The role and outcomes of music therapy during pregnancy: a systematic review of randomized controlled trials

INTRODUCTION

The abundant functions of music and its effects on human's mental and physical health have been verified since ancient times, but rarely received attention as an alternative obstetric intervention.

OBJECTIVE

This study aims to investigate the benefits of music therapy on prenatal and delivery experiences of pregnant women.

METHOD

A systematic search for articles was conducted in electronic databases including CINAHL, Web of Science, PubMed/Medline, and CNKI. A total of 240 articles were identified, and 17 studies were selected for this review. The extracted data included author, year, location, sample size, intervention phase, type of music, music therapy strategy, measuring instruments, and results. The data were organized chronologically based on the publication year of each study.

RESULT

The articles indicated that music therapy has advantages in reducing pain during childbirth, lowering anxiety and stress levels in mothers, improving sleep quality, and increasing fetal movements, basal fetal heart rate, and accelerations.

CONCLUSION

Based on the findings, it can be concluded that music therapy is an effective approach to enhance the experience of pregnant women during pregnancy and delivery. Therefore, its implementation in obstetrical clinical practice is highly recommended.

State-trait anxiety levels and vital signs of pregnant women following intervention with virtual reality during the nonstress test: A randomized controlled trial

BACKGROUND

Pregnant women often experience anxiety due to pregnancy, negatively impacting their and their fetus' health. Non-pharmacological interventions, such as virtual reality (VR), could reduce anxiety levels, potentially impacting non-stress tests or the physiological responses of the pregnant woman and the fetus.

METHODS

A randomized clinical trial conducted between February and December 2022 involved 286 term pregnant women. They were divided into a VR intervention group (146 women) and a control group (140 women). The intervention consisted of 20 min of 3D glasses with images and sounds during a third-trimester nonstress test. Anxiety was measured using the Spielberg State-Trait Anxiety Inventory (STAI), alongside physiological parameters.

RESULTS

The VR group exhibited lower anxiety levels compared to controls (STAI score: Rosenthal's r: -0.54, p = 0.01; state anxiety: Rosenthal's r: -0.40, p = 0.001; trait anxiety: Rosenthal's r: -0.41, p = 0.001). Within the VR group, there was a significant reduction in trait anxiety (Rosenthal's r, 1.27; p < 0.001) and total anxiety (Rosenthal's r, 1.63; p < 0.001) post-intervention, along with decreased systolic blood pressure (p < 0.001), diastolic blood pressure (p < 0.001), and maternal heart rate (p = 0.02).

LIMITATIONS

Future research could explore additional pregnancy-related variables, such as postpartum anxiety.

CONCLUSIONS

The results confirm that the use of VR is beneficial for pregnant women and their fetuses, as it decreases anxiety levels, and improves physiological parameters such as blood pressure and maternal heart rate during the nonstress test. VR is a technique that is easy to integrate into the healthcare system due to its non-invasive and non-pharmacological nature.

Problematic social media use in childhood and adolescence

At the time of writing, about 4.59 billion people use social media with many adolescents using their social media accounts across a myriad of applications and platforms. According to recent statistics, in 2022 individuals spent an average of 151 minutes on social media each day, illustrating the global relevance of social media (Dixon, 2022a,b). One of the pressing questions, internationally, is whether social media use is harmful and/or addictive. This question is of particular importance because many teenagers - and younger adolescents - spend considerable time on these platforms, which have increasingly become an integral part of their lives. Moreover, considering lifespan development, adolescents may be particularly vulnerable to specific features and advertisements shown to them on social media platforms. Growing prevalence of poor mental health in young people has led to recent recommendations in the United States to routinely screen for anxiety in 8-18 year olds, and for depression and suicide risk for adolescents between 12-18 years of age (US Preventive Services Task Force et al., 2022 a,b) - the conditions often accompanying problematic social media use. The present work not only provides insights into the current state of the literature but provides also recommendations.

A detailed hierarchical model of psychopathology in Chinese clinical sample: Based on the SCL-90-R measure

OBJECTIVE

The Hierarchical Taxonomy of Psychopathology (HiTOP)model is an impressive effort to overcome shortcomings of traditional diagnostic systems. However, almost all of the quantitative empirical evidence used to structure the model comes from Western cultures and is built upon traditional diagnostic categories. This study aims to provide a detailed Chinese version of the HiTOP structure, ranging from symptoms based on The Symptom Checklist 90-R (SCL-90-R) up to the general factor.

METHODS

We explored the detailed hierarchical structure of the SCL-90-R scale in adult (N = 34,222) and adolescent (N = 1973) clinical sample from Shanghai Mental Health Center, using extended bass-ackwards approach to draw the HiTOP model.

RESULTS

The Chinese HiTOP structure had a general factor at the top, 4 higher-order spectra (Internalizing, Externalizing, Broad Thought Disorder and Somatization and Somatic Anxiety) and 6 subfactors (Distress, Somatoform, Hostility, Fear, Psychosis and OCD) across both adult and adolescent samples. In addition, the adult sample contained 2 other subfactors: a) Sleep, and b) Suicide and Guilt. At the symptom level, some items were posited to components diverged from the original SCL-90-R subscales.

CONCLUSIONS

These findings offer the first description of the HiTOP structure in two Chinese samples and demonstrate that the SCL-90-R can be used to examine the HiTOP structure. The Somatization spectrum first emerged as a higher-order dimension, suggesting structural differences between Western and Eastern cultures. The results also suggest that transdiagnostic research should (1) further examine the positioning of somatoform symptoms using measures in other Eastern samples, and (2) place more emphasis on interpreting SCL-90-R results across different cultures.

The legacy of social anxiety-linked negative expectancy: A pathway from pre-event negative expectancies to post-event negative thinking

BACKGROUND AND OBJECTIVES

Following engagement in a social event people with heightened vulnerability to social anxiety report elevated levels of negative thinking about the event, and this post-event negative thinking is implicated in the maintenance of social anxiety vulnerability. It has also been established that heightened social anxiety vulnerability is associated with disproportionately negative expectations of upcoming social events. However, contribution of social anxiety-linked pre-event negative expectancy to post-event negative thinking has not been directly investigated. The objective of the present study was to test the hypothesis that the relationship between social anxiety vulnerability and post-event negative thinking is mediated by pre-event negative expectancies that drive increased state anxiety at the time of encountering the event.

METHODS

One-hundred and ten participants who varied in social anxiety vulnerability completed a simulated job interview. Participants reported negativity of expectancies before the event, state anxiety experienced at the time of encountering the event, and post-event negative thinking across the seven days following the event.

RESULTS

Analyses revealed elevated social anxiety predicted increased negative post-event thinking. The association between social anxiety and post-event negative thinking was fully mediated by a mediation pathway involving pre-event negative expectancies and state anxiety at the time of encountering the interview event.

LIMITATIONS

The study used a laboratory-based social experience, and conclusions could usefully be tested in the context of natural social events.

CONCLUSIONS

The findings suggest that social anxiety-linked variation in pre-event negative expectancy may contribute to post-event negative thinking following a social event via its impact on state anxiety.

Anxiety, pain catastrophizing, and pain outcomes among older adults with chronic orofacial pain

Although chronic orofacial pain (COFP) is common among older adults, the role of psychological factors in pain outcomes among this population has received limited attention. This study examined the role of anxiety and pain catastrophizing, two corelates of pain in other populations, in pain intensity and interference among 166 older adults with COFP (79% female, Mage = 68.84, SD = 5.56). Participants completed an online survey including measures of anxiety, pain catastrophizing, and pain intensity/interference. We applied mediation analyses to test indirect associations between anxiety and pain outcomes via pain catastrophizing. Results indicated that anxiety was positively associated with pain intensity and pain interference (bs = .70-1.12, ps < .05). There was also an indirect association between anxiety and pain interference through pain catastrophizing (b = .35, 95% CI [.0383, .7954]), indicating pain catastrophizing partially accounts for this relationship. Assessing and addressing anxiety and pain catastrophizing has the potential to improve treatment outcomes in this population.

Prenatal stress and hair cortisol in a sample of Latina women

BACKGROUND

Stress during pregnancy adversely impacts maternal and infant health. Dysregulation of the hypothalamic pituitary axis is a mediator of the relationship between stress and health. Evidence supporting an association between prenatal chronic stress and cortisol is limited, and the majority of research published has been conducted amongst White participants, who experience less chronic stress than people of color.

AIM

This study investigated associations between various measures of prenatal stress and hair cortisol concentrations which is a biomarker of the integrated stress response in a sample of Latina participants during the third trimester of pregnancy.

METHOD

Pregnant women (n=45) were surveyed with scales measuring chronic stress, perceived stress, pregnancy-related and pregnancy-specific anxiety. Hair samples were collected as an objective neuroendocrine measure of chronic stress. Linear regression analyses were performed to assess associations between stress measures and hair cortisol. Pre-pregnancy BMI, smoking during pregnancy, and steroid use during pregnancy were used as covariates in adjusted models.

RESULTS

Chronic stress, operationalized as maternal reports of neighborhood/housing strain, daily activities and relationship strain, discrimination, and financial strain, was significantly associated with higher hair cortisol concentrations. No significant associations were found between hair cortisol and perceived stress, pregnancy-related anxiety, nor pregnancy-specific anxiety in adjusted models.

CONCLUSION

Chronic stress may be a more robust correlate of physiological stress, as measured by hair cortisol in pregnancy, than other common measures of prenatal stress and anxiety.

The association between food neophobia, bi-dimensional aspects of orthorexia, and anxiety among vegetarians and omnivores

Vegetarianism is a growing trend, and food neophobia and orthorexia nervosa could act as barriers to achieving a healthy vegetarian diet. The aim of this study is to compare the levels of food neophobia, anxiety, and both healthy and pathological aspects of orthorexia among vegetarians and omnivores. Additionally, the study aims to identify the relationships between food neophobia, anxiety, and orthorexia. In this cross-sectional online survey, a total of 324 vegetarian and 455 omnivores adults participated. The questionnaire consisted of four sections: sociodemographic, lifestyle, and health-related characteristics, the Food Neophobia Scale (FNS), the Teruel Orthorexia Scale (TOS), and the Generalized Anxiety Disorders-7 Scale. Vegetarians exhibited lower FNS scores (p < 0.001) and had higher healthy orthorexic scores (p < 0.001) than omnivores. There were no differences between groups for anxiety scores (p > 0.05). Regression analysis indicated that higher food neophobia (OR: 0.953, 95% CI:0.937-0.968) and TOS-OrNe scores (OR: 0.946, 95% CI: 0.901-0.993) were associated with lower odds of following a vegetarian diet. Conversely, higher TOS-HeOr scores (OR: 1.135, 95% CI:1.096-1.176) were linked to an increased likelihood of adopting a vegetarian diet. Furthermore, both FNS and GAD-7 scores showed negative correlations with TOS-HeOR (r = -0.124, p < 0.001 and r = -0.129 p < 0.001, respectively), and positive correlations with TOS-OrNe (r = 0.106, p < 0.001 and r = 0.146, p < 0.001). In conclusion, vegetarians exhibit lower levels of food neophobia and a greater interest in healthy eating than omnivores. Additionally, the distinct correlation between two dimensions of orthorexia and food neophobia and anxiety provides support for the two-dimensional nature of orthorexia.

The role of explicit and implicit self-esteem in the relationship between childhood trauma and adult depression and anxiety

BACKGROUND

Self-esteem is an important psychological concept that can be measured explicitly (reflective processing) and implicitly (associative processing). The current study examined 1) the association between childhood trauma (CT) and both explicit and implicit self-esteem, and 2) whether self-esteem mediated the association between CT and depression/anxiety.

METHODS

In 1479 adult participants of the Netherlands Study of Depression and Anxiety, CT was assessed with a semi-structured interview, depression/anxiety symptoms with self-report questionnaires and explicit and implicit self-esteem with the Rosenberg Self-Esteem Scale and Implicit Association Test, respectively. ANOVAs and regression analyses determined the association between CT (no/mild/severe CT), its subtypes (abuse/neglect) and self-esteem. Finally, we examined whether self-esteem mediated the relationship between CT and depression/anxiety.

RESULTS

Participants with CT reported lower explicit (but not lower implicit) self-esteem compared to those without CT (p < .001, partial η2 = 0.06). All CT types were associated with lower explicit self-esteem (p = .05 for sexual abuse, p < .001 for other CT types), while only emotional neglect significantly associated with lower implicit self-esteem after adjusting for sociodemographic characteristics (p = .03). Explicit self-esteem mediated the relationship between CT and depression/anxiety symptoms (proportion mediated = 48-77 %).

LIMITATIONS

The cross-sectional design precludes from drawing firm conclusions about the direction of the proposed relationships.

CONCLUSIONS

Our results suggested that the relationship between CT and depression/anxiety symptoms can at least partly be explained by explicit self-esteem. This is of clinical relevance as it points to explicit self-esteem as a potential relevant treatment target for people with CT.

Mindfulness on Symptom Control and Quality of Life in Patients in Palliative Care: A Systematic Review

INTRODUCTION

Palliative care is a medical and humanitarian approach that improves the quality of life of patients, and their families, who are facing problems associated with chronic and life-threatening illnesses. Few studies have evaluated the effectiveness of mindfulness-based interventions for terminally ill or incurable patients. The aim of this study was to systematically review the literature on the effect of mindfulness-based interventions on symptom control and quality of life in patients in palliative care.

METHODS

PubMed, Web of Science and Cochrane databases were searched for articles, published between January 2017 and December 2022, in English, including randomized controlled and clinical trials. Participants: terminally ill or incurable patients. Interventions: any mindfulness-based intervention. Comparators: any. Outcomes: symptom control and quality of life. The risk of bias was analysed through Cochrane's ROB-2 tool.

RESULTS

Eight studies were included involving 609 patients and 75 dyads patients-spousal caregivers. The overall risk of bias was low to moderate. Mindfulness-based interventions are helpful in managing suffering, anxiety and depressive symptoms, fatigue, insomnia, drowsiness, appetite, and spiritual well-being.

CONCLUSION

Mindfulness-based interventions control several symptoms and improve spiritual quality of life in patients in palliative care. Additionally, their informal caregivers also benefit from these interventions. Future trials are crucial to investigate other effects of mindfulness-based interventions, and their long-term benefits, in patients in palliative care.

Adolescent activity-based anorexia has a substantial and prolonged impact on social behavior in young adult female rats

Activity-based anorexia (ABA) is a rodent model of anorexia nervosa (AN) that induces several key components of AN, including voluntary reduction in food intake, reduced body weight, hyperactivity, and alterations to the hypothalamic-pituitary-adrenal (HPA) axis. Previous research has demonstrated persistently increased anxiety-like behavior in the elevated plus maze (EPM), a test measuring avoidance of novel and open areas in adult female rats that experienced ABA during adolescence and are weight-restored in adulthood. Whether the same behavioral effects of two bouts of adolescent ABA emerge in response to different anxiety-provoking stimuli, however, has not been explored. We used the social partition (SP), novelty suppressed feeding (NSF), marble burying, and EPM tests to explore whether two bouts of adolescent ABA have persistent effects on anxiety-like behavior in weight restored young adult female rats. One-way ANOVA analyses revealed that female rats that experienced two bouts of ABA during adolescence had increased anxiety-like behavior in the EPM and SP tests in young adulthood following weight restoration compared with controls. These data demonstrate that the enduring behavioral effects of two bouts of adolescent ABA are specific to particular anxiety-provoking stimuli and suggest that adolescent ABA has enduring effects on social relationships.

Reducing younger and older adults' spatial disorientation during indoor-outdoor transitions: Effects of route alignment and visual access on wayfinding

Getting lost could lead to frustration, anxiety, and even fatal accidents. Previous research primarily focused on disorientation in indoor or outdoor environments separately. The indoor-outdoor transition received little attention, yet it is in this complex transition that individuals often lose their way. Therefore, the effects of indoor-outdoor route alignment, visual access, and age on wayfinding performance and spatial cognition were examined. Twenty older adults (aged 18-25) and twenty young adults (aged 65-82) participated in an experiment through desktop Virtual Reality (VR). They traversed indoor-outdoor environments and were informed within a building to quickly navigate an item inside another building. They also drew the route map. Participants repeated tasks in four different environments. Their spatial cognition and wayfinding performance were analyzed. Four main findings were derived. Firstly, the accuracy of global representation of the routes in the indoor-outdoor route alignment environment was higher than that in the non-aligned environment. Secondly, in environments with higher visual access, the accuracy of global representation of the routes for older adults was higher than that with lower visual access. Thirdly, enhancing visual access attenuated the negative impact of the non-aligned route on global representation of the routes. This effect is particularly beneficial for older adults. Fourthly, the younger adults outperformed the older adults in both wayfinding performance and global representation of the routes in indoor-outdoor environments. This difference could potentially be attributed to variations in education level, mental rotation ability, and digital experience. These findings provide valuable implications for urban design and wayfinding strategies.

Antecedents of major depressive, bipolar, and psychotic disorders: A systematic review and meta-analysis of prospective studies

Major depressive, bipolar, or psychotic disorders are preceded by earlier manifestations in behaviours and experiences. We present a synthesis of evidence on associations between person-level antecedents (behaviour, performance, psychopathology) in childhood, adolescence, or early adulthood and later onsets of major depressive disorder, bipolar disorder, or psychotic disorder based on prospective studies published up to September 16, 2022. We screened 11,342 records, identified 460 eligible publications, and extracted 570 risk ratios quantifying the relationships between 52 antecedents and onsets in 198 unique samples with prospective follow-up of 122,766 individuals from a mean age of 12.4 to a mean age of 24.8 for 1522,426 person years of follow-up. We completed meta-analyses of 12 antecedents with adequate data. Psychotic symptoms, depressive symptoms, anxiety, disruptive behaviors, affective lability, and sleep problems were transdiagnostic antecedents associated with onsets of depressive, bipolar, and psychotic disorders. Attention-deficit/hyperactivity and hypomanic symptoms specifically predicted bipolar disorder. While transdiagnostic and diagnosis-specific antecedents inform targeted prevention and help understand pathogenic mechanisms, extensive gaps in evidence indicate potential for improving early risk identification.

CBT+ Training Initiative in Washington State Community Mental Health: An Evaluation of Child Clinical Outcomes

The Washington State CBT+  Initiative offers a flexible training and consultation approach for community mental health providers in evidence-based practices for four child mental health targets: cognitive behavioral therapy for depression, anxiety, trauma, and behavioral difficulties. As part of consultation, clinicians used an online system to track delivery of treatment components and clinical outcomes using standardized symptom measures. The current study used these clinician-input data to examine symptom change for children using paired sample t-tests. Additionally, we explored if time elapsed or number of sessions between measurements related to symptom change using simple linear regression. Children had significant symptom reduction across all four targets. For most measures, children did not show greater improvements with increased length of time or increased number of sessions between assessment measures. Findings suggest that children treated by a CBT+  trained clinician may demonstrate symptom reduction for their primary clinical problem. Findings add to support for flexible training approaches for community mental health clinicians.

Post-event rumination and social anxiety: a systematic review and meta-analysis

Post-event rumination, the extent to which one engages in persistent, detailed, and negative thinking following social situations, serves as a risk process in the pathophysiology of social anxiety. Although a substantial body of research has assessed post-event rumination and social anxiety, this literature has produced inconsistent results. We conducted a systematic review and meta-analysis to examine whether the magnitude of the association between post-event rumination and social anxiety varied as a function of questionnaire and/or task utilized. We included all studies reporting a correlation between post-event rumination and social anxiety symptomatology. Fisher's z correlation coefficients were calculated through random-effect meta-analyses. Results indicated a moderate association between post-event rumination and social anxiety symptomatology (r = 0.45, p < 0.001, 95%CI [0.40-0.50]). Subgroup meta-analyses indicated that the type of questionnaire used to assess post-event rumination (Q = 44.36, df = 3, p < 0.001) and social anxiety (Q = 26.44, df = 8, p < 0.001), as well as the task conducted prior to assessing post-event rumination (Q = 14.31, df = 2, p < 0.001), influenced the effect size. This study demonstrates a moderate relation between post-event rumination and social anxiety across the anxiety spectrum, illustrating the importance of treatments specifically targeting post-event rumination. Moreover, we highlight the importance of taking care when designing studies to explore relations between post-event rumination and social anxiety.

A feasibility study on indoor therapeutic horticulture to alleviate sleep and anxiety problems: The impact of plants and activity choice on its therapeutic effect

INTRODUCTION

Therapeutic horticulture (TH) is increasingly being applied for sub-health or patient mental health care. Whether plant and activity type will affect TH's effectiveness is unclear.

AIM

To evaluate the feasibility of an indoor TH for alleviating the anxiety symptoms and sleeping problems of people with poor sleep quality, and explore the potential affection of plant and activity type on health benefits.

METHOD

Thirty subjects (all with sleep problems and half with anxiety problems) were randomly assigned to three groups to do horticultural activities with ornamental plants, general aromatic plants, or aromatic plants with reported mental health functions, respectively. Six indoor TH activities were then held sequentially within two weeks. Psychological scales, subjective feedback questionnaires, and physiological indicators were used as evaluation indexes before and after horticulture activities.

RESULTS

The TH relieved subjects' sleep and anxiety problems and was particularly effective in alleviating anxiety among people with high anxiety levels. Using ornamental plants was more effective in relieving stress while functional aromatic plants performed better in sleep improvement and satisfaction to TH. Each horticultural activity could improve mood state but showed different effects on the vitality of the participants.

CONCLUSION

The above findings provided some basis for the potential benefits of selecting plants and activities based on psychological care needs in the development of TH plans. Future research that expands upon the current project is warranted. A larger sample size is beneficial for obtaining more powerful statistical results.

Psychometric evaluation of the appearance anxiety inventory in adolescents with body dysmorphic disorder

The Appearance Anxiety Inventory (AAI) is a self-report measure assessing the typical cognitions and behaviours of body dysmorphic disorder (BDD). Despite its use in research and clinical settings, its psychometric properties have not been evaluated in young people with BDD. We examined the factor structure, reliability, validity, and sensitivity to change of the AAI in 182 youths with BDD (82.9% girls; Mage = 15.56, SD = 1.37) consecutively referred to two specialist outpatient clinics in Stockholm, Sweden (n = 97) and London, England (n = 85). An exploratory factor analysis identified three factors, namely "threat monitoring", "camouflaging", and "avoidance", explaining 48.15% of the variance. The scale showed good internal consistency (McDonalds omega = 0.83) and adequate convergent validity with the Yale-Brown Obsessive-Compulsive Scale Modified for Body Dysmorphic Disorder for Adolescents (BDD-YBOCS-A; rs = 0.42) and the Clinical Global Impression-Severity Scale (rs = 0.32). Sensitivity to change was adequate, with AAI total scores and individual factor scores significantly decreasing over time in the subgroup of participants receiving multimodal treatment for BDD (n = 79). Change of AAI scores over treatment showed a positive statistically significant moderate-to-good correlation (r = 0.55) with changes in BDD symptom severity, measured by the BDD-YBOCS-A. The study provides empirical support for the use of the AAI in young people with BDD in clinical settings.

Interpersonal Trauma and Substance Use Severity: The Serial Mediation of Emotional Intolerance and Emotional Dysregulation

Substance use is highly prevalent in those with trauma histories, especially in women, which may be in part explained by high rates of interpersonal trauma in this population. Research examining the potential mechanisms underlying the relationship between co-occurring interpersonal trauma histories and substance use disorders (SUDs) is in its infancy. The current study examined whether the relationship between interpersonal trauma and SUD severity could be understood via the sequential ordering of two transdiagnostic emotional vulnerability factors: 1) emotional intolerance (anxiety sensitivity, distress intolerance), and 2) emotional dysregulation (negative urgency, lack of clarity, nonacceptance, limited strategies, difficulties with goal-directed behavior). A sample of 130 adult community-based women self-identifying as experiencing substance use problems completed the online survey. Mediation analyses suggest that as women's lifetime interpersonal trauma increases, so does their SUD severity by way of emotional intolerance and subsequent difficulties regulating their emotions. The findings suggests that transdiagnostic interventions targeting tolerance of aversive emotions may facilitate the ability to learn and employ healthy emotion regulation strategies among women with interpersonal trauma histories and SUDs.

Alexithymia or general psychological distress? Discriminant validity of the Toronto Alexithymia Scale and the Perth Alexithymia Questionnaire

BACKGROUND

Alexithymia is an important transdiagnostic risk factor for emotion-based psychopathologies. However, it remains unclear whether alexithymia questionnaires actually measure alexithymia, or whether they measure emotional distress. Our aim here was to address this discriminant validity concern via exploratory factor analysis (EFA) of the 20-item Toronto Alexithymia Scale (TAS-20) and the Perth Alexithymia Questionnaire (PAQ).

METHOD

United States general community adults (N = 508) completed the TAS-20, PAQ, and the Depression Anxiety Stress Scales-21 (DASS-21). EFA was used to examine the latent dimensions underlying these measures' scores.

RESULTS

Our EFA extracted two higher-order factors, an "alexithymia" factor and a "general distress" factor (i.e., depression, anxiety, stress). All PAQ scores loaded cleanly on the alexithymia factor, with no cross-loadings on the distress factor. However, for the TAS-20, Difficulty Identifying Feelings (DIF) facet scores cross-loaded highly on the distress factor.

LIMITATIONS

Our sample consisted of general community adults; future work in clinical settings will be useful.

CONCLUSIONS

Our data indicate that the PAQ has good discriminant validity. However, the TAS-20 appears to have significant discriminant validity problems, in that much of the variance in its DIF facet reflects people's current levels of distress, rather than alexithymia. The TAS-20, which has traditionally been the most widely used alexithymia questionnaire, may therefore not be the optimal alexithymia tool. Our findings add to the body of evidence supporting the validity and utility of the PAQ and suggest that, moving forward, it is a superior option to the TAS-20 for alexithymia assessments.

Caregiver and parent-child relationship during COVID-19: The mediator role of anxiety and life satisfaction

AIM

This research was conducted to evaluate the mediation effect of anxiety and life satisfaction on the relationship between Care burden and Parent Child Relationship in Turkish parents during the COVID-19 epidemic.

METHODS

The research was carried out with parents (221 women and 219 men) who have children between the ages of 6-18 living in Turkey. Data were collected in June-July 2021 using the demographic data form, "Care Burden Scale," "Pervasive Anxiety Disorder-7 Test," "Satisfaction with Life Scale," and "Parent Child Relationship Scale." Path analysis was used to analyse the relationships. In this study, structural equation modelling (SEM) was used to examine the path analysis.

RESULTS

It was found that the burden of care and anxiety of the parents and the parent-child conflict relationship were positively correlated and negatively correlated with the life satisfaction and parent-child closeness relationship (p < 0.05). Path model analyses revealed that the burden of care had a direct effect on anxiety and life satisfaction, and an indirect effect on the parent-child relationship, respectively.

CONCLUSIONS

It shows that parents' perceptions of how the COVID-19 pandemic is affecting their mental health have implications for parent and child well-being, with stronger relationships for low-income families. Anxiety and life satisfaction had a mediating effect between care burden and parent-child relationship. Given the demonstrable impact of COVID-19 on the parent-child relationship, this study may guide the planning of coping strategies and programmes focused on mental health.

The prevalence of impostor phenomenon and its association with burnout amongst urologists

OBJECTIVES

To characterise the prevalence of impostor phenomenon (IP; tendency for high-achieving individuals to perceive themselves as fraudulent in their successes) amongst attending staff in urology, to identify variables that predict more severe impostorism, and to study the association of IP with burnout.

SUBJECTS AND METHODS

A survey composed of the Clance Impostor Phenomenon Scale (CIPS), demographic information, practice details, and burnout levels was e-mailed to urologists via urological subspecialty societies. Survey results were analysed to identify associations between IP severity, survey respondent characteristics, and symptoms of professional burnout. This study was conducted in the United States of America.

RESULTS

A total of 614 survey responses were received (response rate 11.0%). In all, 40% (n = 213) of responders reported CIPS scores qualifying as either 'frequent' or 'intense' impostorism (i.e., scores of 61-100). On multivariable analysis, female gender, fewer years in practice (i.e., 0-2 years), and lower academic rank were all independently associated with higher CIPS scores (adjusted P < 0.05). Regarding burnout, 46% of responders reported burnout symptoms. On multivariable analysis, increase in CIPS score was independently associated with higher odds of burnout (odds ratio 1.06, 95% confidence interval 1.04-1.07; P < 0.001).

CONCLUSION

Impostor phenomenon is prevalent in the urological community and is experienced more severely in younger and female urologists. IP is also independently associated with burnout. Increased female representation may improve IP amongst our female colleagues. More work is needed to determine strategies that are effective in mitigating feelings of IP and professional burnout amongst urologists, particularly those earlier in their careers.

Retinal changes in generalized anxiety disorder patients

OBJECTIVE

Optical coherence tomography (OCT) is a method that allows high-resolution cross-sectional imaging of biological tissues. It was suggested that changes in the cranial structure or functions would be reflected in the retina. OCT has been an important method in the diagnosis and follow-up of diseases via morphometric or quantitative retinal measurements. Free radicals, inflammatory processes, and neurotransmission disorders play a role in the etiology of generalized anxiety disorder (GAD). The study aimed to demonstrate the retinal changes in GAD patients due to neurodegeneration based on the comparison of the OCT data of the GAD patients and controls, and the differences between OCT findings of GAD patients and those of controls.

METHODS

The study group included 21 GAD patients. The control group included 21 individuals without any known psychiatric or organic disease, including eye diseases.

RESULTS

There was a statistically significant difference between the macular volumes (MV) of the GAD and control groups, the macular volume was lower in the GAD group. There were positive correlations between BDI scores and MV, GCLT, RNFLT-i, RNFLT-n, between BAE scores and (RNFLT-n), and between the CGI severity scale scores and MV, RNFLT-n, and RNFLT-t.

CONCLUSION

OCT analysis of the GAD patients demonstrated that MV values were lower when compared to the control group. Patients with GAD should be screened for these retinal changes. OCT, a simple, non-invasive, and relatively inexpensive method could be employed as a supplementary method in the follow-up of GAD patients.

Epidemiology of DSM-5 psychiatric disorders in Kenyan Youth with Low and High Psychosis Risk

INTRODUCTION

There are few psychiatric epidemiology studies among Kenyan youth and fewer among those at high psychosis risk (HR).

METHODS

This study assessed the epidemiology of DSM-5 psychiatric disorders in HR and low-risk (LR) individuals to inform research and mental health services. 567 participants (aged 15-25) in HR (n = 246) and LR (n = 260) groups based on Washington Early Recognition Center Affectivity and Psychosis (WERCAP) Screen scores. Diagnostic Interview Schedule, version 5 (DIS-5) assessed DSM-5 psychiatric disorder prevalence. Diagnostic comorbidity and demographic relationships were investigated.

RESULTS

A higher prevalence was observed for all DSM-5 disorders in the HR group, significantly for gambling disorder (13% vs. 5.8%), major depressive disorder (9.8% vs. 3.8%), antisocial personality disorder (5.7% vs. 2.3%), general anxiety disorder (4.9% vs. 0.4%), oppositional defiant disorder (3.3% vs. 0.4%), panic disorder (2.8% vs. 0.8%), and anorexia nervosa (2.8% vs. 0%). Gambling disorder was the most prevalent and showed significant gender effects (males>females).

DISCUSSION

Psychiatric disorders occur at increased rates among HR compared to LR. Prevalence rates found are lower than in US studies, except for gambling disorder which was highly prevalent. Large-population-based epidemiology studies in Africa are needed to estimate rates, particularly of disorders such as schizophrenia, accurately.

Effects of transitional care interventions on quality of life in people with lung cancer: A systematic review and meta-analysis

AIM

To identify and appraise the quality of evidence of transitional care interventions on quality of life in lung cancer patients.

BACKGROUND

Quality of life is a strong predictor of survival. The transition from hospital to home is a high-risk period for patients' readmission and death, which seriously affect their quality of life.

DESIGN

Systematic review and meta-analysis.

METHODS

The PubMed, Embase, Cochrane Library, Web of Science and CINAHL databases were searched from inception to 22 October 2022. The primary outcome was quality of life. Statistical analysis was conducted using Review Manager 5.4, results were expressed as standard mean difference (SMD) with a 95% confidence interval (CI). The risk of bias of the included studies was assessed using the Cochrane risk of bias assessment tool. This study was complied with PRISMA guidelines and previously registered in PROSPERO (CRD42023429464).

RESULTS

Fourteen randomized controlled trials were included consisting of a total of 1700 participants, and 12 studies were included in the meta-analysis. It was found that transitional care interventions significantly improved quality of life (SMD = 0.21, 95% CI: 0.02 to 0.40, p = .03) and helped reduce symptoms (SMD = -0.65, 95% CI: -1.13 to -0.18, p = .007) in lung cancer patients, but did not significantly reduce anxiety and depression, and the effect on self-efficacy was unclear.

CONCLUSIONS

This study shows that transitional care interventions can improve quality of life and reduce symptoms in patients, and that primarily educational interventions based on symptom management theory appeared to be more effective. But, there was no statistically significant effect on anxiety and depression.

RELEVANCE TO CLINICAL PRACTICE

This study provides references for the application of transitional care interventions in the field of lung cancer care, and encourages nurses and physicians to apply transitional care plans to facilitate patients' safe transition from hospital to home.

PATIENT OR PUBLIC CONTRIBUTION

No Patient or Public Contribution.

Context-dependent approach and avoidance behavioral profiles as predictors of psychopathology

Inhibition (a temperamental profile characterized by elevated levels of avoidance behaviors) is associated with increased likelihood for developing anxiety and depression, whereas exuberance (a temperamental profile characterized by elevated levels of approach behaviors) is associated with increased likelihood for developing externalizing conditions (e.g., attention deficit/hyperactivity disorder and conduct disorder). However, not all children who exhibit high levels of approach or avoidance behaviors develop emotional or behavioral problems. In this preregistered study, we assessed context-dependent profiles of approach and avoidance behaviors in 3-year-old children (N = 366). Using latent profile analysis, four groups were identified: nonsocial approachers, social approachers, social avoiders, and nonsocial avoiders. Analyses revealed that there were minimal differences in internalizing and externalizing symptoms across the four context-dependent groups. However, exploratory analyses assessed whether high levels of approach or avoidance combined across contexts, similar to findings reported in prior work, were related to psychopathology. Children identified as high in avoidance behavior at 3 years of age were more likely to show internalizing symptoms at 3 years of age but not at 5 years of age. Children high in approach were more likely to meet criteria for anxiety and externalizing disorders by age 5 years. These findings further our understanding of individual differences in how young children adjust their behavior based on contextual cues and may inform methods for identifying children at increased likelihood for the development of emotional and behavioral problems. RESEARCH HIGHLIGHTS: Context-dependent approach and avoidance profiles were identified in 3-year-old children using a person-centered approach. Children who were high in approach behavior, regardless of context, at age three had a higher likelihood for developing an anxiety or externalizing disorder by age five. These findings may help identify children at increased risk of developing emotional and behavioral problems.

Exploring the impact of trauma-adapted yoga in forensic psychiatry

The specialized field of forensic psychiatry deals with the care of criminal offenders who suffer from severe mental disorders. As this field is positioned at the intersection of illness, crime, and security, it poses complex challenges. While high-quality clinical studies in forensic psychiatry settings are limited, recent investigations have suggested yoga as a complementary clinical tool within correctional environments. This report of a quasi-experimental study examines the impact of a 10-week trauma-adapted yoga intervention on mental health, antisocial and aggressive behaviors, pain perception, cravings, and character maturity among 56 patients in various forensic psychiatry clinics across Sweden. In the current study, the yoga group demonstrated noteworthy reductions in negative affect states, anxiety, phobic anxiety, paranoid ideations, interpersonal sensitivity, hostility, and overall psychological distress. These reductions were not observed in the comparison group. Additionally, the yoga group exhibited a significant decrease in pain frequency and strengthened self-directedness. However, there were no significant changes in aggressive, antisocial, or self-harm behaviors or cravings in either group. The between-group analyses did not yield significant results, except for pain intensity. The trauma-adapted yoga intervention implemented within forensic psychiatry settings shows feasibility and results in multiple positive changes in patients' health.

Psychosocial Burden During the COVID-19 Pandemic in Adolescents With Type 1 Diabetes in Germany and Its Association With Metabolic Control

PURPOSE

To investigate the psychosocial burden during the COVID-19 pandemic in adolescents with type 1 diabetes and its association with metabolic control.

METHODS

Prospective multicenter observational cohort study based on data from the German Diabetes Prospective Follow-up Registry. Adolescents aged 12-20 years with type 1 diabetes were asked during routine follow-up visits to complete a questionnaire on psychosocial distress and daily use of electronic media during the COVID-19 pandemic from June 2021 to November 2022. Well-being, anxiety, and depression symptoms were assessed using World Health Organization Five Well-Being Index (WHO-5), General Anxiety Disorder scale 7 (GAD-7), and Patient Health Questionnaire-9 questionnaires. The impact of mental health symptoms on metabolic control was analyzed by using multivariable linear regression models adjusted for sex, diabetes duration, treatment, socioeconomic deprivation, and immigrant background.

RESULTS

Six hundred eighty eight adolescents (45.6% females) from 20 diabetes centers participated. Compared with a prepandemic cohort, WHO-5 scores were lower during the COVID-19 pandemic (estimated mean difference -9.6 [95% confidence interval -11.6; -7.6], p < .001), but GAD-7 scores were not different (estimated mean difference 0.6 [95% confidence interval -0.2; 1.5], p = .14). HbA1c was significantly positively associated with GAD-7 and Patient Health Questionnaire-9 and negatively associated with WHO-5 scores (all p < .001). Daily electronic media use was positively associated with adjusted mental health symptoms (all p < .01).

DISCUSSION

Although the overall well-being of adolescents with type 1 diabetes was reduced during the later phase of the COVID-19 pandemic, the additional psychological burden was relatively low. However, mental health symptoms were associated with poorer metabolic control and higher use of electronic media.

EEG Microstates in Mood and Anxiety Disorders: A Meta-analysis

To reduce the psycho-social burden increasing attention has focused on brain abnormalities in the most prevalent and highly co-occurring neuropsychiatric disorders, such as mood and anxiety. However, high inter-study variability in these patients results in inconsistent and contradictory alterations in the fast temporal dynamics of large-scale networks as measured by EEG microstates. Thus, in this meta-analysis, we aim to investigate the consistency of these changes to better understand possible common neuro-dynamical mechanisms of these disorders.In the systematic search, twelve studies investigating EEG microstate changes in participants with mood and anxiety disorders and individuals with subclinical depression were included in this meta-analysis, adding up to 787 participants.The results suggest that EEG microstates consistently discriminate mood and anxiety impairments from the general population in patients and subclinical states. Specifically, we found a small significant effect size for B microstates in patients compared to healthy controls, with larger effect sizes for increased B presence in unmedicated patients with comorbidity. In a subgroup meta-analysis of ten mood disorder studies, microstate D showed a significant effect size for decreased presence. When investigating only the two anxiety disorder studies, we found a significantly small effect size for the increased microstate A and a medium effect size for decreased microstate E (one study). However, more studies are needed to elucidate whether these findings are diagnostic-specific markers.Results are discussed in relation to the functional meaning of microstates and possible contribution to an explanatory mechanism of overlapping symptomatology of mood and anxiety disorders.

Defining the Incidence of the Impostor Phenomenon in Academic Plastic Surgery: A Multi-Institutional Survey Study

BACKGROUND

Impostor phenomenon occurs when high-achieving individuals have persistent self-doubt despite objective measures of competence and success, and has been associated with professional burnout and attenuated career advancement in medical specialties. This study aimed to define the incidence and severity of the impostor phenomenon in academic plastic surgery.

METHODS

A cross-sectional survey containing the Clance Impostor Phenomenon Scale (range, 0 to 100; higher scores indicate greater severity of impostor phenomenon) was distributed to residents and faculty from 12 academic plastic surgery institutions across the United States. Generalized linear regression was used to assess demographic and academic predictors of impostor scores.

RESULTS

From a total of 136 resident and faculty respondents (response rate, 37.5%), the mean impostor score was 64 (SD 14), indicating frequent impostor phenomenon characteristics. On univariate analysis, mean impostor scores varied by gender (67.3 for women versus 62.0 for men; P = 0.03) and academic position (66.5 for residents versus 61.6 for attendings; P = 0.03), but did not vary by race or ethnicity; postgraduate year of training among residents; or academic rank, years in practice, or fellowship training among faculty (all P > 0.05). After multivariable adjustment, female gender was the only factor associated with higher impostor scores among plastic surgery residents and faculty (estimate 2.3; 95% CI, 0.03 to 4.6; P = 0.049).

CONCLUSIONS

The prevalence of the impostor phenomenon may be high among residents and faculty in academic plastic surgery. Impostor characteristics appear to be tied more to intrinsic characteristics, including gender, rather than years in residency or practice. Further research is needed to understand the influence of impostor characteristics on career advancement in plastic surgery.

Optimizing indicated cognitive behavioral therapy to prevent child anxiety and depression: A cluster-randomized factorial trial

Identifying effective components can lead to interventions that are less resource-intensive and better suited for real-world needs. In this 2×2×2 cluster-randomized factorial trial (clinicaltrials.gov NCT04263558), we investigated the effects of three components of an indicated, transdiagnostic CBT intervention for children: 1) Intervention Delivery Format (child group format versus a blended format with group sessions and automated web-based sessions), 2) Parental Involvement in the intervention (group-based versus psychoeducational brochure), and 3) a Measurement Feedback System (MFS; on versus off). The intervention was delivered at schools in a group-based format. The participants (N = 701 children) were school children (age 8-12 years) with elevated symptoms of anxiety or depression, and their parents. The main outcomes were self-reported (N = 633) and parent-reported (N = 725) symptoms of child anxiety and depression post-intervention. The secondary outcome was children's user satisfaction with the intervention. We did not find significant main or interaction effects of Delivery Format, Parental Involvement, or MFS on children's symptom levels. There were no significant effects on children's user satisfaction. Results were compatible with retaining the least resource intensive combination (i.e., blended format, parental brochure, no MFS) in an optimized intervention.

Increased Care Provision and Caregiver Wellbeing: Moderation by Changes in Social Network Care Provision

OBJECTIVES

Previous research links increased care provision to worse wellbeing among family and friend caregivers, both before and during the coronavirus disease 2019 (COVID-19) pandemic. We expand on this by incorporating data on caregivers' social networks and exploring the relationships between own and network changes in care during the pandemic and caregiver wellbeing.

METHODS

We use nationally representative data from 1,876 family and friend caregivers in the first wave of our Care Network Connections over Time study (fielded 12/17/2020-1/4/2021) who had provided care continuously since before the COVID-19 pandemic began. Caregivers were asked about the amount of care that they and each member of their social networks were providing at the time of the survey relative to before the pandemic. We use multivariate regression models to examine the associations between five caregiver wellbeing outcomes and changes in care, and explore the moderating role of networks' changes in care.

RESULTS

Among caregivers who had provided care since prior to the pandemic, most increased (42.0%) or maintained the same (40.8%) care. Their networks also typically increased (33.4%) or maintained (46.5%) care. Increasing one's own care provision was associated with higher levels of anxiety, depression, loneliness, and emotional difficulty than maintaining stable care. Among those who increased care, these levels were highest when the network also increased or decreased care.

DISCUSSION

Increased care provision was most strongly associated with poor caregiver wellbeing in contexts where caregivers' social networks also changed care provisions. Supports for caregivers undertaking additional care tasks should take into account caregivers' networks.

Risk estimation in relation to anxiety and depression for low probability negative events

Foundational cognitive models propose that people with anxiety and depression show risk estimation bias, but most literature does not compute true risk estimation bias by comparing people's subjective risk estimates to their individualized reality (i.e., person-level objective risk). In a diverse community sample (N = 319), we calculated risk estimation bias by comparing people's subjective risk estimates for contracting COVID-19 to their individualized objective risk. Person-level objective risk was consistently low and did not differ across symptom levels, suggesting that for low probability negative events, people with greater symptoms show risk estimation bias that is driven by subjective risk estimates. Greater levels of anxiety, depression, and COVID-specific perseverative cognition separately predicted higher subjective risk estimates. In a model including COVID-specific perseverative cognition alongside anxiety and depression scores, the only significant predictor of subjective risk estimates was COVID-specific perseverative cognition, indicating that symptoms more closely tied to feared outcomes may more strongly influence risk estimation. Finally, subjective risk estimates predicted information-seeking behavior and eating when anxious, but did not significantly predict alcohol or marijuana use, drinking to cope, or information avoidance. Implications for clinical practitioners and future research are discussed.

Prolonged exposure treatment for post-traumatic stress disorder: Single case studies in a sample of adults with mild intellectual disabilities

BACKGROUND

Post-traumatic stress disorder (PTSD) is common in adults with intellectual disabilities. Often there are additional disorders such as substance use, mood and anxiety disorders. The current study focuses on the feasibility and initial efficacy of prolonged exposure (PE) for PTSD in adults with mild intellectual disabilities. The secondary effect of PE on additional mood, anxiety and substance use disorders is also examined.

METHODS

A single case experimental design (N = 12) with an A (baseline)-B (intervention) phase including a follow-up measurement after 3 months was conducted. Time series and single time points measurements were performed.

RESULTS

Six participants dropped-out. The results showed a significant decrease in PTSD symptoms and a significant decrease in additional symptoms (social avoidance, anxiety and stress), among participants who completed treatment.

CONCLUSION

PE appears to be a feasible and effective treatment for PTSD in some adults with mild intellectual disabilities. Suggestions emerge from this study to make standard PE treatment more appropriate for adults with mild intellectual disabilities. Further research is needed to reduce drop-out in trauma treatment. Some suggestions for this are made in this study. Treatment of PTSD with PE did not appear to affect comorbid mood disorders. Further research is needed.

Let's Stop the Pain: A Trauma-Informed Care Approach to Pediatric Vaccination

Exposure to pain during routine vaccinations and other injections can cause lifelong anxiety for pediatric patients that may persist into adulthood. Teaching pediatric providers and staff to use intentional and humane approaches to pain management, including distraction, positioning, and use of purposeful language can help to mitigate these fears. We share our experience with assessing pre and post changes to pain management in our pediatric outpatient setting caring for underserved patients and implementing a trauma-informed care approach.

Seeing is believing: The effect of subtle communication in social media on viewers' beliefs about depression and anxiety symptom trajectories

OBJECTIVE

One barrier to treatment seeking, uptake, and engagement is the belief that nothing can be done to reduce symptoms. Given the widespread use of social media to disseminate information about important issues, including psychological health, we sought to understand how the influence of social media communication regarding mental health impacts viewers' beliefs about psychopathology recovery.

METHOD

Undergraduate participants from a large Midwestern university (N = 322) were randomized to view a series of Tweets characterizing psychopathology from a fixed mindset perspective, a growth mindset perspective, or, in the control condition, Tweets unrelated to psychopathology. Afterward, they completed a series of questionnaires designed to assess beliefs about recovery from depression and anxiety.

RESULTS

Participants in the growth mindset condition endorsed less pessimistic beliefs about their ability (i.e., self-efficacy) to alleviate symptoms of depression and anxiety, and they believed these symptoms to be less stable and innate relative to those in the fixed mindset condition.

CONCLUSION

Social media communication that characterizes psychopathology from a growth mindset perspective may be a viable intervention for improving beliefs around mental health self-efficacy and the malleable nature of mental illness, particularly depression and anxiety. Clinicians may be able to use social media platforms to promote functional beliefs around mental illness.

Internet-delivered therapy for alcohol misuse: engagement, satisfaction, and outcomes when patients select their preference for therapist- or self-guided treatment

BACKGROUND

Alcohol misuse is common and causes substantial harm. Internet-delivered cognitive behaviour therapy (ICBT) is effective in reducing alcohol misuse; however, the literature investigating how treatment outcomes are impacted by patients' preferences for therapist- versus self-guided ICBT for alcohol misuse is sparse.

METHODS

In this preference trial, 74 eligible patients (who reported ≥ 14 drinks in the previous week and obtained scores suggesting hazardous or harmful drinking) chose between enrolling in either therapist- or self-guided ICBT for alcohol misuse. We investigated whether those who chose therapist- versus self-guided ICBT differed in their (a) drinking outcomes-as measured by Timeline Follow-Back (TLFB) and heavy drinking days (HDD) at post-treatment and 3-month follow-up-and (b) post-treatment ICBT engagement and satisfaction.

RESULTS

The majority (81.1%) of eligible patients chose therapist-guided ICBT. These patients reported higher psychotropic medication use, drinking difficulties, and anxiety symptoms. For both the therapist- and self-guided patients, a modified intention-to-treat analysis revealed large within-group treatment effects for TLFB (β =  - 2.64, SE 0.66; p < 0.001) and HDD (β =  - 0.34, SE 0.07; p < 0.001), with large pre-to-post-treatment Cohen's effect sizes of d = 0.97 (95% CI [0.49, 1.45]) for TLFB and d = 1.19 (95% CI [0.69, 1.68]) for HDD. The interaction comparing the effects of therapist- to self-guided ICBT over time was not significant for TLFB (p = 0.34) or HDD (p = 0.06). With treatment, for both therapist- and self-guided patients, there was a significant improvement in drinking difficulties, cravings, and confidence with controlling cravings, as well as in anxiety, depression, and functional impairment. Further, the majority (75.7%) of patients completed five or more lessons, as well as reported overall satisfaction with the treatment (88.9%) and increased confidence in managing their symptoms (86.7%); these outcomes also did not differ between therapist- and self-guided patients.

CONCLUSIONS

The current study shows that ICBT for alcohol misuse is associated with reduced drinking and comorbid mental health difficulties over time, irrespective of whether patients chose to complete the course on their own or with therapist guidance.

TRIAL REGISTRATION NUMBER

NCT04611854 ( https://clinicaltrials.gov/ct2/show/NCT04611854 ).

An insight into the use of telemedicine technology for cancer patients during the Covid-19 pandemic: a scoping review

BACKGROUND

The use of telemedicine technology has significantly increased in recent years, particularly during the Covid-19 pandemic. This study aimed to investigate the use of telemedicine technology for cancer patients during the Covid-19 pandemic.

METHODS

This was a scoping review conducted in 2023. Various databases including PubMed, Web of Science, Scopus, Cochrane Library, Ovid, IEEE Xplore, ProQuest, Embase, and Google Scholar search engine were searched. All quantitative, qualitative, and mixed-method studies published in English between 2020 and 2022 were included. Finally, the needed data were extracted, and the results were synthesized and reported narratively.

RESULTS

A total of 29 articles were included in this review. The results showed that teleconsultation, televisit, and telerehabilitation were common telemedicine services, and video conferencing and telephone were common technologies used in these studies. In most cases, patients and healthcare providers preferred these services compared to the face-to-face consultations due to their convenience and advantages. Furthermore, the findings revealed that in terms of clinical outcomes, telemedicine could effectively reduce anxiety, pain, sleep disorders, and hospital admission rates.

CONCLUSION

The findings provided valuable insights into the various telemedicine technologies, services, users' perspectives, and clinical outcomes in cancer patients during the Covid-19 pandemic. Overall, the positive outcomes and users' satisfaction showed that the use of telemedicine technology can be expanded, particularly in cancer care. Future research needs to investigate both clinical and non-clinical effectiveness of using various telemedicine services and technologies for improving cancer care delivery, which can help to develop more successful strategies for implementing this technology.

Interventions for anxiety and depression in patients with atopic dermatitis: a systematic review and meta-analysis

Atopic dermatitis (AD) is a chronic inflammatory skin disease that is associated with anxiety and depression. Few studies have addressed interventions for symptoms of anxiety and depression in this population. To determine the efficacy of interventions for anxiety and depression in patients with AD. PubMed, MEDLINE, EMBASE, and PsycINFO were searched from inception to November 2023. English-language studies published in peer-reviewed journals evaluating the effect of interventions on anxiety and/or depression using validated assessment tools on patients with AD were included. Titles, abstracts, and articles were screened by at least two independent reviewers. Of 1410 references that resulted in the initial search, 17 studies were included. Fourteen of these studies are randomized controlled trials, while the other 3 studies are prospective controlled trials with pre and post-test designs. Data were extracted using a standardized extraction form, and the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed. To accommodate trials with multiple interventions (each compared to a control group), we conducted a mixed-effects meta-analysis with the trial as a random effect. Prespecified outcomes were changes in symptoms of anxiety and depression in patients with AD as evaluated using standardized assessment tools. Of the 17 studies included in this systematic review, 7 pharmacological intervention studies with 4723 participants examining 5 different medications were included in a meta-analysis. Of these studies, only 1 study evaluated medications prescribed to treat anxiety and/or depression; the rest evaluated medications prescribed to treat AD. Meta-analysis of all the pharmacological interventions resulted in significant improvement in anxiety, depression, and combined anxiety-depression scale scores (standardized mean difference [95% CI]: - 0.29 [- 0.49 to - 0.09], - 0.27 [- 0.45 to - 0.08], - 0.27 [- 0.45 to - 0.08]) respectively. The 10 non-pharmacological studies with 2058 participants showed general improvement in anxiety but not depression. A meta-analysis of the non-pharmacological interventions was not conducted due to variable approaches and limited data. Pharmacological interventions designed to improve AD were found to improve anxiety and depression in patients with moderate-severe disease. More comprehensive studies on non-pharmacological and pharmacological interventions that primarily target anxiety and depression are needed.

Improving immersive experiences in virtual natural setting for public health and environmental design: A systematic review and meta-analysis of randomized controlled trials

In recent years, virtual reality (VR) technology has emerged as a powerful tool in the field of therapeutic landscapes. For hospitalized patients or individuals with limited mobility, VR provides highly personalized therapy by simulating authentic natural environments within a safe, convenient, and engaging setting. This study investigated the effectiveness of immersing patients in virtual natural environments for health recovery and compared the varying impacts of different types of landscapes on patients' recovery levels. The aim was to complement traditional medical approaches and enhance environmental design in the field of public health. Researchers systematically reviewed databases (January 2018 to August 2, 2023) to identify randomized controlled trials comparing the efficacy of virtual nature immersion with other treatments. The inclusion/exclusion criteria were established based on the population, intervention, comparison, outcomes, study design, and other aspects (expanded PICO) framework. The Cochrane tool was employed to assess the risk of bias. Meta-analysis was conducted by pooling the mean differences with a 95% confidence interval. Among 30 trials, a total of 2123 patients met the inclusion criteria, with 15 studies included in the meta-analysis. 30 trials met the criteria. Results show significant improvements in pain, anxiety, fear, and some physiological indicators with virtual nature-based treatments. On the other hand, natural scenes incorporating blue and green elements have been applied more extensively and have shown more significant effects. In comparison to conventional methods, this study strongly advocates that virtual reality environments are a crucial tool in bridging the gap between patients and nature, demonstrating their potential to reshape medical interventions and improve environmental design in the field of public health.

Six-month psychopathological symptom trajectories following the COVID-19 outbreak: Contrasting mental health outcomes between nurses and the general population

The COVID-19 pandemic prompted a social, economic and health crisis that had a major impact on the mental health of the global community, particularly nurses. The objective of the current study is to conduct a longitudinal evaluation of the trajectory of depressive, anxiety, trauma, and fear of COVID-19 symptoms, comparing self-reports of nurses and the general population over a six-month period. Self-report questionnaires were administered online to a sample of 180 nurses and 158 individuals from the general population for the baseline assessment (T1) and follow-up at 6 months (T2). Levels of symptoms reported by nurses were generally greater and tended to worsen over time, as opposed to the levels of symptoms reported by the general population that tended to improve. Levels of depressive, anxiety, and trauma symptoms were significantly different between nurses and the general population over time. Levels of fear of COVID-19 declined significantly from T1 to T2 in both groups. These results suggest that it is crucial to monitor the longer-term effects of COVID-19 and to develop resilience-promoting interventions tailored to the unique needs of this vulnerable group.

Factors Influencing Recovery From Pediatric Stroke Based on Discussions From a UK-Based Online Stroke Community: Qualitative Thematic Study

BACKGROUND

The incidence of stroke in children is low, and pediatric stroke rehabilitation services are less developed than adult ones. Survivors of pediatric stroke have a long poststroke life expectancy and therefore have the potential to experience impairments from their stroke for many years. However, there are relatively few studies characterizing these impairments and what factors facilitate or counteract recovery.

OBJECTIVE

This study aims to characterize the main barriers to and facilitators of recovery from pediatric stroke. A secondary aim was to explore whether these factors last into adulthood, whether they change, or if new factors impacting recovery emerge in adulthood.

METHODS

We performed a qualitative thematic analysis based on posts from a population of participants from a UK-based online stroke community, active between 2004 and 2011. The analysis focused on users who talked about their experiences with pediatric stroke, as identified by a previous study. The posts were read by 3 authors, and factors influencing recovery from pediatric stroke were mapped into 4 areas: medical, physical, emotional, and social. Factors influencing recovery were divided into short-term and long-term factors.

RESULTS

There were 425 posts relating to 52 survivors of pediatric stroke. Some survivors of stroke posted for themselves, while others were talked about by a third party (mostly parents; 31/35, 89% mothers). In total, 79% (41/52) of survivors of stroke were aged ≤18 years and 21% (11/52) were aged >18 years at the time of posting. Medical factors included comorbidities as a barrier to recovery. Medical interventions, such as speech and language therapy and physiotherapy, were also deemed useful. Exercise, particularly swimming, was deemed a facilitator. Among physical factors, fatigue and chronic pain could persist decades after a stroke, with both reported as a barrier to feeling fully recovered. Tiredness could worsen existing stroke-related impairments. Other long-standing impairments were memory loss, confusion, and dizziness. Among emotional factors, fear and uncertainty were short-term barriers, while positivity was a major facilitator in both short- and long-term recovery. Anxiety, grief, and behavioral problems hindered recovery. The social barriers were loneliness, exclusion, and hidden disabilities not being acknowledged by third parties. A good support network and third-party support facilitated recovery. Educational services were important in reintegrating survivors into society. Participants reported that worrying about losing financial support, such as disability allowances, and difficulties in obtaining travel insurance and driving licenses impacted recovery.

CONCLUSIONS

The lived experience of survivors of pediatric stroke includes long-term hidden disabilities and barriers to rehabilitation. These are present in different settings, such as health care, schools, workplaces, and driving centers. Greater awareness of these issues by relevant professional groups may help ameliorate them.

SARS-CoV-2 infection is associated with self-reported post-acute neuropsychological symptoms within six months of follow-up

BACKGROUND

Chronic neuropsychological sequelae following SARS-CoV-2 infection, including depression, anxiety, fatigue, and general cognitive difficulties, are a major public health concern. Given the potential impact of long-term neuropsychological impairment, it is important to characterize the frequency and predictors of this post-infection phenotype.

METHODS

The Epidemiology, Immunology, and Clinical Characteristics of Emerging Infectious Diseases with Pandemic Potential (EPICC) study is a longitudinal study assessing the impact of SARS-CoV-2 infection in U.S. Military Healthcare System (MHS) beneficiaries, i.e. those eligible for care in the MHS including active duty servicemembers, dependents, and retirees. Four broad areas of neuropsychological symptoms were assessed cross-sectionally among subjects 1-6 months post-infection/enrollment, including: depression (Patient Health Questionnaire-9), anxiety (General Anxiety Disorder-7), fatigue (PROMIS® Fatigue 7a), and cognitive function (PROMIS® Cognitive Function 8a and PROMIS® Cognitive Function abilities 8a). Multivariable Poisson regression models compared participants with and without SARS-CoV-2 infection history on these measures, adjusting for sex, ethnicity, active-duty status, age, and months post-first positive or enrollment of questionnaire completion (MPFP/E); models for fatigue and cognitive function were also adjusted for depression and anxiety scores.

RESULTS

The study population included 2383 participants who completed all five instruments within six MPFP/E, of whom 687 (28.8%) had at least one positive SARS-CoV-2 test. Compared to those who had never tested positive for SARS-CoV-2, the positive group was more likely to meet instrument-based criteria for depression (15.4% vs 10.3%, p<0.001), fatigue (20.1% vs 8.0%, p<0.001), impaired cognitive function (15.7% vs 8.6%, p<0.001), and impaired cognitive function abilities (24.3% vs 16.3%, p<0.001). In multivariable models, SARS-CoV-2 positive participants, assessed at an average of 2.7 months after infection, had increased risk of moderate to severe depression (RR: 1.44, 95% CI 1.12-1.84), fatigue (RR: 2.07, 95% CI 1.62-2.65), impaired cognitive function (RR: 1.64, 95% CI 1.27-2.11), and impaired cognitive function abilities (RR: 1.41, 95% CI 1.15-1.71); MPFP/E was not significant.

CONCLUSIONS

Participants with a history of SARS-CoV-2 infection were up to twice as likely to report cognitive impairment and fatigue as the group without prior SARS-CoV-2 infection. These findings underscore the continued importance of preventing SARS-CoV-2 infection and while time since infection/enrollment was not significant through 6 months of follow-up, this highlights the need for additional research into the long-term impacts of COVID-19 to mitigate and reverse these neuropsychological outcomes.

Investigating the association of anxiety disorders with heart rate variability measured using a wearable device

BACKGROUND

Reduced vagally-mediated heart rate variability (HRV) has been associated with anxiety disorders (AD). The aim of this study was to use a wearable device and remote study design to re-evaluate the association of HRV with ADs, anxiety-related traits, and confounders.

METHODS

240 individuals (AD = 120, healthy controls = 120) completed an at-home assessment of their short-term resting vagally-mediated HRV using a wristband, monitored over videoconference. Following quality control, analyses were performed investigating differences in HRV between individuals with AD (n = 119) and healthy controls (n = 116), associations of HRV with anxiety-related traits and confounders, and antidepressants effects on HRV in patients, including analyses stratified by ancestry (i.e., European, East Asian, African).

RESULTS

Among the confounders investigated, only age had a significant association with HRV. Patients with an AD had significantly lower vagally-mediated HRV than healthy controls in the European subsample, with a trend of significance in the whole sample. HRV was significantly associated with the Hamilton Anxiety Rating Scale (HAM-A) but not with antidepressant use in the European subsample.

LIMITATIONS

The study measures occurred in a non-standardized at-home setting, and the three ancestry group sample sizes were unequal.

CONCLUSIONS

This study demonstrates reduced vagally-mediated HRV among patients with ADs compared to healthy controls. Results also point to low HRV being related to more physical anxiety symptoms (measured via HAM-A), suggesting a possible anxiety subtype. Overall, this study highlights the feasibility of using wearables for patients and encourages exploration of the biological and clinical utility of HRV as a risk factor for ADs.

Bibliometric analysis of published articles on perinatal anxiety from 1920 to 2020

INTRODUCTION

Trends and gaps in perinatal anxiety research remain unknown. The objective of this bibliometric review was to analyze the characteristics and trends in published research on perinatal anxiety to inform future research.

METHODS

All published literature in Web of Science on perinatal anxiety from January 1, 1920 to December 31, 2020 were screened by two reviewers. VOSViewer was utilized to visualize linkages between publications. Bibliometric data were extracted from abstracts.

RESULTS

The search strategy identified 4561 publications. After screening, 2203 publications related to perinatal anxiety were used for the visualization analysis. For the bibliometric data, 1534 publications had perinatal anxiety as a primary focus. There were 7910 different authors, over half named only once (55.5 %), from 63 countries. 495 journals were identified, with over half (56.0 %) publishing only one article. Most articles were published between 2011 and 2020 (75.9 %). In terms of perinatal timing, over half (54.2 %) published on antenatal anxiety. Only 6.0 % of studies reported on perinatal anxiety in fathers and 56.5 % also reported on perinatal depression.

LIMITATIONS

Web of Science was solely used, and manual screening of each publication was required.

CONCLUSION

This bibliometric analysis found: (1) perinatal anxiety is a growing field of research, with publications increasing over time; (2) there is variation in authors and journals; (3) over half of the publications focus on antenatal anxiety; (4) paternal anxiety is understudied; and (5) only 6 % of publications came from low and lower-middle income countries. Gaps related to maternal postnatal anxiety and paternal perinatal anxiety exist.

Social media addiction: associations with attachment style, mental distress, and personality

BACKGROUND

Social media bring not only benefits but also downsides, such as addictive behavior. While an ambivalent closed insecure attachment style has been prominently linked with internet and smartphone addiction, a similar analysis for social media addiction is still pending. This study aims to explore social media addiction, focusing on variations in attachment style, mental distress, and personality between students with and without problematic social media use. Additionally, it investigates whether a specific attachment style is connected to social media addiction.

METHODS

Data were collected from 571 college students (mean age = 23.61, SD = 5.00, 65.5% female; response rate = 20.06%) via an online survey administered to all enrolled students of Sigmund Freud PrivatUniversity Vienna. The Bergen Social Media Addiction Scale (BSMAS) differentiated between students addicted and not addicted to social media. Attachment style was gauged using the Bielefeld Partnership Expectations Questionnaire (BFPE), mental distress by the Brief Symptom Inventory (BSI-18), and personality by the Big Five Inventory (BFI-10).

RESULTS

Of the total sample, 22.7% of students were identified as addicted to social media. For personality, it was demonstrated that socially media addicted (SMA) students reported significantly higher values on the neuroticism dimension compared to not socially media addicted (NSMA) students. SMA also scored higher across all mental health dimensions-depressiveness, anxiety, and somatization. SMA more frequently exhibited an insecure attachment style than NSMA, specifically, an ambivalent closed attachment style. A two-step cluster analysis validated the initial findings, uncovering three clusters: (1) secure attachment, primarily linked with fewer occurrences of social media addiction and a lower incidence of mental health problems; (2) ambivalent closed attachment, generally associated with a higher rate of social media addiction and increased levels of mental health problems; and (3) ambivalent clingy attachment, manifesting a medium prevalence of social media addiction and a relatively equitable mental health profile.

CONCLUSIONS

The outcomes are aligned with previous research on internet and smartphone addiction, pointing out the relevance of an ambivalent closed attachment style in all three contexts. Therapeutic interventions for social media addiction should be developed and implemented considering these findings.

Associations of chronotype with anxiety, depression and insomnia among general adult population: A cross-sectional study in Hubei, China

BACKGROUND

The relationship between chronotype and anxiety, depression, and insomnia was inconsistent. We aimed to assess the association between chronotype and mental health and the potential moderating effect of age and socioeconomic status (SES).

METHODS

A multi-stage sampling cross-sectional study with 12,544 adults was conducted. Chronotype, anxiety, depression, and insomnia were investigated by 5-item Morning and Evening, 7-item Generalized Anxiety Disorder, 9-item Patient Health, and the 7-item Insomnia Severity Index Questionnaires. Logistic regression was conducted.

RESULTS

The predominant chronotype was morning chronotype (69.2 %), followed by 27.6 % intermediate and 3.2 % evening chronotype. The prevalence of anxiety, depression, and insomnia was 0.7 %, 1.9 %, and 9.6 %, respectively. Compared with intermediate chronotype, morning chronotype participants had a lower risk of anxiety (OR = 0.28,95%CI:0.18-0.44), depression (OR = 0.54,95%CI:0.41-0.72) and insomnia (OR = 0.67,95%CI:0.58-0.77), while evening chronotype participants had a higher risk of depression (OR = 1.98,95%CI:1.06-3.71) but not anxiety or insomnia. Interactions between chronotype with age and SES on insomnia (Pinteraction < 0.05) were found. A more profound association between morning chronotype and insomnia was observed in <65 years participants (OR = 0.59,95%CI:0.50-0.71) and those with monthly household income ≥10,000yuan (OR = 0.21,95%CI:0.12-0.35), compared with their counterparts.

LIMITATIONS

The cross-sectional design limited causal conclusions. Only adults were included; the findings could not be generalized to children.

CONCLUSIONS

The morning chronotype might be protective for anxiety, depression, and insomnia, while the evening chronotype might be a risk factor for depression. Future studies are needed to assess the efficacy of chronotype-focused intervention for mental health. Insomnia prevention efforts should pay more attention to the elderly and those with lower incomes.