Trait vs. state anxiety in different threatening situations

An Analysis of Student Anxiety Affecting on Online Learning on Conceptual Applications in Physics: Synchronous vs. Asynchronous Learning

This study examines the impact of students’ anxiety, due to online learning, in different learning environments: a synchronous (Zoom) and asynchronous learning environment (YouTube) to compare students’ conceptual understanding of electric circuits. Multiple linear regression and factor analyses were conducted to examine the factor of students’ anxiety and conceptual understanding. A sample of 99 vocational students participated in the study, including YouTube (n = 49) and Zoom (n = 50) groups. The DIRECT was used to diagnose test for conceptual understanding in the electric circuits, and OTAI was used to assess anxiety in online learning test. The OTAI consists of three factors: psychological, physiological, and online. The results showed that students’ anxiety, in some factors, affected their conceptual understanding of the electric circuits in both groups. However, there was a significant increase in conceptual understanding in both treatment groups. Although the students’ conceptual understanding had a slight increase, online learning has to improve to reduce the anxiety of learners.

Network modeling of anxiety and psychological characteristics on suicidal behavior: Cross-sectional study

BACKGROUND

Suicide is influenced by complex interactions among various psychopathological features. We aimed to examine the relationship between suicide risk and psychological risk factors such as defense mechanisms, personality, and anxiety.

METHODS

We established a psychiatric database by utilizing the Observational Medical Outcomes Partnership Common Data Model. We conducted a 1:1 propensity score matching with age, sex, and depression severity, and identified a sample (n = 258) with two groups: those with suicidal behavior and those with non-suicidal behavior. Using principal component analysis, we extracted nine psychological scales and applied network analysis to compare relationships among psychological factors between the two groups.

RESULTS

Patients with non-suicidal behaviors showed associations between trait anxiety and defense mechanisms, while those with suicidal behaviors did not. For patients with suicidal ideation there was an association between somatization and trait anxiety. Patients with suicide attempts showed associations between paranoia and dissociation connected to trait anxiety.

LIMITATIONS

Longitudinal research is required to fully observe transitions from suicidal ideation to attempts and recurrent suicidal events. In addition, these networks may not generalize suicidal behaviors because the group participants are not homogeneous. Lastly, data from self-report questionnaires limits the reliability of responses.

CONCLUSIONS

We presented important new insights on suicidal behavior by estimating psychological networks. Patients with non-suicidal behavior may exhibit discrete relationships between defense mechanisms and anxiety, compared to those with suicidal behavior. Patients with suicidal ideation and suicide attempts may show distinct associations between anxiety and psychopathological features.

Interactions between Sleep and Emotions in Humans and Animal Models

Recently, increased interest and efforts were observed in describing the possible interaction between sleep and emotions. Human and animal model studies addressed the implication of both sleep patterns and emotional processing in neurophysiology and neuropathology in suggesting a bidirectional interaction intimately modulated by complex mechanisms and factors. In this context, we aimed to discuss recent evidence and possible mechanisms implicated in this interaction, as provided by both human and animal models in studies. In addition, considering the affective component of brain physiological patterns, we aimed to find reasonable evidence in describing the two-way association between comorbid sleep impairments and psychiatric disorders. The main scientific literature databases (PubMed/Medline, Web of Science) were screened with keyword combinations for relevant content taking into consideration only English written papers and the inclusion and exclusion criteria, according to PRISMA guidelines. We found that a strong modulatory interaction between sleep processes and emotional states resides on the activity of several key brain structures, such as the amygdala, prefrontal cortex, hippocampus, and brainstem nuclei. In addition, evidence suggested that physiologically and behaviorally related mechanisms of sleep are intimately interacting with emotional perception and processing which could advise the key role of sleep in the unconscious character of emotional processes. However, further studies are needed to explain and correlate the functional analysis with causative and protective factors of sleep impairments and negative emotional modulation on neurophysiologic processing, mental health, and clinical contexts.

The role of death anxiety on marksmanship performance: a virtual reality simulator study

Despite the well-established relationship between state anxiety and marksmanship performance, few efforts have examined the individual differences that affect the extent to which individuals experience state anxiety in combat situations. Thus, further studies are needed to increase the probability of mission accomplishment, which could ultimately serve to safely bring soldiers home. The present study examined how death anxiety, a trait-based difference affects state anxiety, which in turn affects shooting performance on a battlefield. In particular, we used a virtual reality simulator to create a realistic engagement setting in which simulated death anxiety is salient. On a sample of 99 active-duty enlisted men in the Republic of Korea Army, we found that death anxiety, and not trait anxiety, increased state anxiety, which in turn decreased marksmanship performance. Overall, the current findings highlight the role of death anxiety in combat situations. The practical implications and avenues for future research are also discussed.

COVID-19-Related Anxiety and Cognition in Middle-Aged and Older Adults: Examining Sex as a Moderator

Aging populations experience disproportionate risk for cognitive decline, which may be exacerbated by coronavirus (COVID-19) illness, particularly among women. This study tested sex as a moderator of associations between COVID-19 state anxiety and cognition in middle-aged/older adults. Adults aged 50+ (N = 275; 151 men/124 women) completed the Coronavirus Anxiety Scale and Cognitive Failures Questionnaire online from remote locations in July/August 2020. A subset of participants (n = 62) completed an objective cognitive task (Stroop). Multiple regressions determined whether sex moderated associations between COVID-19 anxiety and cognitive outcomes. Sex was a significant moderator, such that for women (not men), greater COVID-19 anxiety was associated with more memory failures and blunders (subjective measures) and worse processing speed (objective measure). COVID-19 state anxiety is linked to everyday cognition and processing speed in women, but not men. Consistency across subjective and objective measures promotes the need for sex-specific understanding of the pandemic’s behavioral and cognitive effects in mid-to-late life.

Mental Health Outcomes and Mental Hygiene in the COVID-19 Era: A Cross-Sectional Study Among Healthcare Workers from a Regional Hospital in Ghana

Purpose

The COVID-19 pandemic is affecting healthcare workers (HCWs) in unique ways which include the risk of infection and subsequent transmission to their colleagues and families, the issue of vulnerability due to lack of PPEs and access to equipment needed to provide best care for patients, moral injury in making triage decisions, the lack of professional and/or social support and psychological burdens during this period. This study thus investigates the mental health outcomes (fear, depression, anxiety, and stress) and mental hygiene among HCWs in Ghana in this COVID-19 era.

Methods

The study adopted a descriptive cross-sectional design.

Results

Our findings revealed a shared count of psychological outcomes among HCWs in Ghana. State anxiety was a prominent psychological outcome among HCWs. Being a female HCW was significantly associated with state anxiety. Correlation analysis showed a positive and significant relationship among all the psychological outcomes at P<0.05 and 0.01. There were no mental hygiene systems and/or structures in place at the regional hospital.

Conclusion

It is recommended that healthcare facilities and systems must swiftly implement and establish mental hygiene structures for their HCWs in this period of the pandemic to secure holistic, balanced life, and professional support for HCWs now and beyond this pandemic.

Validation of a Computerized Version of the Trait Subscale of the Physical Appearance State and Trait Anxiety Scale in Mexican Preadolescents

Anxiety is a feeling of fear, dread or restlessness and can develop into a weight-related disorder. The objective was to analyze the psychometric properties of the trait anxiety subscale of the Physical Appearance State and Trait Anxiety Scale (PASTAS), as well as the invariance in Mexican preadolescents. The sample consisted of 604 participants, 285 female and 319 male, whose ages ranged between 11 and 12 years (M = 11.37; SD = 0.48). The questionnaire’s factor structure was analyzed using confirmatory factor analyses. The analyses show the viability and adequacy of a two-factor structure (weight and non-weight factors) both for the total sample and for the populations of male and female. The two-factor structure showed adequate reliability and validity fit indicators. The factor structure, the factor loadings and intercepts are considered invariant according to the variable sex; however, differences between female and male participants were found for levels of anxiety caused by physical appearance. In conclusion, the PASTAS can be considered a convenient instrument to assess the variables related to anxiety generated by one’s physical appearance, as well as allowing more participants to be quickly assessed.

Association between anxiety and mortality in patients with congestive heart failure after implantation of cardiac electronic devices

OBJECTIVE

Several studies suggest that psychological factors including anxiety are associated with negative outcomes and in particular higher mortality rates among heart failure (HF) patients. However, the impact of anxiety on mortality in patients with implanted cardiac devices has not been fully appreciated. The aim of this study was to assess the association between state (SA) and trait (TA) anxiety and all-cause mortality in patients with HF after cardiac electronic devices implantation.

METHODS

The monocentric prospective study enrolled 265 patients (215 men and 50 women) aged 23 to 84 years (mean age 57.1 ± 10.0), who received cardiac resynchronization therapy or cardioverter-defibrillator implantation. Mean duration of prospective follow-up was 62.3 ± 36.6 months. State-Trait Anxiety Inventory (STAI) was used to measure anxiety symptoms. Cox proportional hazards multivariate regression model was used to calculate hazard ratio (HR) of all-cause mortality with 95% confidence interval (95% CI).

RESULTS

During the prospective follow-up period, 45 (17.0%) patients died due to all causes. According to quantitative analysis, HR for death used for SA scale was 1.04 (95% CI 1.00-1.07, p = 0.07) and for the TA scale 1.02 (95% CI 0.99-1.05, p = 0.21). Analysis of categorical indicators found statistically significant higher HR of mortality in patients with severe SA (2.35, 95% CI 1.17-4.71, p = 0.02), and TA (2.02, 95% CI 1.04-3.94, p = 0.04).

CONCLUSION

High levels of SA and TA was significantly and independently associated with a high risk of all-cause mortality in patients, who underwent implantation of cardiac electronic devices.

Prenatal Anxiety and Exercise. Systematic Review and Meta-Analysis

The prevalence of prenatal anxiety has increased during the COVID-19 pandemic. Anxiety is associated with other cardiovascular, physiological, and mental illnesses, resulting in adverse health effects for the mother and foetus. The purpose of this study was to evaluate the effects of physical activity (PA) during pregnancy on the prevalence of prenatal anxiety or symptoms of anxiety. A systematic review and two meta-analyses were performed (Registration No. CRD42021275333). Peer-reviewed articles reporting the effect of a PA intervention on anxiety during pregnancy were included. The first meta-analysis (MA) included 10 studies reporting final scores of prenatal anxiety. A negative association between moderate PA during pregnancy and prenatal anxiety was found in this analysis (z = −2.62, p < 0.01; ES = −0.46, 95% CI = −0.80, −12, I2 = 84%, Pheterogeneity = 0.001). The second MA included eight studies in which measures both before and after a PA intervention were reported. The findings of this analysis revealed a positive association between exercise practice during pregnancy and a decrease in prenatal anxiety scores (z = −3.39, p < 0.001; ES = −0.48, 95% CI = −0.76, −0.20, I2 = 71%, Pheterogeneity = 0.001). Supervised PA during pregnancy could prevent and reduce prenatal anxiety and anxiety symptoms.

Assessing the Nomological Network of the South African Personality Inventory With Psychological Traits

The purpose of this study was to expand internal construct validity and equivalence research of the South African Personality Inventory (SAPI), as well as to investigate the nomological validity of the SAPI by examining its relationship with specific and relevant psychological outcomes. The internal and external validity of the SAPI was assessed within three separate samples (N = 936). Using the combined data from all three samples, Exploratory Structural Equation Modelling (ESEM) indicated that the six-factor SAPI model fit proved to be excellent. Measurement invariance analyses showed that the SAPI dimensions in the ESEM model were invariant across gender and race groups. Next, two separate studies explored the associations of the SAPI factors with relevant psychological outcomes. An ESEM-within-CFA (set ESEM) method was used to add the factors into a new input file to correlate them with variables that were not part of the initial ESEM model. Both models generated excellent fit. In Study 1, psychological well-being and cultural intelligence were correlated with the SAPI factors within a sample of students and working adults. All of the psychological well-being dimensions significantly correlated with the SAPI factors, while for cultural intelligence, the highest correlations were between Meta-cognition and Openness and Meta-cognition and Positive Social-Relational Disposition. In Study 2, work locus of control and trait anxiety was correlated with the SAPI factors within a sample of adults from the general South African workforce. Work Locus of Control correlated with most factors of the SAPI, but more prominently with Positive Social-Relational Disposition, while Neuroticism correlated strongly with trait anxiety. Finding an appropriate internal structure that measures personality without bias in a culturally diverse context is difficult. This study provided strong evidence that the SAPI meets the demanding requirements of personality measurement in this context and generated promising results to support the relevance of the SAPI factors.

Association between Anxiety, Depressive Symptoms, and Quality of Life in Patients Undergoing Diagnostic Flexible Video Bronchoscopy

Bronchoscopy is one of the basic invasive procedures in pulmonology accompanied by patients’ anxiety. This study aimed to find an association between predictors of state anxiety/depression and patient’s quality of life (QOL) with pulmonary symptoms undergoing diagnostic flexible video bronchoscopy (FVB). A total of 125 adult patients before FVB were included in a prospective observational study. The quality of life (QOL) was assessed by WHOQOL-BREF questionnaire, the depression possibility by the Beck’s Depression Inventory-II (BDI-II), and the anxiety level by Spielberger’s State-Trait Anxiety Inventory (STAI-S; STAI-T). Results show that the older patients and patients with more comorbidities showed a significantly higher anxiety level. The previous FVB under deep sedation significantly reduced state anxiety. A significantly positive association was found between the STAI score and total BDI-II score. More severe symptoms of anxiety were especially related to lower QOL (physical health, psychological and environmental domains) in patients. Statistically higher trait anxiety in lower social QOL domain scores was observed. Our findings show that high state and trait anxiety were associated with higher depression scores and lower quality of life in the elderly. It seems that the elderly and patients at risk of depression development require more attention in the clinical setting to minimize the anxiety accompanying the bronchoscopy.

Emotionality and Quality of Life in Patients with Musculoskeletal Disorders

Introduction: It is well-known that musculoskeletal conditions are related with pain and anxiety. Anxiety is a complex concept that involves a transient state caused by different factors, as well as a persistent mood. Aim: The aim of the study is to reveal the associations between the discomfort caused by some musculoskeletal disorders and the emotionality (anxiety as a trait or a state) on the one hand and, on the other hand, the level of quality of life. Material and method: The study was cross-sectional and was performed in a period of 6 months on an outpatient basis of 174 patients with musculoskeletal disorders. Thus, we have taken into consideration 5 groups of patients, according to the presented medical condition: low back pain, law back osteoporosis, hand osteoarthritis, knee osteoarthritis, coxarthrosis. We have administered two scales to all the patients: The State Trait Anxiety Inventory (STAI) form X1 (anxiety a s a state) and form X2 (anxiety as a trait) and the Quality of Life (QOL) Results: For patients who were diagnosed with low back pain, quality of life was 60.71% of the maximum value. Anxiety by using the S.T.A.I. form X1 at an average value was 46.5, anxiety assessed by the STAI form X2 scale, indicates an average value of 39. In the case of osteoporosis, the value of their quality of life was 90.18%. Anxiety (form X1) was 36, and anxiety (form X2) was 52. For the patients diagnosed with hip osteoarthritis, respectively with knee osteoarthritis, the quality of life were 87.5% and 77.67%, anxiety (form X1) were 41 and 48, anxiety (form X2) were 47 and 61. For patients diagnosed with hand disorders, the quality of life was 81.25%, anxiety (form X1) was 62 and anxiety (form X2) was 47. Conclusions: It was found that in the case of the low back pain, the quality of life had the lowest value (60.71% of the maximum value). In knee osteoarthritis it was found the highest value of anxiety as a trait was 61, and the highest value of anxiety as a condition was found in osteoarthritis of the hand as 62. Keywords: anxiety, quality of life, musculoskeletal disorders,

Psychological Wellbeing of Parents with Infants Admitted to the Neonatal Intensive Care Unit during SARS-CoV-2 Pandemic

The current SARS-CoV-2 disease (COVID-19) pandemic is a sudden major stressor superimposed on pre-existing high distress in parents of infants admitted to the neonatal intensive care unit (NICU). This study aimed to investigate the psychological wellbeing of NICU parents during the COVID-19 pandemic. Forty-four parents of 25 inpatients of the Padua University Hospital NICU were included from June 2020 to February 2021. At 7–14 days postpartum parents completed the Edinburgh Postnatal Depression Scale (EPDS), State-Trait Anxiety Inventory (STAI), Parental Stressor Scale: NICU (PSS:NICU) and an ad-hoc questionnaire measuring parental COVID-19 related stress. About one third of parents reported extreme/high stress and a relevant negative impact on parenthood experience. Less time (82%) and less physical contact (73%) with infants due to COVID-19 preventive measures were the most frequent negative factors. Higher COVID-19 related parental stress was positively associated with anxiety, depression, NICU parental stress, stress related to NICU environment, and parental role alterations. Depression symptoms, stress related to infant condition and parental role alterations were higher in mothers. The pandemic affected parental emotional and relational wellbeing directly through additional stress due to COVID-19 concerns and indirectly through the impact of restrictions on the experience of becoming parents.

The association between anxiety and academic performance in children with reading disorder: A longitudinal cohort study

The purpose of this study was to examine the association between anxiety and overall academic performance (AP) in children with reading disorder (RD). This two-year longitudinal cohort study included 128 participants (aged 7-14 years) with RD. Anxiety symptoms were evaluated using the School Anxiety Scale - Teacher Report for the first year and the eight-item Spence Children's Anxiety Scale for the second year. AP was assessed by teacher ratings of progress in academic content areas, including reading, writing and math. Teachers completed evaluations every 3 months. We standardized all scores (to z scores). Multivariate linear regression models (adjusting for age, sex and Attention-Deficit/Hyperactivity Disorder symptoms) assessed the association cross-sectionally at each timepoint of survey completion. Repeated measures analysis using mixed models assessed the relationship longitudinally. Results from both univariate and multivariate analyses showed anxiety being significantly negatively associated with AP in children with RD, both cross-sectionally and longitudinally. Importantly, increased anxiety was significantly associated with reduced AP over time within an individual (adjusted β = -0.22, p = .002). This lends support to screening for anxiety disorders in children with RD. Future research should examine the directionality of this relationship, potential mediators in the pathway and whether interventions to reduce anxiety increase AP.

Culture Related Factors May Shape Coping During Pandemics

This study aimed to examine how anxiety related to different styles of coping during the COVID-19 pandemic and how these relationships were moderated by the cultural orientations of individualism/collectivism and a person’s sense of meaning in life. A sample of 849 participants from Georgia completed an online survey during the final stage of lockdown. To measure the main variables, we used the State Anxiety Inventory, the Horizontal and Vertical Individualism and Collectivism Scale, the Meaning of Life Questionnaire, the COVID-19 Worry Scale, and the Ways of Coping Scale tailored to COVID-19 pandemic. The latter measured rational coping via the subscales of information accessing/processing and action-planning coping, and affective coping – via the subscales of passive-submissive and avoidant coping. Results suggested that anxiety positively predicted both affective coping styles and negatively predicted the action-planning coping style, while COVID-19 worry predicted all coping styles; presence of meaning in life positively predicted both rational coping styles and negatively predicted the avoidant coping style, while search for meaning positively predicted all coping styles; individualism negatively predicted the passive-submissive style and positively predicted the action-planning style, whereas collectivism predicted all coping styles; furthermore, individualism and collectivism moderated the link between anxiety and the passive-submissive coping style, presence of meaning in life moderated the link between anxiety and avoidant coping style, while search for meaning in life moderated the link between anxiety and the action-planning coping style. Overall, the findings enrich the cultural transactional theory of stress and coping, and generate insights for the culture-sensitive approach to the meaning in life. The results were conceptualized vis-a-vis Georgia’s intermediate position between clear-cut individualism and clear-cut collectivism.

Effects of Social Distancing During the COVID-19 Pandemic on Anxiety and Eating Behavior-A Longitudinal Study

As social animals, humans need to live in groups. This contact with conspecifics is essential for their evolution and survival. Among the recommendations to reduce transmission of the new coronavirus (SARS-CoV-2) responsible for COVID-19 are social distancing and home confinement. These measures may negatively affect the social life and, consequently, the emotional state and eating behavior of individuals. We assessed the impact of the COVID-19 pandemic on the anxiety, premenstrual symptoms, and eating behavior of young women. Data collection was conducted in person (prepandemic—from March to December 2019) and online (during the pandemic—August 2020). A total of 71 participants, average age of 21.26 years (SD = 0.41), took part in the study. Trait anxiety during the pandemic was significantly lower than in the prepandemic period. Investigation of the “anxiety/stress” symptom of the Premenstrual Symptoms Screening Tool (PSST) revealed that this symptom was more severe before the pandemic. There was a decline in the desire for sweet and fatty foods during the pandemic. However, craving for traditional foods rose significantly in the same period. Uncontrolled and emotional eating were significantly lower during the pandemic. The results suggest that the pandemic may have had a positive impact on anxiety and eating behavior of the participants, which may be due to differences between urban and rural populations and the latter living with their families. These findings are important for raising a discussion regarding the effects of the current environment on the regulation of cognitive and dietary adaptations.

Producción científica sobre ansiedad bibliotecaria: un análisis bibliométrico y cienciométrico desde Scopus

La ansiedad bibliotecaria (AB) es el estado de incertidumbre que experimentan algunos usuarios cuando acuden a la biblioteca, cuyo estudio comenzó en los años 80, pero que carece de un análisis métrico actualizado. El objetivo de este estudio fue hacer un análisis bibliométrico y cienciométrico de los artículos sobre AB indizados en la base de datos Scopus entre 1989 y 2018. Se analizaron 118 publicaciones según indicadores de producción, colaboración, impacto y mapas bibliométricos. Se encontró que las publicaciones sobre AB han aumentado progresivamente, que la colaboración de autores fue baja, que una revista influyente en el área fue Library Review, y que los autores con más impacto fueron Onwuegbuzie y Jiao. Asimismo, destacaron palabras clave sobre la formación del usuario y cuatro frentes de investigación: instrumentos de medición, resultados, marcos teóricos y tipos de unidades de análisis. Dichos resultados sugieren que la AB es un tema fructífero de investigación.

Attentional Bias, Alcohol Craving, and Anxiety Implications of the Virtual Reality Cue-Exposure Therapy in Severe Alcohol Use Disorder: A Case Report

Aims: Attentional bias (AB), alcohol craving, and anxiety have important implications in the development and maintenance of alcohol use disorder (AUD). The current study aims to test the effectiveness of a Virtual Reality Cue-Exposure Therapy (VR-CET) to reduce levels of alcohol craving and anxiety and prompt changes in AB toward alcohol content. Method: A 49-year-old male participated in this study, diagnosed with severe AUD, who also used tobacco and illicit substances on an occasional basis and who made several failed attempts to cease substance misuse. The protocol consisted of six VR-CET booster sessions and two assessment sessions (pre- and post-VR-CET) over the course of 5 weeks. The VR-CET program consisted of booster therapy sessions based on virtual reality (VR) exposure to preferred alcohol-related cues and contexts. The initial and final assessment sessions were focused on exploring AB, alcohol craving, and anxiety using paper-and-pencil instruments and the eye-tracking (ET) and VR technologies at different time points. Results: Pre and post assessment sessions indicated falls on the scores of all instruments assessing alcohol craving, anxiety, and AB. Conclusions: This case report, part of a larger project, demonstrates the effectiveness of the VR-CET booster sessions in AUD. In the post-treatment measurements, a variety of instruments showed a change in the AB pattern and an improvement in craving and anxiety responses. As a result of the systematic desensitization, virtual exposure gradually reduced the responses to significant alcohol-related cues and contexts. The implications for AB, anxiety and craving are discussed.

Is the choice of anesthesia during gastrointestinal endoscopic procedures a result of anxiety?

BACKGROUND AND STUDY AIMS

Esophagogastroduodenoscopy (EGD) and colonoscopy (CS) are vital endoscopic procedures in the diagnosis and follow-up of gastrointestinal tract diseases. Endoscopic procedures can be performed with or without anesthesia as per patient preferences. These procedures can cause some anxiety in almost all patients, and the degree of anxiety differs for each individual. Thus, we aimed to evaluate the trait and state anxiety levels of the patients and assess the relationship between the preference of anesthesia and anxiety levels.

PATIENTS AND METHODS

To investigate this issue, 723 patients who underwent elective endoscopy (EGD and/or CS) were enrolled. The researchers collected sociodemographic data and medical history records as reported by the patients. State and trait anxiety levels of the patients were evaluated using the State and Trait Anxiety Inventory (STAI).

RESULTS

The patients were divided into two groups as with anesthesia and without anesthesia. Of the respondents, 43.4% requested anesthesia during endoscopic procedure. Sociodemographic data, except sex, showed similar characteristics. The STAI trait scores of the two groups were similar; however, there was a significant difference in the STAI state scores of the groups (p = 0.018). A significant difference was observed in the anesthesia preference and the type of endoscopic procedure (EGD, CS, or both) (p < 0.001). Type of endoscopic procedure, STAI state scores, and sex were determined as the predictors of the anesthesia choice.

CONCLUSION

Endoscopic procedures are known to cause anxiety among many patients. Our findings suggest that the anesthesia preferences of patients are an important factor in preventing these situational concerns. However, this study found that being a woman and undergoing a CS procedure are important factors related to anesthesia preferences. Thus, more detailed assessments on this subject are required.

Effect of Hand Massage on Pain, Anxiety, and Vital Signs in Patients Before Venipuncture Procedure: A Randomized Controlled Trial

BACKGROUND

Massage is one of the relaxation techniques commonly used in recent years to control pain, stress, and anxiety.

AIMS

This study was conducted to evaluate the effect of hand massage application on pain, anxiety, and vital signs before venipuncture procedure.

METHODS

The sample of the study consisted of 97 individuals (48 experimental and 49 controls) who were admitted to a training and research hospital in Turkey between December 2018 and May 2019. Individuals assigned to the experimental group received hand massage. The data were obtained with an individual information form, a visual analog scale (VAS), and the State-Trait Anxiety Inventory (STAI).

RESULTS

The mean age of the participants was 49.52 ± 12.48 years. There was no significant difference between the pain levels of the experimental and control groups (p > .05), but the anxiety level of the experimental group was significantly less than that of the control group (p < .05). There was also a significant difference between the experimental and control groups in terms of systolic and diastolic blood pressure and heart rate. The blood pressure and heart rate of the experimental group decreased significantly (p < .05).

CONCLUSION

Hand massage was found to be a simple, non-pharmacologic, inexpensive, and independent nursing practice that could be used to reduce anxiety and positively affect vital signs in patients before venipuncture procedure.

Depressive Symptoms Predict Delayed Ambulation After Traumatic Injury

BACKGROUND

Impaired psychological state, such as anxiety and depressive symptoms, occurs in up to 40% of patients hospitalized for traumatic injury. These symptoms, in the acute period, may delay engagement in activity, such as ambulation, following injury. The purpose of this study was to determine whether baseline anxiety and depressive symptoms predicted delayed (>48 hr from admission) ambulation in patients hospitalized for major traumatic injury.

METHODS

Adults (n = 19) admitted for major trauma (Injury Severity Score [ISS] = 15) provided a baseline measure of anxiety and depressive symptoms (Hospital Anxiety and Depression Scale [HADS]). Logistic regression was used to determine the predictive power of baseline HADS Anxiety and HADS Depression subscale scores for delayed ambulation while controlling for ISS.

RESULTS

At baseline, anxiety was present in 32% of patients; 21% reported depressive symptoms. Baseline HADS Anxiety score did not predict the ambulation group. However, for each 1 point increase in baseline HADS Depression score, the likelihood of patients ambulating after 48 hr from admission increased by 67% (odds ratio = 1.67; 95% CI [1.02, 2.72]; p = .041).

CONCLUSION

Worsening depressive symptoms were associated with delayed ambulation in the acute period following injury. Future, larger scale investigations are needed to further elucidate the relationship between psychological symptoms and the acute recovery period from trauma to better inform clinicians and guide development of interventions to improve patient outcomes.

How anxious did you feel during lockdown? The roles resilience, living environment, and gender play on the level of anxiety state during pandemic isolation

In the unique context of the coronavirus disease 2019 (COVID-19) pandemic, researchers and clinicians alike drew attention to the risks involved by physical and social isolation for mental health. Factors like resilience, gender, urban/rural environment, or preexisting anxiety can impact anxious states produced by home forced isolation. Based on these, we assumed that: i) there are significant differences in the level of anxiety (state) during the pandemic, depending on the living area of the subjects; ii) gender plays a moderating role in the relationship between resilience and anxiety; and iii) anxiety (trait), experiential avoidance, resilience, and family connectedness, determine the level of anxiety (state). The MemoryLab team conducted the present study on 495 subjects (n=411 women, age between 18 and 65). Of these, 350 live in large and medium urban areas, 63 in small urban areas, and 82 in rural areas. As instruments, we used The State-Trait Anxiety Inventory (STAI 2.0), The Acceptance and Action Questionnaire 2 (AAQ-2), The Aggression Questionnaire (AQ), The Family Connectedness Questionnaire, and Connor-Davidson Resilience Scale 10 (CD-RISC-10), as well as the standard division of living areas according to community size. Data collection took place online during the spring peak of the pandemic. According to ANOVA analysis, people living in small urban areas have a higher level of anxiety. The difference is significant compared to those living in large and medium cities and villages. Gender has no moderating role in the relationship between resilience and the anxiety state. Also, experiential avoidance, anxiety (trait), and resilience play a significant role on the level of anxiety (state), measured during social isolation. The results could be an important indicator for understanding psychological mechanisms guiding interventions to support the communities effectively.

Evaluation of the Relationship between Trait and State Anxiety and Temporomandibular Dysfunction

Background:

Anxiety is an important factor in the process of chronic pain in patients with Temporomandibular Dysfunction (TMD).

Objective:

The objective of this study was to evaluate the influence of minimally invasive management of muscular TMD on the levels of anxiety (state and trait), pain, and other parameters in patients with muscular TMD.

Methods:

A total of 83 patients (64 women and 19 men; mean age, 25.16 ± 4.40 years) who were clinically diagnosed with TMD were evaluated. During the first clinical session (T1) and after clinical evaluation and diagnosis, the participants filled out a pain visual analog scale and answered the Trait Anxiety Inventory (STAI-T) and State Anxiety Inventory (STAI-S). In addition, the bite strength of the participants was evaluated, and minimally invasive management (thermotherapy, orientation exercises, and cognitive behavioral therapy) was initiated in that session. After 8 weeks (T2), all parameters were reevaluated. The results obtained were statistically analyzed and found to have a significance level of 5%.

Results:

A significant decrease in pain, STAI-T, and STAI-S scales were observed from T1 to T2 (p < 0.0001). Higher values of bite strength were observed at T2 compared to T1 (p < 0.0001). Furthermore, a significant correlation was observed between the levels of pain, trait-anxiety, and state-anxiety.

Conclusion:

Minimally invasive management of TMD resulted in a reduction in the levels of pain and anxiety (trait and state) of the participants evaluated, suggesting a possible association of these factors with chronic myofascial pain.

Effects of a Person Centered Dementia Training Program in Greek Hospital Staff-Implementation and Evaluation

People with Dementia (PwD) are frequently admitted in general hospitals. However, health care professionals have lack of dementia knowledge, negative attitudes toward dementia, and lack of confidence in caring those patients. The aim of this study is to develop, implement and evaluate a dementia staff training program in Greek general hospitals. It was a repeated-measures research design. Fourteen (14) two-day workshops were conducted, consisting of six targeted and interactive modules. Staff members (N = 242) attended the program and were assessed according to (1) individual performance: questionnaires about attitudes towards dementia, confidence in care, knowledge about dementia and anxiety before, immediately after the training and three months later, (2) an overall training evaluation immediately after the training and (3) an evaluation of training implementation three months later. Positive attitudes towards dementia, improvement of confidence in care and decrease of feeling of anxiety as a trait, were sustained over time. Knowledge about dementia also increased after the training and sustained, with, however, a slight decrease over time. A well applied training program seems to provide the basis of a better care in PwD during hospitalization. However, changes in the organizational level and a transformation of care culture are necessary for training sustainability over time.

Continuous positive airway pressure treatment and anxiety in adults with coronary artery disease and nonsleepy obstructive sleep apnea in the RICCADSA trial

BACKGROUND

Anxiety and obstructive sleep apnea (OSA) coexist among adults with coronary artery disease (CAD) following revascularization. Continuous positive airway pressure (CPAP) is the first line treatment of OSA patients with daytime sleepiness. The current study evaluated the effect of CPAP on anxiety in CAD patients with nonsleepy OSA.

METHODS

Two hundred forty-four revascularized CAD patients with nonsleepy OSA (apnea-hypopnea index ≥15/h, Epworth Sleepiness Scale score <10) were randomly assigned to CPAP or no-CPAP between 2005 and 2010. Zung Self-rating Anxiety Scale (SAS) was administered at baseline and after 3 and 12 months with higher scores suggesting more anxiety.

RESULTS

A total of 208 patients with complete SAS scores at baseline and 12-month follow-up were included (CPAP, n = 103; no-CPAP, n = 105). In the intention-to-treat analysis, CPAP had no significant effect on the SAS scores. On-treatment analysis revealed a significant increase in the median of delta SAS score (+3.75) after three months among the participants using the device 2.8 h/day or more while there was a decline in the median of delta SAS score (-1.25) in the non-adherent or no-CPAP group (p = 0.031). The increase in the SAS score (+1.25) in the adherent group, and the decline (-1.25 points) in the non-adherent/no-CPAP group remained significant after one year (p = 0.011). Baseline SAS score predicted non-adherence [adjusted odds ratio 1.11; 95% confidence interval (CI) 1.04-1.18; p = 0.003], and there was an association between the increase in the SAS scores and accumulated CPAP hours/day [standardized β = 0.144 (95% CI 0.005-0.695), p = 0.047].

CONCLUSION

Our results suggest that anxiety should be considered in the management of CAD patients with nonsleepy OSA following revascularization.

CLINICAL TRIAL REGISTRATION

NCT00519597.

Investigating the link between serum concentrations of brain-derived neurotrophic factor and behavioral measures in anxious alcohol-dependent individuals

Brain-derived neurotrophic factor (BDNF) plays a role in different neurophysiological processes, including those involved in alcohol- and anxiety-related behaviors. Preclinical and clinical studies indicate that chronic excessive alcohol use leads to a downregulation of BDNF production in the periphery and in the brain. In addition, a decrease in BDNF concentrations in the blood has been reported to be associated with increased anxiety levels. Non-treatment-seeking alcohol-dependent individuals with high trait anxiety were studied to assess whether serum BDNF concentrations may be linked to self-reported levels of alcohol drinking, anxiety, and other behavioral measures. Participants had a current diagnosis of alcohol dependence, high trait anxiety score, and were not seeking treatment for alcohol dependence or anxiety. A fasting blood sample was collected from each participant and serum BDNF was measured using an enzyme-linked immunosorbent assay (ELISA). Behavioral data were collected on the same day, including measures of alcohol drinking, craving, dependence severity, and anxiety. Bivariate correlations were run between BDNF levels and behavioral measures. Serum BDNF concentrations were negatively correlated with average drinks per drinking days (r = -0.41, p = 0.02) and positively correlated with obsessive-compulsive drinking scale (r = 0.48, p = 0.007) and state-trait anxiety inventory (r = 0.52, p = 0.003) scores. These findings shed light on the possible role of the BDNF system in the neurobiology of alcohol- and anxiety-related behaviors.

Can Psychologic Stress Elevate Intraocular Pressure in Healthy Individuals?

PURPOSE

To investigate if a stress event can influence intraocular pressure (IOP) in a group of healthy individuals.

DESIGN

Case-control study.

PARTICIPANTS

A total of 28 healthy subjects were included: 17 in the stress group and 11 in the control group.

METHODS

The Trier Social Stress Test (TSST) is a tool to evaluate cortisol response to psychologic stimulation based on the stress induced by public speaking. All participants underwent a modified diurnal tension curve (DTC) 1 week before the TSST, with 3 IOP measurements performed between 8:00 am and 2:00 pm. We evaluated the response to the TSST measuring the levels of salivary cortisol, IOP, and heart rate before, immediately after, and 40 minutes after TSST. The State Trait Anxiety Inventory (STAI) was applied to evaluate the levels of anxiety at the same time intervals.

MAIN OUTCOME MEASURES

Changes in IOP (mmHg), salivary cortisol, heart rate, and STAI scores.

RESULTS

At baseline, there were no significant differences between case and controls regarding age (52.2 ± 6.26 vs. 53.8 ± 8.4 years, P = 0.661), gender (52.94% male vs. 45.45% female, P = 0.669), and ethnicity. Salivary cortisol (6.8 nmol/l, P < 0.001) and heart rate (7.2 beats/min, P = 0.035) increased significantly after the TSST. We observed a mean IOP increase of 1.0 mmHg (right eye, P = 0.003) and 1.1 mmHg (left eye, P = 0.004) when comparing IOP measurements obtained during the DTC and immediately after TSST. In addition, 35% (6/17) of the subjects in the TSST group showed an IOP increase higher than 2 mmHg after the test compared with 18% (2/11) in the control group. The STAI state score significantly increased after the stress event compared with baseline (P = 0.026) and decreased from poststress to the recovery period (P = 0.006) in the TSST group. The control group did not show significant changes in IOP, heart rate, salivary cortisol levels, and STAI scores.

CONCLUSIONS

Significant elevations of IOP, salivary cortisol, STAI scores, and heart rate occurred after inducing psychologic stress with TSST in a group of healthy individuals.

The Effects of Childhood Sexual Abuse: The Role of Anxiety and Alcohol Use among Haitian Women Living with HIV

Childhood abuse has been linked to problematic drinking in adulthood. It is also documented that people living with HIV have higher rates of alcohol use than the general population. In Haiti, a total of 25% of women living with HIV have experienced childhood sexual abuse (CSA), which puts them at an increased risk for alcohol abuse. CSA has also been associated with anxiety disorders in adulthood. Therefore, it is critical to understand the relationship between CSA, anxiety, and alcohol use among women living with HIV. A total of 244 women living with HIV participated in this study, with 35% reporting CSA. Alcohol abuse was measured with the AUDIT, anxiety with the State-Trait Anxiety Inventory test, and sexual abuse with the Childhood Trauma Questionnaire. Compared to participants who did not experience childhood sexual abuse, participants who experienced childhood sexual abuse reported greater levels of alcohol use [(17.0, SD = 9.1) (11.9, SD = 8.6) p =.001] and anxiety [(55.8, SD = 9.8) (48.9 SD = 8.3) p =.001] respectively. The indirect effect of anxiety on the association between CSA and alcohol use was significant [(ß =.19 p =.05) 95% bootstrap CI.019 -.13] Thus, women who reported being sexually abused as children reported anxiety, which in turn, was associated with an increased risk for alcohol abuse. Results demonstrate that alcohol may be used as a negative coping mechanism to alleviate anxiety symptoms triggered by CSA. These findings elucidate the need for further research examining the impact that sexual trauma has on mental health.

Anxiety in Parkinson's disease is associated with changes in the brain fear circuit

BACKGROUND

Anxiety is frequent in Parkinson's disease (PD) and has a negative impact on disease symptoms and quality of life. The underlying mechanisms remain largely unknown. The aim of this study was to identify anatomical and functional changes associated to PD-related anxiety by comparing the volume, shape and texture of the amygdala, the cortical thickness as well as the functional connectivity (FC) of the fear circuit in patients with and without clinically relevant anxiety.

METHODS

Non-demented PD patients were recruited, and anxiety was quantified using the Parkinson Anxiety Scale. Structural MRI was used to compare cortical thickness and amygdala structure and resting-state functional MRI to compare FC patterns of the amygdala and resting-state functional networks in both groups.

RESULTS

We included 118 patients: 34 with (A+) and 84 without (A-) clinically relevant anxiety. Clusters of cortical thinning were identified in the bilateral fronto-cingulate and left parietal cortices of the A+ group. The texture and the shape of the left amygdala was different in the A+ group but the overall volume did not differ between groups. FC between the amygdala and the whole brain regions did not differ between groups. The internetwork resting-state FC was higher between the "fear circuit" and salience network in the A+ group.

CONCLUSION

Anxiety in PD induces structural modifications of the left amygdala, atrophy of the bilateral fronto-cingulate and the left parietal cortices, and a higher internetwork resting-state FC between the fear circuit and the salience network.

A Comparison of the Acute Effects of Different Forms of Yoga on Physiological and Psychological Stress: A Pilot Study

Yoga is a frequently recommended stress management strategy; however, the acute stress response to varying types of yoga are not fully clear. Thus, the purpose of this study was to compare the acute effects of meditative and power yoga on indices of physiological and psychological stress. In a crossover counterbalanced design, physically active females (n = 13; age = 20.8 yrs ± 0.8, height = 164.5 cm ± 6.1, body mass = 65.0 kg ± 13.8) who did not regularly participate in yoga or mindful training enrolled in this study. Participants completed two visits each, with a standardized instructional-video 30-min yoga session with either A) meditative (Hatha style) yoga or B) power (Vinyasa style) yoga. Prior to and immediately after each yoga bout, psychological stress was assessed using the State–Trait Anxiety Inventory (STAI) questionnaire, and salivary cortisol samples were obtained to measure indices of physiological stress. State anxiety scores were significantly lower following meditative yoga (p = 0.047) but were not different following power yoga (p = 0.625). Salivary cortisol levels were significantly lower following meditative yoga (p = 0.020) but not following power yoga (p = 0.242). Results indicate that acute engagement in meditative yoga decreases markers of psychological and physiological stress, while power yoga does not impart a significant stress-relieving benefit. Findings indicate that differing types of yoga may have various stress-relieving capabilities and should be considered by individuals seeking anxiolytic benefits.

High-fat diet negatively impacts both metabolic and behavioral health in outbred heterogeneous stock rats

Obesity is influenced by genetics and diet and has wide ranging comorbidities, including anxiety and depressive disorders. Outbred heterogeneous stock (HS) rats are used for fine-genetic mapping of complex traits and may be useful for understanding gene by diet interactions. In this study, HS rats were fed diets containing 60% kcal from fat (high-fat diet, HFD) or 10% kcal from fat (low-fat diet, LFD) and tested for metabolic (study 1) and behavioral (study 2) outcomes. In study 1, we measured glucose tolerance, fasting glucose and insulin, fat pad weights and despair-like behavior in the forced swim test (FST). In study 2, we assessed anxiety-like (elevated plus maze, EPM; open field test, OFT) and despair-like/coping (splash test, SpT; and FST) behaviors. Body weight and food intake were measured weekly in both studies. We found negative effects of HFD on metabolic outcomes, including increased body weight and fat pad weights, decreased glucose tolerance, and increased fasting insulin. We also found negative effects of HFD on despair-like/coping and anxiety-like behaviors. These include increased immobility in the FST, decreased open arm time in the EPM, and increased movement and rest episodes and decreased rearing in the OFT. The diet-induced changes in EPM and OFT were independent of overall locomotion. Additionally, diet-induced changes in OFT behaviors were independent of adiposity, while adiposity was a confounding factor for EPM and FST behavior. This work establishes the HS as a model to study gene by diet interactions affecting metabolic and behavioral health.

Correlation between crowdedness in emergency departments and anxiety in Chinese patients

BACKGROUND

Emergency department (ED) overcrowding is a severe health care concern, while anxiety and depression rates among ED patients have been reported to be substantially higher compared to the general population. We hypothesized that anxiety due to over crowdedness may lead to adverse events in EDs.

AIM

To investigate correlations between crowdedness in EDs and anxiety of patients and nurses, and to identify factors affecting their anxiety.

METHODS

In this prospective observational study, a total 43 nurses and 389 emergency patients from two tier III hospitals located in Beijing were included from January 2016 to August 2017. Patients were grouped into inpatients when they were hospitalized after diagnoses, or into outpatients when they were discharged after treatments. The State Trait Anxiety Inventory (STAI Form Y) questionnaire was used to investigate patient and nurse anxieties, while crowdedness of EDs was evaluated with the National Emergency Department Over Crowding Score.

RESULTS

The present results revealed that state anxiety scores (49.50 ± 6.00 vs 50.80 ± 2.80, P = 0.005) and trait anxiety scores (45.40 ± 5.70 vs 46.80 ± 2.70, P = 0.002) between inpatients (n = 173) and outpatients (n = 216) were significantly different, while the state anxiety of nurses (44.70 ± 5.80) was different from those of both patient groups. Generalized linear regression analysis demonstrated that multiple factors, including crowdedness in the ED, were associated with state and trait anxieties for both inpatients and outpatients. In addition, there was an interaction between state anxiety and trait anxieties. However, multivariable regression analysis showed that while overcrowding in the ED did not directly correlate with patients’ and nurses’ anxiety levels, the factors that did correlate with state and trait anxieties of inpatients were related to crowdedness. These factors included waiting time in the ED, the number of patients treated, and the number of nurses in the ED, whereas for nurses, only state and trait anxieties correlated significantly with each other.

CONCLUSION

Waiting time, the number of patients treated, and the number of nurses present in the ED correlate with patient anxiety in EDs, but crowdedness has no effect on nurse or patient anxiety.

Do state-trait anxiety and previous unpleasant dental experiences predict the need for sedation in women having third molar surgery?

The aim of this study was to examine the need for sedation in women who had or had not had a previous unpleasant dental experience, and to assess possible contributory factors. The sample size required was estimated at 312 subjects. Healthy women listed for the surgical removal of third molars were asked to complete a questionnaire regarding their health, clinical and personal experience, past dental experience, result of the Indicator of Sedation Need (IOSN) scale, and of the Spielberger's State-Trait Anxiety Inventory. The participants were categorised before analysis by the nature of their previous dental experience. The number of participants who required sedation, their mean IOSN score, and the mean degree of state anxiety were significantly higher in the unpleasant experience group. The younger the patient at the time of the experience, the worse the state-anxiety (r=-0.25). The odds that sedation would be needed were 2.24 times higher in the same group. The final model correctly predicted the need for sedation in 75.3% of the cases. Healthy women having third molar surgery who had had a previous upsetting dental experience were more likely to need sedation and had worse state-anxiety than those who had not.

Fear and anxiety managing methods during dental treatments: a systematic review of recent data

INTRODUCTION

The management of anxiety and fear of patients experiencing medical treatment is always a major issue. Dentistry is a branch of medicine that is daily in managing these problems, especially in the case of pediatric patients. Odontophobia can be managed in different ways, and the purpose of this study is to eventually review which methods are currently accepted and which are the most effective.

EVIDENCE ACQUISITION

The literature analysis was conducted on a number of articles, suitably skimmed, after a first research, obtained from the most common scientific databases. The number of works included in the review is 28.

EVIDENCE SYNTHESIS

From the RCTs evaluated we could highlight that there are different methods in the literature, equally effective and certainly conditioned by the systemic condition of the patient. Another chapter instead turns out to be that linked to the management of the syndromic patient.

CONCLUSIONS

It is clear that there are different methods and equally different ways to manage our patients in the event of non-cooperation in the case of dental care. In addition to proper management by the clinician, in the literature methods linked to audiovisual distractions, hypnosis or pharmacological methods that produce conscious sedation are effectively reported.

A computationally inspired in-vivo approach identifies a link between amygdalar transcriptional heterogeneity, socialization and anxiety

Pharmaceutical breakthroughs for anxiety have been lackluster in the last half-century. Converging behavior and limbic molecular heterogeneity has the potential to revolutionize biomarker-driven interventions. However, current in vivo models too often deploy artificial systems including directed evolution, mutations and fear induction, which poorly mirror clinical manifestations. Here, we explore transcriptional heterogeneity of the amygdala in isogenic mice using an unbiased multi-dimensional computational approach that segregates intra-cohort reactions to moderate situational adversity and intersects it with high content molecular profiling. We show that while the computational approach stratifies known features of clinical anxiety including nitric oxide, opioid and corticotropin signaling, previously unrecognized druggable biomarkers emerge, such as calpain11 and scand1. Through ingenuity pathway analyses, we further describe a role for neurosteroid estradiol signaling, heat shock proteins, ubiquitin ligases and lipid metabolism. In addition, we report a remarkable behavioral pattern that maps to molecular features of anxiety in mice through counterphobic social attitudes, which manifest as increased, yet spatially distant socialization. These findings provide an unbiased approach for interrogating anxiolytics, and hint toward biomarkers underpinning behavioral and social patterns that merit further exploration.

Psychological Factors in Dental Patient Care: Odontophobia

Dentistry and oral health are at the heart of the systemic health of humans. Often this branch of medicine is underestimated either due to socioeconomic reasons or due to fear. In fact, in dentistry, there is often a widespread condition of odontophobia among patients. A clinician's knowledge of this condition, and an accompanying understanding of how to successfully manage it, is surely one of the first steps to gaining a patient's trust and maintaining his or her patronage. Being able to manage a dental phobic patient in the best way is the key to successful therapy. Psychological techniques often have to work alongside dentistry in managing these patients. A future perspective concerns precisely the implementation of non-invasive practices such as hypnosis in the management of the latter.

State and Trait Anxiety and Diabetes Outcomes in Youth With Type 1 Diabetes

PURPOSE

The purpose of this exploratory pilot study was to examine the associations of state and trait anxiety with glycemic control, self-management, and diabetes-specific quality of life (QOL) in youth 10 to 16 years of age with type 1 diabetes (T1D).

METHODS

Bivariate Pearson correlations and multiple linear regression modeling were conducted to examine the relationship among anxiety symptoms, hemoglobin A1C (A1C), self-management, QOL, and covariates.

RESULTS

A sample of 67 adolescents was 50.7% female, and 87.1% were non-Hispanic white, with a mean ± SD age of 13.4 ± 1.85 years and an A1C of 8.3% ± 1.2% (67 mmol/mol). Higher state anxiety was correlated with older age. Better self-management was correlated with lower trait anxiety and lower state anxiety. Higher state and trait anxiety were associated with poorer self-management. Higher state anxiety was associated with higher A1C. Higher trait anxiety was associated with poorer diabetes-specific QOL.

CONCLUSIONS

State and trait anxiety may differentially affect diabetes outcomes. State anxiety may be a modifiable target for physiologic (A1C) and psychosocial (QOL) outcomes in youth with T1D, while trait anxiety may be a modifiable target for psychosocial outcomes (QOL). Anxiety symptoms should be assessed at regular clinic visits. Interventions to improve anxiety symptoms may in turn improve physiologic and psychosocial outcomes.

Pre-specified Anxiety Predicts Future Decision-Making Performances Under Different Temporally Constrained Conditions

In real-life circumstances, people occasionally require making forced decisions when encountering unpredictable events and situations that yield socially and privately unfavorable consequences. In order to prevent future negative consequences, it is beneficial to successfully predict future decision-making behaviors based on various types of information, including behavioral traits and/or psychological states. For this prospective purpose, the present study used the Iowa Gambling Task, which simulates multiple aspects of real-life decision-making processes, such as choice preference, selection and evaluation of output feedback, and investigated how anxiety profiles predict decision-making performances under conditions with different temporal pressures on task execution. To conduct a temporally causal analysis, we assessed the trait and state anxiety profiles of 33 young participants prior to the task and analyzed their subsequent decision-making performances. We separated two disadvantageous card decks with high rewards and losses into high- and middle-risk decks, and calculated local performance indexes for decision-making immediately after salient penalty events for the high-risk deck in addition to traditional global performance indexes concerning overall trial outcomes such as final winnings and net scores. For global decision-making, higher trait anxiety predicted more risky choices solely in the self-paced condition without temporal pressure. For local decision-making, state anxiety predicted risk-taking performances differently in the self- and forced-paced conditions. In the self-paced condition, higher state anxiety predicted higher risk-avoidance. In the forced-paced condition, higher state anxiety predicted more frequent choices of the middle-risk deck. These findings suggest not only that pre-specified anxiety profiles can effectively predict future decision-making behaviors under different temporal pressures, but also newly indicate that behavioral mechanisms for moderate risk-taking under an emergent condition should be focused on to effectively prevent future unfavorable consequences when actually encountering negative events.