Predicting Anxiety Symptoms Using the Uncertainty and Anticipation Model of Anxiety: A Prospective Longitudinal Study

BackgroundAnxiety and depression are common mental health problems among patients with cancer. While many psychological variables have been proven to influence anxiety and depressive symptoms, the variables are not mutually exclusive and their integrated effects on patients with oral cancer are yet unknown. The present study aims to explore the prevalence of anxiety and depressive symptoms among patients with oral cancer, to find out key potentially predictive factors associated with anxiety and depressive symptoms.MethodA cross-sectional study was carried out for Chinese patients with oral cancer between May 2016 and October 2017 in two Grade-A Tertiary Hospitals in Shenyang, China. Two hundred thirty patients with oral cancer were interviewed with questionnaires on demographic variables, Zung Self-Rating Anxiety Scale (SAS), Center for Epidemiologic Studies Depression Scale (CES-D), Herth Hope Index (HHI), Social Impact Scale, Multidimensional Scale of Perceived Social Support (MSPSS), Revised Life Orientation Test (LOT-R), Perceived Stress Scale-10 (PSS-10), and General Perceived Self-efficacy Scale(GSE). Chi-square test, nonparametric test, t-test and logistic regression analyses were conducted where appropriate to explore predictive factors of anxiety symptoms and depressive symptoms.ResultsThe prevalence of anxiety symptoms and depressive symptoms in the sample population was 36.96% (85/230) and 65.21% (150/230), respectively. Social isolation dimension of stigma (β = 0.436, OR = 1.547, CI:1.211 ~ 1.975), optimism (β = − 0.276, OR = 0.759, CI:0.624 ~ 0.922), and perceived stress (β = 0.217, OR = 1.243, CI:1.092 ~ 1.414) were predictors of anxiety symptoms. Marriage (β = 1.648, OR = 5.198, CI:1.427 ~ 18.924), positive readiness and expectancy dimension of hope (β = − 0.505, OR = 0.604, CI:0.395 ~ 0.923), social isolation dimension of stigma (β = 0.314, OR = 1.368, CI:1.054 ~ 1.776) and perceived stress (β = 0.273, OR = 1.314, CI:1.134 ~ 1.524) were predictors of depressive symptoms among oral cancer patients.ConclusionThe prevalence of anxiety symptoms and depressive symptoms was high among oral cancer patients in China. The communal predictors of anxiety and depressive symptoms in patients with oral cancer were levels of perceived stress and social isolation of stigma. In addition, optimism was a predictor of anxiety symptoms and hope was a predictor of depressive symptoms.Trial registration2015–16, registered 20 Dec 2015.

Background: The rapid spread of Coronavirus Disease-19 (COVID-19) infection has been the most important public health crisis across the globe since the end of 2019. Anxiety and depression are the most common mental health problems among people during the pandemic, and many studies have reported anxiety and depressive symptoms in college students. However, information on the mental health status of international medical students during this critical period of time has been scarce, which hinders the efforts in making proper policy or strategies to help these students. The present study aims to explore the prevalence of anxiety and depressive symptoms in international medical students in China and to find out the factors that have potential predictive value for anxiety and depressive symptoms.Method: A cross-sectional study was carried out for international medical students during November 2020 at China Medical University in Shenyang, China. Five hundred and nineteen international students were interviewed with questionnaires containing demographic variables, Stressors in school, Generalized Anxiety Disorder Assessment (GAD-7), Patient Health Questionnaire-9 (PHQ-9), Simplified Coping Style Questionnaire (SCSQ), Perceived Stress Scale (PSS-10), the Multidimensional Scale of Perceived Social Support (MSPSS), Revised Life Orientation Test (LOT-R) and Resilience Scale-14 (RS-14). Univariate logistic regression and stepwise multiple logistic regression analyses were conducted where appropriate to explore the predictive factors of anxiety symptoms and depressive symptoms.Results: The prevalence of anxiety symptoms and depressive symptoms in the sample population was 28.5% (148/519) and 31.6% (164/519), respectively. Stressors in school (β = 0.176, OR = 1.192, CI: 1.102–1.289), negative coping style (β = 0.639, OR = 1.894, CI: 1.287–2.788) and perceived stress (β = 0.230, OR = 1.258, CI: 1.184–1.337) were found to be the predictors of anxiety symptoms among the international medical students; while gender (β = −0.594, OR = 0.552, CI: 0.315–0.968), stay up late (β = 0.828, OR = 2.288, CI: 1.182–4.431), current place of residence (β = 1.082, OR = 2.951, CI: 1.256–6.931), stressors in the school (β = 0.303, OR = 1.354, CI: 1.266–1.496), negative coping style (β = 0.866, OR = 2.377, CI: 1.516–3.725), perceived stress (β = 0.233, OR = 1.262, CI: 1.180–1.351) were found to be predictors of depressive symptoms.Conclusion: The prevalence of anxiety symptoms and depressive symptoms was moderate among international medical students in China. The communal predictors of anxiety and depressive symptoms were stressors in school, negative coping style and perceived stress; while demographic factors such as gender (male), stay up late at night and current place of residence were found associated with depressive symptoms. These results suggest that proper stress management and specific interventions are needed to help students maintain their mental health during the COVID-19 pandemic period.

Background:Mothers’ and fathers’ internalizing symptoms may influence children’s anxiety symptoms differently.Objective:To explore the relationship between parental internalizing symptoms and children’s anxiety symptoms in a clinical sample of children with anxiety disorders.Method:The sample was recruited through community mental health clinics for a randomized controlled anxiety treatment trial. At pre-intervention, children (n = 182), mothers (n = 165), and fathers (n = 72) reported children’s anxiety symptoms. Mothers and fathers also reported their own internalizing symptoms. The children were aged 8 to 15 years (Mage = 11.5 years, SD = 2.1, 52.2% girls) and all had a diagnosis of separation anxiety, social phobia, and/or generalized anxiety disorder. We examined parental internalizing symptoms as predictors of child anxiety symptoms in multiple regression models.Results:Both mother and father rated internalizing symptoms predicted children’s self-rated anxiety levels (adj. R2 = 22.0%). Mother-rated internalizing symptoms predicted mother-rated anxiety symptoms in children (adj. R2 = 7.0%). Father-rated internalizing symptoms did not predict father-rated anxiety in children.Conclusions:Clinicians should incorporate parental level of internalizing symptoms in their case conceptualizations.

BackgroundChildren who witness parental intimate partner violence (IPV) are more likely to develop mental health issues compared to those who do not witness such violence.ObjectiveThe main objective of this study is to assess the association between parental intimate partner violence and child mental health outcomes.MethodologyThis cross-sectional study involved 548 participants divided into two groups: parents (N = 304) and offspring (N = 244). The participants were recruited from Mageragere Sector in the City of Kigali (urban), as well as Mbazi and Ruhashya sectors in Huye District (rural). To assess the difference about mental difficulties reported by the offspring, a Mann-Whitney U test was employed to compare the responses of parents and their children on mental health outcomes. Additionally, multiple linear regression analysis was conducted to explore the association between parental intimate partner violence (IPV) and the mental health outcomes of their offspring.ResultsThe results highlighted significant levels of mental and emotional challenges in children, as reported by both parents and the children themselves. Depression and youth conduct problems were more prevalent among the children compared to their parents, whereas anxiety and irritability were more commonly reported by parents than by their children. Intimate partner violence showed to be a predictor of irritability and anxiety symptoms in offspring. In terms of irritability, depression, and youth conduct problems they were identified as predictors of anxiety symptoms. Particularly, anxiety and irritability were revealed to predict youth conduct problems.ConclusionThe study indicates that parental intimate partner violence (IPV) has an impact on the mental well-being of their offspring. Furthermore, it was observed that there is not only a correlation between IPV and poor mental health outcomes, but also a connection between different mental conditions, implying that children exposed to IPV are more prone to experiencing a range of mental issues. As a result, intervention programs should place emphasis on addressing the mental disorders of both parents and children.

Objective To explore the interaction between a serotonin transporter gene promoter region polymorphism(5-HTTPR) and stress in predicting anxiety symptoms. Methods Through random cluster sampling, a total of 252 healthy adolescents participated in this study.During the initial assessment, all participants completed the Adolescent Life Events Questionnaire (ALEQ) and Multidimensional Anxiety Scale for Children (MASC) to assess their levels of stress and anxiety and were genotyped for the 5-HTTLPR polymorphism. Participants subsequently completed MASC and ALEQ once every three months during the subsequent 24 months. A multilevel model was used to investigate the interaction between 5-HTTLPR and stress that predict anxiety symptoms. Results The results indicated no major effect of 5-HTTLPR in males (β=0.80, P>0.05)or females(β=-0.21, P>0.05). There were major effects of stress in males(β=0.30, P<0.01) and females (β=0.33, P<0.01)and a significant interaction between 5-HTTLPR and stress. Females with at least one 5-HTTLPR S allele(β=0.11, P<0.01)and males with at least one 5-HTTLPR L allele(β=-0.10, P<0.01)exhibited more anxiety symptoms under stressful situations. Conclusion The interaction between 5-HTTLPR and stress can predict anxiety symptoms in adolescents. There are gender differences on the 5-HTTLPR × stress interaction. Key words: Anxiety symptoms; Serotonin transporter gene promoter region polymorphism; Stress; Adolescent

Purpose Parental emotional neglect has been linked to an increased risk of anxiety symptoms, but the mechanisms driving this connection remain insufficiently understood, especially in adolescence, a pivotal stage for mental health during which relationships with family members and emotional experiences significantly influence psychological outcomes. This study explores how emotional neglect, adolescents’ perceptions of family functioning (APFF), and anxiety symptoms interact over time in adolescents. Methods A sample of 1,866 Italian adolescents (mean age = 15.51, SD = 1.10) participated in a longitudinal study, with assessments conducted at three time points: baseline (Time 1), six months later (Time 2), and another six months later (Time 3). Using structural equation modeling, we examined reciprocal influences and potential mediation effects. Results Findings showed that emotional neglect at Time 1 negatively impacted both APFF and anxiety symptoms at Time 2. In turn, APFF at Time 2 predicted anxiety symptoms at Time 3. Mediation analyses revealed that emotional neglect at Time 1 influenced anxiety symptoms at Time 3 via emotional neglect at Time 2, APFF at Time 2, and anxiety symptoms at Time 2. Similarly, APFF at Time 1 predicted anxiety symptoms at Time 3 through APFF at Time 2 and anxiety symptoms at Time 2. Conclusions These results highlight the role of emotional trauma and family relationships in shaping mental health trajectories, demonstrating that dysfunctional family environments can intensify mental health issues. The study underscores the importance of early interventions aimed at addressing emotional neglect, strengthening family support systems, and improving communication to help mitigate adolescent anxiety.

Background: Globally, mental disorders are common among nursing students; therefore, effective prevention and early detection are urgently needed. However, the prevalence rate of anxiety symptoms has not been investigated in South African nursing colleges. Aim: The study aimed to assess the prevalence of anxiety symptoms and their sociodemographic risk factors among nursing students in Gauteng province, South Africa. Methods: This cross-sectional descriptive study was conducted at Chris Hani Baragwanath and SG Lourens nursing colleges in the first week of June 2022. A purposeful sampling technique selected the third- and fourth-year nursing students aged ≥ 18 years registered at the two nursing colleges. The seven-item Generalised Anxiety Disorder scale was used to assess anxiety symptoms. Results: The prevalence of anxiety symptoms was 74.7% (95% confidence interval: 69.9–78.9). Being a student at nursing college B, being in the fourth academic year of study and use of substances were identified as predictors of anxiety symptoms in these nursing students. Conclusions: The prevalence of anxiety symptoms in this study is relatively high, with predictors of developing anxiety being a student at nursing college B, in the fourth academic year and current use of psychoactive substances were predictors of anxiety symptoms. These findings highlight the need to develop interventions and strategies to promote mental health assessments and management to prevent and reduce the problem of mental disorders among nursing students.

The present study investigated the relations between youth anxiety sensitivity and perceived anxiety control over Internal Reactions and perceived anxiety control over External Threats within the context of a (partially) mediated model in the prediction of anxiety symptoms. Youth sex also was investigated as a moderator of the conceptual model. The sample consisted of 333 children and adolescents (51.4% boys; M = 10.27 years old) referred to a youth anxiety disorders specialty research clinic. Findings showed that high anxiety sensitivity predicted high levels of anxiety symptoms for both boys and girls. Findings also showed that for both boys and girls, high anxiety sensitivity predicted low perceived anxiety control over Internal Reactions, as well as low perceived anxiety control over External Threats. Interestingly, perceived anxiety control over Internal Reactions was a partial mediator of the relation between anxiety sensitivity and anxiety for boys, but not girls. In contrast, perceived anxiety control over External Threats was a partial mediator of the relation between anxiety sensitivity and anxiety for girls, but not boys. The results are discussed within the context of the study's conceptual model as well as potential clinical implications.

Objectives: The objectives of the present study are to investigate the association among symptoms of depression and anxiety, sociodemographic variables and personality factors and also verify the predictive power of these variables in cancer outpatients. Method: The sample was composed by 220 individuals, 138 (62.7%) women and 82 (37.3%) men. The instruments used were: Questionnaire on sociodemographic and clinical data; NEO-FFI Personality Inventory Revised (NEO-FFI-R) and Hospital Anxiety and Depression Scale (HADS). The t test and the Spearman correlation were used to verify the relation between sociodemographic and clinic variables and symptoms of anxiety and depression. A Multiple Linear Regression analysis was made to verify the predictive power of sociodemographic and clinic variables and personality factors. Results: The personality factor neuroticism was predictor of anxiety symptoms. The variable previous psychiatric history and the personality factors neuroticism and extraversion were predictors of depressive symptoms. Conclusion: Depression and anxiety symptoms are associated with some sociodemographic variables and personality factors, and these variables can be deemed risk factors for the development of these symptoms. It is important that health professionals who follow-up this population design strategies to collect this information, in order to help patients manage treatment the best way possible.

While both maternal emotional disorders and perturbed fear learning increase risk for emotional disorder, it remains unclear the way in which these factors interact. This preliminary study examined whether responding during Pavlovian fear conditioning and extinction (Time 1) differentially predicted anxiety and depression symptoms 12 months later (Time 2) in 23 children with maternal risk for emotional disorders and 23 low risk comparisons. At Time 1, participants completed diagnostic and symptom measures and a discriminative conditioning and extinction task using shape conditional stimuli paired with (CS+) and without (CS-) an aversive tone unconditioned stimulus (UCS). Skin conductance responses (SCRs) were assessed in latency windows corresponding to CS orienting (first interval), UCS anticipation (second interval) and response to the UCS (third interval). Diagnostic and symptom measures were repeated at Time 2. Larger acquisition first interval SCRs during CS+ trials predicted higher Time 2 anxiety symptoms in high risk offspring but not low risk comparisons. Larger acquisition third interval SCRs during CS- trials predicted higher Time 2 anxiety symptoms in all children, irrespective of maternal diagnostic status. There were no significant effects involving fear extinction responses. All analyses involving the prediction of depression symptoms were not significant. Elevated responding to safety cues may be a general risk marker among children, and larger orienting responses to threat cues may be a specific risk marker in high risk offspring for increasing anxiety but not depressive symptoms over time.

Childhood maltreatment may have an influence on anxiety symptoms and coping styles. This longitudinal study aimed to estimate the prospective associations between different types of childhood maltreatment and anxiety symptoms among Chinese adolescents, with a particular focus on investigating whether these associations vary by the tendency of coping styles. Data were from the Longitudinal Study of Adolescents’ Mental and Behavioral Well-being Research. The baseline sample included 1957 participants (response rate: 99.03%) and followed up at 1-year later (n = 1836, retention rate: 93.8%). Anxiety symptoms, childhood maltreatment, the tendency of coping styles, morning cortisol level, depressive symptoms, self-esteem, and other demographics were measured. Overall, the mean age of the baseline students was 13.6 (SD: 1.5) years. The final results showed that childhood emotional abuse (unstandardized β-estimate = 0.13, 95% CI = 0.07–0.18), physical abuse (unstandardized β-estimate = 0.08, 95% CI = 0.01–0.16), and sexual abuse (unstandardized β-estimate = 0.17, 95% CI = 0.04–0.29) were positively associated with anxiety symptoms at follow-up after adjusting for significant covariates at baseline. Additionally, the stratified analyses demonstrated that only among students with negative coping styles, childhood emotional abuse, physical abuse, and sexual abuse were associated with subsequent anxiety symptoms; the differences between the positive and negative coping style strata were significant (P < 0.05). Childhood maltreatment appears to be a predictor of anxiety symptoms among adolescents, and the tendency of coping styles may have a moderating role in these longitudinal associations. The efforts to prevent anxiety symptoms are recommended to be focused on adolescents with the experience of childhood maltreatment and negative coping styles.

Gender differences are prevalent in major depressive disorder (MDD), but the gender differences in the relationship between comorbid anxiety and thyroid hormones in young first-episode and drug-naive (FEND) MDD patients are unknown. A total of 1,289 young outpatients with FEDN MDD were recruited. Demographic and clinical data were collected for each patient. The patient's blood glucose, blood pressure, thyroid hormone, and thyroid antibody levels were measured. The Hamilton depression scale (HAMD), Hamilton anxiety scale (HAMA), and Positive and Negative Syndrome Scale (PANSS) were used to assess patients' depression, anxiety, and positive symptoms, respectively. The prevalence of comorbid anxiety disorders was 80.4 and 79.4% in male and female MDD patients, respectively. Patients with anxiety had higher HAMD and PANSS scores, higher serum thyroid stimulating hormone (TSH), anti-thyroglobulin antibody (A-TG), and thyroid peroxidase antibody (A-TPO) levels, higher blood glucose and blood pressure levels, and more patients with psychotic symptoms and suicide attempts. Male patients were younger and had a younger age of onset. Logistic regression analysis showed that HAMD score and comorbid suicide attempts were significant predictors of anxiety symptoms in both males and females, whereas A-TG predicted anxiety symptoms in female patients only. Limitations: No causal relationship could be drawn due to the cross-sectional design. This study showed gender differences in factors associated with anxiety symptoms in patients with MDD. Some factors were associated with anxiety symptoms in both male and female patients, while A-TG was only associated with anxiety symptoms in female patients.

Hair cortisol has been proposed as a temporally integrated measure of systemic cortisol suitable for studies of chronic stress. We compared hair cortisol and depressive and anxiety symptoms between two groups of healthy male adolescents differing in exposure to chronic stress, one attending regular high school (n = 33) and the other incarcerated for 11-867 days in juvenile detention (n = 29), and examined the association of hair cortisol and depressive and anxiety symptoms among all adolescents. Hair cortisol was determined by liquid chromatography tandem mass spectrometry, and depressive and anxiety symptoms were measured by the Self-Rating Depression and Anxiety Scales. Hair samples (1-cm segments closest to the scalp at the posterior vertex) were collected 2 weeks after psychometric testing. Results revealed that incarcerated adolescents showed significantly more anxiety and depression symptoms, and higher hair cortisol levels than high school adolescents (ps < .05). The regression results revealed that hair cortisol levels could negatively predict depression symptoms (p < .05) but could not predict anxiety symptoms (p > .05) among all adolescents from the two groups. In summary, incarcerated adolescents experienced significantly higher chronic stress than high school adolescents. Hair cortisol showed a negative association with depression symptoms and no association with anxiety symptoms among adolescents with different exposures to chronic stress.

To evaluate mental health among children with congenital ectopia lentis (CEL) and to develop an effective nomogram for predicting risk of mental health symptoms in CEL. In total, 48 children with CEL and 50 control subjects aged 7-18 years old were enrolled in this study. Participants were required to complete the Children's Depression Inventory (CDI) and the Screen for Child Anxiety Related Emotional Disorders (SCARED) questionnaire to screen depressive and anxiety symptoms. Three potential predictors were tested and chosen to build a prediction model using logistic regression. Compared with normal controls, CDI and SCARED scores were higher among children with CEL (P < 0.05). 35.4% of CEL children had varying degrees of depressive or anxiety symptoms. Child's age (odds ratio [OR] = 1.815, 95% confidence interval [CI], 1.084-3.039), duration of disease (OR = 1.557, 95% CI, 1.009-2.403), and systemic abnormalities (OR = 19.894, 95% CI, 1.660-238.463) were identified as predictors of anxiety symptoms. The combination of the above predictors shows good predictive ability, as indicated by area under the curve of 0.924 (95% CI, 0.845-1.000). The calibration curves showed good agreement between the prediction of the nomogram and the actual observations. Additionally, decision curve analysis showed that the nomogram was clinically useful and had better discriminatory power in identifying patients with significant anxiety symptoms. Children with CEL experience higher level of depressive and anxiety symptoms. Child's age, duration of disease and systemic abnormalities are associated factors and can serve as useful indexes in predicting mental illness among CEL children.

Introduction: Atopic dermatitis (AD) is not only a cosmetic nuisance but is also associated with a significant impact on mental health and quality of life. Psychological symptoms are highly related to poor treatment adherence and recovery, more comorbidities, and a significant overall socioeconomic burden. Identifying the factors associated with anxiety and depression among patients with AD is important to modify and reduce the risk of developing these psychiatric complications. Methods: This was correlational research conducted in the dermatology clinic of four hospitals in Klang Valley, namely Hospital Kuala Lumpur, Hospital Tengku Ampuan Rahimah Klang, Hospital Selayang, and Hospital Ampang. By using a purposive sampling method, 128 samples (n=128) of adult patients with AD aged 18-65 were included. A questionnaire was administered regarding sociodemographic background, illness characteristics of AD, the Investigator’s Global Assessment (IGA), Malay version of the Automatic Thought Questionnaire-17, GAD-7, and PHQ-9. Results: The prevalence of anxiety and depressive symptoms among adult patients with AD is 31.3% and 46.9% respectively. Multivariable logistic regression analysis revealed that age and personal maladjustment (PM) predict anxiety symptoms, while only negative self-concept/expectation (NSNE) predicts depressive symptoms. The hierarchical logistic regression model explained 51% (Nagelkerke’s R2) of the variance in anxiety symptoms and 56% (Nagelkerke’s R2) of depressive symptoms. Conclusion: There is a high proportion of anxiety and depressive symptoms among adult patients with AD which is associated with negative automatic thoughts. In the management of adult patients with AD, clinicians should consider mental health symptom screening and monitoring.