Agreement between a single-item measure of anxiety and depression and the Hospital Anxiety and Depression Scale: A cross-sectional study

Linking Caregivers' Evaluation of Children's Mood to Brain Network

Using functional near-infrared spectroscopy technique, this study identified lower brain network efficiency in children with anxiety and/or depression compared to healthy controls, with caregivers' evaluation of mood correlating with brain network efficiency.

Air Pollution's Hidden Toll: Links Between Ozone, Particulate Matter, and Adolescent Depression

Rising rates of depression among youth present a growing mental health crisis. Despite growing concerns regarding the risks of air pollution exposure on youth mental and physical health, associations between ambient air pollutants and depression have been largely overlooked in youth. In this cross-sectional study, we investigated associations between ozone, particulate matter, and depressive symptoms in adolescents across 224 Colorado census tracts (average age of 14.45 years, 48.8% female, 48.9% of minority race/ethnicity). Students in participating schools reported depressive symptoms and demographic information, and school addresses were used to compute ozone and particulate matter levels per census tract. Possible confounding variables, including sociodemographic and geographic characteristics, were also addressed. Exploratory analyses examined demographic moderators of these associations. Census tracts with higher ozone concentrations had a higher percentage of adolescents experiencing depressive symptoms. Particulate matter did not emerge as a significant predictor of adolescent depressive symptoms. Secondary analyses demonstrated that associations with ozone were moderated by racial/ethnic and gender compositions of census tracts, with stronger effects in census tracts with higher percentages of individuals with marginalized racial/ethnic and gender identities. Ultimately, this project strengthens our understanding of the interplay between air pollution exposures and mental health during adolescence.

Sports-Related Concussion Among Physically Active Adolescents in the Southeastern United States: Effects on Mental Health During the Pandemic

Sports-related concussions (SRC) pose risks to young people's physical and mental health. During the COVID-19 pandemic, we studied linkages between youths' SRC experiences and internalizing problems (depression, self-harm, and suicidality) among a representative sample in Southeastern state (n = 4,668 total, n = 547 reported SRC experience). Logistic regressions indicated significant associations between youths' SRC experiences and depression (AOR = 1.32, p < .05), suicidality (e.g., attempted suicide AOR = 2.68, p < .001), and self-harm (AOR = 1.97, p < .001) while controlling for being bullied or teased, gender, age, race, and COVID-19's mental health impact. Contrary to prior findings: (1) SRC associations with self-harm and suicide attempts were consistent across genders; and (2) African American students with SRC were significantly more likely to experience depression, self-harm, suicide planning, and attempts than peers without SRC. Results indicated mental health resilience post-concussion for Latinx youth. Implications advocate population-specific health promotion measures that address vulnerabilities and protective factors while emphasizing SRC education for parents, coaches, and young athletes for timely psychological evaluation and support.

Higher anxiety level and associated work-related factors of delivery workers in South Korea: from the 6th Korean working conditions survey

OBJECTIVE

This study investigates anxiety risk and work-related factors among platform workers. The recent growth in the platform industry is a worldwide trend, with delivery workers in Korea representing typical platform workers.

METHODS

This cross-sectional study used the 6th Korean Working Conditions Survey to assess anxiety risk among 532 delivery workers compared to general employees. It identified associations between work-related factors and anxiety, including job demands and autonomy, legal protection, and emotional labor.

RESULTS

Delivery workers exhibited significantly higher anxiety (odds ratio [OR] = 1.67 95% confidence interval [CI] = 1.23-2.28) and work-related anxiety (OR = 2.17 95% CI = 1.48-3.18) risk than the general workforce, and a significantly higher risk of having unfavorable work environment factors. Their anxiety risk was significantly associated with work-related factors, such as long shifts, quick return, time pressure, job stress, absence of union, work-family conflict, and emotional labor.

CONCLUSIONS

This study identified high levels of anxiety among Korean delivery workers and associated occupational factors. It highlights the importance for industry and government interventions to enhance mental health support, mitigate poor employment conditions, and ensure legal safeguards.

Criterion validity of a single-item measure of fear avoidance behavior following mild traumatic brain injury

Maladaptive coping such as fear avoidance behavior can prolong recovery from mild traumatic brain injury (mTBI). Routine assessment of fear avoidance may improve management of mTBI. This study aimed to validate a single-item measure of fear avoidance to make its assessment more pragmatic. The present study is a secondary analysis of a clinical trial that involved adults with persistent post-concussion symptoms (N = 90, 63% female). Participants completed the single-item fear avoidance rating, a validated legacy measure of fear avoidance (Fear Avoidance Behavior after Traumatic Brain Injury; FAB-TBI), and measures of anxiety (General Anxiety Disorder-7), depression (Patient Health Questionnaire-9), post-concussion symptoms (Rivermead Postconcussion Symptoms Questionnaire), and disability (World Health Organization Disability Assessment Schedule 12.0). Questionnaires were completed twice, at baseline (mean 18.1 weeks post injury) and again 12-16 weeks later following study-delivered rehabilitation in addition to usual care. We analyzed the associations (Spearman's correlations) and agreement (weighted Kappa) between the single-item and FAB-TBI at baseline, posttreatment, individual FAB-TBI item scores, and the change in scores between baseline and posttreatment. In addition, we examined correlations between the single-item fear avoidance measure and related constructs, including anxiety, depression, post-concussion symptoms, and disability. The single-item fear avoidance measure correlated strongly with the FAB-TBI both at baseline and following treatment (ρ = 0.63 - 0.67, p < .001), and moderately with FAB-TBI item scores (ρ = 0.4 - 0.6). The correlation between the change in these scores from baseline to posttreatment was moderate (ρ = 0.45, p < .001). Agreement between the single-item fear avoidance measure and discretized FAB-TBI scores was moderate (κ = 0.45 - 0.51). Before and after treatment, the single-item fear avoidance measure correlated moderately with anxiety (ρ = 0.34), depression (ρ = 0.43), post-concussion symptoms (ρ = 0.50), and disability (ρ = 0.43). The FAB-TBI was more strongly correlated with these measures (ρ = 0.53 - 0.73). In summary, the present study supports the criterion validity of the single-item fear avoidance measure. This measure may be a useful screening and monitoring tool for patients with mTBI but is not a substitute for the FAB-TBI questionnaire.

Exploring the Relationship Between Education, Living Environment, and Anxiety/Depression Among Stable Patients: Insights from the COPD-AD China Registry Study

Background

Education and living environment are related to mental health. But the independent and combined effects of them on mental health among patients with chronic obstructive pulmonary disease (COPD) are uncertain.

Methods

The independent and combined effects of education and living environment on mental health were assessed by binary logistic regression in 1064 COPD patients. Additive interaction was assessed with the relative excess risk ratio (RERI), attribution percentage (AP), and synergy index (SI).

Results

Our results shown that low education level and urban living environment were independently associated with higher risks for anxiety (odds ratio [OR]: 1.56, 95% confidence interval [CI] 1.06-2.29 and OR:2.15, 95% CI 1.51-2.05) or depression (OR:1.62, 95% CI 1.17-2.27 and OR: 2.01, 95% CI 1.46-2.75) among COPD patients. The combination effect of them was also associated with higher risks for anxiety (OR: 7.90, 95% CI 3.83-16.29, P < 0.001) or depression (OR: 11.79, 95% CI 5.77-24.10, P < 0.001) among these patients. Furthermore, we observed strong synergistic additive interactions between them for anxiety (SI: 11.57, 95% CI 1.41-95.27; RERI: 6.31, 95% CI 1.60-11.01; AP: 0.8, 95% CI 0.66-0.94) and depression (SI: 31.31, 95% CI 1.59-617.04; RERI: 10.44, 95% CI 2.66-18.23; AP: 0.89, 95% CI 0.8-0.97).

Conclusion

Low education levels and living in urban areas had an independent and synergistic effects on mental health among COPD patients.

Non-fear emotions in changes in posttraumatic stress disorder symptoms during treatment

BACKGROUND AND OBJECTIVES

Posttraumatic stress disorder (PTSD) is not only associated with fear but also with other emotions. The present study aimed to examine if changes in shame, guilt, anger, and disgust predicted changes in PTSD symptoms during treatment, while also testing if PTSD symptoms, in turn, predicted changes in these emotions.

METHODS

Participants (N = 155) with childhood-related PTSD received a maximum of 12 sessions of eye movement desensitization and reprocessing or imagery rescripting. The data was analyzed using Granger causality models across 12 treatment sessions and 6 assessment sessions (up until one year after the start of treatment). Differences between the two treatments were explored.

RESULTS

Across treatment sessions, shame, and disgust showed a reciprocal relationship with PTSD symptoms, while changes in guilt preceded PTSD symptoms. Across assessments, anger was reciprocally related to PTSD, suggesting that anger might play a more important role in the longer term.

LIMITATIONS

The individual emotion items were not yet validated, and the CAPS was not administered at all assessments.

CONCLUSIONS

These findings partly differ from earlier studies that suggested a unidirectional relationship in which changes in emotions preceded changes in PTSD symptoms during treatment. This is in line with the idea that non-fear emotions do play an important role in the treatment of PTSD and constitute an important focus of treatment and further research.

Movement Behaviors and Mental Health of Catholic Priests in the Eastern United States

The purpose of this observational study was to examine (a) the proportion of Catholic priests in the United States that have anxiety/depression and meet the Canadian 24-Hour of Movement Guidelines, and (b) the association of meeting these guidelines with the likelihood of anxiety and depression. A sample of (arch)diocesan priests (n = 335) completed demographic and behavior survey, International Physical Activity Questionnaire (IPAQ-SF), and Hospital Anxiety and Depression Scale (HADS). Results indicated that 21.1% of priests surveyed met all three movement guidelines (physical activity, sleep, and screentime) and 7.8% met none. Priests who reported excessive recreational screentime (≥ 3 h/day) were more likely to have anxiety (OR = 3.17) and depression (OR = 2.91), and who were physically inactive (< 150 min/week) were more likely to have depression (OR = 8.89). Data from this study addresses a gap in the literature regarding Catholic priests, movement behavior, and mental wellbeing.

The emotional and social concerns of mothers of children with cleft palate: A cross-sectional study

PROBLEM

Among birth defects, a cleft palate is one of the most common defects globally, with a prevalence rate of 1 in 700 live-born children per annum. Caring for a child with cleft palate is considered a challenge for mothers who provide around clock care for these children. Despite this, there is limited knowledge of their experiences and needs particularly in low resource settings.

BACKGROUND

Previous literature emphasized that mothers of children with cleft palate face many challenges involving emotional distress, social isolation, and financial burden.

QUESTION

To investigate the emotional and social concerns of mothers of children with Cleft Palate compared to mothers of children without cleft palate.

METHODS

A comparative study design was conducted at the Jordanian Royal Medical Services using convenience sample of 312 mothers of children with and without cleft palate in Jordan.

FINDINGS

There was a significant difference in the presence of anxious feelings between mothers of children with cleft palate and those mothers without cleft palate children. Within group comparison for mothers of children with cleft palate has shown a significant difference in their social concerns with regards to social support and child's future.

DISCUSSION

Mothers of children with cleft palate reported significantly higher levels of sadness feelings. These emotions could be attributed to several factors, including the financial burden associated with medical treatment and interventions, the burden of caring for a child with special needs, the social stigma related to the child's appearance, the lack of public awareness, and the insufficient social support services.

CONCLUSION

Mothers of children with Cleft Palate experience a considerable amount of emotional and social concerns which require urgent interventions.

Association between the COVID-19 pandemic and mental health in very old people in Sweden

BACKGROUND

During the COVID-19 pandemic, Sweden implemented social distancing measures to reduce infection rates. However, the recommendation meant to protect individuals particularly at risk may have had negative consequences. The aim of this study was to investigate the impact of the COVID-19 pandemic on very old Swedish peoples' mental health and factors associated with a decline in mental health.

METHODS

We conducted a cross-sectional study among previous participants of the SilverMONICA (MONItoring of Trends and Determinants of CArdiovascular disease) study. Of 394 eligible participants, 257 (65.2%) agreed to participate. Of these, 250 individuals reported mental health impact from COVID-19. Structured telephone interviews were carried out during the spring of 2021. Data were analysed using the χ2 test, t-test, and binary logistic regression.

RESULTS

Of 250 individuals (mean age: 85.5 ± 3.3 years, 54.0% women), 75 (30.0%) reported a negative impact on mental health, while 175 (70.0%) reported either a positive impact (n = 4) or no impact at all (n = 171). In the binary logistic regression model, factors associated with a decline in mental health included loneliness (odds ratio [95% confidence interval]) (3.87 [1.83-8.17]) and difficulty adhering to social distancing recommendations (5.10 [1.92-13.53]). High morale was associated with positive or no impact on mental health (0.37 [0.17-0.82]).

CONCLUSIONS

A high percentage of very old people reported a negative impact on mental health from the COVID-19 pandemic, primarily from loneliness and difficulty adhering to social distancing measures, while high morale seemed to be a protective factor.

Clinical and economic burden of anxiety/depression among older adult COPD patients: evidence from the COPD-AD China Registry study

Background

Anxiety and depression are common in patients with chronic obstructive pulmonary disease (COPD), especially older adult patients. This can complicate the disease progression and lead to increased clinical and economic burden. We sought to investigate the clinical and economic burdens associated with the presence of anxious and/or depressive symptoms among older adult COPD patients.

Methods

We screened 579 patients aged over 60 years and diagnosed with COPD via a lung function test following the 2017 Global Initiative Chronic Obstructive Lung Disease (GOLD) guidelines. Anxiety and depression were measured using the Hospital Anxiety and Depression Scale (HADS) through face-to-face interviews at admission. Follow-up was conducted by telephone calls at 6, 12, 18, 24, and 36 months after discharge to assess clinical and economic burden. COPD-anxiety and/or depression patients were matched to patients without anxiety and depression (COPD-only) using propensity scores. Multivariate regression models were used to compare clinical and economic burden between COPD-anxiety and/or depression and COPD-only groups.

Results

Compared with COPD-only patients, COPD patients complicated with anxiety and/or depression had increased clinical burden, including higher COPD-related outpatient visits, COPD-related hospitalizations, and length of COPD-related hospitalizations (p < 0.001). Moreover, they also had an increased economic burden, including higher annual total healthcare costs, medical costs, and pharmacy costs (p < 0.001).

Conclusion

Older adult COPD patients with anxiety or depression had significantly higher clinical and economic burdens than patients without these comorbidities. These findings deserve further exploration and may be useful for the formulation of relevant healthcare policies.

"Consumed by creed": Obsessive-compulsive symptoms underpin ideological obsession and support for political violence

Radicalization is a process by which individuals are introduced to an ideological belief system that encourages political, religious, or social change through the use of violence. Here we formulate an obsessive-compulsive disorder (OCD) model of radicalization that links obsessive passion (OP; one of the best predictors of radical intentions) to a larger body of clinical research. The model's central tenet is that individual differences in OCD symptom severity could shape radical intentions via their influence on OP. Across four ideological samples in the United States (Environmental activists, Republicans, Democrats, and Muslims, Ntotal  = 1114), we found direct effects between OCD symptom severity and radical intentions, as well as indirect effects of OCD on radical intentions via OP. Even after controlling for potential individual difference and clinical confounds (e.g., adverse childhood experiences, loss of significance, and substance abuse), these relationships remained robust, implying that OCD plays a significant role in the formation of violent ideological intentions and opening new avenues for the treatment and prevention of violent extremism. We discuss the implications of conceptualizing radicalization as an OCD-like disorder with compulsive violent tendencies and ideology-related concerns.

The role of interpretation biases and safety behaviours in social anxiety: an intensive longitudinal study

BACKGROUND

Interpretation bias and safety behaviours (Safe-B) have been proposed as factors perpetuating social anxiety (SA). However, longitudinal research on how they contribute to SA in everyday life is scarce.

AIM

The aim was to examine whether interpretation bias predicts daily Safe-B and SA. A mediated moderation was hypothesized, where the relationship between daily social stressors and Safe-B would be moderated by interpretation bias, and Safe-B, in turn, would mediate the association between stressors and SA levels. In addition, it was hypothesized that prior levels of SA would predict higher Safe-B use, especially in co-occurrence with stressors.

METHOD

An intensive longitudinal design was employed, with 138 vocational training students (51% men, mean age 20.15 years). They completed initial measures of SA and interpretation bias and 7-day diaries with measures of social stressors, Safe-B, and SA. They reported SA levels two months later.

RESULTS

Both stressors and interpretation bias in ambiguous situations predicted Safe-B, which in turn predicted daily SA levels. However, neither interpretation bias nor Safe-B predicted SA levels at the follow-up, and interpretation bias did not moderate the association between stressors and daily SA. In addition, the relationship between stressors and Safe-B was stronger in people with higher initial SA levels.

CONCLUSIONS

The results suggest that Safe-B are a mechanism through which earlier SA levels and interpretation bias contribute to higher SA levels in daily life.

Unpacking the role of adolescent religious affiliation in youth outcomes

INTRODUCTION

The purpose of this study was to unpack the role of adolescent religious affiliation in positive and negative youth outcomes.

METHODS

We used data from Wave 1 (2002-2003) of the National Study of Youth and Religion (NSYR). Participants were a nationally representative sample of 3290 adolescents from across the United States. Measures were adolescent-report or parent-report items of religiousness (individual religiousness, family religiousness, peer religiousness, and religious community supportiveness) and youth outcomes (future orientation, grades, community involvement, alcohol use, sexual activity, and depression).

RESULTS

First, ANOVAs revealed that four dimensions of religiousness (individual religiousness, family religiousness, peer religiousness, and religious community supportiveness) and five youth outcomes (future orientation, grades, community involvement, alcohol use, and sexual activity, but not depression), varied significantly across religious affiliation. Second, regressions examining direct effects found that the multicategorical nominal variable of religious affiliation predicted all outcomes except alcohol use and depression after accounting for the four dimensions of religiousness. Third, each of the four dimensions of religiousness mediated relations between religious affiliation and at least one of the outcomes.

CONCLUSIONS

In short, religious affiliation seems to play a unique role in youth outcomes, above and beyond other dimensions of religiousness. This role of religious affiliation perhaps functions in part via individual and contextual dimensions of religiousness.

Physical activity, sleep, and mental health during the COVID-19 pandemic: A one-year longitudinal study of Spanish university students

The objective of this longitudinal study was to analyze changes in physical activity, sedentary time, sleep, anxiety, mood, and perceived health as a result of COVID-19 pandemic in a cohort of Spanish university students, both during the home confinement and one year after. Additionally, we analyzed the associations between physical activity, sedentary time, and other measured parameters. Data were collected through two online questionnaires that included the International Physical Activity Questionnaire-Short Form, the Pittsburgh Sleep Quality Index, and self-reported anxiety, mood, and perceived health levels before, during and one year after home confinement. Participants reported decreased physical activity, increased sedentary time, and deterioration in sleep quality and perceived health during confinement. Most parameters had improved one year later; however, the participants still reported less physical activity, more sedentary time, and deterioration in sleep quality and perceived health compared to before confinement. Men reported greater reduction of physical activity during home confinement than women. In contrast, women reported reduced physical activity one year after confinement, whereas men reported increased activity. Participants reported higher anxiety and worse mood both during and one year post-confinement compared to pre-confinement, with women reporting higher levels of anxiety than men. Sports science students were closer to regaining pre-pandemic levels of physical activity one year post-confinement than students in other disciplines. Sleep, anxiety, and mood were worse among students with obesity compared to students in other BMI categories. Overall, increased physical activity and decreased sedentary time were associated with less anxiety and better sleep, mood, and perceived health during and one year post-confinement. In conclusion, our results demonstrate that physical activity, sedentary behavior, sleep, anxiety, mood, and perceived health were disrupted one year after home confinement. Higher levels of physical activity and lower sedentary time were associated with preserved sleep and mental health during the pandemic.

Anxiety, concerns and COVID-19: Cross-country perspectives from families and individuals with neurodevelopmental conditions

Background

The COVID-19 pandemic had a major impact on the mental health and well-being of children with neurodevelopmental conditions (NDCs) and of their families worldwide. However, there is insufficient evidence to understand how different factors (e.g., individual, family, country, children) have impacted on anxiety levels of families and their children with NDCs developed over time.

Methods

We used data from a global survey assessing the experience of 8043 families and their children with NDCs (mean of age (m) = 13.18 years, 37% female) and their typically developing siblings (m = 12.9 years, 45% female) in combination with data from the European Centre for Disease Prevention and Control, the University of Oxford, and the Central Intelligence Agency (CIA) World Factbook, to create a multilevel data set. Using stepwise multilevel modelling, we generated child-, family- and country-related factors that may have contributed to the anxiety levels of children with NDCs, their siblings if they had any, and their parents. All data were reported by parents.

Results

Our results suggest that parental anxiety was best explained by family-related factors such as concerns about COVID-19 and illness. Children's anxiety was best explained by child-related factors such as children's concerns about loss of routine, family conflict, and safety in general, as well as concerns about COVID-19. In addition, anxiety levels were linked to the presence of pre-existing anxiety conditions for both children with NDCs and their parents.

Conclusions

The present study shows that across the globe there was a raise in anxiety levels for both parents and their children with NDCs because of COVID-19 and that country-level factors had little or no impact on explaining differences in this increase, once family and child factors were considered. Our findings also highlight that certain groups of children with NDCs were at higher risk for anxiety than others and had specific concerns. Together, these results show that anxiety of families and their children with NDCs during the COVID-19 pandemic were predicted by very specific concerns and worries which inform the development of future toolkits and policy. Future studies should investigate how country factors can play a protective role during future crises.

Social participation and self-reported depression during the COVID-19 pandemic among older adults

OBJECTIVES

The COVID-19 pandemic has increased depressive symptoms and disrupted activities that might typically mitigate depressive symptoms. Pandemic restrictions to social participation that supports well-being in older adults may contribute to worse mental health outcomes, but how participation relates to pandemic depressive symptoms is unclear.

METHODS

Using longitudinal data from the nationally representative National Health and Aging Trends Study (N = 3181), we assessed whether older adults' pandemic depressive symptoms were associated with participation in paid work, volunteering, religious services, and other organized activities during the pandemic, as well as changes in participation in these activities compared to pre-pandemic engagement.

RESULTS

Of participation during the pandemic, only attending religious services predicted pandemic depression, with religious attendance associated with higher risk of mild pandemic depressive symptoms. However, for changes in participation, stopping paid work during the pandemic predicted higher risk of moderate/severe pandemic depressive levels, while stopping attending religious services predicted lower risk of mild pandemic depression.

CONCLUSION

This work demonstrates the importance of social participation for mental health and indicates what types of disruptions may reduce integration to increase older adults' vulnerability to depressive symptoms during a global pandemic.

Symptoms of anxiety and depression in patients with persistent asthma: a cross-sectional analysis of the INSPIRERS studies

OBJECTIVES

Anxiety and depression are relevant comorbidities in asthma, but, in Portugal and Spain, data on this topic are scarce. We assessed, in patients with asthma, the frequency of anxiety and depression using the Hospital Anxiety and Depression Scale (HADS) and the European Quality of Life Five Dimension Questionnaire (EQ-5D); the level of agreement between these questionnaires, and the factors associated with these symptoms.

METHODS

This is a secondary analysis of the INSPIRERS studies. A total of 614 adolescents and adults with persistent asthma (32.6±16.9 years, 64.7% female) were recruited from 30 primary care centres and 32 allergy, pulmonology and paediatric clinics. Demographic and clinical characteristics, HADS and EQ-5D were collected. A score ≥8 on Hospital Anxiety and Depression Scale-Anxiety/Hospital Anxiety and Depression Scale-Depression or a positive answer to EQ-5D item 5 indicated the presence of these symptoms. Agreement was determined by Cohen's kappa. Two multivariable logistic regressions were built.

RESULTS

According to HADS, 36% of the participants had symptoms of anxiety and 12% of depression. According to EQ-5D, 36% of the participants had anxiety/depression. The agreement between questionnaires in identifying anxiety/depression was moderate (k=0.55, 95% CI 0.48 to 0.62). Late asthma diagnosis, comorbidities and female gender were predictors of anxiety/depression, while better asthma control, health-related quality of life and perception of health were associated with lower odds for anxiety/depression.

CONCLUSION

At least 1/3 of the patients with persistent asthma experience symptoms of anxiety/depression, showing the relevance of screening these disorders in patients with asthma. EQ-5D and HADS questionnaires showed a moderate agreement in the identification of anxiety/depression symptoms. The identified associated factors need to be further investigated in long-term studies.

Measuring the Work Environment: The Voice of the Staff Nurse

OBJECTIVE

The aims of this study were to obtain direct care hospital nurse input on the relevance of the Practice Environment Scale of the Nursing Work Index (PES-NWI) and to determine whether additional items are needed to measure the contemporary nursing work environment (NWE).

BACKGROUND

Instruments accurately measuring the NWE are essential due to the NWE's association with nurse, patient, and organizational outcomes. However, the most frequently used instrument for measuring the NWE has not been scrutinized by today's practicing direct care nurses to ensure its current relevancy.

METHODS

Researchers administered a survey with a modified PES-NWI and open-ended questions to a national sample of direct care hospital nurses.

RESULTS

Three items from the PES-NWI may be suitable for removal, and additional items may be added to accurately measure the current NWE.

CONCLUSION

Most PES-NWI items remain relevant for modern nursing practice. However, some revisions could enable greater precision in measuring the current NWE.

Evidence for the Validation of a Single Item Recovery Question (SIRQ) in Children With Mild and Complicated Mild Traumatic Brain Injury

BACKGROUND

Recovery from a brain injury occurs in varying degrees. The objective of this study was to investigate the concurrent validity of a parent-reported 10-point scale for degree of recovery, Single Item Recovery Question (SIRQ), in children with mild traumatic brain injury (mTBI) or complicated mTBI (C-mTBI) compared with validated assessments of symptom burden (Post-Concussion Symptom Inventory Parent form-PCSI-P) and quality of life (Pediatric Quality of Life Inventory [PedsQL]).

METHODS

A survey was sent to parents of children aged five to 18 years who presented to pediatric level I trauma center with mTBI or C-mTBI. Data included parent-reported postinjury recovery and functioning of children. Pearson correlation coefficients (r) were calculated to measure the associations of the SIRQ with the PCSI-P and the PedsQL. Hierarchical linear regression models were used to examine if covariates would increase the predictive value of the SIRQ to the PCSI-P and the PedsQL total scores.

RESULTS

Of 285 responses (175 mTBI and 110 C-mTBI) analyzed, Pearson correlation coefficients for the SIRQ to the PCSI-P (r = -0.65, P < 0.001) and PedsQL total and subscale scores were all significant (P < 0.001) with mostly large-sized effects (r ≥ 0.500), regardless of mTBI classification. Covariates, including mTBI classification, age, gender, and years since injury, resulted in minimum changes in the predictive value of the SIRQ to the PCSI-P and the PedsQL total scores.

CONCLUSIONS

The findings demonstrate preliminary evidence for the concurrent validity of the SIRQ in pediatric mTBI and C-mTBI.

Feasibility of a secondary school-based mental health intervention: Reprezents' On The Level

AIMS

There is a need for innovative school-based mental health interventions to promote good mental health, healthy coping strategies, and engagement with support services. Consequently, Reprezent, a youth development organization, with mental health professionals and young people co-developed an online mental health intervention show, On The Level (OTL). This study assessed the acceptability and feasibility of delivering OTL to young people (aged 11-18 years) in 36 secondary schools across London and Essex, UK.

METHODS

OTL was delivered online as part of the school curriculum, in classrooms at timepoint 1 (T1, 50 min). Follow-up data was collected at timepoint 2 (T2) 4-6 weeks later, during a 20-min OTL review show. For interactive OTL elements and data collection participants logged into an online survey. Measures of acceptability and engagement, mental health and well-being outcomes and intervention evaluation were taken at T1 and T2. We also assessed the feasibility of implementing the OTL intervention in secondary schools.

RESULTS

10,315 participants received the intervention (T1) and 3369 attended the follow-up session (T2), this high attrition, and potential selection bias, was due to only 30% of schools being able to take part in T2. Rates of acceptability were high among young people and school staff. At T1, 88% found OTL engaging, and 84% felt more confident they had the tools to help them better manage stress and anxiety. At T2, 66% viewed mental health in a more positive way, and 71% had better understanding of how to maintain good mental health. Rates of engagement with mental health tools and services were good, and significant reduction in levels of stress were found 4-6 weeks after the OTL show (T2). The low mental health and well-being indices reported by the school children at baseline strongly support the need and use for a mental health intervention such as OTL in secondary schools.

CONCLUSION

These findings indicated good feasibility and acceptability of OTL intervention and support the delivery of the OTL mental health intervention at UK-based secondary schools to educate young people about mental health and well-being and give them the necessary tools to support their mental health.

Imagery Rescripting as a stand-alone treatment for posttraumatic stress disorder related to childhood abuse: A randomized controlled trial

BACKGROUND AND OBJECTIVES

Posttraumatic stress disorder (PTSD) related to childhood abuse (CA) is associated with high symptom complexity. This study examined the efficacy of Imagery Rescripting (ImRs) as a stand-alone treatment versus a sequenced approach with Skills training in Affective and Interpersonal Regulation (STAIR) followed by ImRs for CA-related PTSD.

METHODS

Outpatients of two mental health clinics with CA-related PTSD (N = 61) were randomly assigned to ImRs (16 sessions; n = 21), STAIR/ImRs (8 STAIR-sessions followed by 16 ImRs-sessions; n = 20), or Waitlist (8 weeks; n = 20). Patients of the waitlist condition were also randomized to the two active conditions for comparison of STAIR/ImRs (total n for this condition = 31) and ImRs (total n for this condition = 30) and started treatment after waitlist completion. Assessments took place at pre-treatment, after each treatment phase and at 12-week post-intervention follow-up. PTSD symptoms and diagnosis were primary outcome measures, and depression, emotion regulation and interpersonal functioning were secondary outcomes.

RESULTS

ImRs showed greater reduction of PTSD severity (effect sizes [ES] 1.40-1.63) than STAIR (ES, 0.23-0.33) as compared to waitlist. When comparing STAIR/ImRs and ImRs directly, (i.e. including re-randomized Waitlist-patients), PTSD symptoms reduced significantly (within condition ES, 1.64-2.10) and improved further to 12-week follow-up (within-condition ES, 2.33-2.66), with no significant difference between both conditions (between-condition ES, 0.21-0.45). Loss of PTSD diagnosis was achieved by 70% in the ImRs condition and 86% in the STAIR/ImRs condition.

LIMITATIONS

The sample size was relatively small.

CONCLUSIONS

Results show that ImRs is an effective treatment for CA-related PTSD, whereby the current data do not convincingly show an additive effect of STAIR.

An exploratory study on emotion regulation strategy use in individuals with Williams syndrome, autism spectrum disorder and intellectual disability

Background

Individuals with neurodevelopmental disorders often have atypical emotion profiles, but little is known about how they regulate their emotions. While several studies have examined emotion regulation strategy use in autism spectrum disorder (ASD), only a few have included individuals with intellectual disability (ID) or focused on specific syndromes such as Williams syndrome (WS).

Methods

A parent-reported survey launched during the first months of the COVID-19 pandemic allowed to exploratorily study emotion regulation strategy use and its link to anxiety in individuals with ASD with (N=785) and without ID (N=596), WS (N=261), and Intellectual Disability not otherwise specified (N=649).

Results

Using multilevel analyses, besides revealing specific group differences in emotion regulation strategy use, a variety of strategies (e.g., rumination, avoiding information, repetitive behaviors) were found to be linked to elevated levels of anxiety, while focusing on the positive was linked to lower anxiety levels in all groups. Moreover, only autistic people without ID used humor more frequently while experiencing lower anxiety levels.

Conclusion

This study sheds light on an underexplored area of emotion regulation strategy use in different neurodevelopmental disorders. It also paves the way to further examine emotion regulation in more rigorous ways to better understand emotion regulation in different neurodevelopmental disorders as well as the impact on outcome measures such as anxiety. This exploratory study may help to develop and validate adequate measures to study a broad array of ER strategies used by individuals with neurodevelopmental disorders.

Outcomes associated with comorbid anxiety and depression among patients with stable COPD: A patient registry study in China

BACKGROUND

Anxiety and depression are common among patients with chronic obstructive pulmonary disease (COPD), but the associations between psychiatric symptoms and specific COPD outcomes are uncertain.

METHODS

Associations of psychiatric symptoms (anxiety and depression) and COPD outcomes (COPD Assessment Test (CAT), modified Medical Research Council dyspnea scale (mMRC), number of acute exacerbations and percentage predicted forced expiratory volume in 1 second (FEV₁% predicted)) sets were performed by canonical correlation analysis in 876 patients with COPD.

RESULTS

In primary analysis, we discovered a statistically significant relationship between symptoms of anxiety/depression and COPD outcomes sets (1 - Λ = 0.11; P < .001). Symptoms of anxiety/depression and four COPD outcomes sets shared 11 % of variance. CAT was the main driver of the relationship (r_s = -0.930; r_s² = 0.8649) followed by mMRC (r_s = -0.632; r_s² = 0.3994) and exacerbation history (r_s = -0.478; r_s² = 0.2285); FEV₁% predicted did't make a significant contribution to the relationship (r_s = 0.134; r_s² = 0.018). In secondary analysis, women were associated with a stronger correlation based on the shared variance between psychiatric symptoms and COPD outcomes sets (17.4 %) than men (9.8 %).

LIMITATIONS

Some confounding factors such as education level, income, didn't be included. There were considerably fewer women enrolled in this study than men.

CONCLUSION

Psychiatric symptoms were associated with COPD subjective outcomes, and more related to COPD outcomes in women.

Risk factors for acute mental health symptoms and tobacco initiation in Coast Guard Responders to the Deepwater Horizon oil spill

Acute mental health symptoms experienced during oil spill response work are understudied, especially among nonlocal responders. We assessed potential risk factors for acute mental health symptoms and tobacco initiation among U.S. Coast Guard responders to the 2010 Deepwater Horizon (DWH) oil spill who completed a deployment exit survey. Cross-sectional associations among responder characteristics, deployment-related stressors (deployment duration, timing, crude oil exposure, physical symptoms, injuries), and professional help-seeking for stressors experienced with concurrent depression/anxiety and tobacco initiation were examined. Log-binomial regression was used to calculate adjusted prevalence ratios (aPRs) and 95% confidence intervals. Sensitivity analyses excluded responders with a history of mental health conditions using health encounter data from the Military Health System Data Repository. Of the 4,855 responders, 75.5% were deployed from nonlocal/non-Gulf home stations, 5.8% reported concurrent depression and anxiety, and 2.8% reported the initiation of any tobacco product during oil spill response. Self-report of concurrent depression and anxiety was more prevalent among female responders and positively associated with longer deployments, crude oil exposure via inhalation, physical symptoms and injuries, and professional help-seeking during deployment, aPRs = 1.54-6.55. Tobacco initiation was inversely associated with older age and officer rank and positively associated with deployment-related stressors and depression/anxiety during deployment, aPRs = 1.58-4.44. Associations remained robust after excluding responders with a history of mental health- and tobacco-related health encounters up to 3 years before deployment. Depression, anxiety, and tobacco initiation were cross-sectionally associated with oil spill response work experiences among DWH responders, who largely originated outside of the affected community.

Sleep and Mental Health Among Adolescents During the COVID-19 Pandemic

OBJECTIVE

This study aimed to investigate the association of sleep with mental health among Korean adolescents during the coronavirus disease (COVID-19) pandemic.

METHODS

Using data from the 16th Korea Youth Risk Behavior Web-Based Survey (2020) of 46,475 adolescents, we examined sleep duration and satisfaction and examined mental health for depressive symptoms, anxiety, and suicidal ideation. The data were analyzed using complex sample descriptive statistics and a multiple logistic regression model.

RESULTS

In 2020, the average sleep duration was 6.3 hours, and the sleep satisfaction rate was 30.8%. Depressive symptom and suicidal ideation rates were 24.2 and 10.3, respectively. These values are slightly better than those previously reported, before COVID-19. However, poor sleep was still associated with mental health. The likelihood of mental health problems was higher among those who slept for six hours or less than for those who slept for eight hours or more (p<0.05). Additionally, the results showed that the lower the sleep satisfaction, the higher the likelihood of mental health problems (p<0.05).

CONCLUSION

Even after the COVID-19 outbreak, poor sleep associated with mental health problems remained as high as before the outbreak of COVID-19.

Efficacy of New Mindfulness-Based Swinging Technique Intervention: A Pilot Randomised Controlled Trial Among Women With Breast Cancer

Objective

Combining 3rd-wave-therapies with Cognitive-Behavioural-Therapy (CBT) has increased in recent years. Usually these therapies require longer sessions which therefore increases the psychotherapy drop-out rate for cancer patients for multiple medical reasons. This inspired intervention of a shorter 20 min-long mindfulness-therapy (MBST) to be developed for Breast-Cancer-patients (BC).

Method

This pilot randomised controlled trial was to assess the immediate-outcome of the MBST-intervention for its efficacy for BC-patients by using the Pearson Chi-square test, Fisher-Freeman-Halton exact test, and McNemar test for categorical variables; Mann-Whitney U and Wilcoxon test for the continuous variables. The Emotion Thermometer, State Trait Anxiety Inventory, Hospital Anxiety and Depression Scale, Self-Efficacy for Managing Chronic Disease, and Beck's Hopelessness Scale were used for measuring the intervention outcomes. One hundred seventy-three BC patients were randomly assigned in two-groups (equal-mean-age, p = 0.417). Control-Group (CG, n = 82) received cognitive-disputation-technique a form-of-CBT, and Intervention-Group (IG, n = 74) received MBST. The directives are given to IG: psychoeducation about Mindfulness, and to imagine themselves swinging-in a peaceful environment. When the patients imagine their swing going up, they physically take a deep-breath, and when going down they physically release their breath, and this process is repeated.

Result

Outcomes post-treatment showed significant higher-improvement in IG in all the assessed-measurements, with large-effect-size: anxiety (p < 0,05, r = 0,67) and depression-levels (p < 0,05, r = 0,71); anxiety-trait (p < 0,05; r = 0,79) reduced, it increases self-efficacy for managing-disease (p < 0,05, r = 0,82) as-well-as hopefulness (p < 0,05, r = 0,61) and saturation-level measured by pulse-meter/oximeter (p < 0,05, r = 0,51).

Conclusion

MBST is an efficacious intervention to reduce psychotherapy session time for immediate relief from clinical anxiety and hopelessness as well as increase self-efficacy and improve tranquillity for BC-women. It may have a particular clinical significance for supporting patient's adherence to treatment. Although in this pilot sample MBST was found to be effective for short-term-outcome, its efficacy for longer-term-outcome should be examined in future trials. Additionally, breathing laps can be increased possibly for a greater result on rise of saturation levels of patients.

Biopsychosocial Markers of Body Image Concerns in Patients with Head and Neck Cancer: A Prospective Longitudinal Study

(1) Background: Patients and survivors of head and neck cancer (HNC) are at a high risk of developing body image concerns. Despite the prevalence of body image concerns in patients with HNC, there is a lack of longitudinal research exploring the wide array of its associated determinants. The current longitudinal study examined the determinants and longitudinal course of body image dissatisfaction in patients with HNC. (2) Methods: Patients participated in Structured Clinical Interviews and self-administered questionnaires at four time-points: (T1) upon cancer diagnosis, (T2) at 3 months post-diagnosis, (T3) at 6 months post-diagnosis, and (T4) at 12 months post-diagnosis. They also underwent a disfigurement rating on an objective scale. (3) Results: Two hundred and twenty-four patients participated in our study. Fourteen percent to twenty-eight percent of patients reported at least moderate body image concerns across time points, with the lowest rates at baseline and the highest at 3 months (T1). It was found that patients more predisposed to developing higher levels of body image concerns presented physical markers (i.e., advanced cancer stage, lower physical functioning, higher disfigurement), psychosocial markers (i.e., higher depression, higher anxiety, and higher levels of coping with denial), and health disparities (i.e., younger age, female sex, French language, and marital status, with divorced and widowers most affected). (4) Conclusions: The findings of this study highlight the multifaceted nature of body image concerns in patients with HNC and its biopsychosocial determinants. Clinicians should pay specific attention to these biopsychosocial markers in their clinics to predict high levels of body image concerns and tailor communication/refer for support accordingly.

A Short Performance Anxiety Scale for Musicians

Given the prevalence of debilitating anxiety associated with music performance, there is a need for rapid, pinpointed assessment of the extent to which an individual experiences music performance anxiety (MPA). A short, five item scale, the Mazzarolo Music Performance Anxiety Scale (M-MPAS), was developed to capture retrospective self-reported estimates of the frequency, intensity and aversion tendency associated with performing music. 102 musicians completed the scale, as well as an established MPA inventory. The M-MPAS was found to be internally reliable (Cronbach's alpha = 0.894) with all items being statistically relevant to the overall scale. Furthermore, the M-MPAS was correlated with the relevant factors of an established MPA measure (r = 0.791), suggesting that the new scale exhibited good construct validity. M-MPAS is easy to score, with a scale range of 0-30. A score of 11 or above is suggested as the range in which a diagnosis of potential high MPA can be made, but more research into this and the psychometric robustness of the scale is called for. Nevertheless, the reliability and validity demonstrated in the present study, along with the brevity of the M-MPAS suggest that the newly proposed scale may offer considerable triaging benefits for pinpointed assessment of the extent to which an individual experiences MPA.

Perceived helpfulness of service sectors used for mental and substance use disorders: Findings from the WHO World Mental Health Surveys

BACKGROUND

Mental healthcare is delivered across service sectors that differ in level of specialization and intervention modalities typically offered. Little is known about the perceived helpfulness of the combinations of service sectors that patients use.

METHODS

Respondents 18 + years with 12-month DSM-IV mental or substance use disorders who saw a provider for mental health problems in the year before interview were identified from WHO World Mental Health surveys in 17 countries. Based upon the types of providers seen, patients were grouped into nine mutually exclusive single-sector or multi-sector 'treatment profiles'. Perceived helpfulness was defined as the patient's maximum rating of being helped ('a lot', 'some', 'a little' or 'not at all') of any type of provider seen in the profile. Logistic regression analysis was used to examine the joint associations of sociodemographics, disorder types, and treatment profiles with being helped 'a lot'.

RESULTS

Across all surveys combined, 29.4% (S.E. 0.6) of respondents with a 12-month disorder saw a provider in the past year (N = 3221). Of these patients, 58.2% (S.E. 1.0) reported being helped 'a lot'. Odds of being helped 'a lot' were significantly higher (odds ratios [ORs] = 1.50-1.89) among the 12.9% of patients who used specialized multi-sector profiles involving both psychiatrists and other mental health specialists, compared to other patients, despite their high comorbidities. Lower odds of being helped 'a lot' were found among patients who were seen only in the general medical, psychiatrist, or other mental health specialty sectors (ORs = 0.46-0.71). Female gender and older age were associated with increased odds of being helped 'a lot'. In models stratified by country income group, having 3 or more disorders (high-income countries only) and state-funded health insurance (low/middle-income countries only) were associated with increased odds of being helped 'a lot'.

CONCLUSIONS

Patients who received specialized, multi-sector care were more likely than other patients to report being helped 'a lot'. This result is consistent with previous research suggesting that persistence in help-seeking is associated with receiving helpful treatment. Given the nonrandom sorting of patients by types of providers seen and persistence in help-seeking, we cannot discount that selection bias may play some role in this pattern.

Evaluating How Mental Health Changed in Australia through the COVID-19 Pandemic: Findings from the 'Taking the Pulse of the Nation' (TTPN) Survey

The COVID-19 pandemic has had a significant impact on mental health at the level of the population. The current study adds to the evidence base by examining how the prevalence of psychological distress changed in Australia during the pandemic. The study also assesses the psychometric properties of a new single-item measure of mental distress included in a survey program conducted regularly throughout the pandemic. Data are from 1158 respondents in wave 13 (early July 2020) of the nationally representative Taking the Pulse of the Nation (TTPN) Survey. The questionnaire included the six-item Kessler Psychological Distress Scale (K6) and a new single-item measure of distress. Results show a significant increase in the prevalence of psychological distress in Australia, from 6.3% pre-pandemic to 17.7% in early July 2020 (unadjusted odds ratio = 3.19; 95% CI (confidence interval) = 2.51 to 4.05). The new single-item measure of distress is highly correlated with the K6. This study provides a snapshot at one point in time about how mental health worsened in Australia during the COVID-19 pandemic. However, by demonstrating the accuracy of the new single-item measure of distress, this analysis also provides a basis for further research examining the trajectories and correlates of distress in Australia across the pandemic.

Metabolic Dysfunction-Associated Fatty Liver Disease Increases the Risk of Gastroesophageal Reflux Symptoms

OBJECTIVE

The present study aimed to explore the relationship between metabolic dysfunction-associated fatty liver disease (MAFLD) and gastroesophageal reflux symptoms (GERS).

METHODS

The present study was a cross-sectional observational study. The study population was 3002 subjects from a single hospital who underwent a health checkup from September 1, 2019, to December 31, 2020. The diagnosis of MAFLD was based on the diagnosis of fatty liver in the subject by ultrasound or computed tomography (CT) and the presence of one of the following conditions: overweight or obesity (body mass index [BMI] ≥ 23), type 2 diabetes mellitus, and metabolic abnormalities. The subjects were divided into the GERS group (n = 305) and the non-GERS group (n = 2697) based on the presence or absence of GERS, based on the GerdQ score.

RESULTS

The prevalence of MAFLD was significantly higher in the GERS group than in the non-GERS group (p = 0.001). In the univariate analysis of risk factors for GERS, MAFLD was identified as a risk factor for GERS (OR 1.5; 95% CI 1.176-1.913; p = 0.001). With adjustment of confounding factors such as BMI, waist circumference, lipid levels, and blood pressure, the correlation between MAFLD and GERS was attenuated but still significant (OR 1.408; 95% CI 1.085-1.826; p = 0.010).

CONCLUSION

MAFLD might be an independent risk factor for GERS.

Hesitancy to Return to the Pre-pandemic Routine

The goal of the present study was to explore COVID-19 related hesitancy, which represents the inability of people to return to previous levels of functioning after a major medical crisis like the current pandemic. A new questionnaire was developed to evaluate participants' hesitancy. The study was conducted online in November, 2020, using convenience sampling. A total of 538 individuals from the general Greek population participated in the study and completed the Hesitancy Questionnaire, the Generalized Anxiety Disorder 2-item (GAD-2), the Short Health Anxiety Inventory and a COVID-19-related worry question. The Hesitancy Questionnaire proved to have adequate psychometric properties. Correlation with anxiety as assessed by GAD-2 proved to be significant but low, indicating that the two scales are measuring two different concepts. The greatest hesitancy was observed in older adults for both genders (males, M = 40.86, SD = 15.24; females, M = 49.34, SD = 14.74). Women in general appeared more hesitant than men scoring higher (males, M = 36.13, SD = 15.25; females, M = 42.63, SD = 17.31) with a statistically significant difference [t(536) = - 3.706, p = .001). This study provided a tool to informed understanding on how citizens perceive the new normality after the COVID-19 pandemic. If not appropriately addressed, hesitancy may increase stress levels and result in mental health or socialization problems.

Mental Health Outcomes Among Parents of Children With a Chronic Disease During the COVID-19 Pandemic: The Role of Parental Burn-Out

Objective

The COVID-19 pandemic and associated quarantine measures highly impacted parental psychological well-being. Parents of children with chronic diseases might be specifically vulnerable as they already face multiple challenges to provide adequate care for their child. The research questions of the current study were twofold: (a) to examine whether parents of children with a chronic disease experienced more anxiety and depression compared to parents of healthy children and (b) to examine a series of risk factors for worsened well-being (i.e., depression, anxiety, and sleep problems), such as sociodemographic variables, COVID-19-specific variables (i.e., financial worries, living space, and perceived quality of health care), and parental psychological experiences (i.e., parental burn-out and less positive parenting experiences).

Methods

Parents of children with a chronic disease (i.e., the clinical sample; N = 599 and 507 for Research Questions 1 and 2, respectively) and parents of healthy children (i.e., the reference sample: N = 417) filled out an online survey.

Results

Findings demonstrated that the parents in the clinical sample reported higher levels of anxiety than parents in the reference sample. Analyses within the clinical sample indicated that COVID-19-specific stressors and parental psychological experiences were associated with higher levels of anxiety, depression, and sleep problems. Mediation analyses furthermore indicated that the association of COVID-19-specific stressors with all outcome measures was mediated by parental burn-out.

Conclusions

Parents of children with a chronic disease constitute a vulnerable group for worse well-being during the current pandemic. Findings suggest interventions directly targeting parental burn-out are warranted.

The association between screen time and reported depressive symptoms among adolescents in Sweden

BACKGROUND

How screen use is associated with adolescents' mental health has been widely debated in public media during the last decade, but there is still lack of information about if and how the associations vary between types of electronic media.

OBJECTIVE

This study aimed to examine how time spent on types of screen use (social media, gaming alone, gaming in groups and watching TV) was associated with depressive symptoms among adolescents in Sweden, and whether gender moderated these associations.

METHODS

We analysed data from the Swedish section of the Children of Immigrants: Longitudinal Survey in Four European Countries. The final sample consisted of 3556 eighth grade adolescents in 2011 (51% girls). We used logistic regression analysis to estimate the odds ratio of feeling depressed often versus less often/not at all using time spent on different types of screen use as predictor variables. Additionally, we tested interaction effects between gender and the predictor variables.

RESULTS

Our results showed that spending more than 2 hours on social media was associated with higher odds of feeling depressed often compared with spending 2 hours or less. Not watching TV was associated with higher odds of feeling depressed often compared with watching TV. These patterns did not differ across genders. Gaming alone and gaming in groups were not associated with depressive symptoms.

CONCLUSIONS

Our findings suggest that more frequent social media use and not watching TV were associated with a higher level of depressive symptoms.

I won't comply because it is a hoax: Conspiracy beliefs, lockdown compliance, and the importance of psychological flexibility

The COVID-19 pandemic has brought unprecedented situations (government lockdowns, quarantines, etc.) and stressors (a seemingly “phantom” virus that can be lurking anywhere) causing uncertainty for the future, uncontrollable and unpredictable situations. It appears that especially during times of uncertainty and high stress, conspiracy theories flourish and these can affect the way individuals behave, especially in response to governmental recommendations for social isolation and quarantine. Psychological flexibility, we hypothesized, may act as a protective factor in the relation between COVID-19 distress, conspiracy theory beliefs and consequent behaving. In this respect, the aim of this paper was to examine how conspiracy theory beliefs, COVID-19 distress, adherence behavior, and psychological flexibility interact. Participants were 1001 individuals (802 women; Mage = 35.59years, SD = 10.07), who completed an online survey approximately one month after the first governmental measures of self-isolation and quarantine were enforced. Psychological flexibility was found to mediate the relation between conspiracy theory beliefs and compliance behavior. Further, being highly stressed appeared to increase the probability that a person will believe conspiracy theories, while such beliefs influenced whether a person would follow public health recommendations. Psychological flexibility appeared to be a protective factor at low and moderate distress levels. However, at high levels of COVID-19 distress, individuals prone to conspiracy theory beliefs would be less likely to conform to governmental public health recommendations irrespective of their psychological flexibility levels.

Single-item measures of stress during work- and private time in healthcare workers

BACKGROUND

While the psychosocial work environment within the hospital sector is a topic of great debate, surveys assessing stress often do not differentiate between stress related to work- and private life. Identifying risk factors associated with these domains of daily life would help improve policies as well as target relevant treatment options. Therefore, the aim of this study was to evaluate associations between stress during to work- and private time with Cohen's Perceived Stress Scale (CPSS).

METHODS

Perceived stress was assessed by the full version of CPSS (scores 0-40) as well as by two single-item questions related to stress related to work- and private life, respectively. Associations between these single-items and CPSS were modelled using general linear models controlling for lifestyle factors.

RESULTS

Overall, stress due to both work- and private time was strongly associated with CPSS scores. In the full population (n = 3,600), "never experiencing stress" during both work- and private time was associated with low stress scores (6.0, 95%CI 5.1-6.9). "Never experiencing" work-related stress but experiencing private time stress "very often" was associated with high stress scores (22.4, CI 19.8-25.1). Likewise, experiencing work-related stress "very often" but "never experiencing" private time stress was also associated with high stress scores (22.2, CI 20.3-24.2). Lastly, Spearman's r between the full CPSS and the two single-item questions about work- and private time stress were 0.62 (p < 0.0001) and 0.52 (p < 0.0001), respectively, while the two items were only weakly correlated (r = 0.32).

CONCLUSION

The present study shows that perceived stress due to both work and private time is strongly associated with Cohen's Perceived Stress Scale scores. The results illustrate the feasibility of using single-item questions related to work- and private time in identifying domain-specific risk factors for psychosocial stress.

Coping with the COVID-19 pandemic: Contemplative practice behaviors are associated with better mental health outcomes and compliance with shelter-in-place orders in a prospective cohort study

Psychosocial health can influence the development and experience of several chronic diseases, and has been negatively affected for many individuals amid the COVID-19 global pandemic. To understand the impact of contemplative practices on emotional and mental health during COVID-19, the Stanford WELL for Life Study (US component), incorporated a series of additional surveys into its ongoing study. A total of 1,097 participants residing in California who responded to at least one of three COVID-19 surveys were included in this analysis. Linear and generalized mixed-effects regression models were used to investigate relationships between individual contemplative practice behaviors (CPB) (embodied observing meditation, non-reactive mindfulness meditation, self-compassion cultivation, cultivation of compassion for others) and four psychosocial outcomes measured in the original WELL questionnaire (resilience, dealing with stress, positive emotions, and negative emotions). In addition, the associations between CPB and depression, distress, and compliance with local Shelter-In-Place orders were also investigated. Participants who engaged in any contemplative practice reported significantly more resilience and positive emotions, dealing better with stress, lower distress, and were less likely to report an experience with depression in the last week. Similar findings held when CPB was modeled as a continuous variable. Significant interactions between the duration of the SIP and CPB were also observed for resilience and SIP compliance outcomes, indicating that steeper declines were observed among participants with little or no CPB across the study period. Further investigation into the potential protective benefits of CPB during times of major disruption and uncertainty is warranted.

Prenatal maternal stress and autistic-like behaviours in Chinese preschoolers

Exposure to prenatal maternal stress (PNMS) has been implicated as a risk factor for a range of psychiatric disorders in children. However, there have been a few studies showing inconsistent associations between PNMS and offspring autistic-like behaviours. We therefore aimed to examine whether trimester-specific PNMS exposure might be related to an increased risk of autistic-like behaviours among preschoolers. Using data from Longhua Children Cohort Study, mothers of 65,931 preschool children were asked to recall their level of PNMS in each of the three trimesters of pregnancy, while children's current autistic-like behaviours were assessed using the Autism Behaviour Checklist. A series of Cox regression models were fitted to assess the association between PNMS exposure and autistic-like behaviours. After adjusting for potential confounders, the Cox regression models showed that PNMS exposure, especially during the second pregnant trimester, was significantly and positively associated with the presence of children's autistic-like behaviours. The strength of these associations was enhanced with the increase of PNMS exposure level. Furthermore, based on different permutations of exposure versus no exposure in each trimester, the participants were divided into eight groups. A cross-over analysis confirmed the aforementioned finding that the second pregnant trimester might be the sensitive period for PNMS exposure increasing the risk of autistic-like behaviours. Our findings supported the hypothesis of an association between PNMS exposure and autistic-like behaviours among preschoolers. Preventive interventions should be trialled to examine whether minimizing maternal psychological stress during pregnancy, especially the second trimester, may reduce the risk of offspring autistic-like behaviours.

Screening for distress and needs: Findings from a multinational validation of the Adolescent and Young Adult Psycho-Oncology Screening Tool with newly diagnosed patients

OBJECTIVE

Adolescents and young adults (AYAs) diagnosed with cancer commonly experience elevated psychological distress and need appropriate detection and management of the psychosocial impact of their illness and treatment. This paper describes the multinational validation of the Distress Thermometer (DT) for AYAs recently diagnosed with cancer and the relationship between distress and patient concerns on the AYA-Needs Assessment (AYA-NA).

METHODS

AYA patients (N = 288; 15-29 years, M_age  = 21.5 years, SD_age  = 3.8) from Australia (n = 111), Canada (n = 67), the UK (n = 85) and the USA (n = 25) completed the DT, AYA-NA, Hospital Anxiety Depression Scale (HADS) and demographic measures within 3 months of diagnosis. Using the HADS as a criterion, receiver operating characteristics analysis was used to determine the optimal cut-off score and meet the acceptable level of 0.70 for sensitivity and specificity. Correlations between the DT and HADS scores, prevalence of distress and AYA-NA scores were reported.

RESULTS

The DT correlated strongly with the HADS-Total, providing construct validity evidence (r = 0.65, p < 0.001). A score of 5 resulted in the best clinical screening cut-off on the DT (sensitivity = 82%, specificity = 75%, Youden Index = 0.57). Forty-two percent of AYAs scored at or above 5. 'Loss of meaning or purpose' was the AYA-NA item most likely to differentiate distressed AYAs.

CONCLUSIONS

The DT is a valid distress screening instrument for AYAs with cancer. The AYA-POST (DT and AYA-NA) provides clinicians with a critical tool to assess the psychosocial well-being of this group, allowing for the provision of personalised support and care responsive to individuals' specific needs and concerns.

COVID-19 Scientific Facts vs. Conspiracy Theories: Is Science Failing to Pass Its Message?

Science may be failing to convince a significant number of people about COVID-19 scientific facts and needed public health measures. Individual and social factors are behind believing conspiracy theories. Adults (N = 1001) were asked to rate their beliefs in various conspiracy theories circulating in social media, rate their psychological distress relating to COVID-19, rate their trust in science to solve COVID-19 problems, and rate their willingness to adhere to measures regarding social distancing and quarantine. The findings showed conspiracy theories are widely believed and related to lower age, lower education, living in less densely populated areas, and lower income. Stronger conspiracy theory beliefs predicted science mistrust and unwillingness to adhere to public health measures. Psychological state was a strong predictor of conspiracy beliefs. Recommendations, stemming from the findings, for reducing such beliefs and better serving public health are discussed.

Impact of Initial Emotional States and Self-Efficacy Changes on Nursing Students' Practical Skills Performance in Simulation-Based Education

Training through simulation has shown to increase relevant and specific skills sets across a wide range of areas in nursing and related professions. Increasing skills has a reciprocal relation to the development of self-efficacy. A study was conducted to assess changes in the development of self-efficacy in simulation training for 2nd year nursing students. Initial emotional states, pre and post self-efficacy, and expert ratings of simulation performance were assessed. Results show that students who displayed an increase in self-efficacy as a result of simulation training were also judged to perform better by expert ratings. The effect of simulation on self-efficacy could be influenced by initial states of physiological activation and over control. Results also showed that initial emotional states did not moderate self-efficacy development on outcome measures. These findings improve our understanding on the relationship between students’ self-efficacy and performance of practical skills and inform pedagogical designs and targeted interventions in relation to feedback and supervision in nursing education.

Psychiatric comorbidities among COVID-19 survivors in North India: A cross-sectional study

BACKGROUND

The coronavirus disease-19 (COVID-19) emerged from China and rapidly spread to many other countries all over the world. This study aimed to assess the prevalence of anxiety, depression, posttraumatic stress disorder, and obsessive-compulsive (OC) symptoms among COVID-19 survivors after their discharge from the COVID-19 treatment center.

MATERIALS AND METHODS

This was a cross-sectional, hospital-based study performed among 119 COVID-19 survivors. The Hospital Anxiety and Depression Scale (HADS) was used to measure anxiety and depression. Posttraumatic Stress Disorder (PTSD)-Checklist (PCL) and Brief OC Scale were used to measure PTSD and OC symptoms. Data were analyzed by descriptive and inferential statistics using the SPSS (IBM Corp. Released 2015 version 23.0).

RESULTS

The mean anxiety, depression, and PTSD scores were, 7.12 ± 0.68, 8.08 ± 0.22, and 19.78 ± 0.88, respectively. Based on cutoff scores, the prevalence of anxiety, depression, and PTSD among COVID-19 survivors was n = 53, 44.54%; n = 73, 61.34%; and n = 30, 25.21%, respectively. Older COVID-19 survivors (≥50 years) were more likely to show symptoms of depression and anxiety (P < 0.001) compared to younger ones. Furthermore, COVID-19 survivors who were ≥50 years of age experienced a greater level of PTSD compared to younger ones; similar trends were seen in those experiencing OC symptoms. In the present study, n = 98 (82.4%) were obsessed with fears of contamination and an equal number had compulsive handwashing.

CONCLUSION

Anxiety, depression, PTSD, and OC symptoms are common among the COVID-19 survivors and that underscores the need to diagnose and manage mental health morbidities among these survivors long after their recovery from COVID-19.

A Novel Group Cognitive Behavioral Therapy Approach to Adult Non-rapid Eye Movement Parasomnias

Background: Following the success of Cognitive Behavioral Therapy (CBT) for insomnia, there has been a growing recognition that similar treatment approaches might be equally beneficial for other major sleep disorders, including non-rapid eye movement (NREM) parasomnias. We have developed a novel, group-based, CBT-program for NREM parasomnias (CBT-NREMP), with the primary aim of reducing NREM parasomnia severity with relatively few treatment sessions. Methods: We investigated the effectiveness of CBT-NREMP in 46 retrospectively-identified patients, who completed five outpatient therapy sessions. The outcomes pre- and post- CBT-NREMP treatment on clinical measures of insomnia (Insomnia Severity Index), NREM parasomnias (Paris Arousal Disorders Severity Scale) and anxiety and depression (Hospital Anxiety and Depression Scale), were retrospectively collected and analyzed. In order to investigate the temporal stability of CBT-NREMP, we also assessed a subgroup of 8 patients during the 3 to 6 months follow-up period. Results: CBT-NREMP led to a reduction in clinical measures of NREM parasomnia, insomnia, and anxiety and depression severities [pre- vs. post-CBT-NREMP scores: P (Insomnia Severity Index) = 0.000054; P (Paris Arousal Disorders Severity Scale) = 0.00032; P (Hospital Anxiety and Depression Scale) = 0.037]. Improvements in clinical measures of NREM parasomnia and insomnia severities were similarly recorded for a subgroup of eight patients at follow-up, demonstrating that patients continued to improve post CBT-NREMP. Conclusion: Our findings suggest that group CBT-NREMP intervention is a safe, effective and promising treatment for NREM parasomnia, especially when precipitating and perpetuating factors are behaviorally and psychologically driven. Future randomized controlled trials are now required to robustly confirm these findings.

Test-retest & familial concordance of MDD symptoms

Psychopathology research has increasingly sought to study the etiology and treatment of individual symptoms, rather than categorical diagnoses. However, it is unclear whether commonly used measures have adequate psychometric properties for assessing individual symptoms. This study examined the test-retest reliability and familial concordance (an indicator of validity) of the symptoms of Major Depressive Disorder (MDD), a disorder consisting of nine core symptoms, most of which are aggregated (e.g., symptom 7 of the DSM criteria for MDD is worthlessness or guilt). Lifetime MDD symptoms were measured in 504 young adults (237 sibling pairs) using the Structured Clinical Interview for DSM-5 (SCID). Fifty-one people completed a second SCID within three weeks of their first SCID. Results indicated that aggregated and unaggregated symptoms demonstrated moderate to substantial test-retest reliability and generally significant, but slight to fair familial concordance (with the highest familial concordance being for markedly diminished interest or pleasure and its unaggregated components - decreased interest and decreased pleasure). Given the increasing focus on the differential validity of individual MDD symptoms, the present study suggests that interview-based assessments of depression can assess most individual symptoms with adequate levels of reliability and validity.

Gaps in patient-centered follow-up cancer care: a cross sectional study

Objective There are published guidelines on the care that should be provided to cancer patients upon finishing treatment (i.e. follow-up care). Gaps in care may arise where patients' reported experiences of care do not align with guideline recommendations. The aim of this study was to explore whether oncology patients report gaps in patient-centered follow-up care. Methods This study was a cross-sectional survey of adult cancer patients receiving follow-up care within four outpatient oncology clinics. Patients were approached in clinic waiting rooms and asked to complete an electronic survey. The survey examined patients' self-report of receiving six aspects of follow-up care. Results A total of 239 participants completed the survey (study consent rate = 83%). Only 49% of participants received all six items of care. Patients reported high rates of being told who to contact if they have any questions or concerns (95%); who to contact if signs or symptoms occur (91%); and what to expect in their follow-up care (90%). A lower proportion of patients indicated they were informed about the role of their GP after treatment has finished (79%); what symptoms or signs might suggest the cancer had returned (74%); or were given a written care plan (71%). Conclusions: The study highlights that there is a gap between some aspects of optimal patient-centered care, and the actual care received by patients. Health care providers and researchers should consider how to improve follow-up care experiences to ensure best practice cancer care delivery during this important stage in cancer survivorship.

Transcranial Direct-Current Stimulation May Improve Discourse Production in Healthy Older Adults

Background: The use of transcranial direct-current stimulation (tDCS) for therapeutic and neurorehabilitation purposes has become increasingly popular in recent years. Previous research has found that anodal tDCS may enhance naming ability and verbal fluency in healthy participants. However, the effect of tDCS on more functional, higher level language skills such as discourse production has yet to be understood. Aims: The present study aimed to investigate in healthy, older adults (a) the effect of anodal tDCS on discourse production vs. sham stimulation and (b) optimal electrode placement for tDCS to target language improvement at the discourse level. Methods: Fourteen healthy, older right-handed participants took part in this sham controlled, repeated measures pilot study. Each participant experienced three different experimental conditions; anodal tDCS on the left inferior frontal gyrus (IFG), anodal tDCS on the right IFG and sham stimulation while performing a story telling task. Significant changes in language performance before and after each condition were examined in three discourse production tasks: recount, procedural and narrative. Results: Left and right IFG conditions showed a greater number of significant within-group improvements (p < 0.05) in discourse production compared to sham with 6/12 for left IFG, 4/12 for right IFG and 2/12 for sham. There were no significant differences noted between tDCS conditions. No relationship was noted between language performance and physical activity, age, or gender. Conclusions: This study suggests that anodal tDCS may significantly improve discourse production in healthy, older adults. In line with previous tDCS language studies, the left IFG is highlighted as an optimal stimulation site for the modulation of language in healthy speakers. The findings support further exploration of tDCS as a rehabilitative tool for higher-level language skills in persons with aphasia.

Association Between Current Physical Activity and Current Perceived Anxiety and Mood in the Initial Phase of COVID-19 Confinement

The World Health Organization (WHO) has declared a world pandemic due to COVID-19, and several enacted measures such as compulsory confinement may have collateral consequences on both physical and mental health. We aimed to investigate associations between current physical activity (PA) and current perceived anxiety and mood among a sample of Spanish adults confined due to COVID-19 restrictions of movement. Using an online survey, we collected data on the Spanish adult population regarding health habits during the first days of enacted confinement. A total of 2250 participants (54.8% women) aged 35.3 (SD 13.6) completed the survey, which included questions about sociodemographic characteristics (i.e. age, gender, civil status, education, and occupation), health habits (i.e. prior PA, alcohol consumption, smoking, screen exposure, and sleep hours) and COVID-19 confinement context (i.e. number of isolation days, solitude, and exposure to COVID-19). Physical Activity Vital Sign (PAVS) short form was used to estimate weekly minutes of PA, whereas a single-item question was used to assess both current perceived anxiety and mood. We conducted weighted binomial logistic regressions to check associations between current adherence to WHO guidelines of PA and current perceived anxiety and mood of confined adults. Significant inverse associations between overall adherence to PA and current perceived anxiety in the final adjusted model (OR, 0.66; 95% CI, 0.54-0.79) as well as in several subgroup analyses such as younger women were observed. In addition, a borderline significant inverse association was found between current PA and current perceived worse mood when fully adjusted (OR, 0.82; 95% CI, 0.68-1.00); this association was significantly stronger in women than men. The results of the present study indicate that current PA adherence to WHO guidelines in the initial phase of COVID-19 confinement associates with both lower current perceived anxiety and lower current perceived worse mood among a sample of Spanish adults.

Examining social isolation and loneliness in combination in relation to social support and psychological distress using Canadian Longitudinal Study of Aging (CLSA) data

BACKGROUND

Although a large body of research has focused on social isolation and loneliness, few studies have examined social isolation and loneliness together. The objectives of this study were to examine: 1) the relationship between four groups derived from combining social isolation and loneliness (socially isolated and lonely; only socially isolated; only lonely; neither socially isolated nor lonely) and the desire for more social participation, and social support; and 2) the relationship between the four groups and psychological distress.

METHODS

The study was based on the Comprehensive Cohort of the Canadian Longitudinal Study on Aging. Using CLSA baseline data (unweighted N = 30,079), ordinary and logistic regression analysis was used to examine the cross-sectional relationship between the four social isolation/loneliness groups and desire for more social participation and four types of social support (tangible, positive interaction, affection, and emotional support). Prospective logistic regression analysis was possible for psychological distress, which was derived from the Maintaining Contact Questionnaire administered about 18 months after the baseline questionnaire (unweighted N = 28,789).

RESULTS

Findings indicate that being socially isolated and lonely was associated with the most social support gaps; this group also had an increased likelihood of psychological distress, relative to those who were neither socially isolated nor lonely. Participants who were only socially isolated, and those only lonely also perceived some social support gaps. In addition, the only lonely group was more likely to be psychologically distressed than the only socially isolated group and the neither isolated nor lonely group.

CONCLUSION

Examining the four social isolation/loneliness was useful, as it provided more nuanced risk profiles than would have been possible had we examined social isolation and loneliness separately. Findings may suggest avenues for interventions tailored to the unique needs of at-risk individuals.