7-item Generalized Anxiety Disorder Research Articles

Depression, generalized anxiety and risk of problematic substance use in high school students

To estimate the prevalence and comorbidity of depression, generalized anxiety, and risk of problematic substance use in adolescents, and to examine the sociodemographic variables associated with these mental health problems. 2,022 students from first to third year of high school (9th to 11th grade) from 8 educational establishments in the northern area of Santiago, Chile, participated in the study. The mean age was 15.2 years and 49.5% of the sample was female. Sociodemographic, measures of depression (Patient Health Questionnaire-9 [PHQ-9]), generalized anxiety (Generalized Anxiety Disorder 7-item [GAD-7]), and risk of problematic substance use (Car, Relax, Alone, Forget, Family/Friends, Trouble [CRAFFT]) data were collected. Data were analyzed using bivariate hypothesis testing and logistic and Poisson regression models. 52.9% met the criteria for one or more mental health problems. A total of 35.2% scored positive for depression, 25.9% for generalized anxiety, and 28.2% for risk of problematic substance use, with differences by gender in the first two and differences by gender and age in the third. A total of 26.5% scored positive for two or more mental health problems. Regression models showed differences in the associations between gender, age, and not living with both parents with the mental health problems studied. There is a high prevalence and comorbidity in the three mental health problems studied. The results show the importance of assessing comorbidity in clinical work with adolescents and the development of transdiagnostic preventive interventions for this population.

Anxiety in Response to Sustaining Spinal Cord Injuries and Disorders: When Should Clinicians Be Concerned?

ObjectiveTo recommend a cut-off score for the brief 2-item Generalized Anxiety Disorder (GAD-2) measure for persons with spinal cord injuries/disorders (PwSCI/D) and to estimate anxiety occurrence within this population using the full 7-item Generalized Anxiety Disorder (GAD-7). DesignMulticenter retrospective analyses. SettingOne inpatient rehabilitation center and 2 community sites for PwSCI/D. ParticipantsPwSCI/D 18 years or older (N=909) were included for analysis using retrospectively collected GAD-2 and GAD-7 data. InterventionsNot applicable. Main Outcome Measure(s)Occurrence of anxiety symptoms were compared using cut-off scores of ≥8 and ≥10 on the GAD-7. A cut-off score recommendation for the GAD-2 was determined using ROC curve, and sensitivity and specificity analyses. ResultsOccurrence of anxiety symptoms was 21% using a GAD-7 cut-off of ≥8 and 15% using a cut-off of ≥10. Analyses indicated optimal sensitivity for a GAD-2 score of ≥2 when a GAD-7 cut-off of ≥8 was used. ConclusionsAnxiety occurrence is elevated among PwSCI/D compared with the general population. For PwSCI/D, it is recommended that a cut-off score of ≥2 is used for the GAD-2 to maximize sensitivity and that a threshold of ≥8 is used for the GAD-7 to ensure the maximum number of individuals presenting with symptoms of anxiety are recognized for diagnostic interview. Study limitations are discussed.

Psychometric property study of the Affective Lability Scale-short form in Chinese patients with mood disorders.

This study aimed to investigate the psychometric properties of the Affective Lability Scale-short form (ALS-SF) among Chinese patients with mood disorders, and to compare ALS-SF subscale scores between patients with major depressive disorder (MDD) and patients with bipolar disorder (BD) depression. A total of 344 patients with mood disorders were included in our study. Participants were measured through a set of questionnaires including the Chinese version of ALS-SF, Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder 7-item (GAD-7), and NEO-Five Factor Inventory (NEO-FFI). Exploratory factor analysis and confirmatory factor analysis were applied to examine the psychometric properties of ALS-SF. Besides, correlation and regression analyses were performed to explore the relationship between affective lability and depression, anxiety, and neuroticism. Independent samples t-tests were used to compare the subscale scores of ALS-SF between the MDD and BD depression groups. Results of factor analysis indicated that the model of ALS-SF was consistent with ALS-SF. The ALS-SF showed a solid validity and high internal consistency (Cronbach's alpha = 0.861). In addition, each subscale of ALS-SF was significantly correlated with PHQ-9, GAD-7, and NEO-FFI neuroticism subscale, except for the anger subscale showed no significant correlation with PHQ-9. Besides, the depression/elation and anger factor scores in patients with BD depression were higher than in patients with MDD. Our study suggests that the Chinese version of ALS-SF has good reliability and validity for measuring affective lability in Chinese patients with mood disorders. Assessing affective lability would assist clinicians to distinguish between MDD and BP depression and may decrease the risks of misdiagnosis.

Vickybot, a Chatbot for Anxiety-Depressive Symptoms and Work-Related Burnout in Primary Care and Health Care Professionals: Development, Feasibility, and Potential Effectiveness Studies.

Many people attending primary care (PC) have anxiety-depressive symptoms and work-related burnout compounded by a lack of resources to meet their needs. The COVID-19 pandemic has exacerbated this problem, and digital tools have been proposed as a solution. We aimed to present the development, feasibility, and potential effectiveness of Vickybot, a chatbot aimed at screening, monitoring, and reducing anxiety-depressive symptoms and work-related burnout, and detecting suicide risk in patients from PC and health care workers. Healthy controls (HCs) tested Vickybot for reliability. For the simulation study, HCs used Vickybot for 2 weeks to simulate different clinical situations. For feasibility and effectiveness study, people consulting PC or health care workers with mental health problems used Vickybot for 1 month. Self-assessments for anxiety (Generalized Anxiety Disorder 7-item) and depression (Patient Health Questionnaire-9) symptoms and work-related burnout (based on the Maslach Burnout Inventory) were administered at baseline and every 2 weeks. Feasibility was determined from both subjective and objective user-engagement indicators (UEIs). Potential effectiveness was measured using paired 2-tailed t tests or Wilcoxon signed-rank test for changes in self-assessment scores. Overall, 40 HCs tested Vickybot simultaneously, and the data were reliably transmitted and registered. For simulation, 17 HCs (n=13, 76% female; mean age 36.5, SD 9.7 years) received 98.8% of the expected modules. Suicidal alerts were received correctly. For the feasibility and potential effectiveness study, 34 patients (15 from PC and 19 health care workers; 76% [26/34] female; mean age 35.3, SD 10.1 years) completed the first self-assessments, with 100% (34/34) presenting anxiety symptoms, 94% (32/34) depressive symptoms, and 65% (22/34) work-related burnout. In addition, 27% (9/34) of patients completed the second self-assessment after 2 weeks of use. No significant differences were found between the first and second self-assessments for anxiety (t8=1.000; P=.34) or depressive (t8=0.40; P=.70) symptoms. However, work-related burnout scores were moderately reduced (z=-2.07, P=.04, r=0.32). There was a nonsignificant trend toward a greater reduction in anxiety-depressive symptoms and work-related burnout with greater use of the chatbot. Furthermore, 9% (3/34) of patients activated the suicide alert, and the research team promptly intervened with successful outcomes. Vickybot showed high subjective UEI (acceptability, usability, and satisfaction), but low objective UEI (completion, adherence, compliance, and engagement). Vickybot was moderately feasible. The chatbot was useful in screening for the presence and severity of anxiety and depressive symptoms, and for detecting suicidal risk. Potential effectiveness was shown to reduce work-related burnout but not anxiety or depressive symptoms. Subjective perceptions of use contrasted with low objective-use metrics. Our results are promising but suggest the need to adapt and enhance the smartphone-based solution to improve engagement. A consensus on how to report UEIs and validate digital solutions, particularly for chatbots, is required.

Psychometric Properties and Validation of the General Anxiety Disorder 7-Item Scale Among Adolescents With Persistent Post-Concussive Symptoms.

The General Anxiety Disorder 7-Item (GAD-7) scale is commonly used in primary care as a self-report measure of general anxiety symptoms with adult populations. There is little psychometric research on this measure with adolescent populations, particularly those with persistent post-concussive symptoms (PPCS). This study examined the psychometrics properties of the GAD-7 among youth with PPCS. We used baseline data from a randomized controlled trial of collaborative care for treatment of PPCS among 200 sports-injured adolescents 11-18 years of age (Mage = 14.7 years, standard deviation = 1.7). Eligible adolescents had three or more PPCS that lasted for ≥1 month and spoke English. Adolescents reported on their anxious (GAD-7 and Revised Child Anxiety and Depression Scale-Short Version [anxiety subscale]; RCADS) and depressive (Patient Health Questionnaire-9; PHQ-9) symptoms. Parents used the RCADS to report on their adolescents' anxious symptoms. The GAD-7 had good internal validity (Cronbach's alpha = 0.87), and significant (p < 0.001) correlations were detected between the GAD-7 and youth and parent report of anxiety on RCADS (r = 0.73 and r = 0.29) and PHQ-9 (r = 0.77) scores. Confirmatory factor analysis suggested a one-factor solution. These results suggest that the GAD-7 is a valid measure of anxiety with good psychometric properties for youth experiencing PPCS. ClinicalTrials.gov identifier: NCT03034720.

App-Based Mindfulness Intervention to Improve Psychological Outcomes in Pretransplant Patients With Heart Failure

Patients hospitalized with life-threatening conditions experience psychological stressors that can lead to anxiety and poor patient outcomes. Mindfulness stress reduction interventions have been shown to decrease stress and anxiety with sustained effect. In a single center's cardiac care units, only pharmacological stress reduction options were embedded in the daily care plan. This project evaluated the feasibility and effect of a brief mindfulness intervention on stress, anxiety, and resilience in 20 hospitalized patients with advanced heart failure awaiting transplant. A 1-group, pretest-posttest design over a 4-week period was used. The intervention included a one-on-one mindfulness education session and a 12-minute audio-guided tablet computer app for daily self-practice. Outcome variables measured at baseline and 2 and 4 weeks after implementation included stress (10-item Perceived Stress Scale), anxiety (7-item Generalized Anxiety Disorder instrument), and resilience (10-item Connor-Davidson Resilience Scale). Statistical analysis included descriptive statistics and repeated-measures analysis of variance with Friedman tests, Bonferroni post hoc tests, and Wilcoxon matched-pairs tests. Significant reductions in stress and anxiety and increase in resilience occurred from baseline to 2 weeks and 4 weeks after intervention (all P = .001). Feasibility and acceptability were evident from patient experience survey data and focused interview responses. A brief mindfulness intervention holds promise for improving stress, anxiety, and resilience for patients with advanced heart failure awaiting transplant. Nurse-led stress reduction interventions are imperative for best patient outcomes. An evidence-based intervention of mindfulness practice embedded into daily usual patient care may be a feasible option.

The Comorbidity of Depression and Anxiety Symptoms in Tinnitus Sufferers: A Network Analysis

Sufferers of tinnitus, especially of the prolonged type, frequently suffer from comorbid depression and anxiety. From the perspective of the network model, this comorbidity is thought to be an interacting system of these two symptoms. In our study, we conducted a network analysis of depression and anxiety comorbidity in tinnitus sufferers, aiming to identify the central and bridge symptoms and make informed suggestions for clinical interventions and psychotherapy. A total of 566 tinnitus sufferers were enrolled in our study. The Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder 7-Item Questionnaire (GAD-7) were selected to evaluate depression and anxiety symptoms, respectively, followed by network analysis to construct the interacting networks. The findings identified six edges of strongest regularized partial correlations in this network. Of these, three were depression symptoms and three were anxiety symptoms. The anxiety symptoms "Unable to control worry" and "Relaxation difficulty" and the depression symptom "Feeling depressed or hopeless" had the highest expected influence centrality. The analysis results also revealed three bridge symptoms: "Afraid something awful might happen", "Feeling of worthlessness", and "Trouble concentrating". As for "Suicidal ideation", the direct relations between this symptom and "Afraid something awful might happen" and "Feeling depressed or hopeless" were the strongest. The central and bridge symptoms of the interacting network of depression and anxiety symptoms in tinnitus sufferers can be considered a significant transdiagnostic intervention target for the management of this comorbidity. In particular, clinical prevention and psychotherapy should be implemented, targeting the symptoms that have the strongest associations with suicidal ideation.

Predicting Generalized Anxiety Disorder From Impromptu Speech Transcripts Using Context-Aware Transformer-Based Neural Networks: Model Evaluation Study.

The ability to automatically detect anxiety disorders from speech could be useful as a screening tool for an anxiety disorder. Prior studies have shown that individual words in textual transcripts of speech have an association with anxiety severity. Transformer-based neural networks are models that have been recently shown to have powerful predictive capabilities based on the context of more than one input word. Transformers detect linguistic patterns and can be separately trained to make specific predictions based on these patterns. This study aimed to determine whether a transformer-based language model can be used to screen for generalized anxiety disorder from impromptu speech transcripts. A total of 2000 participants provided an impromptu speech sample in response to a modified version of the Trier Social Stress Test (TSST). They also completed the Generalized Anxiety Disorder 7-item (GAD-7) scale. A transformer-based neural network model (pretrained on large textual corpora) was fine-tuned on the speech transcripts and the GAD-7 to predict whether a participant was above or below a screening threshold of the GAD-7. We reported the area under the receiver operating characteristic curve (AUROC) on the test data and compared the results with a baseline logistic regression model using the Linguistic Inquiry and Word Count (LIWC) features as input. Using the integrated gradient method to determine specific words that strongly affect the predictions, we inferred specific linguistic patterns that influence the predictions. The baseline LIWC-based logistic regression model had an AUROC value of 0.58. The fine-tuned transformer model achieved an AUROC value of 0.64. Specific words that were often implicated in the predictions were also dependent on the context. For example, the first-person singular pronoun "I" influenced toward an anxious prediction 88% of the time and a nonanxious prediction 12% of the time, depending on the context. Silent pauses in speech, also often implicated in predictions, influenced toward an anxious prediction 20% of the time and a nonanxious prediction 80% of the time. There is evidence that a transformer-based neural network model has increased predictive power compared with the single word-based LIWC model. We also showed that the use of specific words in a specific context-a linguistic pattern-is part of the reason for the better prediction. This suggests that such transformer-based models could play a useful role in anxiety screening systems.

Impact of Loneliness and Social Isolation on Mental Health Outcomes Among Individuals With Rheumatic Diseases During the COVID-19 Pandemic.

The study objective was to assess mental and social health outcomes for individuals with rheumatic disease during the COVID-19 pandemic and evaluate the relationship of loneliness and social isolation with depression and anxiety. We administered an international cross-sectional online survey to individuals with rheumatic disease(s) (≥18 years) between April 2020 and September 2020, with a follow-up survey from December 2020 to February 2021. We used questionnaires to evaluate loneliness (3-item UCLA Loneliness Scale [UCLA-3]), social isolation (Lubben Social Network Scale [LSNS-6]), depression (Patient Health Questionnaire [PHQ-9]), and anxiety (Generalized Anxiety Disorder 7-item [GAD-7] Scale). We used multivariable linear regression models to evaluate the cross-sectional associations of loneliness and social isolation with depression and anxiety at baseline. Seven hundred eighteen individuals (91.4% women, mean age: 45.4 ± 14.2 years) participated in the baseline survey, and 344 completed the follow-up survey. Overall, 51.1% of participants experienced loneliness (UCLA-3 score ≥6) and 30.3% experienced social isolation (LSNS-6 score <12) at baseline. Depression (PHQ-9 score ≥10) and anxiety (GAD-7 score ≥10) were experienced by 42.8% and 34.0% of participants at baseline, respectively. Multivariable models showed that experiencing both loneliness and social isolation, in comparison to experiencing neither, was significantly associated with an average 7.27 higher depression score (ß=7.27; 95% confidence interval [CI]: 6.08-8.47) and 5.14 higher anxiety score (ß=5.14; 95% CI: 4.00-6.28). Aside from showing substantial experience of loneliness and social isolation during the COVID-19 pandemic, our survey showed significant associations with depression and anxiety. Patient supports to address social health have potential implications for also supporting mental health.

Clinical and Psychosocial Outcomes Associated With a Tele-behavioral Health Platform for Families: Retrospective Study.

The burden of pediatric mental illness in the United States has steadily worsened over the past decade. A recent increase in employer-sponsored behavioral health programs has focused on the needs of the general population. However, these programs do not provide the specialty mental health care required for children, adolescents, and their families. This study aimed to evaluate the effects of a technology-enabled pediatric and family behavioral health service on clinical outcomes among children and caregiver strain. The service is available to commercially insured populations and provides educational content; tele-behavioral health care, including coaching, therapy, and psychiatry; and care escalation and coordination. A retrospective cohort analysis of members using the service between February and September 2022 was conducted. Clinical outcomes for children and their caregivers were collected using the Pediatric Symptom Checklist-17 (PSC-17), Generalized Anxiety Disorder 7-item (GAD-7), Patient Health Questionnaire 8-item (PHQ-8), and Caregiver Strain Questionnaire-Short Form 7 (CGSQ-SF7). Rates of reliable improvement were determined by calculating the reliable change index for each outcome. Paired, 2-tailed t tests were used to evaluate significant changes in assessment scores at follow-up compared to baseline. Of the 4139 participants who enrolled with the service, 48 (1.2%) were referred out for more intensive care, 2393 (57.8%) were referred to coaching, and 1698 (41%) were referred to therapy and psychiatry. Among the 703 members who completed the intervention and provided pre- and postintervention outcomes data, 386 (54.9%) used psychoeducational content, 345 (49.1%) received coaching, and 358 (50.9%) received therapy and psychiatry. In coaching, 75% (183/244) of participants showed reliable improvement on the PSC-17 total score, 72.5% (177/244) on the PSC-17 internalizing score, and 31.5% (105/333) on the CGSQ-SF7 total score (average improvement: PSC-17 total score, 3.37 points; P<.001; PSC-17 internalizing score, 1.58 points; P<.001; and CGSQ-SF7 total score, 1.02 points; P<.001). In therapy and psychiatry, 68.8% (232/337) of participants showed reliable improvement on the PSC-17 total score, 70.6% (238/337) on the PSC-17 internalizing score, 65.2% (219/336) on the CGSQ-SF7 total score, 70.7% (82/116) on the GAD-7 score, and 67.5% (77/114) on the PHQ-8 score (average improvement: PSC-17 total score, 3.16 points; P<.001; PSC-17 internalizing score, 1.66 points; P<.001; CGSQ-SF7 total score, 1.06 points; P<.001; GAD-7 score, 3.00 points; P<.001; and PHQ-8 score, 2.91 points; P<.001). Tele-behavioral health offerings can be effective in improving caregiver strain and psychosocial functioning and depression and anxiety symptoms in a pediatric population. Moreover, these digital mental health offerings may provide a scalable solution to children and their families who lack access to essential pediatric mental health services.

Emotional distress and burnout at a fever clinic in China: Comparison between different periods of COVID-19.

Frontline healthcare workers (FHWs) experienced psychological stress and heavy workload during COVID-19 pandemic. This study examined the psychological symptoms and occupational burnout of FHWs in a fever clinic during different periods of the pandemic. A cross-sectional survey of FHWs in the fever clinic of a tertiary hospital was carried out during both the outbreak period and regular period of COVID-19. Psychological measurement instruments including Generalized Anxiety Disorder 7-item, the 9-Question Patient Health Questionnaire, the Maslach Burnout Inventory-Human Service Survey, and the General Self-Efficacy Scale were used to evaluate anxiety, depression, burnout, and self-efficacy, respectively. The correlation between clinical variables was explored. A total of 162 participants were involved in this study, including 118 FHWs during the outbreak period (Group 1) and 44 FHWs during the regular period (Group 2). Anxiety symptoms were more prevalent in Group 2 (x 2 = 27.477) while depressive symptoms were significantly more prevalent in Group 1 (x 2 = 69.538). Burnout rate was higher in Group 2 (x 2 = 29.526). Self-efficacy was higher in Group 1 (t = 3.194). Burnout was positively correlated with anxiety symptoms (r 2 = 0.424) and negatively correlated with self-efficacy (r 2 = -0.312). Anxiety, depressive symptoms and burnout were prevalent in FHWs during different periods of the COVID-19 pandemic. There is a tendency to be less depressed, but more anxious and burned out over time, although the severity of the pandemic is decreasing. Self-efficacy may be an important factor in protecting FHWs from occupational burnout. Support and intervention plans for FHWs should be made at the institutional level.

Association between Mothers' Emotional Problems and Autistic Children's Behavioral Problems: The Moderating Effect of Parenting Style.

Mothers' emotional problems are associated with autistic children's behavioral problems. We aim to test whether parenting styles moderate associations between mothers' mood symptoms and autistic children's behavioral problems. A sample of 80 mother-autistic child dyads were enrolled at three rehabilitation facilities in Guangzhou, China. The Social Communication Questionnaire (SCQ) and the Strengths and Difficulties Questionnaire (SDQ) were used to collect the autistic symptoms and behavioral problems of the children. Mothers' depression and anxiety symptoms were measured using the Patient Health Questionnaire 9 (PHQ-9) and the General Anxiety Disorder 7-item (GAD-7) scale, respectively, and parenting styles were measured using the Parental Behavior Inventory (PBI). Our results show that mothers' anxiety symptoms were negatively associated with their children's prosocial behavior scores (β = -0.26, p < 0.05) but positively related to their social interaction scores (β = 0.31, p < 0.05). Supportive/engaged parenting styles positively moderated the effects of mothers' anxiety symptoms on their prosocial behavior score (β = 0.23, p = 0.026), whereas hostile/coercive parenting styles had a negative moderation (β = -0.23, p = 0.03). Moreover, hostile/coercive parenting styles positivity moderated the effects of mothers' anxiety symptoms on social interaction problems (β= 0.24, p < 0.05). The findings highlight, where mothers adopted a hostile/coercive parenting style while experiencing high anxiety, their autistic child may have more serious behavioral problems.

Prevalence and risk factors of anxious and depressive symptoms in first-trimester females and their partners: a study during the pandemic era of COVID-19 in China

BackgroundThe pandemic of coronavirus disease 2019 lastingly affects public mental health. Many studies have described symptoms of anxiety and depression in pregnant women before the pandemic. However, the limited study focuses on the prevalence and risk factors of mood symptoms among first-trimester females and their partners during the pandemic in China, which was the aim of the study.MethodsOne hundred and sixty-nine first-trimester couples were enrolled. The Edinburgh Postnatal Depression Scale, Patient Health Questionnaire-9, Generalized Anxiety Disorder 7-Item, Family Assessment Device-General Functioning (FAD-GF), and Quality of Life Enjoyment and Satisfaction Questionnaire, Short Form (Q-LES-Q-SF) were applied. Data were mainly analyzed through logistic regression analysis.Results17.75% and 5.92% of first-trimester females had depressive and anxious symptoms, respectively. Among partners, 11.83% and 9.47% had depressive and anxious symptoms, respectively. In females, higher scores of FAD-GF (OR = 5.46 and 13.09; P < 0.05) and lower scores of Q-LES-Q-SF (OR = 0.83 and 0.70; P < 0.01) were related to the risk of depressive and anxious symptoms. Higher scores of FAD-GF were associated with the risk of depressive and anxious symptoms in partners (OR = 3.95 and 6.89; P < 0.05). A history of smoking was also related to males’ depressive symptoms (OR = 4.49; P < 0.05).ConclusionThis study prompted prominent mood symptoms during the pandemic. Family functioning, quality of life, and smoking history increased risks of mood symptoms among early pregnant families, which facilitated the updating of medical intervention. However, the current study did not explore interventions based on these findings.

Effect of Psychological Intervention on Differentiated Thyroid Cancer Patients in the Treatment with Radioactive Iodine.

This study aimed to design a standard method of psychological intervention and evaluate the effect of such psychological intervention against the psychological distress of differentiated thyroid cancer (DTC) patients in the treatment with radioactive iodine. The enrolled patients were randomly divided into the intervention group and the control group. Both the patients in the 2 groups received the routine nursing care, while the patients in the intervention group also received the additional standard psychological interventions. The questionnaires including patient health questionnaire-9 (PHQ-9), generalized anxiety disorder 7-item (GAD-7), cancer fatigue scale (CFS) and positive and negative affect schedule (PANAS) were used to assess psychological status. These questionnaires were performed at week 0 (T0), week 8 (T1, immediately after the last time of intervention) and week 24 (T2, 16 weeks after the intervention). PHQ-9, GAD-7, CFS and Negative Affect (NA) scores measured at T1 and T2 in the intervention group were significantly lower than those in the control group (P < 0.001). And intervention group also had higher positive affect (PA) scores at T1 and T2 (P < 0.001). Furthermore, the changes of PHQ-9, GAD-7, CFS, PA and NA scores from T0 to T1 and T0 to T2 were more evident in the intervention group than in the control group. Psychological intervention could significantly improve psychological distress of DTC patients in the treatment with radioactive iodine.

Text4Hope Effectiveness in Reducing Psychological Symptoms among Young Adults in Canada: Longitudinal and Naturalistic Controlled Program Evaluation

Chronic stress, anxiety, and depression are psychological problems that can hurt young adults, interfering with their everyday function, academic achievement, and interpersonal relationships. This study aimed to assess the impact of Text4Hope, an online mental health service, on the psychological well-being of young adults. This study adopted both longitudinal and naturalistic controlled trial designs. It examined clinical outcomes in young adult (≤26 years old) subscribers of Text4Hope who completed surveys at baseline and six weeks and compared clinical parameters in two groups of subscribers. The first group comprised the intervention group (IG) (young adult subscribers who received once-daily supportive text messages for six weeks and completed sixth-week evaluation measures between 26 April and 12 July 2020), and the second group was the control group (CG) (young adult subscribers who joined Text4Hope in the same time frame and completed a baseline survey and were yet to receive any text messages). The prevalence of moderate to high stress, anxiety, and depression was measured at baseline and six weeks in the longitudinal study and between the two groups for the naturalistic controlled study using the Perceived Stress Scale (PSS-10), Generalized Anxiety Disorder 7-item (GAD-7), and Patient Health Questionnaire-9 (PHQ-9). Inferential statistics, including the t-test, McNemar test, chi-square, and binary logistic regression analyses, were used to evaluate the differences in the prevalence and severity of the psychological symptoms. In the longitudinal study, of the 9214 subscribers to Text4Hope who completed the baseline survey, 1047 (11.4%) were identified as youth. For the young adult subscribers who completed both the baseline and sixth-week surveys (n = 114), a significant reduction in the prevalence of moderate to high stress (8%) and likely GAD (20%) from baseline to six weeks was reported. Similarly, there was a significant reduction in the mean scores on the PSS-10, GAD-7, and Composite Mental Health score but not the PHQ-9 from baseline to six weeks. The largest reduction in mean scores was for the GAD-7 scale (18.4%), with a small effect size overall. For the naturalistic study, the IG included 173 young adult subscribers of Text4Hope who completed the sixth-week survey compared to 92 subscribers in the CG who completed the baseline survey during the designated period. There was a significantly lower prevalence for likely Moderate Depressive Disorder (MDD) (25.2%) and suicidal thoughts/thoughts of self-harm (48.4%), with a small effect size in the IG compared to the CG. Similarly, lower mean scores were reported for all outcome variables in the IG compared to the CG, with a small to medium effect size. The receipt of daily supportive text messages for six weeks resulted in significantly lower odds of both likely GAD and experiencing thoughts of self-harm or death wish while controlling for sociodemographic characteristics. The Text4Hope service is an effective tool for mental health support for young adult subscribers. Young adults receiving the service exhibited a reduction in psychological symptoms, including thoughts of self-harm or death wish. This population-level intervention program can be used to effectively support young adult mental health and in suicide prevention programs.

Apparent effective Text4Hope online mental health support for male subscribers during the COVID-19 pandemic- Naturalistic randomized controlled trial

IntroductionMental illness is not uncommon among males. While the estimates of the males who are dissatisfied with their lives, die by suicide, become alcohol-dependent and drug users are high, low numbers seek mental health support.ObjectivesIn this study, we aimed to assess Text4Hope, a texting mental health support service, provided to people in Alberta during the COVID-19 pandemic, and examine its effectiveness among male subscribers.MethodsIn a naturalistic randomized controlled trial design, a comparison was run between two populations of Text4Hope male subscribers; an intervention group (IG, Text4Hope subscribers who received once-daily supportive text messages for 6 weeks) and a control group (CG, Text4Hope subscribers who joined the program in the same time frame but were yet to receive text messages). The severity and the prevalence of likely stress, anxiety, and depression were examined between the two groups, using the Perceived Stress Scale (PSS-10), the Generalized Anxiety Disorder 7-item (GAD-7), and the Patient Health Questionnaire-9 (PHQ-9), and defined the Composite Mental Health (CMH) score as the sum of these three. T-test, Chi-squared association, and binary logistic regression analyses were applied.ResultsThere were 286 male subscribers to Text4Hope. The majority were above 40 years, white, employed, had postsecondary education, were in a relationship, and owned a home. Mean scores of PSS-10, GAD-7, and PHQ-9 scales and the CMH were significantly higher for the CG compared to the IG, 11.4, 28.8, 25.8, and 18.7%, respectively. Similarly, there was a statistically significant lower prevalence in IG, compared to the CG, on likely MDD (58.15 vs. 37.4%) and likely GAD (50 vs. 30.8%), with a small effect size. The IG was a significant predictor for lower odds of both likely MDD and likely GAD while controlling for sociodemographic characteristics.ConclusionsText4Hope is an effective tool for mental health support for male subscribers, during the COVID-19 pandemic. Compared to the subscribers who didn’t receive the service, those who received it were in a better mental health condition. Further efforts are still needed to encourage males to participate in such online services that can provide adequate support, particularly during crisis time.Disclosure of InterestNone Declared

Quality of sleep among healthcare workers treating patients with coronavirus disease-19

IntroductionSince the declaration of the first Covid-19 case on December 08th ,2019, and to curb the spread of this pandemic, each country and notably Tunisia, has implemented a preventive strategy dominated by general lockdowns in accordance with social distancing and basic hygiene measures. These measures were not applicable in the health care sector as health care workers are at the forefront in the fight against COVID-19. This condition affects not only their physical health caused by elevated workload, but also their mental health causing anxiety, fear, and depression. Previous studies have reported that health care professionals feel stigmatized, experience high levels of anxiety and symptoms of depression, and have sleep problems. Impaired Quality of Sleep (QoS) can affect their efficiency in providing medical services and adequate psychological support for patients suffering from COVID-19.ObjectivesTo evaluate the QoS among health care professionals treating patients with COVID-19 and quantifying the symptoms of depression and levels of anxiety.MethodsA cross-sectional study was conducted in 75 health care professionals matched by age and sex working in public hospital Taher Sfar Mahdia. The study was based in a self administred, French language questionnaire containing three validated questionnaires: 7-item Generalized Anxiety Disorder (GAD-7) Scale, 9-items Patient Health Questionnaire (PHQ-9) Scale, Pittsburgh Sleep Quality Index (PSQI) and additional survey constructed for the purpose of the study.ResultsHealthcare professional treating COVID-19 patients (Group I) group was predominately females mean aged of 32.67±7.04. The health professionals treating COVID-19 patients had poorer Quality of Sleep; Pittsburgh score 10.6 ± 742 vs 7.89 ± 6.14 in the group not treating COVID-19 patients ( p=0.001). Levels of anxiety and depression were significantly higher in the group I (respectively p=0.005 and 0.03). Multiple linear regression analysis revealed that higher scores on GAD (beta = .809, p &lt; .01) and the lower one was the number of persons in charge (beta = –0.632; p &lt; .01) were independent predictors of a poorer quality of sleepConclusionsThis study has revealed the heavy mental health burden health care professionals treating infected patients in Tunisia during the COVID-19 pandemic are exposed to. Providing early psychological support and a psychologically safe environment for these healthcare workers may alleviate their stress and, consequently, ameliorate their QoS. More attention should be devoted to their quality of sleep and work schedules. In many countries, online training, telehealth supports, behavioral group therapy, cognitive behavioral therapy, and mindfulness-based therapy have been deployed for frontier Healthcare workers and have proven effective in such circumstances.Disclosure of InterestNone Declared

Relationship between Glycated Hemoglobin (HbA1c) in Adolescents with Type 1 Diabetes Mellitus (T1DM) and Parental Anxiety and Depression

IntroductionT1D is the most common chronic endocrine pathology in children. The management of type 1 diabetes requires strong diet, physical activity, lifelong insulin therapy, and proper self-monitoring of blood glucose and is usually complicated and, therefore may result in a psychosocial problem for the whole family. Metabolic control of the disease is determined by glycated haemoglobin (HbA1c), the main criterion for diabetes compensation. It is assumed that anxiety and depression symptoms negatively affect glycemic control. A correlation was observed between anxiety and depression level and glycaemic control, as well as a three-way interaction among HbA1c, frequency of blood glucose monitoring, and diabetes-related stress (Buchberger et al., 2016). Parental psychological distress was associated with higher child self-report of stress and depressive symptoms, and it had negative effects on diabetes management.ObjectivesTo evaluate the relationship between parental depression and anxiety and metabolic control of their adolescents with T1DM.MethodsThe cross-sectional study recruited adolescents with T1D (N=251) and their parents (N=251). The 7-item Generalized Anxiety Disorder (GAD-7) scale measured anxiety level. The Patient Health Questionnaire – 9 (PHQ-9) detected depressive symptoms. Glycaemic control of patients was assessed using the last glycated haemoglobin (HbA1c) values. GLM mediation analysis was performed to determine the potential mediating effect of parent’ mental health depression and anxiety on the relationship between depression and anxiety of child on the level of HbA1c.Results502 respondents were eligible for screening. Mediation analysis was performed to assess the mediating role of parent GAD-7 on the linkage between HbA1c and child GAD-7 and child PHQ-9. the results relevated that the total effect of child GAD-7 on HbA1c was significant but the total effect of child PHQ-9 was not significant. With the inclusion of the mediating variable (parent GAD-7) (Figure 1), the impact of child GAD-7 and child PHQ-9 was founding insignificant (p ≥ 0.05) but the indirect effect of child GAD-7 and child PHQ-9 on HbA1c though parent GAD-7 was found significant (p ≤ 0,01) (Table 1). This indicates that the relationship between HbA1c and child GAD-7 and PHQ-9 is fully mediated by parent GAD-7.Image:Image 2:ConclusionsGlycated haemoglobin in adolescents with Type 1 diabetes is related to adolescents’ mental health via parents’ anxiety. It means that parents’ anxiety plays more significant role in the level of glycated haemoglobin in adolescents than depression and anxiety of the adolescent.Disclosure of InterestNone Declared

Factors Influencing the Level of Depression and Anxiety of Community-Dwelling Patients with Schizophrenia in China during the COVID-19 Pandemic.

Using a cross-sectional survey, we collected 15,165 questionnaires. Assessments included demographic information, concern about COVID-19-related information, sleep status, anxiety and depressive symptoms, and accompanying illnesses. The 7-item Generalized Anxiety Disorder (GAD-7) and the 9-item Patient Health Questionnaire (PHQ-9) were used to evaluate depression and anxiety levels. Group comparison was conducted by t-test, ANOVA, or chi-square test wherever suitable, with Bonferroni pairwise correction. Multivariate logistic regression was performed to identify predictors for anxiety and depression. 16.9% of patients had at least moderate anxiety, and 34.9% had at least moderate depression. T-test showed that females scored higher on GAD-7 and PHQ-9 than males, and patients without accompanying long-standing diseases, who were not concerned about COVID-19, had lower GAD-7 and PHQ-9 scores. ANOVA showed that participants aged from 30 to 39, with higher education scored higher on GAD-7, and patients with better sleep, and having less concern about COVID-19, had lower GAD-7 and PHQ-9 scores. Regression analysis indicated that participant ages of 30-39 and 40-49 positively predicted anxiety, whereas patient ages of 30-39 years positively predicted depression. Patients with poor sleep, accompanying diseases, and concern about the COVID-19 pandemic were more likely to experience anxiety and depression. During the pandemic, Chinese community-dwelling patients with schizophrenia had high rates of anxiety and depression. These patients deserve clinical attention and psychological intervention, especially those with risk factors.

Impact of the COVID-19 pandemic on women's perinatal mental health and its association with personality traits: An observational study.

The burden of perinatal mental health problems was expected to increase during the COVID-19 pandemic. We prospectively investigated the impact of the COVID-19 pandemic on the mental health of pregnant and postpartum women in Norway and explored associations with their sociodemographic characteristics and personality traits. Sociodemographic information and the self-reported impact of pandemic on wellbeing of pregnant women was collected using an online survey. To assess women's mental health, two validated questionnaires, the Edinburgh Postpartum Depression Scale (EPDS) and the Generalized Anxiety Disorder-7 item Scale (GAD-7), were used prenatally and postnatally. Personality traits were evaluated using HumanGuide, a web-based ipsative psychological evaluation instrument. 772 women were included prenatally, of which 526 also responded to the survey 4-6 weeks postnatally. The median age was 29 years, 53.6% of the women were nulliparous when enrolled, and 35.1% worked in the healthcare sector. The median EPDS (6.0; interquartile range [IQR] 3.0-10.0 vs 6.0; IQR: 3.0-10.0) and the median GAD-7 (5.0; IQR 2.0-9.0 vs 5.0; IQR 2.0-9.0) were similar pre-and postnatally. Prenatally, the proportion of women scoring ≥13 on EPDS and ≥10 on GAD-7 was 14.5% (112/772) and 21.5% (166/772), whereas the postnatal figures were 15.6% (82/526) and 21.5% (113/526), respectively. The differences were not significant (P=0.59 and P=0.99). Being <25 years of age, being on pre-pregnancy psychotherapy or psychotropic medication, frequent voluntary isolation, perception of maternity care not proceeding normally, avoiding seeking medical assistance due to fear of infection and having negative economic consequences during the COVID19 pandemic significantly increased the risk of both anxiety (GAD-7 ≥10) and depression (EPDS ≥13). Nullipara had a higher risk of anxiety, whereas being a healthcare worker had a lower risk. The personality trait factors Power (P=0.008), Quality (P=0.008), Stability (P < 0.001) and Contacts (P < 0.001) were significant predictors of depression among pregnant women, whereas the Quality (P=0.005) and Contacts (P=0.003) were significant predictors of anxiety. During the initial phase of the COVID-19 pandemic, the prevalence of depression (EPDS ≥ 13) and anxiety (GAD-7 ≥ 10) was 14.5% and 21.5%, respectively, among Norwegian pregnant women. Certain sociodemographic characteristics and personality traits were significant predictors of depression and anxiety.