to: * ''Coping Mechanism'' (album) * ''Coping Mechanisms'' (Si Schroeder album) * ''Coping Mechanisms'' (Tayla Parx album) * Coping mechanism Coping refers to conscious or unconscious strategies used to reduce ...

against distress. Hence, in cases where patients decline psychosocial support, educational materials should be provided, accessibility improved via

advertising Advertising is the practice and techniques employed to bring attention to a Product (business), product or Service (economics), service. Advertising aims to present a product or service in terms of utility, advantages, and qualities of int ...

, and comprehensive care integrated in the normal disease treatment.

History of Psychosocial Distress in Oncology

In the 1990s, under recognition, medical coverage, and treatment of psychosocial symptoms stemmed from heavy stigmatization of the term “Psychological Distress”. As a result, the term "Psychosocial Distress" was coined in 1999 by the National Comprehensive Cancer Network (NCCN), as a means to differentiate between the two and destigmatize such discussion between healthcare providers and patients. At the same time, they released the first psychosocial distress guidelines, where early standards were set for distress management. However, adherence to these guidelines was lacking until in 2015, "Psychosocial Support" was officialized as a criterion in Commission on Cancer (CoC) accreditation by the American College of Surgeons (ACS), which raised universal recognition of distress.

Research directions

Research is needed for psychosocial care models, care disparities (for vulnerable populations), mental-emotional-relational health,

population health Population health has been defined as "the health outcomes of a group of individuals, including the distribution of such outcomes within the group". It is an approach to health that aims to improve the health of an entire human population. It ha ...

(with demographic diversity) and digital health interventions, according to the APOS Roadmap. In addition, there needs to be more research on how metastatic/advanced disease and

demographic characteristics Demography () is the statistical study of human populations: their size, composition (e.g., ethnic group, age), and how they change through the interplay of fertility (births), mortality (deaths), and migration. Demographic analysis examine ...

(e.g., gender influence) can impact treatment effectiveness. Following the

COVID-19 epidemic The COVID-19 pandemic (also known as the coronavirus pandemic and COVID pandemic), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), began with an disease outbreak, outbreak of COVID-19 in Wuhan, China, in December ...

(2019-2023), further development of psychosocial crisis prevention and intervention models in an epidemic scenario is essential.

References

{{Reflist Mental states Stress (biological and psychological)