Quality of life in anxious adolescents

A Systematic Review and Meta-Analysis of Impairment and Quality of Life in Children and Adolescents with Anxiety Disorders

Anxiety disorders are common, emerge during childhood, and pose a significant burden to society and individuals. Research evaluating the impact of anxiety on functional impairment and quality of life (QoL) is increasing; however, there is yet to be a systematic review and meta-analysis of these relationships in pediatric samples. This systematic review and meta-analysis were conducted to determine the extent of impairments in functioning and QoL that young people with anxiety disorders experience relative to their healthy peers, as well as sociodemographic and clinical moderators of these relationships. Studies were included when they compared young people (mean age range within studies 7-17 years) with a primary clinical anxiety disorder to a healthy comparison group and measured impairment and/or QoL via a validated instrument. A total of 12 studies met criteria for this review (N = 3,129 participants). A majority of studies (K = 9) assessed impairment as an outcome measure, and three assessed QoL outcomes. Meta-analysis of nine studies (N = 1,457 children) showed large relationships between clinical anxiety and life impairment (g = 3.23) with the strongest effects seen for clinician report (g = 5.00), followed by caregiver (g = 2.15) and child (g = 1.58) report. The small number of studies and diversity in methodology prevented quantitative investigation of moderating factors. In the systematic review of QoL outcomes, all three studies reported significantly poorer QoL for youth with anxiety disorders relative to unaffected peers. Findings support the importance of measuring functioning and QoL as outcomes in clinical research and practice among anxious young people.This study is registered with PROSPERO under the identification number CRD42023439040.

Indonesian COVID-19 lesson: A mixed-methods study on adolescent health status and health services during pandemic

TOPIC

The COVID-19 pandemic affected adolescents' physical and psychological health. There must be specific services to cater to the needs of adolescents during COVID-19 in Indonesia. Lessons learned from previous pandemics will be beneficial for nurses and other health professionals to prepare services for future pandemics.

PURPOSE

This mixed-method study aimed to examine 459 Indonesian adolescents' health, literacy, preventive measures, and preferred health services during the COVID-19 pandemic. This study also examines sociodemographics, respondent characteristics, health information sources, and media choices.

RESULTS

A total of 47.5% of adolescents knew about COVID-19, 26.8% experienced physical health changes, and 61.7% considered wearing masks. Adolescent health information came from teachers (26.6%) and the Internet (32.9%). Psychological changes showed 67.8% irritation. Indonesians preferred online counseling (53.8%) and WhatsApp (45.8%) for pandemic health services. COVID-19 literacy did not affect physical or mental health (p > 0.05).

CONCLUSIONS

Most adolescents reported mental and physical health changes during COVID-19. Our data suggest that adolescents' strong COVID-19 knowledge did not prevent anxiety and other psychological difficulties. The longitudinal studies could be utilized if pandemic demands social and physical distance. The government, as well as nurses, might utilize WhatsApp-based remote online treatment for health services.

Postconcussion Moderate to Vigorous Physical Activity Predicts Anxiety Severity among Adolescent Athletes

PURPOSE

This study aimed to examine how moderate-to-vigorous physical activity (MVPA) during concussion recovery influences self-reported anxiety symptoms at follow-up assessment. We hypothesized that more MVPA after concussion would be associated with lower anxiety rating at follow-up.

METHODS

We performed a prospective study of participants aged 13-18 yr initially assessed within 14 d of diagnosed concussion. Participants rated concussion symptoms using the Post-Concussion Symptom Inventory and were provided a wrist-worn actigraphy device to track activity for 1 wk after assessment. At follow-up assessment, participants rated anxiety symptoms using the four-question Patient-Reported Outcomes Measurement Information System (PROMIS) anxiety subscale. Each question ranged from 1 (never) to 5 (almost always), with an overall score range of 4-20. For univariable analysis, we calculated correlation coefficients between MVPA and PROMIS anxiety subscale scores. We then created a multiple linear regression model with follow-up PROMIS anxiety subscale score as the outcome and MVPA, sex, initial symptom severity, and preconcussion anxiety as predictors.

RESULTS

We enrolled and initially tested 55 participants, and 48 were included in the final analysis (age, 14.6±2.7 yr; 56% female; initial assessment, 7.3± 3.1 d; follow-up assessment, 42.0±29.7 d). We observed an inverse and low correlation between MVPA and follow-up PROMIS anxiety subscale T-scores ( r = -0.30, P = 0.04). Multivariable regression results indicated that MVPA ( β = -5.30; 95% confidence interval (CI), -10.58 to -0.01), initial Post-Concussion Symptom Inventory score ( β = 0.11; 95% CI, 0.03 to 0.19), and preconcussion anxiety ( β = 5.56; 95% CI, 0.12 to 11.0), but not sex ( β = -2.60; 95% CI, -7.14, to 1.94), were associated with follow-up PROMIS anxiety subscale T-scores.

CONCLUSIONS

After adjusting for covariates, more MVPA early after concussion predicted lower PROMIS anxiety subscale scores at follow-up. Although initial concussion symptom severity and preconcussion anxiety were also associated with follow-up PROMIS anxiety subscale score, MVPA represents a modifiable factor that may contribute to lower anxiety symptoms.

The relationship between gender, psychosocial factors, pain, health literacy and health-related quality of life in parents of Norwegian adolescents one year into the COVID-19 pandemic

BACKGROUND

Stress impacts healthy behaviours and may influence life and health-related quality of life (HRQOL). A stressful event occurred when the COVID-19 pandemic hit in March 2020. The present study aims to explore possible gender differences in stress, psychosocial factors (self-efficacy, self-esteem, loneliness), pain, HL, and HRQOL in parents of adolescents one year into the COVID-19 pandemic, and to explore possible associations between gender, demographic and psychosocial factors, pain, HL, and HRQOL.

METHODS

Parents of adolescents aged 16-17 took part in the study from January to February 2021, when the COVID-19 pandemic was ongoing. Data on socio-demographics, stress, self-efficacy, self-esteem, pain, HL, loneliness, and HRQOL were collected. HRQOL was assessed using RAND-36.

RESULTS

Among the 320 parents from the general population, the mean age was 47.6 (standard deviation (SD) = 4.6) years, 81% were mothers, 79% were married or cohabiting, 81% had a university degree, and the majority worked full time (78%) or part time (13%). The average pain score was low, 0.48 (95% CI [0.43-0.54]). However, 50% of the parents reported persistent pain and more mothers reported persistent pain compared to fathers (53% vs. 37%). The parents' mean (SD) score for RAND-36 was 52.1 (95% CI [51.2-53.0]) for the physical component summary (PCS) score and 51.0 (95% CI [50.0-52.1]) for the mental component summary (MCS) score. Mothers reported significantly lower scores for all the eight RAND-36 domains and the PCS and MCS scores. Adjusting for gender, age, living condition, education, pain, HL, self-efficacy and loneliness, we revealed no associations between stress and RAND-36-PCS. University education of four years or more was positively associated (B = 3.29, 95% CI: [0.78-5.80]) with RAND-36-PCS, while persistent pain was negatively associated (B = -7.13, CI: [-9.20- -5.06]). We identified a strong negative association between RAND-36-MCS and stress (B = -43.11, CI: [-48.83- -37.38]) and a positive association with older age (B = 0.21, CI: [ 0.04, 0.39)].

CONCLUSION

One year into the COVID-19 pandemic, we identified a strong negative association between stress and mental HRQOL, while pain was strongly negatively associated with physical HRQOL.

Modified Approaches to Treating Anxiety for Children With Visual-Spatial Problems: A Strengths-Based Perspective

Anxiety disorders are common and impairing1 and affect as many as 30% of youth with2 and without3 neurodevelopmental disorders. Nonverbal learning disability (NVLD) is an understudied neurodevelopmental disorder with an estimated prevalence of 3% in North American children and adolescents.4 Although definitions of NVLD vary, all include a core deficit of difficulty with visual-spatial processing. Importantly, anxiety is also a common psychiatric comorbidity for youth with NVLD, affecting roughly one-third of these youth.4,5 In youth with neurodevelopmental disorders, treatment is often sought or received for comorbid conditions (eg, anxiety, attention-deficit/hyperactivity disorder) or associated impairments, rather than for the symptoms or core deficits of the neurodevelopmental disorder itself.6 Considerable work has examined the adaptation of anxiety disorder treatments for children with attention-deficit/hyperactivity disorder7 and autism.8 Comparatively little work has explored treatment approaches for children with NVLD. Given the overlap of anxiety symptoms and visual-spatial problems in NVLD,9,10 herein we consider how these cognitive problems might interfere with patients' abilities to engage with common treatment approaches.

Exploring the Prevalence and Predictors of Anxiety among Lithuanian Adolescents during Times of Crisis: A Cross-Sectional Study

Recent events in Europe, like the COVID-19 pandemic and the 2022 Russo-Ukrainian War (RUW), might have sparked anxiety among adolescents. This study aimed to compare anxiety levels in Lithuanian adolescents post-COVID-19 peak (Study 1, October 2021) and during the onset of the RUW (Study 2, April-June 2022). Data from 459 participants in Study 1 and 6637 in Study 2, aged 11-17, were collected through HBSC pilot and national surveys in Lithuania. Self-reported questionnaires assessed anxiety, social media use, stress, loneliness, self-efficacy, and peer support factors. Analysis was conducted using multivariable logistic regressions. Notably, anxiety prevalence in Lithuanian adolescents showed no significant difference between Study 1 and Study 2, stabilizing around 24%. In 2021, stress (OR = 5.89, 95% CI 3.11-11.17), problematic social media use (OR = 4.58, 95% CI 1.89-10.58), and female gender (OR = 2.87, 95% CI 1.58-5.22) significantly predicted anxiety. By 2022, stress (OR = 3.68, 95% CI 3.14-4.30), loneliness (OR = 2.85, 95% CI 2.43-3.35), and lower self-efficacy (OR = 1.40, 95% CI 1.20-1.60) emerged as important predictors. This study enhances our understanding of adolescent anxiety during crises, emphasizing the urgency of addressing multiple factors to manage and support vulnerable youth.

The German version of the Revised Children's Anxiety and Depression Scale-Psychometric properties and normative data for German 8- to 17-year-olds

OBJECTIVES

Anxiety and depression are internalizing mental disorders often commencing in childhood and manifesting in adolescence. The Revised Anxiety and Depression Scale (RCADS) is an internationally widely used standardized diagnostic tool, but the German version has only been validated in a pediatric chronic pain sample; normative data are not available. The aim of this study is to test its reliability (internal consistency) and validity (factorial, convergent, known-groups) in a representative German school sample and to provide norm data.

METHODS

Data were collected from N = 1562 German schoolchildren (Mage  = 12.2; SDage  = 2.33; range 8-17 years; 52.4% girls).

RESULTS

Cronbach's α ranged from 0.73 to 0.96 for the total and the six subscales (five anxiety and one depression). Confirmatory factor analysis showed the 6-factor model had acceptable to good model fit with CFI = 0.93, TLI = 0.93, RMSEA = 0.05, SRMR = 0.05, which was better than 1- and 2-factor models. The (sub)scales correlated moderate to high negatively with health-related quality of life (-0.31 ≤ τ ≤ -0.51; p < 0.001) and positively with functional impairment (0.31 ≤ τ ≤ 0.48; p < 0.001). Mean scores of anxiety and depression scales were significantly higher in girls and partly in adolescents.

CONCLUSION

Findings provide support for the good psychometric properties of the German RCADS in a community sample.

Comparing Short-Term Knee-Related Quality of Life and Associated Clinical Outcomes Between Youth With and Without a Sport-Related Knee Injury

OBJECTIVE

To compare short-term changes in knee-related quality of life (QOL) and associated clinical outcomes between youth with and without a sport-related knee injury.

DESIGN

Prospective cohort study.

SETTING

Sport medicine and physiotherapy clinics.

PARTICIPANTS

Youth (11-19 years old) who sustained an intra-articular, sport-related knee injury in the past 4 months and uninjured youth of similar age, sex, and sport.

INDEPENDENT VARIABLE

Injury history.

MAIN OUTCOME MEASURES

Knee-related QOL (Knee injury and Osteoarthritis Outcome Score, KOOS), knee extensor and flexor strength (dynamometry), physical activity (accelerometer), fat mass index (FMI; bioelectrical impedance), and kinesiophobia (Tampa Scale for Kinesiophobia, TSK) were measured at baseline (within 4 months of injury) and at 6-month follow-up. Wilcoxon rank sum tests assessed between-group differences for all outcomes. Regression models assessed the association between injury history and outcome change (baseline to 6-month follow-up), considering sex. The influence of injury type, baseline values, and physiotherapy attendance was explored.

RESULTS

Participants' (93 injured youth, 73 uninjured control subjects) median age was 16 (range 11-20) years and 66% were female. Despite greater improvements in KOOS QOL scores (20; 95% confidence interval, 15-25), injured participants demonstrated deficits at 6-month follow-up (z = 9.3, P < 0.01) compared with control subjects, regardless of sex. Similar findings were observed for knee extensor and flexor strength and TSK scores but not for physical activity or FMI. Lower baseline values were associated with greater outcome changes in injured youth.

CONCLUSIONS

Youth have worse knee-related QOL, muscle strength, and kinesiophobia early after a sport-related knee injury than control subjects. Despite improvements, deficits persist 6 months later.

The mental condition of Polish adolescents during the COVID-19 pandemic and war in Ukraine

Recently, the experience of the COVID-19 global pandemic has significantly affected the mental condition of entire societies by increasing anxiety and stress resulting from its sudden and completely unexpected nature. In Poland, apart from the pandemic, there is an ongoing threat of an armed conflict just across the border, which can constitute direct and indirect threats to physical and mental health. Each of these situations is unusual and difficult. It is also in sharp contrast to the developmental needs of children and adolescents. It especially violates the principal need of this developmental period, which is to grow up in a predictable as well as physically and emotionally safe environment. The purpose of the conducted research was to assess the psychological condition of Polish adolescents, whose social situation is difficult, in order to take appropriate preventive measures based on this assessment. The study was conducted using the "Who are You?" Scale of Transparency Anxiety and the Revised Child Anxiety and Depression Scale (RCADS), as well as a researcher-made survey containing questions about well-being in relation to the pandemic, distance learning and the ongoing war in a neighbouring country. Approval was obtained from the Bioethics Committee to conduct the projected research. The study included 945 adolescents aged 11 to 15 (M = 13.10; SD = 1.11) making a representative sample of adolescents from 14 regions in Poland. The results of the research and analyses show that the adolescents under study have a medium level of intensity of neuroticism, with the highest levels occurring in adolescents aged 14. Moreover, the adolescents manifest relatively lower symptoms of anxiety and depression as well as concern about the pandemic and the war in Ukraine than expected.

How Self-Regulation and Executive Functions Deficits Affect Quality of Life of Children/Adolescents with Emotional Regulation Disorders

BACKGROUND

Deficits in self-regulation and executive functions (EFs) frequently characterize children/adolescents with emotional regulation disorders and restrict their daily function and quality of life (QOL). These deficits are mainly manifested by neuropsychological measures in laboratory settings. This study aimed to compare self-regulation and EFs by ecological measures to reflect the implications in daily life between children with emotional regulation disorders and healthy controls and examine the relations between self-regulation, EFs and QOL in the study group.

METHODS

the participants were 49 children aged 8-18: 25 children/adolescents with emotional regulation disorders and 24 healthy children. The parents completed a socio-demographic questionnaire, the Child Behavior Checklist (CBCL), the Behavior Rating Inventory of Executive Functions (BRIEF) and the Pediatric Quality of Life Inventory (Peds-QL).

RESULTS

The study group had greater self-regulation difficulties (internalization and externalization problems), executive dysfunctions (EFdys) (including metacognition difficulties) and a lower QOL. Their internalization and externalization problems correlated with reduced EFs and QOL. Internalization predicted the physical and emotional QOLs, while metacognition predicted social and school-related QOLs.

CONCLUSIONS

Deficits in self-regulation and EFs are prevalent in children/adolescents with emotional disorders and restrict their daily function and QOL. Therefore, they should be routinely evaluated by ecological instruments to reflect daily restrictions.

Exploring the Impact of Emotional and Cognitive Factors on Anxiety Symptoms of Chinese Adolescents: a Serial Mediation Study

The onset age of anxiety is decreasing worldwide, yet the majority of the study conducted on anxiety were focused on adult populations. This study aimed to investigate the mediating effect of psychological capital and coping style tendency on the relationship between emotional intelligence and anxiety in Chinese adolescents and provide empirical evidence for research and prevention. A cross-sectional study recruited 5747 participants from 5 randomly selected middle schools in the northeast China. Study results showed that high emotional intelligence (P < 0.05), high level of psychological capital (P < 0.05), and positive coping style tendency (P < 0.05) were correlated to lower level of anxiety symptoms in adolescents. Psychological capital and coping style tendency performed partial and serial mediating effect on the relationship between emotional intelligence and anxiety. Teaching adolescents how to regulate emotions can strengthens their positive mentalities, promotes the use of positive coping strategies, and then attenuates the severity of anxiety symptoms in a nonadditive manner.

The relationship between stress and health-related quality of life and the mediating role of self-efficacy in Norwegian adolescents: a cross-sectional study

BACKGROUND

During the transitional phase from childhood to adulthood, adolescents encounter many changes and challenges. Stress is associated with reduced health-related quality of life (HRQOL) in adolescents and, thus, impacts all aspects of their life. Adolescents' thoughts and beliefs in their capacity may be essential with regard to their subjective perception of stress and coping with it. Insights into the complexity of stress and exploration of the possible underlying mechanisms in adolescence are needed. We sought to describe stress, HRQOL, and self-efficacy and explore the association between stress and HRQOL by testing for self-efficacy as a possible mediator in adolescents.

METHODS

In total, 696 school-based adolescents aged 14-15 years participated in this study. Participants were recruited from 22 schools in the Eastern and Southern parts of Norway. All participants completed an electronic survey in their respective classrooms. The survey included demographic data, the Perceived Stress Questionnaire, the KIDSCREEN-27 questionnaire measuring HRQOL, and the General Perceived Self-Efficacy Scale. Statistical analyses were conducted using the PROCESS macro for SPSS Statistics software by Andrew Hayes model 4.

RESULTS

Descriptive analyses revealed overall low levels of stress with a score of 0.29 (SD, 0.15). Nevertheless, stress was negatively associated with all HRQOL subscales: physical well-being (B =  - 25.60), psychological well-being (B =  - 38.43), autonomy and parents (B =  - 28.84), social support and peers (B =  - 21.05), and school environment (B =  - 30.28). Furthermore, these respective associations were all mediated by self-efficacy, which explained approximately one-fifth of the reduction in HRQOL. The highest degree of mediation and, thus, the largest indirect effect was estimated for the HRQOL subscale physical well-being (31.7%).

CONCLUSIONS

Our findings extend prior research on the mechanisms underlying the relationship between perceived stress and HRQOL in adolescents. They demonstrated that perceived stress explained most of the reduction in the HRQOL after adjusting for the effect of self-efficacy. Hence, stress itself appears to be an important target for future interventions to enhance HRQOL, rather than purely focusing on increasing self-efficacy to enhance the HRQOL in adolescents. Our findings highlight the importance of a better understanding of the underlying mechanisms to develop strategic and accurate interventions for adolescents.

Anxiety and Its Associated Factors Among School-aged Adolescents in East Jakarta, Indonesia during the Coronavirus Disease-2019 Pandemic

BACKGROUND: The coronavirus disease-2019 (COVID-19) pandemic can be a significant psychological stressor which is associated with increased levels of anxiety and stress during the COVID-19 pandemic. AIM: To determine adolescent anxiety prevalence and associated risk factors. MATERIALS AND METHODS: An online cross-sectional survey was performed from February to April 2021 at SMPN 9, East Jakarta, on 304 adolescents. The subjects were examined using sociodemographic form and self-report measures of anxiety, COVID-19 knowledge, and physical activity. The statistical significance level was set at p ˂ 0.05. RESULTS: Median age was 14 years (range 12–16) and prevalence of anxiety 19.4%. Multivariable logistic regression findings: gender (adjusted odd ratio [aOR] = 2.50; 95% confidence interval [CI] = 1.26–4.98; p = 0.009), physical activity (aOR = 2.16; 95% CI = 1.15–4.06; p = 0.017;), knowledge level of COVID-19 (aOR = 1.81; 95% CI = 0.99–3.32; p = 0.053); age (aOR = 0.53; 95% CI = 0.19–1.46; p = 0.218); education (aOR = 0.96; 95% CI = 0.35–2.64; p = 0.932). Gender and physical activity were significantly associated with risk of adolescent anxiety. CONCLUSION: Inactive physical activity status increases the risk of adolescent anxiety. Governmental regulations are needed on the planning and implementation of a health education program for increasing physical activity among adolescents to improve physical and mental health. As a follow-up to this study, there is a need for conducting a study to determine changes in prevalence rates of adolescent anxiety during as well as after the pandemic and its associated risk factors with a better design study.

Negative life events and internalizing problems among Romanian youth

During adolescence individuals face multiple stressful events, but it is not clear how these impact adolescents' adjustment and what factors buffer their negative effects. The present exploratory study investigates the relationship between frequency, proximity, and intensity of negative life events and occurrence of internalizing symptoms in a sample of Romanian adolescents. 2690 youth aged 15-16 from capital city of Romania filled in a series of measures from Youth in Europe Study. Hierarchical regression was employed to test for the explanatory value of individual (gender and family status), relational (parents and peer support), and negative life events on depressive and anxiety symptoms. Frequency and proximity of negative life events explained 35.8% in the displaying of depressive symptoms. After controlling for individual and relational variables, occurrence, proximity, and intensity of negative life events significantly contributed to explaining heightened anxiety symptoms (R² = .246). Adolescents reporting more frequent, earlier in time and more intensive negative events also reported more depressive and anxiety symptoms, thus, supporting the relationship between occurrence of adversities and negative mental health outcomes.

Association between Anxiety, Quality of Life and Academic Performance of the Final-Year-Students in Latvia

The main objective of this study was to investigate the association between final-year students’ anxiety level and quality of life (QOL) with their academic achievements. A longitudinal study was performed in regular schools and in high-rated gymnasiums at the beginning and at the end of the school year. Multiple linear regression models were built for the association between level of anxiety/QOL with academic achievements. Type of school and gender—but not the level of anxiety—were the main predictors of academic achievements of 287 adolescents (e.g., for mathematics, the effect estimates were: β = −1.71 [95% confidence interval −2.21; −1.21]; β = −0.50 [−0.95; −0.06], β = 0.09 [−0.02; 0.20] for the type of school, gender, and changes in level of anxiety, respectively). To conclude, particular efforts should be made to reduce the level of anxiety in girls, especially those that study in high-rated schools.

Potentiated perceptual neural responses to learned threat during Pavlovian fear acquisition and extinction in adolescents

Adolescents' experience of heightened anxiety and increased vulnerability to develop anxiety disorders is believed to partly result from blunted fear extinction processes. However, whether this anxiety is mediated by adolescent-specific differences in perceptual responses to learned threat is not known. To investigate this, we used EEG to examine reinforcement-dependent changes in early visual event-related potentials in adolescents (N = 28, 13-14 years) and adults (N = 23, 25-26 years old) during a differential Pavlovian fear conditioning task, with one conditioned stimulus (CS+) paired with an aversive sound (unconditioned stimulus [US]) on 50% of trials, and another (CS-) never paired with the US. An immediate extinction phase followed, where both CSs were presented alone. We found age-dependent dissociations between explicit and implicit measures of fear learning. Specifically, both adolescents and adults demonstrated successful fear conditioning and extinction according to their explicit awareness of changes in CS contingencies and their evaluative CS ratings, and their differential skin conductance responses. However, for the first time we show age differences at the neural level in perceptual areas. Only adolescents showed greater visual P1 and N1 responses to the CS+ compared to the CS- during acquisition, a dissociation that for the N1 was maintained during extinction. We suggest that the adolescent perceptual hyper-responsivity to learned threat and blunted extinction reported here could be an adaptive mechanism to protect adolescents from harm. However, this hyper-responsivity may also confer greater vulnerability to experience pathological levels of anxiety at this developmental stage.

Change in quality of life and self-esteem in a randomized controlled CBT study for anxious and sad children: can targeting anxious and depressive symptoms improve functional domains in schoolchildren?

BACKGROUND

Quality of life and self-esteem are functional domains that may suffer when having mental problems. In this study, we examined the change in quality of life and self-esteem when targeting anxious and depressive symptoms in school children (8-12 years) using a CBT-based transdiagnostic intervention called EMOTION, Kids Coping with anxiety and depression. The aim of this study was to investigate quality of life and self-esteem in children with elevated levels of anxious and depressive symptoms, and further if the EMOTION intervention could influence these important functional domains.

METHODS

The study had a clustered randomized design (cRCT), where N = 795 children recruited from 36 schools participated. The children were included based on self-reports of anxious and depressive symptoms. Schools were the unit of randomization and were assigned to intervention or control condition. Children in the intervention condition received the 10-week EMOTION intervention. Mixed effects models were used to take account of the possible clustering of data. Separate models were estimated for the dependent variables.

RESULTS

Children with elevated levels of anxious and depressive symptoms reported lower levels of quality of life and self-esteem compared to normative samples, with girls and older children reporting the lowest levels. For both genders and older children, a large and significant increase in quality of life and self-esteem was found among the children who received the intervention compared to the children in the control condition. Children in the intervention group reporting both anxious and depressive symptoms showed a significantly larger increase in both quality of life and self-esteem compared to the controls. Reductions in quality of life and self-esteem were partially mediated by reductions in symptoms of anxiety and depression.

CONCLUSIONS

Participating in an intervention targeting emotional symptoms may have a positive effect on quality of life and self-esteem in addition to reducing anxious and depressive symptoms. Improved quality of life may increase the child's satisfaction and subjective perception of wellbeing. As low self-esteem may lead to anxious and depressive symptoms, improving this functional domain in children may make them more robust dealing with future emotional challenges. Trial registration NCT02340637, retrospectively registered.

An Examination of Correlates of Quality of Life in Children and Youth With Mental Health Issues

Quality of life (QoL) is significantly lower in children with mental health issues compared to those who are typically developing or have physical health problems. However, little research has examined factors associated with QoL in this particularly vulnerable population. To address this limitation, 347 clinically referred children and adolescents were assessed using the interRAI Child and Youth Mental Health (ChYMH) Assessment and Self-reported Quality of Life- Child and Youth Mental Health (QoL-ChYMH). Hierarchical multiple linear regression analyses were conducted to examine QoL at the domain-specific level. Children and adolescents who experienced heightened anhedonia and depressive symptoms reported lower social QoL (e.g., family, friends and activities; p = 0.024, 0.046, respectively). Additionally, children and youth who experienced heightened depressive symptoms reported lower QoL at the individual level (e.g., autonomy, health; p = 0.000), and level of basic needs (e.g., food, safety; p = 0.013). In contrast, no mental state indicators were associated with QoL related to services (e.g., school, treatment). Due to the paucity of research examining predictors of QoL in children and youth with mental health challenges, this study contributes to the field in assisting service providers with care planning and further providing implications for practice.

Correlates of Quality of Life in Anxiety Disorders: Review of Recent Research

PURPOSE OF REVIEW

Anxiety disorders are highly prevalent conditions that have a detrimental impact on quality of life (QOL), particularly when left untreated. In the present review, we summarize recent literature, published within the last 3 years, on QOL in anxiety disorders, with a focus on factors that may play a role in the relationship between anxiety and QOL.

RECENT FINDINGS

We organize our findings into four categories: (1) subjective distress, (2) behavioral responses, (3) functional impairment, and (4) clinical factors. Results indicate that greater anxiety symptom severity is linked with poorer QOL, and cognitive behavioral therapies for anxiety yield positive effects on QOL. Additional transdiagnostic mechanisms are highlighted, including anxiety sensitivity, distress tolerance, emotion regulation, and avoidant coping. We examine the role of functional impairment, and we discuss factors related to treatment, including comorbidity and longitudinal effects. We also consider early research from the COVID-19 pandemic. Understanding the underlying factors that contribute to QOL detriments provides important insight into the impact of anxiety disorders and identifies targets for enhancing QOL through treatment.

Depression, anxiety, and stress mediate the associations between internet gaming disorder, insomnia, and quality of life during the COVID-19 outbreak

BACKGROUND

For many individuals, the COVID-19 outbreak has increased their psychological distress, changed their behaviors, and impacted their health. With more time spent indoors, many individuals have engaged in increased videogame playing. However, the associations between such behaviors during the COVID-19 outbreak period is unclear.

OBJECTIVE

The present study examined the mediating role of psychological distress (depression, anxiety, and stress) in the association between internet gaming disorder (IGD) and two health outcomes (insomnia quality of life) among adolescents during this COVID-19 pandemic.

METHODS

A cross-sectional study comprising adolescents (N = 1512) aged 13-18 years (mean age = 15.51 years) was utilized to assess measures on insomnia, depression, anxiety, and stress, IGD, and quality of life during the COVID-19 pandemic.

RESULTS

There were small to large significant relationships between the variables. Psychological distress (i.e., depression, anxiety, and stress) served as a strong mediator in the association between IGD and insomnia and quality of life. IGD directly influenced insomnia and quality of life among the participants.

CONCLUSIONS

IGD is associated with different psychosocial outcomes comprising multiple pathways. Parents need to pay special attention to how much time and how frequently their children play videogames. Parents may need to assist their children in coping with psychological distress during the ongoing COVID-19 pandemic period.

Quality of life, self-stigma, and coping strategies in patients with neurotic spectrum disorders: a cross-sectional study

Background

Modern psychiatry focuses on self-stigma, coping strategies, and quality of life (QoL). This study looked at relationships among severity of symptoms, self-stigma, demographics, coping strategies, and QoL in patients with neurotic spectrum disorders.

Methods

A total of 153 clinically stable participants who met criteria for generalized anxiety disorder, social phobia, panic disorder, agoraphobia, mixed anxiety-depressive disorder, adjustment disorders, somatoform disorders, or obsessive-compulsive disorder were included in a cross-sectional study. Psychiatrists examined patients during regular psychiatric checkups. Patients completed the Quality of Life Satisfaction and Enjoyment Questionnaire (Q-LES-Q), Internalized Stigma of Mental Illness Scale (ISMI), a sociodemographic questionnaire, the Stress Coping Style Questionnaire (Strategie Zvládání Stresu [SVF] 78), and the Clinical Global Impression (CGI) scale.

Results

The diagnostic subgroups differed significantly in age and use of negative coping strategies, but not in other measured clinical or psychological variables. The findings showed that neither sex nor partnership played a role in perceived QoL. All Q-LES-Q domains correlated negatively with all ISMI domains, except school/study. Unemployed and employed groups of patients differed in QoL. Each of the coping strategies, except the need for social support, was related to self-stigma. The findings showed that sex, partnership, education, and employment played no role in self-stigma. No differences between sexes in positive coping strategies, severity of disorder, self-stigma, or QoL were found. QoL correlated significantly with all coping strategies, except for guilt denial. Multiple regression showed the most important factors to be positive coping, employment, and overall self-stigma rating, explaining 32.9% of QoL. Mediation analysis showed self-stigma level and negative coping strategies to be the most influential. The most substantial factors associated with self-stigma, as indicated by regression analysis, were Q-LES-Q total, subjective CGI, and positive coping strategies, which clarified 44.5% of the ISMI.

Conclusion

The study confirmed associations among self-stigma, quality of life, disorder severity, and coping strategies of outpatients with neurotic spectrum disorders.

Spanish validation of the Spence Preschool Anxiety Scale

BACKGROUND

The Preschool Anxiety Scale (PAS) is a 28-item measure designed to assess anxiety symptoms in preschoolers aged 31 to 83 months.

METHODS

The present study aims to extend the literature by examining the psychometric properties and factorial structure of the PAS in a Spanish community sample of 274 preschoolers aged 3 to 7 years.

RESULTS

Factor analysis confirmed the five-factor original model after removing eight items, suggesting a shorter 20-item version for the Spanish preschoolers. The scale demonstrated to have good internal consistency (Cronbach's α = 0.84). Moderate but significant correlations with a measure of health-related quality of life supported the convergent validity of the PAS.

CONCLUSIONS

The Spanish version of the PAS demonstrated to have good psychometric properties, providing these results initial support to its use for assessing a broad range of anxiety symptoms in Spanish-speaking preschoolers.