Factors associated with gender and sex differences in anxiety prevalence and comorbidity: A systematic review

Prevalence and correlates of generalized anxiety disorder and subthreshold anxiety symptoms in south China: A network perspective

AIMS

To investigate the prevalence of generalized anxiety disorder (GAD) and subthreshold anxiety symptoms (SAS) in Guangdong province of China, and to identify the central anxiety symptoms, while further exploring their associations with sociodemographic characteristics, lifestyle factors, and somatic diseases.

METHODS

This survey was conducted in 21 administrative regions of Guangdong province with multistage-stratified cluster random sampling method. Multivariate logistic regression analyses were performed to estimate the adjusted odds ratios (ORs) and their 95 % confidence intervals (CIs). Network analyses were conducted to explore the centrality of anxiety symptoms.

RESULTS

A total of 16,377 individuals were included in this study. The weight 12-month prevalence rates for GAD and SAS were 3.5 % and 10.0 %, respectively. Multivariable logistic regression analysis identified several factors significantly associated with increased risks of GAD and SAS, including younger age, female, no spouse, current alcohol consumption, never exercising, comorbidities, sleep duration of less than 7 h. Notably, the factors related to GAD and SAS largely overlapped, with urban residency and napping correlating specifically with SAS, and mental health literacy correlating specifically with GAD. Network analysis identified "Trouble relaxing" (GAD4) as the most central symptom of anxiety.

CONCLUSIONS

GAD and SAS were prevalent among residents in south China. More attention and assistance should be prioritized to individuals with younger age, female, no spouse, current alcohol consumption, sleep less than 7 h, and comorbid with somatic diseases. Taking regular exercise and improving mental health literacy may be beneficial in preventing and controlling anxiety.

Feasibility, acceptability, and preliminary efficacy of a blended transdiagnostic group CBT for the treatment of emotional disorders

Introduction

The transdiagnostic approach and Internet-based administration can help to implement evidence-based treatments for emotional disorders (ED). However, not all patients benefit from online format and dropout rates are high. Blended format combines the strengths of face-to-face and Internet self-applied interventions to help overcome these barriers. Group format can also help to overcome these difficulties and improve the cost-effectiveness binomial. This study aimed to analyze the feasibility, acceptability, and preliminary efficacy of a blended transdiagnostic group CBT for ED.

Methods

A single-group, open-trial design with three measurement points: pre-treatment, post-treatment and 3-month follow-up. A total of 34 adults (mean age = 32.21 years; 79.4 % female) from a community sample with at least one ED diagnosis according to DSM-5-TR criteria participated in the study. The intervention combined 8 group sessions delivered via videoconference with the completion of 16 online modules in a web-platform.

Results

Of the total participants, 67.6 % completed the treatment and another 14.7 % completed at least half of the modules and attended at least half of the group sessions. The expectations and satisfaction with the treatment were high (47.39 and 49.39 out of 60, respectively). The system usability was above desirable and around 'excellent' (84.02 out of 100 after the first use of the platform and 80.98 out of 100 at post-treatment). Opinions on the online modules and videoconference sessions were good. Participants completed an average of 12.91 online modules out of 16 and attended an average of 5.44 sessions out of 8. There was a significant reduction in anxious and depressive symptomatology at post-treatment and follow-up compared to baseline. There was also a significant change in other secondary clinical measures.

Conclusions

A transdiagnostic protocol applied in blended and group formats seems to be feasible, acceptable and preliminary effective in addressing ED. However, more research is needed to test the efficacy of this innovative format.

To focus on a confederate or oneself? Attentional bias and state anxiety in socially anxious individuals during real-time online video calls

Attentional bias toward threatening stimuli and heightened self-focused attention are pivotal factors in the activation and perpetuation of high social anxiety. Literature on attentional biases between external social cues and self-relevant information has yielded inconsistent findings due to diverse experimental tasks and materials. With a videoconferencing platform and eye-tracking technology, this study assessed state anxiety and attentional bias between self- and other-related cues among individuals with different sex and social anxiety levels (n = 82) in various social contexts (speech and conversation) and social feedback (positive, neutral, and negative). Eye-movement data revealed that individuals focus more on the other person than themselves during online video interactions. However, individuals with high social anxiety tend to focus more on themselves and less on others compared to those with low social anxiety, particularly in males. Males with high social anxiety distributed their attention equally between their social partners and themselves, while females with high social anxiety did not. Self-reported data indicated higher anxiety during speeches than conversations. Those with high social anxiety showed significant differences from baseline levels during tasks, in contrast to those with low social anxiety. Subjective anxiety was more pronounced for negative feedback than for neutral or positive feedback, especially in females. These findings enhance understanding of attentional biases in individuals with high social anxiety and suggest that videoconferencing could benefit therapy for individuals with social anxiety disorder.

Psychological distress among nurses: Exploring the role of support in the work-place in Morocco

AIM

This study aimed to assess the psychological distress, specifically anxiety and depression, among nurses employed at University Hospital Center of Rabat in Morocco and tested the associations between support in the workplace and nurses' psychological well-being.

METHODS

A cross-sectional observational study was conducted at University Hospital Center of Rabat in Morocco, based on a prospective data collection employing an ad-hoc self-report questionnaire. 223 nurses were enrolled with a minimum of 1 year of practice in any care unit. Socio-demographic and professional characteristics of each participant were included. A validated tool was utilized to measure the support from superiors and colleagues in the workplace, while the Hospital Anxiety and Depression Scale (HADS) was employed to evaluate anxiety and depression. Univariate and multivariate analyses were conducted to explore the relationships between different independent and dependent variables.

RESULTS

Significant socio-demographic and professional factors associated with increased anxiety included female gender, age over 41 years old, Baccalaureate level of education, intention to leave the hospital, and less support from superiors. Regarding the levels of depression, the Baccalaureate level of education was significantly associated with higher levels of depressive symptoms (β 2.444; CI [1.203, 3.686]).

CONCLUSIONS

Our findings suggested that ensuring support from superiors was crucial for safeguarding the psychological well-being of nurses. Therefore, hospital managers should prioritize addressing the workplace support for professionals, and the organizational enhancement.

Sex-specific regulation of microglial MyD88 in HMGB1-Induced anxiety phenotype in mice

Stress is a significant risk factor for the development and recurrence of anxiety disorders. Stress can profoundly impact the immune system, and lead to microglial functional alterations in the medial prefrontal cortex (mPFC), a brain region involved in the pathogenesis of anxiety. High mobility group box 1 protein (HMGB1) is a potent pro-inflammatory stimulus and danger-associated molecular pattern (DAMP) released from neuronal and non-neuronal cells following stress. HMGB1 provokes pro-inflammatory responses in the brain and, when administered locally, alters behavior in the absence of other stressors. In this study, we administered dsHMGB1 into the mPFC of male and female mice for 5 days to investigate the cellular and molecular mechanisms underlying HMGB1-induced behavioral dysfunction, with a focus on cell-type specificity and potential sex differences. Here, we demonstrate that dsHMGB1 infusion into the mPFC elicited behavior changes in both sexes but only altered microglial morphology robustly in female mice. Moreover, preventing microglial changes with cell-specific ablation of the MyD88 pathway prevented anxiety-like behaviors only in females. These results support the hypothesis that microglial MyD88 signaling is a critical mediator of HMGB1-induced stress responses, particularly in adult female mice.

Multiple emergency department visits and suicidal behavior in children and adolescents

BACKGROUND

Suicidal behaviour is a growing problem in child and adolescents, and the Emergency Department (ED) is often where the first contact with Mental Health occurs. Here we factors associated with suicidal behaviour in this children and adolescents attended at the ED.

METHODS

Our sample consisted of children and adolescents who attended the ED of Hospital 12 de Octubre for psychiatric reasons between January 1st and December 31st, 2022. Inclusion criteria were age under 18 years. No restrictions by diagnosis, ethnicity, nationality, gender or any other variables. We conducted an initial interview with patients in the ED and reviewed patients' digital patient records for the six months following their first visit during 2022.

RESULTS

We found that the variables that were independently associated with a repeated visits for suicidal behaviour were eating problems, transgender identity, emotional dysregulation and previous mental health follow-up.

CONCLUSION

In our study, we found that ED revisits were concentrated in the first month after the first visit. Just as associated factors and approaches have historically been studied in the adult population, the child and adolescent population needs an even more in-depth study of this alarming situation.

Trajectory of Post-Traumatic Stress During the First Year after Pediatric Traumatic Brain or Orthopedic Injury

Up to 50% of children sustaining physical injury develop post-traumatic stress symptoms (PTSS). Most studies of PTSS have not included patients with traumatic brain injury (TBI); consequently, the influence of injury type and severity on the longitudinal course of PTSS is unclear. To address this gap, we completed a longitudinal prospective cohort study examining the trajectory of self-reported PTSS severity during the first year after TBI or orthopedic injury (OI). Within a biopsychosocial framework, we examined PTSS in relation to injury variables, demographic characteristics, and pre-injury child and family functioning. Patients ages 9-15 years with TBI or OI were recruited from two level I pediatric trauma centers. Online surveys were completed as soon as possible following injury (mdn = 8 days). Caregivers rated pre-injury family, sociodemographic, and child characteristics. Follow-up surveys assessing children's self-reported PTSS using the Children's PTSD Symptom Scale (CPSS) were scheduled 3,6, and 12 months after injury. English-speaking families completed surveys either online or by telephone interview; Spanish-speaking families were interviewed. Baseline surveys were completed by 303 families; 265 (87%) completed at least 1 follow-up and comprised the cohort. General linear mixed models examined the influence of injury group and severity, age, sex, and time of assessment on CPSS scores. Pre-injury estimates of child and family functioning were examined as predictors in supplemental models. Participants (72% boys, mean [SD] age 12.7 [1.9] years) included 204 with TBI (76 mild, 82 complicated-mild/moderate, 46 severe) and 61 with OI. Relative to OI, patients with TBI had significantly elevated mean CPSS scores at 3 (3.7 points, 95% confidence intervals [CI]: 1.1, 6.3); 6 (3.2, 95% CI: 0.7, 5.7) and 12 months (2.3, 95% CI: 0.1, 4.5). The primary model indicated that TBI severity had a nonlinear relation with CPSS. Mild TBI (mTBI) had the highest mean scores; with significant differences relative to OI at 3 (4.6 points, 95% CI: 1.6, 7.6); 6 (5.7, 95% CI: 2.7, 8.6) and 12 months (3.2, 95% CI: 0.6, 5.8). This model also revealed that adolescent females had higher CPSS scores than children or adolescent males. Differences relative to younger males at 6 and 12 months were 4.9 (95% CI: 1.6, 8.3) and 5.0 points (95% CI: 2.1, 8.0). In supplemental models, higher symptom burden was associated with poorer baseline family functioning and with higher levels of children's pre-injury anxiety, affective problems, and conduct problems. PTSS persisted for a significant minority of patients with TBI across the first year of recovery, particularly those with mTBI. Screening should emphasize risk factors to target patients with the greatest need for trauma-focused intervention. Cost-effective, scalable, evidence-based trauma-focused interventions are essential to meet American College of Surgeons standards to provide psychological screening and treatment to children sustaining PTSS.

Psychological distress among Israelis during crisis: A comparison between COVID-19 and the Iron Swords War

This study aimed to compare stress reactions and coping resources among the Jewish population in Israel during two different crises: the COVID-19 pandemic and the current Iron Swords War. The study included 421 respondents during the COVID-19 period and 604 respondents during the Iron Swords War. Participants completed self-report questionnaires designed to evaluate sense of coherence, hope, and Community resilience as indicators of coping resources and the Brief Symptom Inventory as a measure of psychological distress. Overall, the mental state of the entire population was more severe during the Iron Swords War than it was during the COVID-19 period (p0.001> (. Sense of coherence and hope were both strongly negatively correlated with psychological distress (p<.001). Moreover, hope, sense of coherence, gender, and age were significant predictors of psychological distress (p< .01). These findings indicate the importance of personal coping resources, such as sense of coherence, during times of crisis. This is particularly important for vulnerable groups. Policymakers should prioritize mental-health services and targeted interventions in emergency response plans.

Sex differences in the association between error-related negativity and harm avoidance during emotional Stroop task

OBJECTIVE

The aim of this study was to investigate the relationship between personality trait harm avoidance and error-related negativity (ERN), emotional Stroop task performances, and to analyze whether sex could serve as a moderator between them.

METHODS

A total of 40 healthy adults (17 men, 23 women) were included in this study. Personality scores, the accuracy and reaction time of the emotional Stroop task, and ERN at FCz were compared between sexes. The interrelationships of these data were analyzed through correlation and regression analyses, considering sex separately and the interaction of sex with harm avoidance in these analyses.

RESULTS

In multiple linear regression analysis, the interaction item of sex and harm avoidance showed a significant association with ERN when considering all participants. In men, harm avoidance had significant associations with ERN, accuracy and reaction time of the emotional Stroop task. However, in women, associations of harm avoidance with ERN and emotional Stroop task performances were not significant.

CONCLUSION

ERN could be observed through the emotional Stroop task. The significant relationships between harm avoidance and ERN, harm avoidance and emotional Stroop task performances were only established in men. ERN, the emotional Stroop task, and harm avoidance are all associated with internalizing disorders; they can be linked according to the findings.

Evaluating the efficacy of transcranial direct current stimulation (tDCS) in managing neuropathic pain-induced emotional consequences: Insights from animal models

Neuropathic pain is a global health concern due to its severity and its detrimental impact on patients' quality of life. It is primarily characterized by sensory alterations, most commonly hyperalgesia and allodynia. As the disease progresses, patients with neuropathic pain develop co-occurring emotional disorders, such as anxiety and depression, which further complicate therapeutic management. While pharmacotherapy remains the first-line treatment, limitations in its efficacy and the prevalence of side effects often leave patients with insufficient pain relief. Transcranial direct current stimulation (tDCS), a non-invasive brain stimulation technique, has recently emerged as a promising alternative for chronic pain management. This review provides an overview of preclinical studies examining the effects of tDCS in rodent models of neuropathic pain. It specifically highlights the potential of tDCS to modulate the emotional-affective component of pain, with a focus on identifying optimal cortical targets for stimulation to enhance the translational application of tDCS in managing pain-related emotional disorders.

Negative Aging Stereotypes: Fear of Dependency Impact on Anxiety and Depression in Middle and Older Adults, Examined by Gender

Negative stereotypes of aging, such as dependency, tend to paint a picture of older adults as frail or a burden on society. This study aimed to explore the relationship between the Fear of Dependency Scale and anxiety and depression, evaluating gender, age, and physical health as moderators. Findings suggest that age moderated the relationship between fear of dependency and depression and anxiety in women, with middle-aged women reporting the highest levels of depression and anxiety. Similarly, poor physical health in women with high fear of dependency was related to higher levels of depression and anxiety. Fear of dependency was related to higher levels of depression, but not anxiety in men. Age did not moderate the relationship between fear of dependency and mental health measures, but physical health did moderate the relationship. Men with poor perceived health and a high fear of dependency reported higher levels of depression.

Protective and risk factors of anxiety in children and adolescents during COVID-19: A systematic review and three level meta-analysis

BACKGROUND

In order to gain a deepened understanding of the impact of public health emergency and to develop effective interventions and preventions, this study aimed to evaluate risk and protective factors associated with anxiety in children and adolescents and to explore potential moderators in the background of COVID-19 within the framework of socio-ecological model.

METHODS

A literature search was conducted in Web of Science, MEDLINE, PubMed, Scopus, EBSCO, ScienceDirect, Emerald, and CNKI for studies published from early 2020 to early 2023 that examined factors associated with anxiety among children and adolescents with age range of 6 to 17 years old. Random effects models and a three-level meta-analytic approach were used.

RESULTS

In total, 141 articles and 1,018,171 subjects were included, with 1002 effect sizes extracted. 32 protective factors and 48 risk factors were examined, yielding significance for 14 protective factors and 29 risk factors, including individual factors (e.g., gender, logOR = -0.37, 95 % CI [-0.47, -0.27], p < 0.001; age, logOR = -0.12, 95 % CI [-0.22, -0.02], p = 0.02; emotional functioning, logOR = -1.45, 95 % CI [-1.84, -1.05], p < 0.001; pre-existing condition logOR = 0.94, 95 % CI [0.58, 1.30], p < 0.001; electronic device or internet addiction, logOR = 1.81, 95 % CI [0.74, 2.88], p < 0.001), family factors (e.g., family socioeconomic status, logOR = -0.25, 95 % CI [-0.39, -0.10], p < 0.001; family functioning, logOR = -1.31, 95 % CI [-1.60, -1.02], p < 0.001; anxiety level of caregiver, logOR = 1.06, 95 % CI [0.75, 1.37], p < 0.001), community factors (e.g., overall social support, logOR = -0.93, 95 % CI [-1.84, -1.05], p < 0.001; school burden, logOR = 0.56, 95 % CI [0.21, 0.90], p = 0.002), and COVID-19-related factors (e.g., higher exposure risk in local community or city, logOR = 0.48, 95 % CI [0.17, 0.78], p = 0.002; distant learning, logOR = 0.73, 95 % CI [0.19, 1.28], p = 0.008; COVID-19-related distress, logOR = 1.42, 95 % CI [0.55, 2.29], p = 0.001;). The majority of studies showed no publication bias. Age group moderated the relationship between gender and level of anxiety (F (1,96) = 4.42, p = 0.038), and no other moderator showed significance.

LIMITATIONS

This study does not reveal causality but correlation in nature, and our findings should be interpretated with caution.

CONCLUSIONS

Public health emergencies could bring challenges to the mental health of children and adolescents. Prevention and intervention strategies for children and adolescents with high risks, and family-based and community-based programs should be encouraged to buffer the adverse impact on children and adolescents. This study has been prospectively registered at PROSPERO (registration number: CRD42022316746).

Differences between men and women accessing an Australian perinatal and infant mental health care navigation service-Why do fathers seek help?

This study explored the demographic and psychosocial characteristics, and presenting concerns of new or expectant fathers seeking perinatal mental health (PMH) support through the Australia-based ForWhen service, compared to a sample of mothers. The retrospective observational analysis examined routinely collected data from 105 male and 203 female clients who were supported by ForWhen between February 2022 to June 2024. Fathers and mothers did not differ in terms of demographic characteristics, and both presented with similarly high levels of distress during intake. However, fathers were more likely to report current self-harm and/or suicidal ideation, as well as current relationship issues and financial stress. Conversely, mothers were more likely to report parenting concerns such as infant sleep and settling challenges. Overall, far fewer men than women access support through ForWhen, despite the known prevalence of PMH concerns among fathers. There were also differences in how clients accessed the service, with fathers more often referred by their intimate partner, suggesting that partners may be an important avenue to encourage help-seeking for paternal PMH concerns. These findings highlight the need to adapt PMH services-traditionally designed for women-to be more inclusive of and better engage men.

Gender Differences in Alexithymia, Emotion Regulation, and Impulsivity in Young Individuals with Mood Disorders

Background/Objectives: Alexithymia, emotion regulation, and impulsivity are key factors in youths with mood disorders. However, gender differences within these dimensions remain insufficiently studied in this population. This study seeks to explore these dimensions in a sample of adolescents and young adults with mood disorders, aiming to identify gender-specific characteristics with important clinical implications. Methods: We assessed 115 outpatients aged 13 to 25 years with a DSM-5 diagnosis of mood disorder. The evaluation included the Toronto Alexithymia Scale (TAS-20), the Difficulties in Emotion Regulation Scale (DERS), and the UPPS-P Impulsive Behavior Scale. The associations with suicidal ideation were tested using two different multivariate models. Results were controlled for age and intelligence measures. Results: The first model (Wilks' Lambda = 0.720, p < 0.001) revealed significantly higher scores in women than men for TAS-20 (p < 0.001), DERS (p < 0.001), and the UPPS-P subscales "Lack of Premeditation" (p = 0.004) and "Lack of Perseverance" (p = 0.001). Regression analyses confirmed gender as a significant predictor of these variables, also controlling for age and intelligence. Furthermore, intelligence measure influenced Lack of Premeditation and age influenced Lack of Perseverance. Conclusions: Women with mood disorders exhibit greater alexithymia, emotional dysregulation, and impulsivity, particularly in difficulties with planning and task persistence. These findings highlight the need for gender-sensitive interventions that address emotional awareness and impulse control to improve clinical outcomes.

The Relationship Between E-Health Literacy, Health Anxiety, Cyberchondria, and Death Anxiety in University Students That Study in Health Related Department

Introduction

While the Internet can be a valuable resource for learning about health issues, for those without adequate e-health literacy skills, it can have adverse effects on unwanted anxiety and cyberchondria risk. Improving e-health literacy is essential to manage health and death anxiety and help reduce the risk of cyberchondria. The aim of this study is to determine the e-health literacy, health anxiety, cyberchondria and death anxiety levels of university students, evaluate them in terms of independent variables and examine the relationship between the scales.

Methods

The study was completed with 568 students receiving education in the health department of a university. Data were obtained using the e-Health Literacy Scale, Health Anxiety Inventory, Cyberchondria Severity Scale, and Death Anxiety Scale. The chi-square, Mann-Whitney U, Kruskal-Wallis, Tamhane's T2 post hoc tests, and Spearman correlation were used to analyze the data.

Results

The mean score of e-health literacy was 28.63±4.65; health anxiety was 19.11±8.37, cyberchondria was 86.30±18.28 and death anxiety was 7.34±2.14. Cyberchondria is low in women and those who do not conduct online research on health. E-health literacy was higher in those earning above the minimum wage. Health and death anxiety was low in men and in those who did not conduct online health-related research. Health anxiety was positively correlated with cyberchondria and death anxiety and negatively correlated with e-health literacy. There was a positive relationship between cyberchondria and E-health literacy and death anxiety. This study highlights the complex relationship between eHealth literacy, health anxiety, cyberchondria and death anxiety. It shows that low e-health literacy can increase health anxiety, which in turn can worsen cyberchondria and death anxiety. By emphasising the importance of e-health literacy in health education, the findings may help students manage their anxiety, make informed health decisions, and increase their professional competence.

The Mediating Role of Depersonalization on the Relationship Between Sleep and Psychological Well-Being in an Online Adult Community Sample

Poor sleep quality has been linked to both poor psychological and physical well-being. Mood and anxiety levels are affected by poor quality sleep, and the relationship between these variables appears to be mediated by a tendency to depersonalize or not. This study examines these relationships in 112 Adults (Female = 82, Male = 30), via an online study. The Pittsburgh Sleep Quality Index, Patient Health Questionnaire4, Cambridge Depersonalization Scale-9, and Patient Health Questionnaire-15 were administered using the Gorilla platform. The following variables were analyzed using correlation statistics, and mediation analyses: sleep quality, anxiety, depression, somatic pain, and depersonalization. Poor sleep quality was associated with higher levels of all psychological variables. As predicted, depersonalization mediated the relationship between sleep quality and anxiety, depression and somatic concerns. The findings indicate that sleep quality and the mediating effect of depersonalization have a significant impact on psychological well-being in adults.

Anxiety, depression and acromegaly: a systematic review

PURPOSE

scientific literature highlights risk factors linked to the onset of psychopathology in different medical pathological contexts. Acromegaly is a rare condition, particularly noteworthy due to the associated clinical psychological features. This research aimed at understanding the main psychopathological outcomes related to acromegaly, with particular emphasis to anxiety and depression.

METHODS

In January 2024, in line with PRISMA guidelines, a systematic search based on PubMed, Scopus, Web of Science and PsycInfo was conducted to detect studies considering anxiety, depression and alexithymia in patients suffering from acromegaly. The Keywords used for the search phase were "Acromegaly" AND "Depression" OR "Anxiety" OR "Alexithymia".

RESULTS

Fifty-five studies were eligible. Anxiety and depression were significantly present in patients with acromegaly, with prevalence rates variable based on disease status and psycho-diagnostic instruments. None of the included studies reported alexithymia in patients with acromegaly. No significant difference was found regarding anxiety and depressive symptoms in patients with acromegaly in comparison with patients suffering from different pituitary diseases and chronic conditions. Anxiety and depression were associated with lower perceived HR-QoL, presence of comorbidity, joint issues, delayed diagnosis, disease duration and body image concerns.

CONCLUSIONS

Anxiety and depression may be encountered in patients with acromegaly, impacting HR-QoL and the course of the disease. This systematic review suggests that a deeper evaluation of clinical psychological features in patients suffering from acromegaly is needed. Particularly, the early detection of clinical psychological symptoms may lead to multi-integrate interventions promoting individuals' well-being and a better HR-QoL.

Reliability and validity of the unhelpful thoughts and beliefs scale for Persian-speaking adults who stutter (UTBAS-P): A cross-cultural examination of social anxiety in people who stutter

BACKGROUND AND AIM

An increasing body of research indicates that many adults who stutter (AWS) experience anxiety in social and verbal situations. The Unhelpful Thoughts and Beliefs about Stuttering (UTBAS) scales were developed to assess speech-related anxiety and negative cognitions associated with stuttering. This study aimed to translate the UTBAS into Persian, investigate its psychometric properties for Persian-speaking AWS, and compare the results with previously published UTBAS scores across various cultures.

METHOD

The UTBAS scales were translated into Persian according to the protocols of the International Quality of Life Assessment Project and the World Health Organization. Sixty-two adults with developmental stuttering, aged between 18 and 51 years, participated in this study. The psychometric properties of UTBAS-P were investigated using similar measures to those used in previous studies where valid and reliable versions were available. Additionally, UTBAS-P scores were compared to UTBAS scores previously reported for Australian, Japanese, and Turkish participants.

RESULTS

The results showed that UTBAS-P had an acceptable face, content, and construct validity. It was significantly correlated with other anxiety-related measures. Additionally, its low and negative correlations with unrelated constructs, such as the NEO-PI-R domains of openness, agreeableness, and conscientiousness, confirmed its divergent validity. Regarding reliability, the significant test-retest reliability score (Pearson r = 0.87, p < 0.001) confirmed the stability of UTBAS-P scores over time, and its internal consistency was confirmed by Cronbach's alpha of 0.99. Similarities and differences were found between participants' UTBAS scores across different cultures.

CONCLUSION

All four currently translated versions of the UTBAS have demonstrated high levels of validity and reliability, showing strong correlations with well-known anxiety measures. These findings suggest that the UTBAS has potential for use both clinically and in cross-cultural studies.

Examining psychological distress among youth in Singapore: Insights from the National Youth Mental Health Study

Youth is a period of transition associated with immense biological, physical, and social changes, which increases the vulnerability to mental illnesses. The study aimed to establish the prevalence of severe and extremely severe levels of depression and anxiety symptoms among the youths in Singapore and identify the psycho-social factors associated with them. The National Youth Mental Health Study was a cross-sectional epidemiological study of Singapore Residents aged 15-35 years. The youths self-administered the survey on tablets containing the programmed questionnaires. The Depression Anxiety Stress Scales Short Form (DASS-21) was used to assess youths' mental health. Multiple logistic regressions were conducted to examine the socio-demographic correlates and to identify factors associated with psychological distress. The prevalence of severe and extremely severe symptoms of depression was 14.9 % among youths in Singapore. Severe and extremely severe levels of depression symptoms were highest among those in the age group of 20-24 years (20.9 %). The prevalence of severe and extremely severe levels of anxiety symptoms among youths in Singapore was 27.0 %. The prevalence was significantly higher among females (28.9 %) than males (25.0 %). Severe and extremely severe symptoms of anxiety were highest among those in the age group of 20-24 years (34.1 %). Body shape concerns, daily smoking, and self-esteem were significantly associated with severe and extremely severe symptoms of depression and anxiety. The high prevalence of severe and extremely severe levels of depression and anxiety highlights the need for comprehensive and accessible mental health services tailored to the unique challenges faced by youths.

Higher meal disengagement and meal presentation are uniquely related to psychological distress and lower quality of life in undergraduate students

Objective: Picky eating, which occurs in emerging adulthood and is associated with psychological distress and quality of life, has historically been conceptualized as unidimensional despite research suggesting it is a multifaceted construct. Participants: An undergraduate sample (N = 509; Mage = 19.96). Methods: A cross-sectional survey assessed picky eating facets (food variety, meal disengagement, meal presentation, and taste aversion), disordered eating, anxiety, depression, stress, obsessive compulsive disorder (OCD), and social phobia symptoms, and quality of life. Results: Meal disengagement was uniquely related to higher anxiety, depression, stress, and social phobia symptoms and lower quality of life, whereas meal presentation was uniquely related to higher anxiety, stress, and OCD symptoms, beyond covariates and disordered eating. Food variety and taste aversion were not uniquely related to outcomes. Conclusions: Considering picky eating multidimensionally may yield important insights beyond the broader construct in terms of its relationship with psychological well-being in undergraduates.

Global Prevalence of Anxiety in Gastroenterology and Hepatology Outpatients: A Systematic Review and Meta-Analysis

PURPOSE OF REVIEW

Many patients with chronic health conditions experience anxiety, which can have significant implications on physical health outcomes and quality of life. This systematic review and meta-analysis aimed to examine the prevalence of anxiety in gastroenterology and hepatology outpatients, across factors such as physical health condition, type of anxiety, and patient demographics, with the intention to support clinicians in providing effective patient care.

RECENT FINDINGS

Several recent systematic reviews have been published investigating rates of anxiety in different outpatient settings, and have found consistently high rates across the dermatology, endocrinology, cardiology and respiratory/sleep medicine fields, ranging between 25.1% and 30.3%. Whilst there are established links between gastroenterology and hepatology conditions with anxiety, there has yet to be a study estimating the overall global prevalence of anxiety in this outpatient setting. PubMed, Embase, Cochrane and PsycINFO databases were searched from database inception to January 2023 for studies reporting anxiety in gastroenterology and hepatology outpatients ≥ 16 years of age. Prevalence was extracted from self-report questionnaires, diagnostic interviews, and records. The final meta-analysis included 81 studies, with 28,334 participants. Pooled prevalence of anxiety was 31.2% (95% CI 28.2%-34.4%). Subgroup analyses identified significant differences in prevalence across anxiety type, with health anxiety showing the highest prevalence at 23.7%, followed by generalised anxiety 14.5%, specific phobia 12.5%, panic disorder/agoraphobia 12.2%, social anxiety 11.3%, post-traumatic stress disorder 4.9%, and obsessive-compulsive disorder 4.2%. No other significant differences were found. Anxiety is thus common amongst gastroenterology and hepatology outpatients, and so it is important that careful consideration be given to the identification and management of anxiety in these settings.

Assessing the Level of Panic Symptoms, Anxiety, and Quality of Life Among People Experiencing Panic Attacks

PURPOSE

To assess the severity of panic symptoms, anxiety levels, and quality of life (QOL) among individuals experiencing panic attacks (PAs), as well as their associations with participants' characteristics.

METHOD

This cross-sectional study used data gathered through an internet-based survey covering demographic characteristics, panic symptoms, anxiety levels, and QOL completed by 126 individuals aged 18 to 60 years sampled from the general population in Egypt.

RESULTS

Data analysis showed that 26.2% and 73.8% of participants experienced severe and extreme panic symptoms, respectively. Anxiety levels varied among participants, with most reporting moderate (48.4%) to severe (38.9%) anxiety. Most participants (98%) reported poor QOL. Findings indicated a positive correlation between panic symptoms and anxiety (r = 0.905, p < 0.01), whereas QOL exhibited a negative correlation with panic symptoms (r = -0.888, p < 0.01) and anxiety (r = -0.879, p < 0.01). Regression analysis revealed that panic symptoms were significantly associated with age (B = -3.535, p = 0.005) and sex (B = -2.234, p = 0.011), whereas educational level displayed a significant correlation with QOL (B = -8.110, p = 0.032).

CONCLUSION

Participants experiencing PAs typically exhibited severe to extreme panic symptoms, moderate to severe levels of anxiety, and overall poor QOL. These findings highlight critical implications for the public health system and policymakers and emphasize the need for better access to mental health services and increased awareness of PAs. [Journal of Psychosocial Nursing and Mental Health Services, xx(xx), xx-xx.].

Predicting mental health disparities using machine learning for African Americans in Southeastern Virginia

This study examined mental health disparities among African Americans using AI and machine learning for outcome prediction. Analyzing data from African American adults (18-85) in Southeastern Virginia (2016-2020), we found Mood Affective Disorders were most prevalent (41.66%), followed by Schizophrenia Spectrum and Other Psychotic Disorders. Females predominantly experienced mood disorders, with patient ages typically ranging from late thirties to mid-forties. Medicare coverage was notably high among schizophrenia patients, while emergency admissions and comorbidities significantly impacted total healthcare charges. Machine learning models, including gradient boosting, random forest, neural networks, logistic regression, and Naive Bayes, were validated through 100 repeated 5-fold cross-validations. Gradient boosting demonstrated superior predictive performance among all models. Nomograms were developed to visualize risk factors, with gender, age, comorbidities, and insurance type emerging as key predictors. The study revealed higher mental health disorder prevalence compared to national averages, suggesting a potentially greater mental health burden in this population. Despite the limitations of its retrospective design and regional focus, this research provides valuable insights into mental health disparities among African Americans in Southeastern Virginia, particularly regarding demographic and clinical risk factors.

Using the Hospital Anxiety and Depression Scale in Patients 80 Years-Old and Older: A Systematic Review

AIMS

To identify and report results from studies of anxiety and depression, as measured by The Hospital Anxiety and Depression Scale (HADS) in patients ≥ 80 years admitted to hospital settings, and to inform nurses, researchers and educators in nursing about these findings.

DESIGN

Systematic review.

DATA SOURCES

MEDLINE, EMBASE, PsycINFO, CINAHL, Cochrane, Epistemonikos, Scopus and Web of Science Core Collection of studies published until October 2023.

METHODS

A search strategy was developed with a university librarian. Four independent reviewers screened titles and abstracts based on predefined inclusion criteria. Data were systematically extracted, descriptively analysed, and Critical Appraisal Skills Programme checklists were used to assess studies.

RESULTS

Out of 7076 identified studies, three met the eligibility criteria. Data from 420 participants aged ≥ 80 years were analysed, revealing anxiety prevalence rates between 6% and 18% and mean scores below 4. Depression prevalence rates ranged from 7% to 17%, with a mean score below 4. Most patients with depression were not previously recognised as being depressed.

CONCLUSIONS

Few publications reported on anxiety and/or depression in hospitalised patients aged ≥ 80 years using HADS. A gap in the knowledge base has been identified.

IMPLICATIONS

Anxiety and depression are mental health conditions that can lead to adverse events and strongly affect aging. Increased understanding of the role that these conditions have on hospitalised patients ≥ 80 years is important for nurses when in contact with this patient group.

IMPACT

There is a need for more studies to generate evidence regarding anxiety and depression in an increasingly common and challenging hospital population by building upon evidence that is based on validated instruments such as the Hospital Anxiety and Depression Scale.

REPORTING METHOD

The PRISMA guideline was followed, and the review registered in PROSPERO (Registration number CRD 42022380943).

PATIENT CONTRIBUTION

No patient or public contribution.

TRIAL REGISTRATION

CRD 42022380943.

An Analysis of Primary Hyperparathyroidism in Association with Depression or Anxiety

BACKGROUND

Non-classical manifestations such as neuropsychiatric manifestations in primary hyperparathyroidism (PHPT) have long been documented as symptoms of PHPT and are commonly reported by these patients, despite this connection still being a matter of debate, and they (per se) do not represent an indication of parathyroidectomy.

OBJECTIVE

We aimed to overview the most recent findings regarding the link between depression and/or anxiety (D/A) in subjects confirmed with PHPT, including the impact of the surgery in improving their outcome.

METHODS

This was a comprehensive review of English-based original studies published between January 2020 and October 2024.

RESULTS

The studies (n = 16) included a total of 10,325 patients and an additional 152,525 patients with hypercalcemia (out of whom 13,136 had a PHPT diagnosis and 45,081 were at risk of PHPT diagnosis). Out of these subjects with PHPT, 10,068 underwent parathyroidectomy. Female prevalence was between 62.5 and 92%. Most individuals were over 50, with the youngest studied population having a mean age of 52.7 ± 13.8 years, and the oldest had a median of 71. Depression was documented based on ICD-10 codes (n = 3) and patients' records (n = 2), Depression Anxiety Stress Scales (DASS) (n = 2), Beck Depression Inventory (BDI) (n = 3), BDI-II (n = 3), Symptom Check List 90-revised (SCL) (n = 1), Hamilton Depression Rating Scale (HAM-D) (n = 2), HADS (n = 2), Patient Health Questionnaire-9 (n = 1), and European Quality of Life 5 Dimensions 3-Level Version (EuroQOL-5D-3L) (n = 1). Patient records' (n = 1) and ICD-10 codes (n = 2) were also used for anxiety. Most studies used questionnaires to identify anxiety in PHPT: DASS (n = 2), SCL90R (n = 1), Generalized Anxiety Disorder-7 (n = 1), HADS (n = 2), EuroQOL-5D-3L (n = 1), and State-Trait Anxiety Inventory (n = 1). Depression prevalence varied from 20-36.6% to 65.7% (scale-based assessment) and to 10.5% upon ICD-10. A rate of newly onset depression was reported of 10.7% and of 0.2% with concern to the prevalent suicidal ideation (an incidental rate of 0.4% after a median follow-up of 4.2 years). Most studies identified a moderate depression (when assessing its severity), affecting approximately one third of the surgery candidates. The prevalence of anxiety in PHPT varied between 10.4% and 38.6% (n = 8). Discordant results were generated when applying distinct questionnaires for the same population, and this might come as a potential bias. Other confounding factors are generated by the sub-population referred for surgery that typically displays a more severe parathyroid condition or non-endocrine overlapping conditions (e.g., related to the social or familial status).

CONCLUSION

The modern approach of the patient with PHPT should be complex and go beyond the traditional frame. D/A had a high prevalence in the mentioned studies, associated with increased medication use. Yet, the underlying pathogenic mechanisms remain incompletely elucidated. No correlations between D/A and serum calcium levels were confirmed, while PTH had a slight positive correlation with depression. Parathyroid surgery appears to be beneficial for D/A as it improves the scores, prevalence, and severity. Cinacalcet might reduce depression scores, although more evidence is needed. Women are prone to both PHPT and D/A. The optimal method of D/A screening in PHPT remains to be determined, and the current scales need validation and perhaps adjustment for this specific population sub-group, while PHPT management should be refined upon D/A identification.

Nature of stressors, clinical manifestations and diagnostic concurrence with the new ICD-11 criteria in adjustment disorder: a retrospective data review

PURPOSE

Adjustment disorder (AD) is a maladaptive reaction to psychosocial stressors, with prevalence reaching up to 50% in certain consultation settings. Research on stressors, clinical profiles, and concurrence with ICD-11 criteria in AD is limited. We aim to assess stressor profiles, clinical manifestations, course, and diagnostic concurrence between ICD-10 and ICD-11 criteria in AD.

MATERIALS AND METHODS

Retrospective review of medical records of adults diagnosed with AD between 2016 and 2020. Stressors were categorized using the Adjustment Disorder New Module 8 (ADNM-8), a validated scale assessing AD symptom severity as per ICD-11 criteria. Data were analysed using PSPP.

RESULTS

Women comprised 57.8% of 445 patients, with a mean age of 32.24 (±9.97) years. The most common stressor was interpersonal relationship (IPR) issues or familial stressors (50.1%). The illness or death of loved ones was a more common stressor among women, while men noted work-related stress more often (p = 0.001). Those under 40 years predominantly faced interpersonal/familial stress (55%), while those over 40 years more frequently experienced illness or death of loved ones (32%; p = 0.001). Depressive symptoms were the most common presentation. Among ICD-11 criteria, preoccupation with and failure to adapt to the stressor were noted in 97.1% and 93.9% patients, respectively. Amongst patients who followed up, 77% showed significant improvement with 36.5% of them having follow up of 2-6 months.

CONCLUSION

IPR issues were the most common stressors, with gender and age influencing stressor types. AD commonly presented with depressive symptoms, showing high concurrence with ICD-11 criteria and favourable outcomes.

Cingulate and Frontopolar Cortical Projections to the Cerebellar Vermis Support Prolonged Reaction Time in Identifying Negative Emotional Scenes in Women

We previously observed sex differences in the association of individual anxiety and reaction time (RT) during identification of negative emotional scenes in a Hariri task. Prolonged RT in identifying negative (vs. neutral) images represents a behavioral marker of individual anxiety in women but not in men. However, the neural circuit that supports this behavioral observation remains unclear. Here, with a larger sample (64 men and 62 women), we employed whole-brain regression on individual differences in RT during matching negative vs. neutral images or RT (negative - neutral) and evaluated the results at a corrected threshold. Women but not men showed a significant correlation between individual anxiety and RT (negative - neutral), with a slope test confirming the sex difference. In women alone the cerebellar vermis showed activity in positive correlation with RT (negative - neutral). Further, Granger causality mapping (GCM) showed multiple brain regions, including the anterior cingulate cortex/frontopolar cortex (ACC/FPC), that provide inputs to the cerebellar vermis in women. Amongst these regions, only the ACC/FPC cluster showed activity (β) in significant correlation with both STAI State score and RT (negative - neutral) in women. GCM also identified a small cluster in the pons, suggesting that the cortical pontine cerebellar circuit may support prolonged RT during identification of negative emotions. Path analyses further characterized the inter-relationships amongst the neural markers, RT, and anxiety. These findings highlight a behavioral and circuit marker of anxiety state in neurotypical women. Studies with different behavioral paradigms are needed to characterize the behavioral and neural mechanisms of male anxiety.

Relationship of negative life events with depression and anxiety in nursing students: a moderated mediation model of resilience and gender

BACKGROUND

Compared to ordinary student in the same age group, nursing students experience notably higher rates of depression and anxiety. Negative life events (NLEs) and resilience were recognized as risk factors and protective factors, respectively. There is little literature on the complex interaction of these factors among nursing students.

OBJECTIVES

The study aims to explore the potential relationship of NLEs, resilience, and gender with symptoms of depression and anxiety among nursing students.

METHODS

A cross-sectional design was used for this study. A total of 568 participants from three universities in East, South and North China were recruited. Data collection instruments included socio-demographic characteristics, the Patient Health Questionnaire-9, the Generalized Anxiety Disorder Scale, the 10-item Connor-Davidson Resilience Scale, the Adolescent Life Events Self-Rating Scale, and The Pittsburgh Sleep Quality Index. A moderated mediation model was used to analyze the data.

RESULTS

NLEs and resilience significantly related to depression and anxiety (r = -0.289 ~ 0.454, all ps < 0.01). NLEs had a direct effect on depression (B = 0.251, p < 0.001) and anxiety (B = 0.307, p < 0.001). Analysis of mediating effects revealed that NLEs influenced depression (B = 0.02, 95% CI : 0.004-0.041) and anxiety (B = 0.019, 95% CI : 0.004-0.040) through resilience pathways. Additionally, gender was found to have a moderating effect on the direct association of NLEs with anxiety (B = -0.031, p < 0.05), with males showing a greater association.

CONCLUSIONS

The findings suggest that improving resilience may help break the relationship of NLEs with depression and anxiety in nursing students. Additionally, the mental health of male nursing students needs more attention.

Trauma, resilience and significant relationships: Sex differences in protective factors for military mental health

BACKGROUND

Military service is historically a male-dominated occupation, as such, the majority of research examining the development of mental disorder in Australian Defence Force members has had primarily male samples. While there have been mixed findings internationally regarding sex differences in rates of mental disorder and subthreshold symptoms among military personnel, across studies, the evidence tends to suggest that female military members are at least as likely as males to experience subthreshold mental health symptoms and have similar or higher rates of posttraumatic stress disorder despite the differences in roles during service. What is less understood is the impact of sex differences in symptom emergence over time and in predictors of clinical disorder.

METHOD

The sample included a longitudinal cohort of Australian Defence Force members (N = 8497) surveyed at Time 1 (2010) and followed up at Time 2 (2015) on measures of anger, self-perceived resilience, trauma exposure, deployment exposure, suicidality, help-seeking, relationship satisfaction and mental health disorder symptoms. Outcomes included Subthreshold Disorder (above the optimal screening cut-off on the 10-item Kessler distress scale or posttraumatic stress disorder checklist) and Probable Disorder (above the epidemiological cut-off on the 10-item Kessler distress scale or posttraumatic stress disorder checklist).

RESULTS

Results found that while lifetime trauma exposure remained the strongest predictor of later probable disorder emergence among both males and females, for females specifically, self-reported resilience was also a significant protective factor. In contrast, being in a significant relationship at Time 1 was a protective factor against the development of subthreshold disorder in males.

CONCLUSION

For the first time, sex differences in mental health symptom emergence over time have been explored in a large Australian cohort of military members. The capacity to adapt and bounce back after adversity emerged as a proactive factor against poor mental health for females in the military and could be addressed as part of routine skills training. Social support from significant relationship was particularly important for males' mental health, suggesting that maintaining positive relationships and supporting military spouses and partners are critical for males' mental health.

Dynamic changes and future trend predictions of the global burden of anxiety disorders: analysis of 204 countries and regions from 1990 to 2021 and the impact of the COVID-19 pandemic

Background

Anxiety disorders is a significant contributor to the Global Burden of Diseases (GBD), particularly in the aftermath of the COVID-19 pandemic, which has exacerbated the issue. Previous studies have not examined the impact of the COVID-19 pandemic on anxiety disorders over the entire time series, nor have they offered predictions regarding future trends of global anxiety disorders in the aftermath of the pandemic. This study aims to present the Age-Standardized Prevalence Rates (ASPR), Age-Standardized Incidence Rates (ASIR), and disability-adjusted life years (DALYs) associated with anxiety disorders from 1990 to 2021 across 204 countries and regions, emphasizing the age structure and the disease burden following the pandemic. Additionally, it examines the relationship between the burden of anxiety disorders and the COVID-19 pandemic, as well as trend predictions for the incidence of anxiety disorders from 2022 to 2050.

Methods

We analysed data from the GBD 2021 study, employed the GBD method to integrate epidemiological data on ASPR, ASIR, and DALYs to accurately assess the global burden of anxiety disorders across various regions, genders, and age groups. Additionally, joint point regression analysis was applied to rigorously examine the time trends of anxiety disorders from 1990 to 2021, calculating the annual percentage change (APC), annual average percentage change (AAPC), and their corresponding 95% confidence intervals (CIs). Furthermore, path analysis was utilized to investigate the impact pathways between the COVID-19 pandemic and anxiety disorders. Finally, a Bayesian age-period-cohort (BAPC) model was employed to predict the prevalence trends of anxiety disorders from 2022 to 2050.

Findings

From 1990 to 2021, the ASPR, ASIR, and DALYs associated with anxiety disorders worldwide exhibited a significant upward trend, particularly evident from 2019 to 2021, during which all three metrics experienced a sharp increase. The most pronounced changes in the burden of anxiety disorders from 2019 to 2021 were observed in high socio-demographic index (SDI) regions, where the ASIR surpassed expected levels in tropical Latin America, high-income North America, and Australia in 2021. Bulgaria recorded the highest increase in anxiety disorders burden during this period, with a change rate of 0.32, while Bhutan experienced the smallest increase, with a total change rate of 0.02. Notably, the global anxiety disorders burden among women is greater than that among men. From 2019 to 2021, women aged 20-24 years were particularly impacted by the COVID-19 pandemic, with a change rate of 0.21. Additionally, the ASIR of COVID-19 pandemic in 2021 had a significant positive correlation with the prevalence of anxiety disorders, standardized path coefficient value of 0.224 (z = 2.708, P < 0.01). Projections indicate that by 2050, the number of individuals affected by anxiety disorders may reach 87.36 million (95% UI: 59.28-115.44). It is also anticipated that the prevalence of anxiety disorders among the 15-19 age group will exceed that of other age groups by 2050.

Interpretation

The COVID-19 pandemic has significantly impacted the future burden of anxiety disorders, necessitating greater attention towards young individuals, particularly women. There is an urgent need for the adoption of targeted prevention and treatment strategies on a global scale, especially in high SDI regions, to effectively address the escalating issue of anxiety disorder burden.

Funding

Jilin Province 2023 Health Science and Technology Capability Enhancement Plan Project (2023LC024) and Jilin Provincial Department of Science and Technology project (20230203054SF). Research Project on Teaching Reform of Graduate Education at Beihua University (JG [2024]009), Education and Teaching Reform Project of Beihua University (21xjyb-1241759), Jilin Province Education Science "14th Five Year Plan" Project (GH24295).

Measuring Debilitating and Facilitating Anxiety Within Nursing Simulation

BACKGROUND

Anxiety in simulations can be influenced by various factors that either motivate or immobilize students. Understanding simulation anxiety is crucial for educators to design appropriately challenging scenarios without overwhelming students. No instruments have yet been tested to differentiate between debilitating and facilitating anxiety within nursing simulations.

METHODS

A quantitative repeated measures design was used to examine students' baseline and pre-simulation anxiety with 90 pre-licensure junior level nursing students. The Achievement Anxiety Test (AAT) was administered to differentiate levels of debilitating and facilitating anxiety.

RESULTS

The revised AAT demonstrated preliminary validity and reliability for measuring debilitating and facilitating anxiety when used in nursing simulation. Linear regression showed only debilitating anxiety significantly predicted pre-simulation state anxiety. Baseline anxiety has a significant impact on students, increasing debilitating anxiety in simulated settings.

CONCLUSIONS

To ensure success in practice settings, it is important to address students baseline anxiety to support a successful transition into practice. This study was prospectively determined to be exempt with the University's Institutional Review Board on 6 December 2022 and was not prospectively registered in a formal registry.

Effect of group impromptu music therapy on improving test anxiety and emotional regulation ability in medical students

Introduction

Test anxiety, a prevalent psychological issue among medical students, can profoundly impact their social, behavioral, and emotional development. This condition is significantly associated with challenges in emotional regulation, and to date, no effective clinical treatment has been established to address it. This study aimed to investigate the potential benefits and effects of group impromptu music therapy (GIMT) on enhancing emotional regulation skills and alleviating test anxiety in medical students.

Methods

A total of 29 participants in the experimental group and 30 participants in the control group were finally included for data analysis. Four weeks prior to the final exams, the experimental group commenced GIMT treatment, while the control group did not receive any intervention. Following the four-week intervention period, both groups were assessed using standardized scales and follow-up semi-structured interviews.

Results

The results revealed that students given the GIMT intervention reported significantly lower levels of test anxiety, as measured by the Test Anxiety Scale (TAS), and experienced fewer difficulties with emotional regulation, as indicated by the Difficulties in Emotion Regulation Scale (DERS). Additionally, these students achieved higher examination scores than the control group. Qualitative data from semi-structured interviews further supported these observations.

Discussion

Collectively, these findings demonstrate that GIMT is an effective method for enhancing the emotional regulation abilities of medical students and for relieving the symptoms of test anxiety, ultimately resulting in better academic performance. The study also indicates that GIMT could be a promising clinical auxiliary method for dealing with test anxiety and should be considered for inclusion in the curriculum of healthcare professional education programs. Nonetheless, more efforts are needed to address the limitations of this method before it can be widely used for clinical practice.

Psychometric properties of the pain anxiety symptom scale among postoperative patients in Amol, Iran

Introduction

So far, the psychometric properties of the Persian version of the Pain Anxiety Symptom Scale have not been assessed in Iran. Therefore, this study was conducted to determine the validity and reliability of the Persian version of the Pain Anxiety Symptom Scale among a group of Iranian patients in Amol.

Methods

This methodological study was conducted in 2023 with a sample of 400 postoperative patients from Amol, Iran, selected through convenience sampling. The dataset was divided into two groups of 200 for exploratory and confirmatory factor analyses. Construct validity was assessed using maximum likelihood exploratory factor analysis with Promax rotation, supported by Horn's parallel analysis and network analysis to visualize item relationships. Confirmatory factor analysis, convergent and discriminant validity was performed on the second dataset. Reliability was evaluated through various statistical measures, including Cronbach's alpha, McDonald's omega, average inter-item correlation coefficient, composite reliability, and maximal reliability (MaxR).

Results

Among the 400 participants, the mean age was 44.38 years (SD = 13.49), with 152 (46.1%) being women and 178 (53.9%) men. Most participants (n = 268, 81.2%) had an education level lower than a diploma, and 93 individuals (28.2%) reported a history of surgery. The results of exploratory factor analysis with Promax rotation developed two factors accounting for 66.29% of the variance comprising 15 items. Also, after necessary modifications during confirmatory factor analysis, the final model was approved. As for reliability, the Cronbach's alpha, composite reliability, and MaxR for all constructs were greater than 0.7, demonstrating good internal consistency and construct reliability.

Conclusion

According to the results, the Persian version of the Pain Anxiety Symptom Scale has a valid structure and acceptable reliability. This scale can be used by health professionals in many ways.

Sex Differences in Pain Scores and Medication Consumption for Chronic Non-Cancer Pain

BACKGROUND

Chronic pain is defined as any persistent or recurring pain lasting longer than 3 months that significantly affects a person's quality of life. Millions worldwide are impacted by chronic pain, but its subjective nature makes it difficult to quantify and compare between individuals.

METHODS

This retrospective analysis aimed to examine the differences in pain perception and reporting between male and female patients, as well as how their pain was managed. Data from 1995 patients who met the inclusion criteria were selected from the Advocate Illinois Masonic Pain Clinic database. The types of pain assessed in this study included lower back pain, neck pain, and osteoarthritis.

RESULTS

The findings indicate that females suffer more from chronic pain conditions than males, where lower back pain had the highest prevalence in both sexes (63.7% reported). Baseline Numeric Rating Scale (NRS) scores at the first inpatient visit were statistically higher in females than males (7.95 ± 1.35 vs. 7.72 ± 1.46, p = 0.006). After 1 year of treatment, both sexes reported a clinical improvement in their symptoms. With regards to medication, females reported a higher use of medications such as muscle relaxants, benzodiazepines, and tricyclic antidepressants, while males reported a higher use of opioids (measured in MMEs).

CONCLUSIONS

This study reveals a significant sex difference in the reporting of non-cancer-related chronic pain, with females reporting higher pain intensity than males.

Health anxiety during a global pandemic: a comparison of medical and non-medical students in Mashhad, Iran

Background

The COVID-19 pandemic has negatively impacted mental health worldwide, especially among healthcare professionals, including medical students, who were more exposed to pandemic-related stressors. However, health anxiety within this vulnerable group remains understudied.

Objective

This study aimed to assess and compare health anxiety and COVID-19 anxiety between medical and non-medical students during the COVID-19 pandemic and to identify factors associated with these forms of anxiety.

Methods

This cross-sectional study recruited Iranian medical and non-medical students studying in Mashhad via convenience sampling using messaging apps. Participants completed a self-reported questionnaire on demographic and social factors, along with the Health Anxiety Inventory (HAI) and the Corona Disease Anxiety Scale (CDAS), with higher scores reflecting greater symptom severity. Statistical analyses evaluated group differences, correlations between HAI and CDAS scores, and the influence of confounding variables.

Results

A total of 305 students participated, with 176 medical students (57.7%) and 129 non-medical students (42.3%). The majority (92.7%) reported mild COVID-19 anxiety, while 3.2% reported moderate and 0.98% reported severe COVID-19 anxiety. COVID-19 anxiety did not significantly differ between medical and non-medical students (P = 0.439). However, medical students reported significantly higher fear of illness consequences than non-medical students (P = 0.037), while no significant differences were found in susceptibility to disease (P = 0.299) or general health concern (P = 0.156). HAI and CDAS scores were significantly correlated (r = 0.30, P < 0.001). Based on logistic regression, Female gender (OR = 4.55, P = 0.002) was associated with susceptibility to health anxiety, while studying a non-medical major was associated with lower health anxiety (OR = 0.01, P < 0.001) and lower COVID-19 anxiety (OR = 0.05, P < 0.001).

Conclusion

Mild COVID-19 anxiety was prevalent among both medical and non-medical students, with comparable levels of health anxiety across the groups. These findings suggest the need for targeted mental health support among students during pandemic conditions.

Characterising the anxiogenic network from functional connectivity analysis of the CO2 challenge model

The CO2 challenge model (CCM) is a gas inhalation paradigm that provides precisely controlled anxiety induction in experimental settings. Despite its potential as an experimental model of anxiety, our understanding of the neural effects of the CCM is incomplete. This study employs resting-state functional magnetic resonance imaging (rs-fMRI) to explore functional connectivity (FC) changes underlying the CCM. Following a preliminary CO2 tolerance assessment, participants completed an MRI session that included three rs-fMRI scans: during inhalation of control air (pre and post), and during a 6% CCM exposure. Here, we confirm that 6% CCM is a tolerable anxiogenic model in the MRI setting. We demonstrate that a transient CCM-induced increase in subjective anxiety is associated with an increase in FC within limbic and anxiety-related regions, with the insula emerging as a central node in this altered connectivity pattern. Further analysis revealed a significant correlation between the levels of subjective anxiety and enhanced FC between the brainstem and medial frontal cortex, highlighting the dynamic role of the brainstem in response to CO2-induced anxiety. These findings underscore the value of combining CCM and rs-fMRI to characterise the neural mechanisms of anxiety, with important implications for evaluating potential therapeutic interventions.

Loss of the zinc receptor ZnR/GPR39 in mice enhances anxiety-related behavior and motor deficits, and modulates KCC2 expression in the amygdala

BACKGROUND

Mood disorders, particularly depression and anxiety, are associated with zinc dyshomeostasis and aberrant GABAergic signaling. Activation of ZnR/GPR39 by synaptic zinc in the hippocampus triggers phosphorylation of extracellular regulated kinase (ERK1/2), which regulates the K+/Cl- cotransporter (KCC2) and thereby GABAergic inhibitory neurotransmission and seizure activity. Therefore, we studied whether impaired ZnR/GPR39 signaling is linked to anxiety-related behavior in male or female mice.

RESULTS

Using the acoustic startle response, elevated plus maze, and open field test, we found increased anxiety-related behavior in ZnR/GPR39 knockout (KO) mice. Despite a well-established sex difference, where females are typically more prone to anxiety, both male and female ZnR/GPR39 KO mice exhibited increased anxiety-related behavior compared to wildtype (WT) mice. Additionally, ZnR/GPR39 KO mice displayed impaired motor coordination in the pole and rotarod tests but did not show reduced muscle strength, as indicated by a grip test. Finally, we found intrinsic alterations in the expression level of KCC2, a major Cl- transporter regulating GABAergic signaling, in the amygdala of naïve ZnR/GPR39 KO mice compared to controls.

CONCLUSIONS

Our findings indicate that loss of ZnR/GPR39 enhances anxiety-related behavior in both male and female mice. Moreover, ZnR/GPR39 KO mice exhibit impaired motor coordination, which may be associated with increased anxiety. Finally, we demonstrate that loss of ZnR/GPR39 modulates the expression of KCC2 in the amygdala. Thus, we propose that ZnR/GPR39 can serve as a target for regulating GABAergic signaling in anxiety treatment.

Workload Is Associated with Anxiety and Insomnia Symptoms in an Italian Nationally Representative Sample of Public Health Medical Residents: The PHRASI Cross-Sectional Study

BACKGROUND/OBJECTIVES

Mental health disorders pose a substantial challenge for healthcare workers, particularly in the post-COVID-19 era. Public health medical residents (PHRs) played a pivotal role during the pandemic and were significantly affected by the heavy workload. This study aims to uncover potential associations between workload characteristics and symptoms of anxiety and insomnia in Italian PHRs based on data collected in 2022 through the Public Health Residents' Anonymous Survey in Italy (PHRASI) study.

METHODS

A total of 379 residents completed the self-administered questionnaire comprising the Generalized Anxiety Disorder-2 (GAD-2), and the Insomnia Severity Index (ISI).

RESULTS

While 36% PHRs reported anxiety symptoms (GAD-2 ≥ 3), 12% reported moderate-to-severe insomnia symptoms (ISI ≥ 15). The multivariate logistic regressions showed that a high work-life interference was associated with the presence of anxiety and insomnia symptoms, while attending two or more simultaneous traineeships was associated with insomnia symptoms. A high workload perceived was positively associated with both the mental health outcomes considered, while the perception of work environment manageability was negatively associated with them.

CONCLUSIONS

These findings underscore the significant role of the workload in influencing the mental health status of PHRs and emphasize the importance of fostering a supportive work environment that prioritizes mental well-being.

The Effect of Lifestyle Interventions on Anxiety, Depression and Stress: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

BACKGROUND/OBJECTIVES

Depression, anxiety, and stress are common mental health issues that affect individuals worldwide. This systematic review and meta-analysis examined the effectiveness of various lifestyle interventions including physical activity, dietary changes, and sleep hygiene in reducing the symptoms of depression, anxiety, and stress. Using stress as an outcome and conducting detailed subgroup analyses, this study provides novel insights into the differential effects of lifestyle interventions across diverse populations.

METHODS

Five databases were systematically searched: PubMed, Web of Science, Scopus, Cochrane Library, and Google Scholar, for gray literature searches. Keywords were used to search each database. The search period was from the conception of the databases until August 2023 and was conducted in English. For each analysis, Hedges' g was reported with a 95% confidence interval (CI) based on the random-effects method. Subgroups were analyzed and heterogeneity and publication bias were examined.

RESULTS

Ninety-six randomized clinical trial studies were included in this meta-analysis. Lifestyle interventions reduced depression (Hedges g -0.21, 95% confidence interval -0.26, -0.15; p < 0.001; I2 = 56.57), anxiety (Hedges g -0.24, 95% confidence interval -0.32, -0.15; p < 0.001; I2 = 59.25), and stress (-0.34, -0.11; p < 0.001; I2 = 61.40).

CONCLUSIONS

Lifestyle interventions offer a more accessible and cost-effective alternative to traditional treatments and provide targeted benefits for different psychological symptoms.

The relationship between frontal alpha asymmetry and self-report measurements of depression, anxiety, stress, and self-regulation

Though previous research yielded inconsistent results, studies suggest an association between frontal alpha asymmetry (FAA), mood, and self-regulation. This inconsistency may be explained by the heterogeneity of experimental protocols and sample characteristics such as the baseline level of distress. The aim of the study was to gain a better understanding of the relationship between FAA and self-report measurements of depression, anxiety, stress, and self-regulation. Using data from 130 participants (Mage = 25.2; SD = 6.8), we conducted correlation analyses and Bayesian statistics to examine these associations. The results revealed moderate-level positive correlations among depression, anxiety, and stress scores measured by the Depression Anxiety Stress Scale, with notable negative correlations observed between self-regulation and depression, as well as between self-regulation and stress. The relationship between FAA and mood was sample-dependent, and effects were restricted to the sample with moderate to extreme levels of distress, revealing consistent patterns within these subgroups. Most importantly, there was a negative correlation between FAA and anxiety. However, there was no clear association between FAA and depression. Consequently, our results show that self-regulation is associated with reduced distress, and that FAA may be a useful biomarker for anxiety in individuals with moderate to high baseline distress levels.

Relationship Between Family and Friend Support and Psychological Distress in Adolescents

OBJECTIVE

This study examines the associations between family and friend support and depressive and anxiety symptoms among adolescents, considering potential sex differences.

METHODS

Secondary data from a longitudinal cohort study of 1,348 adolescents ages 11-17 were analyzed using descriptive statistics and multiple linear regression, controlling for relevant factors. Interaction terms between sex and support were created to examine moderation by sex.

RESULTS

Youth who reported higher family support reported lower depressive symptoms (b = -0.53, p < .001) and lower anxiety symptoms (b = -0.39, p < .001). Similarly, youth's higher reported friend support was associated with lower depressive symptoms (b = -0.52, p < .001) and lower anxiety symptoms (b = -0.44, p < .001). Effects were not modified by sex.

CONCLUSION

Understanding modifiable factors such as supportive systems is important to mitigate mental health disorders. Further investigation of protective factors for promoting adolescent mental health is needed.

An examination of relationships between transdiagnostic psychological processes and mental health disorders in athletes

INTRODUCTION

The aims of this study were (a) to identify links between transdiagnostic psychological processes and mental health disorder (MHD) symptoms, and (b) to examine differences in MHD and transdiagnostic psychological processes as a function of demographic variables, including, gender, status as an athlete (elite vs. non-elite), number of training sessions per week, previous severe injuries, and use of medical care following severe injuries.

METHODS

A total of 159 competitive athletes aged between 18 and 40 years old (44 % female; mean age = 24.20 ± 4.88 years) participated in this cross-sectional study. Participants completed a demographic questionnaire along with validated questionnaires evaluating MHD symptoms and transdiagnostic processes including: motivation to practice sport, emotional competencies, self-efficacy, repetitive negative thinking, meta-cognitive beliefs, and impulsive and perfectionist behaviors.

RESULTS

MHD symptoms were positively correlated with controlled forms of motivation, repetitive negative thinking, meta-cognitive beliefs, and impulsive and perfectionistic behaviors; and negatively correlated with emotional competencies and self-efficacy. Gender differences showed that women were more likely to experience MHD, higher levels of repetitive negative thinking, meta-cognitive beliefs, and lower levels of emotional competencies and self-efficacy than men. Finally, elite athletes showed higher personal standards than their non-elite counterparts and those training more than four times per week showed significantly higher perfectionistic behaviors.

DISCUSSION

These results are in line with previous findings in clinical psychology and shed light on the role of transdiagnostic processes and the risk of MHD in a sample of French athletes. Further research on the identification of key risk factors for MHD in competitive athletes is needed.

Silexan in anxiety, depression, and related disorders: pharmacological background and clinical data

We present a narrative review of clinical trials investigating the anxiolytic and antidepressant effects of silexan, an active substance derived from lavender oil and summarize nonclinical findings from pharmacological studies supporting its therapeutic use. Six studies investigated the efficacy of the lavender oil in patients with subthreshold and generalized anxiety disorders as well as in mixed anxiety and depressive disorder (MADD). Furthermore, we present data indicating that silexan may influence sleep quality as well as anxiety or depressive disorders in individuals with post-COVID-19. Silexan taken orally at a daily dose of 80 mg for 10 weeks was significantly superior to placebo in reducing psychic and somatic symptoms of anxiety and was as effective as 0.5 mg/d lorazepam and 20 mg/d paroxetine. In patients with mild or moderate major depression, silexan was superior to placebo and comparably effective to 50 mg/d sertraline. Significant antidepressant effects were also observed in MADD and depression co-morbid with anxiety. The herbal product had a beneficial effect on activities of daily living and health-related quality of life. Adverse events associated with silexan in clinical trials were limited to eructation and mild, transient gastrointestinal complaints. The herbal product was not associated with drug interactions, sedation, sleep disturbance, dependence and abuse potential, sexual dysfunction, weight gain or withdrawal symptoms. Silexan was therefore safe and effective in subthreshold and syndromal anxiety disorders and in major depression.

Tobacco Smoke Exposure in Children and Adolescents: Prevalence, Risk Factors and Co-Morbid Neuropsychiatric Conditions in a US Nationwide Study

BACKGROUND

Tobacco smoke exposure (TSE) is a major public health concern, impacting not only smokers but also those around them, particularly children and adolescents. TSE is linked to various neuropsychiatric conditions and significantly impacts quality of life. This study examines the prevalence, socio-demographic factors, and the impact of TSE on the severity of neurological and psychiatric co-morbidities.

METHODS

Data from the National Survey of Children's Health (NSCH) in the US from 2020 to 2021 were used in this study. We included 91,404 children and adolescents aged between 0 to 17 years for the TSE prevalence and socio-demographic analysis, and 79,182 children and adolescents aged between 3 and 17 years for the neuropsychiatric co-morbidities analysis. The mean age of these individuals was 8.7 (standard deviation: 5.3), and 11,751 (12.9%) had confirmed TSE.

RESULTS

Our analysis showed that TSE is more common in males (53%) than females (47%). Additionally, the odds of TSE were higher in families with a lower income level and with American Indian/Native Alaska racial descent. We found that 36.4% of youths with TSE developed at least one co-morbid condition. The most common neuropsychiatric co-morbidities were anxiety problems (15.7%), Attention-Deficit Hyperactivity Disorder (ADHD) (15.5%), behavioral and conduct problems (13.7%), and learning disability (12%). Females had lower odds of co-morbid anxiety (OR: 0.3, p = 0.02) and Autism Spectrum Disorder (ASD) (OR: 0.9, p = 0.04) than males. Asians showed lower odds of co-morbid ADHD (OR: 0.3, p-value: 0.001), anxiety problems (OR: 0.4, p-value: 0.003), speech/other language disorder (OR: 0.4, p-value: 0.001), developmental delay (OR: 0.4, p-value: 0.001), behavioral and conduct problems (OR: 0.4, p-value: 0.003), and learning disability (OR: 0.5, p-value: 0.004). Conversely, American Indian children and adolescents had higher odds of co-morbid headaches (OR: 3, p-value: 0.005). TSE co-occurring with Tourette's Syndrome (TS) (OR: 4.4, p < 0.001), ADHD (OR: 1.3, p < 0.001), developmental delay (OR: 1.3, p < 0.001), behavioral problems (OR: 1.3, p < 0.001), headaches (OR: 1.3, p = 0.005), depression (OR: 1.2, p = 0.02), anxiety (OR: 1.2, p < 0.01), ASD (OR: 1.2, p < 0.001), and learning disability (OR: 1.2, p = 0.03) may contribute to a more severe manifestation.

CONCLUSIONS

ADHD, behavioral/conduct problems, and learning disabilities were the most prevalent co-occurring conditions with TSE. Our findings show that 36.4% of youths with TSE had at least one neuropsychiatric comorbidity. Screening for these conditions in youths exposed to TSE is crucial for early detection and interventions to increase their mental health and well-being.

Exploring factors affecting nurse anxiety in Northwest Ethiopia: a multicenter study

Introduction

Anxiety is a commonly reported mental health disorder that significantly contributes to the global burden of disease. However, proper counseling, problem-solving strategies, and promotion of healthy lifestyle practices have a positive effect on reducing nurse anxiety, but there is limited evidence in Ethiopia, particularly in this study area. Therefore, this study aimed to assess the prevalence and identify factors affecting nurse anxiety in Northwest Ethiopia's comprehensive specialized hospitals.

Methods

An institution-based cross-sectional study was conducted among 746 study participants from April 14 to May 20, 2023. A simple random sampling technique was used. An interviewer-administered questionnaire was used. Data were entered into EpiData version 4.6.0 and exported to STATA version 17 for analysis. In binary logistic regression, variables with a p-value of less than 0.25 were considered candidates for multivariable logistic regression. An association was declared at a p-value of less than 0.05 with a 95% confidence interval.

Result

In this study, the prevalence of anxiety was 33.9%. Thus, being female [adjusted odds ratios (AOR) = 1.53, 95% CI = 1.08, 2.22], working in an emergency department (AOR = 3.65, 95% CI = 1.83, 7.28), working night duty shifts (AOR = 3.12, 95% CI = 2.19, 4.46), having conflict with coworkers (AOR = 1.7, 95% CI = 1.14, 2.51), and having poor social support (AOR = 2.13, 95% CI = 1.23, 3.69) were variables significantly associated with anxiety.

Conclusion

This study revealed that one-third of nurses experienced anxiety, which is a critical indicator of mental health within this population. Important factors that were found to be significantly associated with anxiety include being female, working in the emergency department, having a conflict with coworkers, having poor social support, and working night duty shifts. These findings show the need for the implementation of counseling services and the adaptation of effective coping strategies for nurses working at comprehensive specialized hospitals. Understanding the impact of anxiety on nurses is important to design interventions aimed at improving their mental health and job satisfaction.

Network analysis to examine sex differences linked to emotional well-being in cardiovascular disease

Psychosocial dimensions are essential to guarantee an optimal approach to improve emotional well-being in patients with cardiovascular disease (CVD). There is evidence of sex differences regarding these dimensions. Thus, the connections between them are crucial to implement personalized therapies. Network model analyses were conducted on data from 593 CVD patients. The models included scores from the Hospital Anxiety and Depression Scale (HADS), positive (PA) and negative affect (NA), positivity (PS), satisfaction of life (SLS), social support (SS), self-efficacy on emotion regulation (RESE), cardiac self-efficacy (CSE) and the Short Form-12 Health Survey. The main sex differences were found in: PA-PS (p = 0.03), SS-RESE (p = 0.04), for which the positive associations are stronger for men than for women and PA-RESE (p < 0.01) for which the positive association is stronger for women than for men. These nuances should be considered to implement tailored and integrative therapies for each CVD patient.

Sex Differences in Risk Factors for Generalized Anxiety Disorder in Korean Adolescents

Objectives

This study aimed to examine sex differences in the risk factors associated with generalized anxiety disorder (GAD) among Korean adolescents to provide insights for drafting more effective prevention strategies.

Methods

Data from 51845 middle and high school students in the 18th Korea Youth Risk Behavior Web-based Survey were analyzed. GAD was assessed using the 7-item Generalized Anxiety Disorder tool, and factors such as grade, academic performance, economic status, living arrangements, smoking, drinking, sexual experience, and physical activity were included. The prevalence of GAD and its association with these factors were compared between male and female students using chi-square tests and logistic regression. Odds ratios were compared statistically to identify sex-specific differences.

Results

GAD prevalence was higher among girls (42.1%) than boys (30.1%). Both sexes showed increased GAD risk with lower academic performance, lower economic status, smoking, drinking, and sexual experience. Boys living apart from their families had a higher GAD risk, but this was not significant for girls. Additionally, smoking and drinking were associated with a higher increase in GAD risk in girls than in boys.

Conclusion

This study underscores the importance of considering sex differences in the prevention of GAD among adolescents. Tailored sex-specific interventions are crucial for effective prevention and management of GAD in Korean adolescents.

Health survey on anxiety, depression, and stress in Afghanistan: A large-scale cross-sectional study amid ongoing challenges

BACKGROUND

One of the most significant events in recent Afghan history is the rise of the Taliban and the war that followed, which had profound impacts on the lives of Afghans. The present study examined the mental health of Afghans living under the Taliban government.

METHODS

Between June 5, 2023 and February 12, 2024, a cross-sectional study was conducted among the Afghan population in three key regions of Afghanistan. Data were collected using a pre-tested structured questionnaire. The 21-item Depression, Anxiety and Stress scale (DASS-21) was utilized to assess depression, anxiety and stress of the Afghan population. Ethical permission for this study was granted by the Afghanistan Center for Epidemiological Studies (ACES). Logistic regression models were employed to explore the relationship between socio-demographic characteristics and depression, anxiety, and stress among 2,698 participants.

RESULTS

The prevalence of depression was 72.05%, anxiety was 71.94%, and stress was 66.49%. Multiple regression analysis indicated that gender (being female), economic status (being poor), residency (living in rural areas), education level (being illiterate), being a cigarette smoker, and having experienced a bad event during the past month were significantly associated with depression, anxiety and stress.

CONCLUSION

The findings of the present study show very high levels of anxiety, depression, and stress, most likely reflecting the profound impact of recent political, social, and economic changes. Notably, a significant majority of participants, particularly females and individuals above 35 years of age, reported severe to extremely severe mental health symptoms. The mental health crisis in Afghanistan is a complex and urgent issue that requires a comprehensive and compassionate response.

The Relationship between Family Functioning, Emotional Intelligence, Loneliness, Social Support, and Depressive Symptoms among Undergraduate Students

The transition from adolescence to college is a significant developmental stage marked by challenges such as high academic pressure, changes in living environments, and social support systems. These challenges can lead to increased rates of depression among college students. This study investigates the relationships between family functioning, emotional intelligence, loneliness, social support, and depressive symptoms in Chinese college students. A cross-sectional design was employed, with data collected via questionnaires from undergraduate students at Xi'an Jiaotong University. Variables such as family functioning, emotional intelligence, loneliness, social support, and depressive symptoms were assessed. Statistical analyses, including correlation and hierarchical regression, were conducted to explore these relationships. The study found a diverse distribution of depressive symptoms among students, with significant gender differences indicating higher depression rates in females. No significant differences were observed across academic disciplines, grades, or between only children and non-only children. Family functioning, emotional intelligence, and social support were negatively correlated with depressive symptoms, while loneliness was positively correlated. Hierarchical regression analysis confirmed that social support significantly moderated the relationship between family functioning and depressive symptoms. Mediation analysis showed that emotional intelligence and loneliness mediated this relationship. The findings highlight the complex interplay between family dynamics, emotional capabilities, social connectedness, and mental health. Enhancing family functioning, emotional intelligence, and social support can effectively reduce depressive symptoms among college students. These results underscore the need for holistic interventions that address multiple aspects of students' social and emotional lives.

Effects of pain, hospitalization, and medication on depressive symptom in Syrian patients with chronic diseases

Chronic diseases and pain exacerbate depressive symptom in Syria. Limited research on hospital-induced depressive symptom among Syrian patients with chronic diseases warrants further study. A cross-sectional study in four Damascus hospitals revealed high rates of pain and depressive symptom. This study aims to investigate the prevalence and severity of chronic pain and hospital-induced depressive symptom in Syrian patients, as well as the relationship between pain, depressive symptom, and medication behavior. This study analyzes the impact of pain, hospitalization, and medication on patients with chronic diseases. The four Damascus hospitals included 453 patients from various departments. Data were collected through structured interviews and internationally recognized scales such as the PSEQ, HADS, and MMAS. These findings offer insights into pain management and psychological well-being, with implications for patient care and support strategies. The study involved 453 patients with chronic diseases, with gender distribution showing 46.6% females and 53.4% males. The age range was from 7 to 87 years, with an average of 46.87 years. Chi-square tests revealed a significant connection between gender and HADS-A scores, where 48.3% of females had abnormalities (χ2 (1, N = 453) = 7.125, p = 0.028). Marital status was significantly associated with anxiety and depressive symptom levels, particularly among widowed and divorced patients. Employment status, education, and comorbidity were linked to abnormal HADS-A scores, while education level showed a positive correlation with HADS-D scores. ANOVA tests showed significant differences in MMAS scores across income groups (F (3, 449) = 3.167, p = 0.024), with a notable difference between low-income and lower-middle-income groups (mean difference = 0.389, p = 0.031. Chronic pain and HID are prevalent among Syrian patients with chronic diseases and influenced by socio-demographic factors. Personalized interventions are needed to address psychological symptoms and medication behavior.