Symptoms of Anxiety and Depression Among Adults: United States, 2019 and 2022.

Do women with polycystic ovary syndrome (PCOS) have an increased prevalence of moderate and severe depressive and anxiety symptoms compared with control women, and do these symptoms correlate with age, BMI, testosterone, hirsutism or insulin resistance (IR)? Women with PCOS have significantly increased odds of moderate and severe depressive and anxiety symptoms, independent of obesity, and the symptoms are weakly associated with age, BMI, elevated testosterone, hirsutism and IR. Previous studies have reported that women with PCOS have an increased prevalence of mild depressive and anxiety symptoms or an increase in mean depression and anxiety scores, although these scores are usually within the normal range. Thus, it is therefore not clear whether these findings are clinically significant. The prevalence of moderate and severe depressive and anxiety symptoms, which require follow-up and would benefit from treatment, is not known in this population. A comprehensive systematic review (SR) was performed up to January 2016 and included 30 cross-sectional studies, representing 3050 subjects with PCOS and 3858 controls, from 10 different countries. The meta-analysis (MA) on depressive symptoms included 18 studies and the MA on anxiety symptoms included 9 studies. A separate SR identified 15 studies for the meta-regression examining the associations with PCOS-related symptoms or comorbidities. All studies included adult women with PCOS, defined by the National Institutes of Health or Rotterdam criteria, and a control group without PCOS. Ovid, Embase, PsychInfo and Cochrane were searched up to January 2016. Included studies used a validated screening tool to compare the prevalence or mean scores of depressive and/or anxiety symptoms. Random effects MA was used to estimate the pooled odds ratio (OR) of depressive and anxiety symptoms. Sensitivity analyses of methodological characteristics and a meta-regression of the pooled standardized mean difference (SMD) to evaluate PCOS-related clinical and laboratory associations were performed. Women with PCOS had increased odds of any depressive symptoms (OR: 3.78; 95% CI: 3.03-4.72; 18 studies) and of moderate/severe depressive symptoms (OR: 4.18; 95% CI: 2.68-6.52; 11 studies). Women with PCOS had increased odds of any anxiety symptoms (OR: 5.62; 95% CI: 3.22-9.80, nine studies) and of moderate/severe anxiety symptoms (OR: 6.55; 95% CI: 2.87, 14.93; five studies). When subjects were matched on BMI, women with PCOS still had higher odds of both depressive (OR: 3.25; 95% CI 1.73-6.09; four studies) and anxiety symptoms (OR: 6.30, 95% CI: 1.88-21.09; three studies). There was no substantial heterogeneity among studies in the overall MA on depressive symptoms (I2 = 22.4%, P = 0.19), but there was significant heterogeneity among studies in the analysis on anxiety symptoms (I2 = 59.6%, P= 0.01). In the meta-regression evaluating pooled SMDs between groups, women with PCOS and concurrent depression had higher mean values of age, BMI, hirsutism score and IR, while women with PCOS and concurrent anxiety had higher mean values of BMI, hirsutism score and free testosterone (P < 0.05 for all comparisons). All studies were cross-sectional, thus we can only hypothesize that the diagnosis of PCOS precedes the diagnosis of depression and anxiety. There were large variations in methodological characteristics especially in the studies screening for anxiety; however, they only partly explained effect size variation. This evidence-synthesis analysis shows that PCOS diagnosis is associated with an increased risk of moderate and severe depressive and anxiety symptoms and suggests that providers should consider screening women with PCOS for both depression and anxiety. Although age, obesity, hyperandrogenism and IR do not explain the entire association, well-designed studies are needed to assess the impact of treatment of these factors on depressive and anxiety symptoms in women with PCOS. No funding was used for this study. There are no conflicts of interest. N/A.

Up to 37% of colorectal cancer (CRC) survivors report depressive and anxiety symptoms. The identification of risk factors for depressive or anxiety symptoms might help focus supportive care resources on those patients most in need. The present study aims to explore which factors are associated with heightened anxiety or depression symptom severity. In this cross-sectional study, individuals diagnosed with CRC 3.5 to 6 years ago completed questionnaires on sociodemographic information, medical comorbidities, anxiety symptoms (Beck Anxiety Inventory), and depressive symptoms (Inventory of Depressive Symptomatology). The general linear model analysis of covariance was used to identify factors associated with heightened anxiety or depressive symptom severity. The sample included 91 CRC survivors, 40.7% women, mean age 69.1 years. A minority of CRC survivors had moderate (3.4%) or severe (2.3%) anxiety symptoms, and moderate (7.7%) or severe (0%) depressive symptoms. Shorter time since diagnosis and higher number of comorbid diseases were associated with higher anxiety symptom severity. Female sex and higher number of comorbid diseases were associated with higher depressive symptom severity. From this explorative study, it follows that survivors with multiple comorbid diseases, shorter time since diagnosis, and female survivors might be at risk for higher anxiety and/or depressive symptom severity. Survivors with these characteristics might need extra monitoring.

We examined whether anxiety and depression symptoms constitute increased risk of bloodstream infection (BSI), as a proxy for sepsis. A general population with self-reported anxiety and depression symptoms was followed prospectively for hospital-verified BSI. Using multivariable Cox regression analysis, we estimated hazard ratios (HR) with 95% confidence intervals (CI) of BSI and BSI mortality, with and without statistical adjustment for comorbidities, BMI, and life-style factors that may confound or mediate the associations. During 14.8 years median follow-up of 59,301 individuals, 1578 (2.7%) experienced BSI and 328 (0.55%) participants died within 30 days after a BSI. Severe depression symptoms were associated with a 38% increased risk of BSI, adjusted for age, sex, and education (HR = 1.38, 95% CI = 1.10-1.73). The HR was attenuated to 1.23 (0.96-1.59) after adjustment for comorbidities and to 1.15 (0.86-1.53) after additional adjustment for BMI and life-style factors. For severe anxiety symptoms, the corresponding HRs were 1.48 (1.20-1.83), 1.35 (1.07-1.70), and 1.28 (0.99-1.64). Moderate symptoms of depression and anxiety were not associated with increased BSI risk. The analysis of BSI mortality yielded imprecise results but suggested an increased risk of BSI mortality in participants with moderate depression symptoms. Severe depression and anxiety symptoms were associated with a moderately increased risk of BSI. The association may, at least in part, be confounded or mediated by comorbidities, BMI, and life-style. Future research should investigate whether interventions targeting improved BMI and life-style may reduce the risk of BSI and sepsis in people with depression and anxiety symptoms.

Our objective was to examine the influence of COVID-19 vaccination on recent (i.e., past month) moderate or severe symptoms of anxiety (GAD-7 ≥ 10) or depression (PHQ-8 ≥ 10) before and after the COVID-19 vaccine became universally available for adults in the U.S. Participants belonged to the Communities, Households, and SARS-CoV-2 Epidemiology Cohort (CHASING COVID), a national longitudinal study. Our analytic population included 4,832 participants who reported vaccination status from December 2020 to December 2021 with follow-up outcomes assessed through March 2022. We emulated a hypothetical randomized experiment, a target trial, to estimate the effect of COVID-19 vaccination on symptoms of anxiety or depression. Before vaccines were universally available, participants who were vaccinated versus not had significantly lower adjusted odds of symptoms of moderate or severe anxiety (aOR: 0.79; 95% CI: 0.70-0.89). In the universal vaccine era, vaccination was associated with marginally higher adjusted odds of symptoms of moderate or severe anxiety (aOR: 1.23; 95% CI: 1.00-1.50). Vaccination did not influence subsequent moderate or severe depressive symptoms in the preuniversal vaccine era (aOR: 0.92; 95% CI: 0.82-1.03) or universal vaccine era (aOR: 1.11; 95% CI: 0.91-1.36). Research into the longitudinal relationship between COVID-19 vaccination and symptoms of depression and anxiety is warranted, with a focus on advancing understanding of potential mediators on the pathway between vaccination and mental health as well as modifiable factors, such as vaccine hesitancy or vaccine beliefs, that may help identify populations for whom vaccination may be particularly beneficial to their mental health.

Correlates and consequences of anxiety and depressive symptom trajectories during early treatment for alcohol use.

IntroductionPatients with COPD have a high prevalence of anxiety and depression which has been associated with poorer health outcomes. PR has been found to be successful in reducing anxiety and...

To determine the relationship between the female and male athlete triad with depression and anxiety symptoms. Cross-sectional survey. Survey distributed online through social media to participants. Male and female high school, collegiate, and postcollegiate athletes. Participants completed a survey assessing components of the female athlete triad and the Patient-Reported Outcomes Measurement Information System depression and anxiety short-form questionnaires. Participants were classified into those with no, mild, moderate, or severe depression symptoms or anxiety symptoms. A female athlete triad (Triad) cumulative risk score was calculated. Multinomial logistic regressions were used to assess the relationship between triad score and depression/anxiety. Two hundred fifty-four men and 780 women completed the survey; 66.6% of women and 41.3% of men reported at least mild anxiety symptoms; 54.2% of women and 38.7% of men reported at least mild depression symptoms. Triad risk score was significantly related to moderate and severe depression symptoms (P < 0 .0001) and moderate (P = 0.003) and severe (P < 0 .0001) anxiety symptoms in women. We found no significant associations between Triad risk score and depression or anxiety symptoms in men. We found a correlation between the female athlete triad and moderate and severe depression and anxiety symptoms in women. Depression and anxiety symptoms were most strongly related to the low energy availability component of the Triad risk score and to the presence of eating disorders/disordered eating. This suggests that mental health illness is most tied to the behavioral aspects of the Triad. This study demonstrates the importance of screening for and treating mental health illness in those diagnosed with low energy availability, disordered eating, and/or the female athlete triad in addition to focusing on a nutrition intervention.

There is a paucity of studies on psychosocial disorders in clinic populations in Jamaica. Therefore, we sought to determine the prevalence and correlates of symptoms of depression and anxiety in a clinic population in western Jamaica. A total of 338 participants from four outpatient clinics of : A total of 338 participants from four outpatient clinics of the Western Regional Health Authority (WRHA) were screened for symptoms of depression and anxiety using questions from the Beck Depression Inventory-II and the Beck Anxiety Inventory. The Chi-square test was used to examine differences in symptoms of anxiety and depression by gender. Multivariate linear and logistic regression were used to examine the associations between symptoms and sociodemographic variables with significance set at p<0.05. Approximately 30% of participants had moderate or severe depression symptoms while 18.6% had moderate or severe anxiety symptoms. Participants aged 30-39 years were more likely than older participants to have moderate or severe anxiety symptoms (odds ratio [OR]: 2.0, 95% confidence interval [CI]: 1.39, 5.56). Women reported a statistically significant higher prevalence of anxiety symptoms (10.0% vs 7.1%, p = 0.003). There was also a statistically significant difference between anxiety means by gender. Furthermore, income was found to be a significant predictor of anxiety for women only (p = 0.0113). Married persons were more likely than those who had never married to have moderate or severe anxiety symptoms (OR: 2.57, 95% CI: 1.14, 5.76). Our findings suggest that the prevalence of depression may be higher than global estimates in similar outpatient settings. Screening and intervention efforts may need to focus on younger persons, women, and married persons.

The field of plastic surgery was inevitably affected by the severe acute respiratory syndrome coronavirus 2. Residents in plastic surgery programs, although originally not on the frontline, had significant changes to their schedules and were deployed to other medical services in the hospital to help with the surge of the coronavirus disease of 2019 (COVID-19) patients. In the setting of the COVID-19 pandemic, plastic surgery residents are at higher risk of psychological distress and other mental health symptoms.1 To evaluate this, an American Council of Academic Plastic Surgeons–approved survey was distributed to plastic surgery residents in the United States. The nine-item Patient Health Questionnaire and the seven-item Generalized Anxiety Disorder scale were used to assess the severity of symptoms of depression and anxiety. A total of 116 residents responded to the survey from all four U.S. subregions and all levels of training (Table 1). Table 1. - Demographics of Survey Respondents No. of Respondents Percentage Gender Male 61 53% Female 55 47% Age 20–30 yr 44 38% 30–40 yr 71 62% Level of training PGY-1 15 13% PGY-2 17 15% PGY-3 19 17% PGY-4 16 14% PGY-5 16 14% PGY-6 14 12% Ind. PGY-1 7 6% Ind. PGY-2 3 3% Ind. PGY-3 8 7% U.S. subregion South 33 28% West 24 20% Midwest 29 24% Northeast 34 28% PGY, postgraduate year; Ind. PGY, independent postgraduate year. Ten respondents (8.62 percent) reported chronic symptoms of depression or anxiety before the pandemic. During the pandemic, 57 respondents (49.1 percent) and 48 respondents (41.4 percent) had symptoms of depression (p < 0.0001) and anxiety (p<0.0001), respectively. Respondents with one or more children were more likely to report symptoms of depression (64.3 percent versus 42.9 percent; p = 0.033) and anxiety (66.7 percent versus 41.2 percent; p = 0.029). Increased planned physical activity by at least 30 minutes/week was associated with less severe symptoms of anxiety (30.1 percent versus 55.3 percent; p = 0.039) and depression (40.8 percent versus 52.6 percent; p = 0.272). Respondents who described their program's emphasis on wellness as major compared with those who described it as minor were found to have less severe symptoms of anxiety (38.7 percent versus 57.4 percent, p = 0.006) and depression (44.9 percent versus 59.0 percent, p = 0.140). With regard to counseling, 58.9 percent reported that they did not know if participation in counseling wellness programs was confidential, and the majority (93.0 percent) did not use these activities due to long work hours and the stigma associated. Lastly, 38.7 percent of respondents reported an increase in alcohol intake and 7 percent reported an increase in tobacco product use. These results suggest that plastic surgery residents had symptoms of depression and anxiety at the time of distribution of the survey. Certainly, a rise in symptoms of anxiety and coping responses to stress is expected during extraordinary circumstances; however, the increased prevalence of people with anxiety and depression increases the risk of burnout, which in turn may lead to decreased productivity, slower learning capacity, compromised patient safety, and engaging in harmful behaviors, such as suicide and self-harm.2 Reviewing the mental health outcomes from a structural point of view, residents who had increased physical activity and more emphasis on wellness activities were found to have less severe symptoms of anxiety and depression. Wellness activities have been proven to reduce anxiety, reduce depression, and improve productivity, morale, and overall performance among residents, as well as help to decrease the risks of burnout.3–5 However, these activities must be well implemented and encouraged to avoid conveying feelings of weakness and stigma. Our findings corroborate the importance of established wellness programs and trust between faculty and residents in academic programs, as well as identifying residents at risk for burnout, as these effects can have longstanding sequelae and consequently remain, even when the COVID-19 pandemic is over or under control. DISCLOSURE The authors have no potential conflicts of interest to disclose.

Psychological treatment of depression in end-stage renal disease (ESRD) has focused on severely depressed patients. We designed and tested a brief (5weeks) cognitive behavioural intervention (CBI) to reduce mild and moderate depression and anxiety symptoms in patients with ESRD. For the purpose of this study, a single-blind, randomized controlled design was used to compare patients with ESRD under haemodialysis treatment with and without the CBI. Depression and anxiety symptoms were screened in 152 subjects (18-60years old, 84 male). Sixty participants (age 41.8±14.7, 29 males) with mild or moderate scores of depression (Beck Depression Inventory) and anxiety (Beck Anxiety Inventory) were randomly assigned to CBI or the control group. CBI techniques consisted of positive self-reinforcement, deep breathing, muscle relaxation, and cognitive restructuring. Depression, anxiety, quality of life (QoL), and cognitive distortion scores were evaluated at baseline, after 5weeks (end of treatment) and after 4-week follow-up. All scores were compared by ANOVA for repeated measures with post-hoc tests adjusted by Bonferroni's method (p<.05 was considered significant). At follow-up, depression, anxiety, and cognitive distortions had decreased, and QoL had increased in the intervention group, and there were no changes in the control group. Clinical utility was 33% for depression and 43% for anxiety. A brief CBI of 5weeks is effective for decreasing mild or moderate depression and anxiety symptoms and improving QoL in ESRD haemodialysis patients. A brief, systematic and structured cognitive behavioural intervention (CBI) decreases anxiety and depression symptoms and improves quality of life in patients with end-stage renal disease (ESRD) who are being treated with haemodialysis. These benefits are not achieved when anxiety and depression symptoms are identified but not treated psychologically. This CBI consisted of cognitive restructuring of the distorted thoughts (perfectionism, catastrophic thinking, negative self-labelling, and dichotomous thinking) that are correlated with depression and anxiety symptoms and that can be assessed by a validated questionnaire designed for patients with ESRD. The handbooks that were developed for this study are structured and systematic. They could be valuable in supporting the efforts and participation of non-specialized health professionals in CBI such as nurses, physicians, social workers, and psychologists, raising the possibility of further application in a variety of clinical populations. Both the therapy and the client workbooks are available in Spanish upon request.

Change in humor and sarcasm use based on anxiety and depression symptom severity during the COVID-19 pandemic

BackgroundDepression and anxiety often occur in persons with chronic physical illnesses and typically magnify the impairment caused by these physical conditions, but little attention has been paid to this issue in low- and middle-income countries. AimEvaluate the effectiveness of a community-based psychological intervention administered by non-specialized clinicians and volunteers for alleviating depressive and anxiety symptoms in individuals with chronic physical illnesses. MethodsA total of 10, 164 community residents receiving treatment for diabetes or hypertension in Shanghai were arbitrarily assigned to a treatment-as-usual condition (n=2042) or an intervention condition (n=8122) that included community-wide psychological health promotion, peer support groups, and individual counseling sessions. The self-report Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder scale (GAD-7), and 12-item Short-Form Health Survey (SF-12) assessed depressive symptoms, anxiety symptoms, and quality of life at baseline and after the 6-month intervention. ResultsAmong the 8813 individuals who completed the baseline assessment, 16% had mild or more severe depressive or anxiety symptoms (PHQ-9 or GAD-7 ≥5) and 4% had moderate or severe depressive or anxiety symptoms (PHQ-9 or GAD-7 ≥10). The education component of the intervention was effectively implemented, but only 31% of those eligible for peer-support groups and only 9% of those eligible for individual counseling accepted these interventions. The dropout rate was high (51%), and there were significant differences between those who did and did not complete the follow-up assessment. After adjusting for these confounding factors, the results in individuals who completed both assessments indicated that the intervention was associated with significant improvements in depressive symptoms (F=9.98, p<0.001), anxiety symptoms (F=12.85, p<0.001), and in the Mental Component Summary score of the SF-12 (F=16.13, p<0.001). There was, however, no significant change in the self-reported rates of uncontrolled diabetes or hypertension. ConclusionsThese results support the feasibility of implementing community-based interventions to reduce the severity of depressive and anxiety symptoms in persons with chronic medical conditions in low- and middle-income countries where psychiatric manpower is very limited. However, there are substantial methodological challenges to mounting such interventions that need to be resolved in future studies before the widespread up-scaling of this approach will be justified.

Background: Emotional disorders in medical students are expected and deserve more attention, especially during the COVID-19 Pandemic. Objective: Evaluate anxiety and depression disorders among medical students during the COVID-19 Pandemic. Methods: A cross-sectional study at a private medical college in Brazil, two months after stay-at-home order and postponed classes due to the COVID-19 Pandemic. A survey among medical students was conducted in May 2020, using questionnaires regarding social and demographic status, the GAD-7 for symptoms of anxiety, and the PHQ-9 for symptoms of depression. Results: A total of 340 of 347 (97.98%) medical students participated. The average GAD-7 score was 9.18 (±4.75), and the average PHQ-9 score was 12.72 (±6.62). The results indicate a significant positive relationship between GAD-7 and females (F=5.816 P=.016). Using a cut-off score of 10 for GAD-7, 157 (46.17%) students were identified with moderate or severe anxiety symptoms. For the PHQ-9 score, using a cut-off of 10 219 (64.41%), students were recognized with moderate or severe symptoms of depression; the results indicate a significant positive relationship between the PHQ-9 and females (F=5.640 P=.018). Conclusion: The analysis demonstrated a significantly higher prevalence of moderate and severe anxiety and depression symptoms among female medical students during the COVID-19 Pandemic.

Do symptoms of depression, anxiety or stress impair the effectiveness of cognitive behavioural therapy for insomnia? A chart-review of 455 patients with chronic insomnia

Evidence linking end-of-life-care quality in ICUs to bereaved family members' psychologic distress remains limited by methodological insufficiencies of the few studies on this topic. To examine comprehensively the associations of family surrogates' severe anxiety and depressive symptoms with end-of-life-care quality in ICUs over their first 6 months of bereavement. Prospective, longitudinal, observational study. Family surrogates (n = 278) were consecutively recruited from seven medical ICUs at two academically affiliated medical centers in Taiwan. Family surrogates' anxiety and depressive symptoms were assessed 1, 3, and 6 months postloss using the Hospital Anxiety and Depression Scale. Family satisfaction with end-of-life care in ICUs was assessed 1-month postloss by the Family Satisfaction in the ICU questionnaire. Patients' end-of-life care was documented over the patient's ICU stay. Associations of severe anxiety and depressive symptoms (scores ≥ 8 for each subscale) with end-of-life-care quality in ICUs (documented by patient care received and family satisfaction with end-of-life care in ICUs) were examined by multivariate logistic regression models with generalized estimating equation. Prevalence of severe anxiety and depressive symptoms decreased significantly over time. Surrogates' lower likelihood of severe anxiety or depressive symptoms 3-6 month postloss was associated with death without cardiopulmonary resuscitation, withdrawing life-sustaining treatments, and higher family satisfaction with end-of-life care in ICUs. Bereaved surrogates' higher likelihood of these symptoms was associated with physician-surrogate prognostic communication and conducting family meetings before patients died. End-of-life-care quality in ICUs is associated with bereaved surrogates' psychologic well-being. Enhancing end-of-life-care quality in ICUs by improving the process of end-of-life care, for example, promoting death without cardiopulmonary resuscitation, withdrawing life-sustaining treatments, and increasing family satisfaction with end-of-life care, can lighten bereaved family surrogates' severe anxiety symptoms and severe depressive symptoms.