title: New Perspective on Psychosocial Distress in Patients with Dysphonia: The Moderating Role of Perceived Control.
abstract: OBJECTIVE
  Although an association between psychosocial distress (depression, anxiety, somatization, and perceived stress) and voice disorders has been observed, little is known about the relationship between distress and patient-reported voice handicap. Furthermore, the psychological mechanisms underlying this relationship are poorly understood. Perceived control plays an important role in distress associated with other medical disorders. The objectives of this study were to (1) characterize the relationship between distress and patient-reported voice handicap and (2) examine the role of perceived control in this relationship.
  
  
  METHODS
  This is a cross-sectional study in a tertiary care academic voice clinic.
  
  
  METHODS
  Distress, perceived stress, voice handicap, and perceived control were measured using established assessment scales. Association was measured with Pearson correlation coefficients; moderation was assessed using multiple hierarchical regression.
  
  
  RESULTS
  A total of 533 patients enrolled. Thirty-four percent of the patients met criteria for clinically significant distress (ie, depression, anxiety, and/or somatization). A weak association (r = 0.13; P = 0.003) was observed between severity of psychosocial distress and vocal handicap. Present perceived control was inversely associated with distress (r = -0.41; P < 0.0001), stress (r = -0.30; P < 0.0001), and voice handicap (r = -0.30; P < 0.0001). The relationship between voice handicap and psychosocial distress was moderated by perceived control (b for interaction term, -0.15; P < 0.001); greater vocal handicap was associated with greater distress in patients with low perceived control.
  
  
  CONCLUSIONS
  Severity of distress and vocal handicap were positively related, and the relation between them was moderated by perceived control. Vocal handicap was more related to distress among those with low perceived control; targeting this potential mechanism may facilitate new approaches for improved care.
authors: Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Minnesota, Minneapolis MN. Electronic address: smisono@umn.edu.
authors: Stephanie
authors: S
authors: Misono
authors: Department of Psychology, University of Minnesota, Minneapolis MN.
authors: Liza
authors: L
authors: Meredith
authors: Department of Psychology, University of Minnesota, Minneapolis MN; Department of Psychiatry, School of Medicine, University of Minnesota, Minneapolis MN.
authors: Carol B
authors: CB
authors: Peterson
authors: Department of Psychology, University of Minnesota, Minneapolis MN.
authors: Patricia A
authors: PA
authors: Frazier
mesh_terms: D001007:Anxiety / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology*; D003430:Cross-Sectional Studies; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology*; D004185:Disability Evaluation; D055154:Dysphonia / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008910:Minnesota / Q000453:epidemiology; D010465:Perception; D015995:Prevalence; D011446:Prospective Studies; D000068356:Self-Control; D012720:Severity of Illness Index; D013001:Somatoform Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology*; D013315:Stress, Psychological / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology*; D014833:Voice Quality
keywords: Anxiety; Depression; Moderation; Perceived control; Psychosocial distress; Somatization; Stress; Voice disorder; Voice handicap