7-item Generalized Anxiety Disorder Research Articles

P158: Efficacy of a self-help cognitive-behavioral therapy (GSH-CBT) guided by lay providers for generalized anxiety disorder (GAD) in older adults: preliminary results

Background:Only a small proportion of older adults with generalized anxiety disorder (GAD) seek professional help. One reason is the lack of access to mental health professionals licensed to provide psychotherapy. One way to improve access to psychotherapy is through guided self- help (GSH). GSH based on the principles of cognitive-behavior therapy (GSH-CBT) can be guided by trained lay providers (LPs). The purpose of this poster is to report preliminary results from a multisite randomized controlled trial testing the efficacy of a GSH-CBT guided by LPs for GAD in older adults.Methods:The sample included 150 participants (≥ 60 years old) with a diagnosis of threshold or subthreshold GAD randomly assigned to: 1) GSH-CBT guided by LPs (n = 75) or 2) waiting list (n = 75). The GSH-CBT lasted 15 weeks. Participants used a manual presenting weekly reading and at-home exercises. They also received weekly support calls (30 minutes maximum) by LPs (undergraduate psychology students) supervised by psychologists. Repeated-measures regression models were used to compare changes in the groups before and after 15 weeks on three outcomes: severity of GAD symptoms (Generalized Anxiety Disorder 7-item; GAD-7), tendency to worry (Penn State Worry Questionnaire; PSWQ), and level of anxiety (Geriatric Anxiety Inventory; GAI).Results:At the first assessment, both groups were similar in terms of age, sex, level of education, marital status, occupation, and did not differ significantly on outcomes. The GSH- CBT group decreased significantly on all three outcomes (GAD-7: -4.8, 95% CI [-5.7, -3.8], PSWQ: -11.7; 95% CI [-13.6, -9.9], GAI: -5.3 95% CI [-6.5, -4.1]) while the waiting list group remained stable over 15 weeks (GAD-7: -0.3, 95% CI [-1.2, 0.6], PSWQ: 0.7; 95% CI [-1.2, 2.5], GAI: -0.7 95% CI [-1.9, -0.5]).Conclusions:GSH-CBT guided by LPs appears to be an effective intervention for reducing severity of GAD symptoms, tendency to worry, and level of anxiety in older people with GAD. Further analyses will be conducted to test whether the intervention differs in efficacy between participants with a threshold vs. subthreshold GAD. The maintenance of long-term gains (6 and 12 months after the intervention) will also be tested.

The Association Between Nicotine Dependence and Mental Health in the General Population of Saudi Arabia: A Cross-Sectional Analytical Study.

High prevalence of mental disorders is associated with psychoactive substances, significantly contributing to morbidity, disability, and premature mortality. Worldwide, individuals who use electronic-cigarettes (EC) and have a mental health diagnosis are more likely to experience stress, depression, and drug use. This study aims to measure the prevalence of both EC use and mental health disorders namely, anxiety and depression additionally to investigate the association between EC use and mental health status among the general population of Saudi Arabia. A cross-sectional analytical study was conducted across Saudi Arabia from November 2022 to May 2023. The survey was divided into three sections. The first section focuses on the demographics, while the second part asked about both conventional and EC smoking and their frequency. The third section assessed mental health status using a Patient Health Questionnaire with a 9-item depression scale (PHQ-9) and a 7-item Generalized Anxiety Disorder scale (GAD-7). The study revealed 21.1% reporting EC use in the past thirty days. While 19.8% reported smoking tobacco one or more days within the last thirty days. Regarding mental health, 36.6% of individuals had minimal anxiety, while 42.4% experienced mild anxiety. Moreover, most of the participant were considered to have mild followed by minimal depression accounting for 36.7% and 31.9%, respectively. The results indicated a positive and significant correlation between perceived depression scores and nicotine dependence among EC users. Additionally, there was a strong relationship between gender and nicotine dependence, with men being more inclined than women. There is a correlation between nicotine use and mental health outcomes; people who use nicotine products are more likely to experience anxiety and depression.

Association of Long-Term HbA1c Variability with Anxiety and Depression in Patients with Type 2 Diabetes: A Cross-Sectional Retrospective Study.

To explore the relationship between long-term glycemic variability and anxiety and depression in patients with type 2 diabetes. A cohort comprising 214 individuals diagnosed with type 2 diabetes participated in this study. Comprehensive demographic and laboratory information was gathered for them. The evaluation of anxiety relied on the 7-item Generalized Anxiety Disorder Scale (GAD-7), while depression was assessed utilizing the 9-item Health Questionnaire (PHQ-9). Based on the presence or absence of anxiety and depression, participants were categorized into either the mood disorder or control groups. Subsequently, univariate and stepwise multiple binary logistic regression analyses were conducted to investigate the potential correlations between factors and the presence of anxiety and depression. The prevalence of anxiety disorders is 23%, and depression is 32%. The prevalence of smoking, diabetic autonomic neuropathy, stroke, and osteoporosis in the mood disorder group was significantly higher than that in the control group (P < 0.05), the glycated hemoglobin A1c variability score (HVS), mean hemoglobin A1c value, total cholesterol, urinary albumin/creatinine and systemic immune-inflammatory index (SII) were significantly higher in the control group (P < 0.05). The level of high-density lipoprotein in the mood disorder group was significantly lower than the control group (P < 0.05). In stepwise multiple binary logistic regression analyses, the main factors associated with anxiety were depression (P < 0.001, OR=117.581) and gender (P < 0.001, OR=9.466), and the main factors related to depression included anxiety (P < 0.001, OR=49.424), smoking (P=0.042, OR=2.728), HVS (P=0.004, OR=8.664), and SII (P=0.014, OR=1.002). Persistent fluctuations in blood glucose levels have been linked to anxiety and depression. Consequently, maintaining an optimal level of glycemic control and minimizing fluctuations becomes imperative in the comprehensive management of diabetes.

Relation Between Family Environment, Life Satisfaction, Depression and Anxiety

The background of this study is that as the standard of living and stress increases, most people begin to be dissatisfied with their current lives. And there is a gradual increase in the occurrence of mental health problems in people, especially depression and generalised anxiety disorder (GAD). Thus, this study intends to investigate the effect of the interaction of life satisfaction and family environment on individual depression and anxiety. A cross-sectional survey method was used to administer the questionnaire to 121 respondents. The Index of Life Satisfaction Scale(LSIA), Depression Scale(PHQ-9), 7-Item Generalized Anxiety Disorder Scale(GAD-7), and Family Environment Scale(FES) were used to investigate the relationship between current life satisfaction, family environment, and individual depression and anxiety. The results shows that life satisfaction index was significantly associated with depression and anxiety (p&lt;0.05). In addition, anxiety was significantly associated with family members are always give each other the greatest help and support (p=0.008), family members always openly expressing their feelings for each other (p=0.030); depression was significantly associated with family members are always give each other the greatest help and support (p=0.025), members often quarrel at home (p=0.002), there is a kind of harmony and consistency in family (p=0.015), and family members are all heartily supportive of each other(p=0.032). Thus, life satisfaction index affects anxiety and depression, and some family environment situations are significantly associated with the development of anxiety and depression.

Long-Term Efficacy of a Mobile Mental Wellness Program: Prospective Single-Arm Study.

Rising rates of psychological distress (symptoms of depression, anxiety, and stress) among adults in the United States necessitate effective mental wellness interventions. Despite the prevalence of smartphone app-based programs, research on their efficacy is limited, with only 14% showing clinically validated evidence. Our study evaluates Noom Mood, a commercially available smartphone-based app that uses cognitive behavioral therapy and mindfulness-based programming. In this study, we address gaps in the existing literature by examining postintervention outcomes and the broader impact on mental wellness. Noom Mood is a smartphone-based mental wellness program designed to be used by the general population. This prospective study evaluates the efficacy and postintervention outcomes of Noom Mood. We aim to address the rising psychological distress among adults in the United States. A 1-arm study design was used, with participants having access to the Noom Mood program for 16 weeks (N=273). Surveys were conducted at baseline, week 4, week 8, week 12, week 16, and week 32 (16 weeks' postprogram follow-up). This study assessed a range of mental health outcomes, including anxiety symptoms, depressive symptoms, perceived stress, well-being, quality of life, coping, emotion regulation, sleep, and workplace productivity (absenteeism or presenteeism). The mean age of participants was 40.5 (SD 11.7) years. Statistically significant improvements in anxiety symptoms, depressive symptoms, and perceived stress were observed by week 4 and maintained through the 16-week intervention and the 32-week follow-up. The largest changes were observed in the first 4 weeks (29% lower, 25% lower, and 15% lower for anxiety symptoms, depressive symptoms, and perceived stress, respectively), and only small improvements were observed afterward. Reductions in clinically relevant anxiety (7-item generalized anxiety disorder scale) and depression (8-item Patient Health Questionnaire depression scale) criteria were also maintained from program initiation through the 16-week intervention and the 32-week follow-up. Work productivity also showed statistically significant results, with participants gaining 2.57 productive work days from baseline at 16 weeks, and remaining relatively stable (2.23 productive work days gained) at follow-up (32 weeks). Additionally, effects across all coping, sleep disturbance (23% lower at 32 weeks), and emotion dysregulation variables exhibited positive and significant trends at all time points (15% higher, 23% lower, and 25% higher respectively at 32 weeks). This study contributes insights into the promising positive impact of Noom Mood on mental health and well-being outcomes, extending beyond the intervention phase. Though more rigorous studies are necessary to understand the mechanism of action at play, this exploratory study addresses critical gaps in the literature, highlighting the potential of smartphone-based mental wellness programs to lessen barriers to mental health support and improve diverse dimensions of well-being. Future research should explore the scalability, feasibility, and long-term adherence of such interventions across diverse populations.

Experiential avoidance and obsessive-compulsive symptoms in University students

Experiential avoidance is functional diagnostic dimension which refers to the unwillingness to engage with distressing thoughts, feelings, memories, and other internal experiences, despite the subsequent impairment it may cause. The spectrum of obsessive-compulsive symptoms (OCS) is often associated with anxiety and avoidant behaviors. It is still unknown the relation of each OCD dimension with experiential avoidance. This study aims to examine the relationship between dimensions of obsessive-compulsive symptoms and experiential avoidance in a college student sample. A total of 390 undergraduate students participated in this investigation, completing online surveys including DYBOC-short version and the Brief Experiential Avoidance Questionnaire (BEAQ), alongside assessments of anxiety (Generalized Anxiety Disorder 7-Item Scale) and depressive symptoms (Patient Health Questionnaire-9). The findings indicated a significant correlation between experiential avoidance, obsessive-compulsive symptom scores, and depression scores within a non-clinical sample.

Digitally Enabled Peer Support Intervention to Address Loneliness and Mental Health: Prospective Cohort Analysis.

Social isolation and loneliness affect 61% of US adults and are associated with significant increases in excessive mental and physical morbidity and mortality. Annual health care spending is US $1643 higher for socially isolated individuals than for those not socially isolated. We prospectively evaluated the effects of participation with a digitally enabled peer support intervention on loneliness, depression, anxiety, and health-related quality of life among adults with loneliness. Adults aged 18 years and older living in Colorado were recruited to participate in a peer support program via social media campaigns. The intervention included peer support, group coaching, the ability to become a peer helper, and referral to other behavioral health resources. Participants were asked to complete surveys at baseline, 30, 60, and 90 days, which included questions from the validated University of California, Los Angeles Loneliness Scale, Patient Health Questionnaire 2-Item Scale, General Anxiety Disorder 7-Item Scale, and a 2-item measure assessing unhealthy days due to physical condition and mental condition. A growth curve modeling procedure using multilevel regression analyses was conducted to test for linear changes in the outcome variables from baseline to the end of the intervention. In total, 815 ethnically and socially diverse participants completed registration (mean age 38, SD 12.7; range 18-70 years; female: n=310, 38%; White: n=438, 53.7%; Hispanic: n=133, 16.3%; Black: n=51, 6.3%; n=263, 56.1% had a high social vulnerability score). Participants most commonly joined the following peer communities: loneliness (n=220, 27%), building self-esteem (n=187, 23%), coping with depression (n=179, 22%), and anxiety (n=114, 14%). Program engagement was high, with 90% (n=733) engaged with the platform at 60 days and 86% (n=701) at 90 days. There was a statistically (P<.001 for all outcomes) and clinically significant improvement in all clinical outcomes of interest: a 14.6% (mean 6.47) decrease in loneliness at 90 days; a 50.1% (mean 1.89) decline in depression symptoms at 90 days; a 29% (mean 1.42) reduction in anxiety symptoms at 90 days; and a 13% (mean 21.35) improvement in health-related quality of life at 90 days. Based on changes in health-related quality of life, we estimated a reduction in annual medical costs of US $615 per participant. The program was successful in referring participants to behavioral health educational resources, with 27% (n=217) of participants accessing a resource about how to best support those experiencing psychological distress and 15% (n=45) of women accessing a program about the risks of excessive alcohol use. Our results suggest that a digitally enabled peer support program can be effective in addressing loneliness, depression, anxiety, and health-related quality of life among a diverse population of adults with loneliness. Moreover, it holds promise as a tool for identifying and referring members to relevant behavioral health resources.

Think Before You Ink: Perception, Prevalence, and Correlates of Tattooing and Tattoo Regret in US Adults.

Introduction Few population-based studies have examined the perception and prevalence of tattoos and tattoo regret in the general United States (US) adult population. Our objective was to report the perception of people with tattoos and describe the prevalence, socio-demographics, health-related quality of life, and the extent of tattoo regret in US adults. Methods Data were assessed from a cross-sectional study of US adults. Participants were recruited using a random stratified sampling framework similar to the US Census. Data collected for all participants included socio-demographic and clinical characteristics, general health-related quality of life (Veterans RAND 12-item), depression (Patient Health Questionnaire 9-item), anxiety (Generalized Anxiety Disorder 7-item), and perceptions of those with tattoos. Those with tattoos also answered questions about their tattoo(s), including age when first tattooed, reasons for getting a tattoo, and tattoo regret. Categorical data were described by percentages, and continuous data by mean and standard deviation. Proportions were compared with Chi-squared testsand the means with ANOVA. A logistic regression controlling for confounding variables was carried out to assess factors predictive of tattoo regret. Results Of the 3033 participants, 35.3% (1,072) reported having a tattoo. Those more likely to have a tattoo were female (58% vs. 45%), younger (38 vs. 46 years), smoked cigarettes (38% vs. 19% non-smoker), and/or reported analcohol or drug problem (10% vs. 5%). Those without tattoos were more likely to perceive those with tattoos as less attractive, intelligent, professional, and more rebellious. More time (in years) with a tattoo, having a tattoo on the face, neck, hands, wrist, or fingers, getting a tattoo because of peer pressure, being impaired when getting a tattoo, and experiencing an adverse event related to a tattoo were predictive of tattoo regret. Older age and remembrance as the reason for a tattoo were predictive of not having tattoo regret. Conclusion More than one-third of the studysample comprised of adults in the US reported having at least one tattoo. While most people, regardless of their tattoo status, perceived tattooed and non-tattooed individuals equally, tattooed individuals were more likely to be perceived negatively than positively by those without tattoos. Whether tattooed or not, being aware of varying perceptions of tattoo status may be helpful in facilitating positive outcomes.

Effects of Bullying on Anxiety, Depression, and Posttraumatic Stress Disorder Among Sexual Minority Youths: Network Analysis

Background Bullying victimization is highly prevalent among sexual minority youths, particularly in educational settings, negatively affecting their mental health. However, previous studies have scarcely explored the symptomatic relationships among anxiety, depression, and posttraumatic stress disorder (PTSD) among sexual minority youths who experienced bullying on college campuses. Objective The objectives of our study were to (1) characterize the anxiety-depression-PTSD network structures of gay or lesbian, bisexuals, and other sexual minority youths previously bullied on college campuses; and (2) compare symptomatic associations in the anxiety-depression-PTSD networks among bullied sexual minority youths and heterosexual youths’ groups. Methods This cross-sectional study recruited college participants from Jilin Province, China. Data were analyzed using a subset of the data extracted after screening for sexual orientation and history of bullying victimization. Sexual minority youths were then divided into 3 subgroups: gay or lesbian (homosexual), bisexual, and other. Mental health symptom severity was assessed using scales: the 7-item Generalized Anxiety Disorder Scale measuring anxiety, the 9-item Patient Health Questionnaire measuring depression, and the 10-item Trauma Screening Questionnaire measuring PTSD symptoms. Combining the undirected and Bayesian network analyses, the anxiety-depression-PTSD networks were compared among sexual minority youths subgroups, and the difference between heterosexual youths and sexual minority youths was investigated. Chi-square tests were used to compare the difference in categorical variables, while independent-sample t tests were run on continuous variables. Results In this large-scale sample of 89,342 participants, 12,249 identified as sexual minority youths, of which 1603 (13.1%, 95% CI 12.5%-13.7%) reported being bullied on college campuses in the past year. According to the expected influence (EI) and bridge expected influence (bEI) index, in the global network structure of anxiety, depression, and PTSD, sad mood (EI=1.078, bEI=0.635) and irritability (EI=1.077, bEI=0.954) were identified as central and bridge symptoms; emotional cue reactivity (EI=1.015) was a central symptom of PTSD in this global network. In the anxiety-depression-PTSD Bayesian network, anhedonia had the highest prediction priority for activating other symptoms; and feeling afraid linked symptoms from anxiety to the PTSD community. Compared to their heterosexual counterparts, sexual minority youths exhibited a stronger association between difficulty concentrating and appetite. The “sad mood-appetite” edge was strongest in the gay or lesbian network; the “irritability-exaggerated startle response” edge was strongest in the bisexual network. Conclusions For the first time, this study identified the most central and bridge symptoms (sad mood and irritability) within the depression-anxiety-PTSD network of sexual minority youths with past bullying-victim experiences on college campuses. Emotional cue reactivity, anhedonia, and feeling afraid were other vital symptoms in the comorbid network. Symptomatic relationships existed showing heterogeneity in bullied heterosexual youths and sexual minority youth networks, which also was present within the sexual minority youth subgroups. Consequently, refined targeted interventions are required to relieve anxiety, depression, and PTSD symptoms.

47 The Impact of COVID-19 Infection on Objective and Subjective Cognitive Functioning: Resilience as a Protective Factor

Objective:Growing evidence indicates that COVID-19 infection adversely impacts cognitive functioning, with COVID-19 patients demonstrating high rates of objective and subjective cognitive impairments (Daroische et al., 2020; Miskowiak et al., 2021). Given the prevalence and potentially debilitating nature of post-COVID-19 cognitive symptoms, understanding factors that mitigate the impact of COVID-19 infection on cognitive functioning is paramount to developing interventions that facilitate recovery. Resilience, the ability to cope with and grow from challenges, has been associated with improved cognitive performance in healthy adults and linked to decreased perceived cognitive difficulties in post-COVID-19 patients (Connor &amp; Davidson, 2003; Deng et al., 2018; Jung et al., 2021). However, resilience has not yet been examined as a potential attenuator of the relationship between COVID-19 and either perceived or objective cognitive function. This study aims to investigate the role of resilience as a protective factor against experience of cognitive function difficulties in COVID-19 patients by probing the role of resilience as a moderator of the relationship between COVID-19 diagnosis and cognitive functioning (both perceived and objective).Participants and Methods:Participants (mean age=36.93, 30.10% male) were recruited from British Columbia and Ontario. The sample included 53 adults who had never been diagnosed with COVID-19 and 50 adults diagnosed with symptomatic COVID-19 at least three months prior and not ventilated. Participants completed online questionnaires (n=103) to assess depression (the Center for Epidemiological Studies Depression Scale), anxiety (7-item Generalized Anxiety Disorder Scale), subjective cognitive functioning (The Subjective Cognitive Decline Questionnaire), and resilience (2-item Connor-Davidson Resilience Scale). Participants then completed neuropsychological tests (n=82) measuring attention, processing speed, memory, language, visuospatial skills, and executive function via teleconference, with scores averaged to create a global objective cognition score. Moderated multiple regression was employed to assess the impact of resilience on the relationship between COVID-19 diagnosis and both objective and perceived cognition, controlling for gender, ethnicity, income, age, anxiety, and depression.Results:Average scores in the COVID-19 group exceeded diagnostic cut-offs for clinical depression (M=16.67, SD=10.77) and mild anxiety (M=5.27, SD=4.99), while the control group scored below diagnostic thresholds for depression (M=11.96, SD=9.76) and mild anxiety (M=4.48, SD=5.07). Controlling for sociodemographic and mental health characteristics, COVID-19 diagnosis was not associated with objective global cognitive functioning (b=-.07, se=1.71, p=.624) or subjective cognitive functioning (b=.16, se=1.32, p=.12), nor was resilience associated with objective global cognitive functioning (b=.19, se=1.50, p=.44) or subjective cognitive functioning (b=-.02, se=1.09, p=.89).Conclusions:Findings indicate that COVID-19 patients may be at risk for depression and anxiety. Results of this study fail to support a relationship between COVID-19 and cognitive functioning beyond the impact of sociodemographic and mental health variables. Thus, the role of resilience as a protective factor against COVID-19 related cognitive difficulties could not be fully explored. However, findings should be considered in the context of study limitations, including a small sample size. Future research should employ larger samples to further examine the relationship between COVID-19 infection and cognition, focusing on mental health characteristics and resilience as potential risk and protective factors.

Depression and anxiety symptoms among Vietnamese migrants in Japan during the COVID-19 pandemic

This study aimed to examine the mental health status and related factors among Vietnamese migrants in Japan during the COVID-19 pandemic. We conducted an online cross-sectional survey between September 21 and October 21, 2021. Along with Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder 7-item (GAD-7) scores, we collected data on demographics, changes in socioeconomic status due to the pandemic, language proficiency, social support, and health conditions. Multivariate logistic regression was performed to identify factors related to symptoms of depression and anxiety. Among 621 participants who completed the questionnaire, moderate-to-severe symptoms of depression (PHQ-9 score ≥ 10 points) and mild-to-severe symptoms of anxiety (GAD-7 score ≥ 5 points) were observed in 203 (32.7%) and 285 (45.9%) individuals, respectively. Factors related to depressive symptoms were age (95% confidence interval [CI]=0.89-0.99), pre-existing health conditions (95% [CI]=1.61–3.76), and a low subjective socioeconomic status (95% [CI]=1.64–3.71). Factors related to anxiety symptoms were being single (95% [CI]=1.01–2.93), having pre-existing health conditions (95% [CI]=1.63–3.88), subjective socioeconomic status (95% [CI]=1.87–3.97), and absence of a partner to discuss one’s health with (95% [CI]=1.11–2.47). Vietnamese migrants in Japan experienced a decrease in income, worsening working conditions, and poor mental health status during the COVID-19 pandemic. Further investigations are necessary to find an effective way to increase their social support and mitigate socioeconomic adversities.

Mental health and care utilization in survivors of adolescent and young adult cancer.

Adolescent and young adult cancer survivors experience mental health challenges, yet little is known about the evolution of these difficulties. This study explored mental health symptoms and utilization among long-term adolescent and young adult cancer survivors. Using 30 432 respondents from the 2019 National Health Interview Survey, this study compared adults with a history of adolescent and young adult cancer (diagnosed when patients were between 15 and 39 years of age) to adults without adolescent and young adult cancer. Mental health symptom severity was measured using the Patient Health Questionnaire depression scale and 7-item Generalized Anxiety Disorder questionnaires. Care utilization constituted psychotherapy and mental health medication use. Inverse propensity score weights were used to balance demographics and combined with survey weights. Descriptive statistics, multivariable generalized linear models, and structural equation modeling with 2-sided tests were used for analysis. We compared 639 adolescent and young adult survivors with 29 793 controls. Survivors were, on average, 20.5 years (SE = 0.74) past their cancer diagnosis dates. After adjusting for survey and propensity score weights, adolescent and young adult survivors reported more severe depression (incidence rate ratio = 1.42, 95% confidence interval [CI] = 1.09 to 1.84, P < .01) and anxiety (incidence rate ratio = 1.85, 95% CI = 1.55 to 2.21, P < .001). They were more likely to use psychotherapy (odds ratio = 1.91, 95% CI = 1.16 to 3.17, P < .05) and mental health medications (odds ratio = 1.89, 95% CI = 1.15 to 3.11, P < .05). Time since diagnosis was negatively associated with symptoms and utilization. Structural equation modeling demonstrated mediation of utilization effect by symptom severity. Adolescent and young adult survivors experience worse mental health in late survivorship, despite small improvements over time. We highlight the importance of survivorship care that addresses the long-term mental health needs of these survivors.

The Arabic Hospital Anxiety and Depression Scale: validation in a sample of Lebanese patients with cancer

BackgroundDepression and anxiety are common comorbid psychological disorders among patients with cancer. Despite the wide use of the Arabic Hospital and Anxiety Scale (HADS) in oncological settings, it has not been yet validated among Lebanese patients with cancer. We aimed to assess the reliability and validity of the HADS in a sample of Lebanese patients with cancer. One-hundred one Lebanese patients diagnosed with cancer presenting to the Ambulatory Care Center in the Hematology Oncology Department at the American University of Beirut Medial Center filled the Arabic version of the HADS. The Generalized Anxiety Disorder 7-Item Scale (GAD-7) and the Patient Health Questionnaire 9-Item Scale (PHQ-9) were used to assess its concurrent validity in capturing anxiety and depression, respectively.ResultsReliability analysis using Cronbach’s alpha (α) coefficient revealed good internal consistency for the Arabic HADS (α = 0.89) and both subscales (α = 0.86 for depression and α = 0.78 for anxiety). Correlations between HADS with both GAD-7 and PHQ-9 were statistically significant and strong for both depression (r = 0.795; p < 0.0001) and anxiety (r = 0.727; p < 0.0001). Confirmatory factor analysis revealed that the observed data fits the two-factor model of depression and anxiety (Kaiser–Meyer–Olkin = 0.86; Tucker Lewis Index = 0.879; root-mean-square error of approximation = 0.08). Depression and anxiety rates were approximately 52% and 25%, respectively.ConclusionWe conclude that the Arabic version of the HADS is a credible and valid tool for clinical assessment of psychological distress (anxious and depressive states) among Lebanese patients with cancer.

A prospective study of antepartum anxiety screening in patients with and without a history of spontaneous preterm birth

Maternal stress has been identified as one of the most common clinical phenotypes associated with preterm birth. The American College of Obstetricians and Gynecologists recommends anxiety screening at least once in the perinatal period. The prevalence of perinatal anxiety is challenged by the absence of formalized screening protocols and underreporting in high-risk populations, such as those with a history of adverse pregnancy outcomes. This study administered a validated anxiety screening tool in a cohort of patients with and without a previous spontaneous preterm birth and compared differences in score and rate of a positive screen between groups. Moreover, this study evaluated perinatal outcomes associated with a positive screen and described a referral protocol involving evaluation by a perinatal mental health counselor and clinical diagnoses. A hypothesis was made that patients with a previous history of spontaneous preterm birth would have higher self-reported anxiety symptoms than controls and that those with recurrent preterm delivery at <35 weeks of gestation would have the highest anxiety screening scores. This was a prospective observational cohort study administering the Generalized Anxiety Disorder 7-item screen to patients enrolled in 2 prenatal care clinics at our institution. The preterm birth cohort consisted of patients with a history of spontaneous preterm labor, premature rupture of membranes, or cervical insufficiency compared with the control cohort without this history. Screening was initiated at entry to prenatal care or referral to our high-risk obstetrical clinic. The inclusion criteria included English- or Spanish-speaking patients and singleton pregnancy, and the exclusion criteria included pregnancies complicated by a major congenital anomaly, enrollment after 34 weeks of gestation, delivery at <20 weeks of gestation, and incomplete delivery data. Referral to a mental health counselor was offered to those with a Generalized Anxiety Disorder 7-item screen score of ≥10. Perinatal outcomes as a comparison between the Generalized Anxiety Disorder 7-item screen-positive group and Generalized Anxiety Disorder 7-item screen-negative group were performed with statistical methods, including the Student t test, chi-square test, and Wilcoxon rank-sum test, with a P value of <.05 to determine significance. Between September 2020 and December 2021, 1349 participants were analyzed, with 143 patients (11%) in the previous preterm birth cohort and 1206 (89%) patients in the control cohort. Patients with a history of preterm birth and subsequent delivery at ≤35 weeks of gestation in the study pregnancy had significantly higher Generalized Anxiety Disorder 7-item screen scores than controls with delivery after 35 weeks of gestation (median score: 4 [interquartile range, 1-9] vs 2 [interquartile range, 0-6], respectively; P=.006). Overall, 187 participants (14%) screened positive with significantly higher rates in the previous preterm birth group than in the control group (20% vs 13%; P=.036). Of note, 117 patients (63%) accepted a referral, and 32 patients (17%) with a positive screen were diagnosed with a perinatal mood disorder. Patients with recurrent preterm birth have higher self-reported anxiety using the Generalized Anxiety Disorder 7-item screen than controls. Of those with a positive screen, 17% were diagnosed with a perinatal mood disorder.

Model Clinic to Increase Preventive Screenings Among Patients With Physical Disabilities: Protocol for a Mixed Methods Intervention Pilot Study.

People with physical disabilities often experience premature multimorbidity and adverse health events. A tailored primary care approach for this vulnerable population that also accounts for social and functional risk factors could promote healthier aging and more equitable health care. This project will evaluate the implementation of a health program designed for people with physical disabilities. The proposed evaluation result is to generate the first best-practice protocol focused specifically on developing primary care to help reduce preventable causes of morbidity and improve functioning among people with physical disabilities. We will design and implement a pilot health program for people with physical disabilities at a primary care clinic within Michigan Medicine. The health program for people with physical disabilities will be an integrated intervention involving a tailored best practice alert designed to prompt family medicine providers to screen and monitor for common, preventable health conditions. The program will also collect social and functional status information to determine the patient's need for further care coordination and support. Adult participants from this clinic with identified physical disabilities will be targeted for potential enrollment. To create a quasi-experimental setting, a separate departmental clinic will serve as a control site for comparison purposes. A quantitative analysis to estimate the treatment effect of implementing this health program will be conducted using a difference-in-differences approach. Outcomes of interest will include the use of preventative services (eg, hemoglobin A1c for diabetes screening), social work assistance, and emergency and hospital services. These data will be extracted from electronic health records. Time-invariant covariates, particularly sociodemographic covariates, will be included in the models. A qualitative analysis of patient and health care provider interviews will also be completed to assess the effect of the health program. Patient Health Questionnaire-9 and Generalized Anxiety Disorder 7-item scores will be assessed to both screen for depression and anxiety as well as explore program impacts related to addressing health and functioning needs related to physical disabilities in a primary care setting. These will be summarized through descriptive analyses. This study was funded in September 2018, data collection started in September 2021, and data collection is expected to be concluded in September 2023. This study is a mixed methods evaluation of the effectiveness of an integrated health program designed for people with physical disabilities, based on a quasi-experimental comparison between an intervention and a control clinic site. The intervention will be considered successful if it leads to improvements in greater use of screening and monitoring for preventable health conditions, increased social worker referrals to assist with health and functioning needs, and improvements in emergency and hospital-based services. The findings will help inform best practices for people with physical disabilities in a primary care setting. DERR1-10.2196/50105.

The mediation effect analysis of nurse's mental health status and burnout under COVID-19 epidemic.

The objective of this study is to investigate the mental health status of nurses during the outbreak of novel coronavirus pneumonia. Additionally, we aim to analyze the relationship between anxiety, depression, and burnout among nurses. The findings will provide a scientific basis for promoting the psychological health of nurses. Using a cross-sectional study, nurses in Quanzhou in May 2020 completed a general information questionnaire, the 7-item Generalized Anxiety Disorder Questionnaire (GAD-7), Patient Health Questionnaire-9 (PHQ-9), and the Maslach Burnout Inventory (MBI). Data analysis was conducted using structural equation model. 372 questionnaires were returned, with a response rate of 92.5%. The prevalence of anxiety and depression among the participants were 45.2 and 41.4%, respectively. The prevalence of severe burnout among nurses was found to be 7.3%. There was a correlation between nurses' anxiety, depression, and job burnout. The correlation coefficients between anxiety and job burnout, depression and job burnout, and anxiety and depression were found to be statistically significant (p < 0.001). Depression plays a mediating role between anxiety and jod burnout (0.584/1.413, 41.3%). The COVID-19 epidemic has resulted in moderate to high levels of job burnout among nurses. In this context, depression has been found to play a mediating role in the relationship between anxiety and job burnout. It is imperative for hospital administrators to prioritize the mental health of nurses and the provide necessary support to ensure their well-being.

Depression and anxiety outcomes of adults undergoing intermittent theta burst stimulation (iTBS) treatment for major depressive disorder: A naturalistic study

BackgroundStandard repetitive transcranial magnetic stimulation (rTMS) and intermittent theta burst stimulation (iTBS) are approved treatments for major depressive disorder (MDD). iTBS offers shorter treatment durations and increased accessibility. This study examines the clinical outcomes of iTBS for MDD in a tertiary medical center. MethodsPatients who underwent iTBS for MDD at Mayo Clinic Rochester between March 2021 and January 2023 were included. Baseline and endpoint scores of the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder 7-item (GAD-7) were compared using t-tests. Response, remission, and a single question patient-reported outcome (PRO) of "Did the treatment help?" were reported. Outcomes of patients with anxious depression (GAD-7 ≥10) were also reported. ResultsForty-two patients (mean age 41.7 years, 59.5% female) were analyzed. iTBS resulted in a significant reduction in depression symptoms (PHQ-9: baseline mean 19.9, endpoint mean 13.0, p < 0.001). The response rate was 38.1%, remission rate was 9.5%, and PRO was 57.1%. Anxiety symptoms also significantly improved (GAD-7: baseline mean 13.0, endpoint mean 9.1, p < 0.001). The response rate for anxiety was 33.3%, and remission rate was 28.6%. Our response rate for depression was comparable to existing literature, while the remission rate was lower. ConclusioniTBS demonstrated significant reductions in depression and anxiety symptoms among patients with MDD, and in the subset of patients with anxious depression. The single question PRO can be a practical aid in patient discussions. These findings contribute to the growing body of literature on iTBS for MDD.

Problematic Smartphone Use and Its Relationship With Anxiety and Suicidal Ideation Among South Korean Adolescents.

This study aimed to investigate the prevalence of problematic smartphone use (PSU) among adolescents and its association with anxiety and suicidal ideation. The 16th cross-sectional, population-based Korea Youth Risk Behavior Web-Based Survey was administered in 2020 and included 54,948 adolescents. We used the Korean version of the smartphone overdependence scale and the 7-item Generalized Anxiety Disorder scale to assess PSU and anxiety. Suicidal ideation was assessed through responses to the self-report question. Multiple logistic regression analyses with complex sampling were conducted to identify the association of PSU with anxiety and suicidal ideation. In total, 25.1% of the adolescents reported PSU, 33.2% had anxiety symptoms, and 10.9% had seriously considered suicide during the past 12 months. Girls with PSU had a higher risk of anxiety (adjusted odds ratio [aOR], 2.81; 95% confidence interval [CI], 2.65 to 2.97) and suicidal ideation (aOR, 1.77; 95% CI, 1.64 to 1.91) than non-PSU girls. Boys with PSU reported more anxiety (aOR, 2.89; 95% CI, 2.72 to 3.07) and suicidal ideation (aOR, 1.82; 95% CI, 1.66 to 1.99) than the non-PSU group. In addition, girls with the lowest household income reported more suicidal ideation than girls with the highest household income (aOR, 3.40; 95% CI, 2.69 to 4.28). This study demonstrated the prevalence of PSU among South Korean adolescents in 2020. The prioritization of the detection of PSU and the identification of psychological factors may help improve the diagnosis and management of mental health problems and potentially yield significant psychosocial benefits.

Treatment of insomnia in myasthenia gravis-A prospective study on non-benzodiazepine hypnotics in the treatment of myasthenia gravis patients with insomnia.

This study aimed to evaluate the efficacy and safety of non-benzodiazepine hypnotics in the treatment of myasthenia gravis (MG) patients with insomnia. This is a prospective longitudinal study. Outpatients who met the criteria for stable MG and insomnia diagnosis according to the International Classification of Sleep Disorders (third edition) were included in the study. They took a regular dose of non-benzodiazepine hypnotics (zolpidem 10 mg per night or zopiclone 7.5 mg per night) based on their own preferences. Patients received psychotherapy (including sleep health education) and were followed up for 4-5 weeks. Cases with lung diseases, respiratory disorders, or inappropriate use of hypnotic medications were excluded. The primary outcome is the difference in total Pittsburgh Sleep Quality Index (PSQI) score between baseline and the end of follow-up period. Secondary outcomes include the difference in Myasthenia Gravis Activities of Daily Living (MG-ADL) score, 7-item Generalized Anxiety Disorder Questionnaire (GAD-7), and the Patient Health Questionnaire-9 (PHQ-9) between baseline and the end of follow-up period and the safety of medication. A total of 75 MG patients with insomnia were included in this study. After 4-5 weeks of treatment, the total PSQI score and MG-ADL score were lower than baseline (p < 0.01). No patients had an increased MG-ADL score. The incidence rate of adverse events was 16.0% (12 cases), including dizziness (6 cases, 8.0%), drowsiness (3 cases, 4.0%), fatigue (2 cases, 2.7%), and nausea (1 case, 1.3%), all of which were mild. No patients had new onset breathing disorders. Non-benzodiazepine hypnotics are safe and effective for stable MG patients who need insomnia treatment.

An empirical investigation of the associations between metacognition, mindfulness experiential avoidance, depression, and anxiety

BackgroundThe aims of this study were to explore the possible relation between metacognition, mindfulness, and experiential avoidance, as well as their association with symptoms of anxiety and depression.MethodsCross-sectional data was collected from a community sample (N = 364) who completed the Metacognitions Questionnaire-30 (MCQ-30), the Five Facet Mindfulness Questionnaire-24 (FFMQ-24), the Acceptance and Action Questionnaire-II (AAQ-II), the Generalized Anxiety Disorder 7-item (GAD-7), and the Patient Health Questionnaire-9 (PHQ-9).ResultsThere were moderate-strong associations between mindfulness (FFMQ-24), metacognition (MCQ-30), and experiential avoidance (AAQ-II) (0.62 − 0.67), and they showed similar relations with symptoms of depression (PHQ-9) and anxiety (GAD-7) (0.57 − 0.71). Mindfulness, experiential avoidance, and the non-judging subscale of FFMQ-24 constituted a latent factor of flexibility in cognition and emotional experience, while three FFMQ-24 subscales (describing, acting with awareness, and observing) constituted a present-centered attention and awareness factor. Regression analyses indicated that flexibility explained more of the variance in symptoms of anxiety and depression than present-centered attention and awareness.ConclusionsThe results suggest that flexibility in cognitive and emotional regulation skills could be important in explaining symptoms of anxiety and depression.