Addressing Suffering in Patients With Psychiatric Disorders

A cross-national analysis of sociodemographic variation in suffering across 22 countries

BACKGROUND

Suffering has been identified as an important public health issue worthy of closer attention. This preregistered study takes an initial step toward developing an epidemiology of suffering by exploring the distribution of suffering in 22 countries and testing for sociodemographic disparities in suffering.

METHODS

Using nationally representative data from the first wave of the Global Flourishing Study (N = 202,898), we estimated the proportion of people who endorsed some/a lot of suffering in each country. Variation in proportions of suffering across the categories of 9 sociodemographic characteristics (age, gender, marital status, employment status, years of education, immigration status, frequency of religious service attendance, religious affiliation, racial/ethnic identity) were estimated separately for each country. We aggregated country-level estimates of suffering for specific sociodemographic categories using random effects meta-analyses.

RESULTS

We find that the proportion of country-specific populations experiencing suffering varies considerably, ranging from 0.24 (Poland) to 0.60 (Türkiye). Country-level results provide evidence of cross-national heterogeneity in suffering for all sociodemographic categories, although variation is greater for some categories than others. Meta-analytic results support differences in suffering based on marital status, employment status, and years of education across the countries, with the highest suffering observed among those who have separated from their spouse, are either unemployed and looking for a job or endorse the none of these/other employment status category, and have completed 8 or fewer years of education.

CONCLUSIONS

Suffering varies across countries and sociodemographic categories. Our findings lay the foundation for population-level monitoring of suffering and a population health agenda to address suffering among vulnerable subpopulations.

Development of the Self-Directed TRANSCEND Suffering Workbook Intervention: A Population Health Psychology Approach for 'Everyday' Suffering

The discipline of psychology has long been interested in understanding human suffering and identifying suitable approaches for effectively managing it. Although there are many clinical models invoking different philosophical worldviews and therapeutic approaches for addressing suffering, they typically require trained professionals and, therefore, are not widely accessible to the general population. Empirical evidence suggests that even 'everyday' experiences of suffering in nonclinical populations can negatively impact mental health and well-being, which has ushered in calls for a population health psychology approach by developing accessible, affordable, and scalable interventions that attend to the experience of suffering. As a response to such calls, we developed the TRANSCEND Suffering workbook, a brief self-directed workbook intervention for suffering. This project report describes the first phase of the workbook development process, including its scope, theoretical underpinnings, central change objectives, organization, and engagement targets. We summarize feedback that laypeople and experts spanning various academic and applied disciplines provided about the workbook and discuss how this feedback was evaluated and used to make refinements aimed at enhancing the utility of the workbook. While empirical testing is needed to determine the efficacy of the TRANSCEND Suffering workbook, we discuss some potential implications (along with caveats and limitations) of this low-intensity intervention for addressing population-level suffering, facilitating growth through suffering, and promoting human flourishing.

A Two-Way Communication Between Apical Periodontitis and Various Systemic Disorders: A Narrative Review

One prevalent inflammatory disorder that affects the mouth is apical periodontitis. It starts with an infection in the tooth's pulp chamber. The periapical bone may eventually deteriorate as a result of this infection spreading there. Systemic immune responses are triggered when inflammatory cytokines generated in periapical lesions and pathogens and their metabolites in the periapical tissues enter the bloodstream. Numerous systemic disorders may emerge as a result of this procedure. Although endodontic infections can be influenced by systemic disorders, there is ample evidence that these infections can also result in bodily changes that impair general health. Therefore, rather than being a limited oral problem, apical periodontitis may be associated with systemic illnesses. Furthermore, individuals with chronic inflammation-related diseases may experience hyperinflammatory states, which could influence the progression or outcome of apical periodontitis. The underlying mechanisms and the relationship between apical periodontitis and systemic diseases are still unknown. Even though this topic has been explored previously, new information has just come to light. This review's objective is to evaluate the body of knowledge regarding the evolving relationships between endodontic therapy, apical periodontitis, and systemic health. Gaining a better understanding of this relationship will help medical professionals identify risk factors and enhance the recovery of apical periodontitis and systemic illnesses.

Defining suffering in pain: a systematic review on pain-related suffering using natural language processing

ABSTRACT

Understanding, measuring, and mitigating pain-related suffering is a key challenge for both clinical care and pain research. However, there is no consensus on what exactly the concept of pain-related suffering includes, and it is often not precisely operationalized in empirical studies. Here, we (1) systematically review the conceptualization of pain-related suffering in the existing literature, (2) develop a definition and a conceptual framework, and (3) use machine learning to cross-validate the results. We identified 111 articles in a systematic search of Web of Science, PubMed, PsychINFO, and PhilPapers for peer-reviewed articles containing conceptual contributions about the experience of pain-related suffering. We developed a new procedure for extracting and synthesizing study information based on the cross-validation of qualitative analysis with an artificial intelligence-based approach grounded in large language models and topic modeling. We derived a definition from the literature that is representative of current theoretical views and describes pain-related suffering as a severely negative, complex, and dynamic experience in response to a perceived threat to an individual's integrity as a self and identity as a person. We also offer a conceptual framework of pain-related suffering distinguishing 8 dimensions: social, physical, personal, spiritual, existential, cultural, cognitive, and affective. Our data show that pain-related suffering is a multidimensional phenomenon that is closely related to but distinct from pain itself. The present analysis provides a roadmap for further theoretical and empirical development.

Palliative Care Psychiatry: Building Synergy Across the Spectrum

PURPOSE OF REVIEW

Palliative care (PC) psychiatry is a growing subspecialty focusing on improving the mental health of those with serious medical conditions and their caregivers. This review elucidates the current practice and ongoing evolution of PC psychiatry.

RECENT FINDINGS

PC psychiatry leverages training and clinical practices from both PC and psychiatry, addressing a wide range of needs, including enhanced psychiatric care for patients with serious medical illness, PC access for patients with medical needs in psychiatric settings, and PC-informed psychiatric approaches for individuals with treatment-refractory serious mental illness. PC psychiatry is practiced by a diverse workforce comprising hospice and palliative medicine-trained psychiatrists, psycho-oncologists, geriatric psychiatrists, other mental health professionals, and non-psychiatrist PC clinicians. As a result, PC psychiatry faces challenges in defining its operational scope. The manuscript outlines the growth, current state, and prospects of PC psychiatry. It examines its roles across various healthcare settings, including medical, integrated care, and psychiatric environments, highlighting the unique challenges and opportunities in each. PC psychiatry is a vibrant and growing subspecialty of psychiatry that must be operationalized to continue its developmental trajectory. There is a need for a distinct professional identity for PC psychiatry, strategies to navigate administrative and regulatory hurdles, and greater support for novel clinical, educational, and research initiatives.

Encountering suffering in digital care: a qualitative study of providers' experiences in telemental health care

BACKGROUND

Encountering patients who are suffering is common in health care, and particularly when providing mental health care. Telehealth technologies are increasingly used to provide mental health care, yet little is known about the experiences of providers when encountering patients who are suffering within remote care. The present study explored health care providers' lived experiences of encountering patient suffering during telemental health care.

METHODS

A qualitative phenomenological approach was used to uncover participants' experiences. In-depth interviews were conducted with a purposive sample of physicians, psychologists, and therapists who used telemental health in varied clinical practices in Sweden. Data were analyzed using descriptive phenomenology.

RESULTS

Telehealth care with patients who were suffering was experienced by providers as loose connections, both literally in compromised functioning of the technology and figuratively in a compromised ability connecting emotionally with patients. Providers' lived experiences were explicated into the following aspects: insecurity in digital practice, inaccessibility of the armamentarium, and conviction in the value of telehealth care. Interpersonal connection between patient and provider is necessary. Worry and guilt arose for providers with fears that technology would not work, patient status was deteriorated, or the care needed could not be delivered. Providers overcame barriers in telehealth encounters, and expressed they perceived that patients appreciated the care received, and through it found relief.

CONCLUSIONS

This study brings an understanding of experiences in providing telemental care for patients who are suffering. Providers experience challenges in connecting with patients, and in accessing tools needed to enable reaching the goals of the caring encounter. Efforts to ensure functioning of technology, comfort with its use, and accessibility of tools might be some accommodations to support providers for successful and rewarding telehealth care encounters.