Anxiety Disorders Research Articles

Chronic pain over time among Syrian refugees resettled in Norway

Abstract Background Chronic pain disproportionately impacts vulnerable groups such as migrants and refugees. This study investigates the long-term changes in chronic pain experienced by Syrian refugees in Norway and explores the factors influencing these changes. Methods This prospective cohort study used data from the CHART and Integration for Health studies, with data collection at three points: in Lebanon (Wave-1), one year (Wave-2), and four years post-arrival in Norway (Wave-3). All participants who completed surveys at these timepoints were included (n = 132). Chronic pain was measured by asking about pain lasting at least six months. Mixed-effects logistic regression was used to examine changes in prevalence and assess how age, gender, educational level (categorized as low, ≤9 years, and high, >9 years), and mental health symptoms (anxiety, depression, and post-traumatic disorders) affect these changes. Results Between Wave-1 and Wave-3, the proportion of participants reporting chronic pain increased from 31% to 53%, with an odds ratio of 3.6 (95% CI 2.2 - 5.8). There was an interaction between changes in chronic pain over time and participants’ educational level, where the increase in pain prevalence over time was more pronounced among participants with lower educational levels than higher levels. No modification with the other factors were detected. Conclusions The study observed an increase in the number of participants reporting chronic pain over time. Low educational level at baseline emerged as a useful indicator for identifying those at higher risk of chronic pain. Understanding this correlation can be crucial for guiding preventive strategies and optimizing resource allocation to assist those most vulnerable. Key messages • Chronic pain disproportionately impacts vulnerable groups such as refugees. • Refugees with lower education levels at baseline were more likely to experience chronic pain over time.

Gambling disorder and its associated factors in university students

Abstract Background Gambling disorder (GD) is defined as persistent and uncontrollable gambling behaviour that has negative effects on an individual’s life. This can lead to financial problems, poor academic performance, and health problems. GD has been associated with psychological disorders like depression, anxiety, and attention-deficit hyperactivity disorder (ADHD). We aimed to examine the gambling disorder and its associated factors in university students. Methods We conducted a cross-sectional study among students at a university in Eskisehir (Türkiye) in 2024. A stratified random sample design was used. Five faculties were randomly selected. A total of 1,201 students were included according to the stratum weight of the faculties. A questionnaire including sociodemographic characteristics, South Oaks Gambling Screen (SOGS), and Adult ADHD Self-Report Scale (ASRS) was applied. Data were analysed through descriptive statistical analyses and multivariate logistic regression models. Results The mean age was 21.5±2.8 years, and 46.8% were male. While 48.7% of the students stated that they had gambled at least once, 2.2% had a gambling disorder. The three most common types of gambling played by students were stock market (28.2%), bet on sports (22.0%), and scratch cards (18.2%). In multivariate analysis, being male (Odds ratio-OR:6.5, 95%CI:1.4-29.8), having lost years during education (OR:2.7, 1.1-6.8), having relatives with gambling problems (OR:8.0, 1.8-36.2), investing greater amounts of money in gambling (OR:3.7, 1.0-13.0), and having a high probability of ADHD (OR:4.3, 1.4-12.8) were found to be predictors for GD. Conclusions Although about half of the students had engaged in gambling activities, only a small proportion showed signs of GD. We can conclude that being male, having lost years in education, having relatives with gambling problems, investing larger amounts of money in gambling, and having a higher probability of ADHD are predictors of GD among students. Key messages • Implementing educational campaigns at universities to raise awareness of the potential risks and consequences associated with GD could be beneficial. • It may be helpful if mental health services at the university were equipped to consider mental health conditions such as ADHD, that contribute to GD.

Pilot study of a parent-based intervention for functional somatic symptoms in children.

Functional somatic symptoms are associated with significant distress and impairment for children and their families. Despite the central role that families play in their children's care, there is little clinical research to guide how parents can support their children with functional somatic symptoms and promote better functioning. To address this gap, we developed a parent-based intervention for functional somatic symptoms in children and obtained preliminary data on acceptability, feasibility, treatment satisfaction, and clinical outcomes. The intervention was adapted from SPACE (Supportive Parenting for Anxious Childhood Emotions), an evidence-based treatment for anxiety and related disorders in children. The intervention, SPACE-Somatic, was delivered to parents of 16 children (Mage = 14.50 years; 75% girls) with a range of functional somatic symptoms. Parents participated in seven weekly group sessions conducted via telehealth. We found that SPACE-Somatic was acceptable, feasible, and satisfactory to parents. There were significant improvements in several clinical outcomes from baseline to posttreatment, including children's level of functional impairment, with some gains maintained at 3-month follow-up. Parents also reported improvements in their own stress and their accommodation of children's symptoms. This pilot study provides preliminary evidence that a parent-based intervention is viable and beneficial to children with functional somatic symptoms and their parents.

Youth mental health outreach interventions: lessons from an experience capitalisation process

Abstract Issue Young people face socioeconomic, geographical and cultural barriers to access care and support in mental health. Practitioners implement outreach initiatives to improve mental health and address health inequalities, mostly developed in a ‘no-request for care’ context. Methods To better understand the implementation mechanisms of these initiatives, Fondation de France commissioned the French Society for Public Health to carry out an experience capitalisation to inspire other professionals. Experience capitalisation method was used, based on in depth interviews with project stakeholders. Covered themes were: the description of history, strategies and activities; identification of key moment and key levers; skills and knowledge used. Results Nine mental health outreach projects implemented across regions of France were selected with the help of a multidisciplinary steering committee. Each project was synthetised in a capitalisation document and a cross-sectional analysis was undertaken. Lessons • A variety of outreach approaches were carried on: meeting adolescents in the street or at coffee shops; home-based interventions; consultations in converted van etc. • Outreach is not just a matter of physically moving outside health structures but requires non-judging and flexible stance to adjust to the youth’s pace and will. To extend their approach to mobility, professionals deepen their team’s multidisciplinarity, broaden cross-sector partnerships and mobilise new skills and creativity. • Adolescents’ participation to care or support plans was one of projects strengths, whether they suffer from anxiety or mental disorders. However, their participation in governance and decisions regarding global projects remained limited. Key messages • To reduce mental health inequalities and enhance youth participation in outreach interventions, empowerment and wellbeing of interventions practitioners should also be supported. • Capitalisation of experience in health promotion is a promising method contributing to professional acknowledgment and development of shared knowledge on interventions implementation.

Prevalence and social determinants of anxiety and depression among adults in Ghana systematic review

Abstract Background Anxiety and depression are major public health concerns, yet their prevalence and social determinants contributing to mental health disparities remain underexplored. This review, to our knowledge, is the first of its kind, aiming to examine the prevalence of anxiety and depression symptoms and disorders among adults in Ghana, along with social determinants associated with their occurrence. Methods A search of nine electronic databases and seven grey literature sources was conducted up to September 25, 2023. Two reviewers independently screened and appraised the studies. Forty-six studies were included. Prevalence estimates were pooled using a random-effects model. Subgroup analysis and meta-regression explored potential moderators. A narrative synthesis explored social determinants associated with anxiety and depression. Results Preliminary results showed a high prevalence of anxiety (43.7%, 95% CI: 35.6-54.4%) and depression (37.8%, 95% CI; 32.5% to 46%), with regional variations. There were significant differences in the prevalence of anxiety and depression across chronic physical conditions and method of condition assessment. Meta-regression showed significant association between average age and anxiety prevalence. Social determinants associated with anxiety included being female, non-Christian, low income, self-employed, limited social support, and basic education, while that for depression included being young (< 25yr), low income, government employed, childhood physical and sexual abuse, gender-based violence and urban residence. Protective factors for both were male gender, strong social support and higher education. Conclusions Preliminary results indicate a high prevalence of anxiety and depression linked to social determinants. While methodological limitations exist (eg, study heterogeneity), findings highlight a need for evidence-based interventions targeting social determinants to reduce the burden of anxiety and depression among adults in Ghana. Key messages • Our review suggests addressing the social determinants of mental health, aligned with sustainable developmental goals, may reduce the burden of anxiety and depression. • While Ghana is working towards improving mental health via its revised 12year Mental Health Policy launched in 2021, this review can facilitate planning and resource allocation for mental healthcare.

Factors associated with sleeping difficulties in patients with heart failure

Abstract Background Sleeping difficulties is prevalent in heart failure (HF) and a predictor of cardiac events in patients with HF. Purpose To describes the prevalence of sleeping difficulties in patients with HF and factors associated. Method This study used data of a multicentre RCT entitled Tele-Yoga study (clincialtrials.gov:NCT03703609). Patients were included in the analysis when they were diagnosed with HF and completed a questionnaire on sleeping difficulties. Sleeping difficulties were measured with the Minimal Insomnia Symptom Scale (MISS), patients with a score a 6 or higher patients were characterised as having sleeping difficulties. Through a literature search we identified factors that could be associated with sleeping difficulties. Demographic and clinical background variables (age, sex, BMI, marital status, working status, having atrial fibrillation and/or diabetes), anxiety and depressive symptoms (Hospital Anxiety and Depression scale) and Health related Quality of Life (EQ-5D index score) were considered. Logistic regression was performed with backwards elimination of the factors considered associated with having or not having sleeping difficulties. Results In total 244 patients were included (mean age 67±10, 28% women), whereas 27% had sleeping difficulties (n = 68, a score a 6 or higher on the MISS); 28% had moderate till very severe difficulties initiating sleep (n=77), 53% had moderate till very severe problems by waking up at night (n=130), 38% had moderate till very severe problems by not feeling refreshed by sleep (n=92). The logistic regression showed that patients with sleeping difficulties were significantly more often single (27% vs. 18%, OR 0.336 P-value=0.023), more often not working (72% vs. 69%, OR 2.524, P-value=0.047) more often experienced symptoms of anxiety (45% vs. 10%, OR 4.882, P-value<001) and had a lower quality of life, (0.637±0.261 vs. 0.786±0.203, OR 0.042 P-Value=0.001) compared to patients with no sleeping difficulties. Conclusion Patients having symptom of anxiety were at five times greater risk of experiencing sleeping difficulties. Being in a relationship and being employed were associated with less sleeping difficulties. Additionally, patients with sleeping problems reported lower quality of life.

Frailty, cognition and patient-reported outcomes in middle-aged and older adults with congenital heart disease: insights from an international multicentric study

Abstract Background Prior research has demonstrated that a significant proportion of older patients with congenital heart disease (CHD) are frail or pre-frail and experience cognitive impairment. However, it remains unclear whether frailty and cognition are related to patient-reported outcomes (PROs) such as perceived health, anxiety and depression symptoms or quality of life in CHD. Purpose The objective of this study was to explore the relationships between frailty, cognitive function, and PROs in middle-aged and older adults with CHD ranging from mild to severe complexity. Methods As part of the cross-sectional ‘Assessment of Patterns of Patient-Reported Outcomes in Adults with Congenital Heart disease – International Study II’ (APPROACH-IS II), we enrolled 814 individuals aged 40 years and older (median age: 52.0 years [45.0-61.0]; 51.4% female; 12.7% mild, 70.1% moderate, 17.2% complex CHD; 41.9% pre-frail, 5.8% frail; 38.7% cognitively impaired) across 17 centers in 11 countries. Frailty status was assessed using the Fried criteria, which categorize individuals into robust, pre-frail, and frail based on five factors: weakness, slow gait, unintentional weight loss, exhaustion, and low physical activity levels. Cognitive function was determined using the Montréal Cognitive Assessment. Participants completed questionnaires to evaluate perceived health (RAND-12 Health Survey, yielding both Physical and Mental Component Summaries, and EuroQOL-5D Visual Analog Scale), depressive symptoms (Patient Health Questionnaire-8), anxiety symptoms (General Anxiety Disorder scale-7), and quality of life (QoL Linear Analog Scale). Results Frailty was significantly associated with all PROs, with frail and pre-frail individuals reporting less favorable outcomes (see Figure). Cognitive function was linked to perceived health and anxiety, with patients exhibiting cognitive impairments reporting poorer perceived health and more anxiety symptoms. Conclusion This study indicates that concepts of frailty, cognitive functioning and PROs are closely related in adults with CHD. Frailty and cognition thus represent important domains when developing strategies to optimize PROs in adults with CHD. Moreover, when working with patients who are frail or cognitively impaired, healthcare workers are encouraged to consider and inquire about potential impact on PROs. Longitudinal research is needed to explore the direction of the association.

The phobic brain: Morphometric features correctly classify individuals with small animal phobia.

Specific phobia represents an anxiety disorder category characterized by intense fear generated by specific stimuli. Among specific phobias, small animal phobia (SAP) denotes a particular condition that has been poorly investigated in the neuroscientific literature. Moreover, the few previous studies on this topic have mostly employed univariate analyses, with limited and unbalanced samples, leading to inconsistent results. To overcome these limitations, and to characterize the neural underpinnings of SAP, this study aims to develop a classification model of individuals with SAP based on gray matter features, by using a machine learning method known as the binary support vector machine. Moreover, the contribution of specific structural macro-networks, such as the default mode, the salience, the executive, and the affective networks, in separating phobic subjects from controls was assessed. Thirty-two subjects with SAP and 90 matched healthy controls were tested to this aim. At a whole-brain level, we found a significant predictive model including brain structures related to emotional regulation, cognitive control, and sensory integration, such as the cerebellum, the temporal pole, the frontal cortex, temporal lobes, the amygdala and the thalamus. Instead, when considering macro-networks analysis, we found the Default, the Affective, and partially the Central Executive and the Sensorimotor networks, to significantly outperform the other networks in classifying SAP individuals. In conclusion, this study expands knowledge about the neural basis of SAP, proposing new research directions and potential diagnostic strategies.

Echocardiographic associates of impaired sleep quality in patients with anxiety and depression

Abstract Objective Sleep health, mental health and cardiovascular health are multidimensional constructs that are strongly associated with each other. Anxiety and depression are the most common psychiatric diseases in the community and frequently comorbid in routine clinical practice. This study sought to investigate whether there is an association between sleep quality and echocardiographic parameters in patients with anxiety and/or depression. Methods The clinical and instrumental find­ings of consecutive patients diagnosed with either of anxiety disorders and/or depressive disorders and underwent cardiac examination in our tertiary center on the same day were retrospectively reviewed. The diagnosis was made by a psychiatrist according to the criteria listed in the fifth edition of The Diagnostic and Statistical Manual of Mental Disorders. Afterwards, Hospital Anxiety and Depression Scale (HADS) and Pittsburgh Sleep Quality Index (PSQI) were applied to patients to assess symptom severity and sleep quality, respectively. Subsequent to psychiatric examination, the patients underwent echocardiographic examination that includes two-dimensional conventional echocardiography, tissue doppler imaging (TDI) echocardiography, atrial conduction times, and left atrium (LA) volumes and functions. Results The final study population consisted of 167 patients and divided into two groups according to their PSQI score: PSQI<5 (normal sleep quality) (n=32) and PSQI≥5 (impaired sleep quality) (n=135). Aortic diameter, left ventricular (LV) end-systolic diameter, LV end-diastolic and -systolic volume, LV stroke volume and LV stroke volume index, LV outflow tract velocity–time integral (LVOT-VTI), and LA conduit volume calculations were significantly lower in patients with impaired sleep quality compared to patients with normal sleep quality. The other echocardiographic parameters including LV systolic functions, doppler and TDI echocardiography indices, atrial conduction times, atrial mechanical functions including LA function index (LAFI) were similar among groups. Correlation analysis yielded a negative, weak but statistically significant correlation between LAFI and PSQI score (r=-0.17, p=.030) (Figure 1A). Left intra-AEMD positively and significantly correlated with PSQI score at a weak level (r=0.16, p=.043) (Figure 1B). Aortic diameter, LV stroke volume index, LVOT-VTI and conduit volume were determined as echocardiographic parameters significantly associated with impaired sleep quality in univariate analysis. Among these parameters, only conduit volume remained as significant and independent associate of impaired sleep quality in multivariate logistic regression analysis (Odds ratio:0.91, 95% Confidence interval:0.85-0.98, p=.018) (Table 1). Conclusion There is an independent association between LA conduit volume and impaired sleep quality in patients suffering from anxiety and/or depressive disorders.Figure 1Table 1

Investigating the Mental Health Outcomes and Treatment Gap Among Sexual Minorities in Czechia: A National Cross-Sectional Study

Abstract Aims This study aims to (1) estimate the prevalence and relative risk of mental disorders, (2) assess the severity of mental health symptoms, and (3) investigate the treatment gap for mental disorders within SM. Methods Data from a cross-sectional, nationally representative survey of 3,063 Czech adults (response rate = 58.6%) were utilized. The Mini-International Neuropsychiatric Interview was employed to screen for mental disorders. In those identified with mental disorders, help-seeking behaviors over the past 12 months were examined. The severity of mental health symptoms was evaluated using the 9-item Patient Health Questionnaire and the 7-item Generalized Anxiety Disorder scale. Prevalence rates of mental disorders associated treatment gaps, and relative risks of mental disorders were calculated. Results The prevalence of mental disorders among heterosexual, gay or lesbian, bisexual, and more sexually diverse individuals was 18.9% (17.4-20.3), 52.3% (36.9-67.6), 33.3% (19.5-47.2), and 25.9% (13.9-38), respectively. Suicidal thoughts and behaviors were reported in 5.7% (4.9-6.6) of heterosexual individuals compared with 25.0% (11.7-38.3) in gay or lesbian, 22.9% (10.6-35.3) in bisexual, and 11.1% (2.5-19.8) in more sexually diverse individuals. After adjusting for confounders, gay or lesbian individuals demonstrated an increased risk of having at least one current mental disorder compared with heterosexual people (OR = 3.5 95% CI(1.8-6.8)). Bisexual and more sexually diverse individuals demonstrated risks consistent with a null effect. No substantial differences in treatment gap were detected between heterosexuals and SM who scored positively for at least one current mental disorder. Conclusions The findings underscore the urgent need for systemic changes to improve the mental health outcomes of Czech SM. Addressing structural stigma and ensuring sensitive care are imperative to mitigate the health disparities faced by Czech SM.

The identification, referral and management of patients with cardiac-related distress: a new model to support psychological recovery after a cardiac event

Abstract Background Identification, referral and management of patients with psychological distress is an important component of cardiac rehabilitation (CR). We developed a protocol to identify patients in hospital, CR and primary care settings, and refer them to a specialist psychocardiology clinic. Using the newly developed Cardiac Distress Inventory (CDI), we demonstrated that counselling resulted in reduced rates of cardiac-related distress. This study demonstrates the importance of having a clear pathway from screening to referral to intervention to support cardiac patients in their recovery. Purpose The team identified a dearth of high-quality research on distress in cardiac patients, including a lack of data on the resolution of cardiac-related distress after psychotherapeutic intervention. This was due to the lack of appropriate measurement of cardiac distress, and the absence of clear pathways for identification, referral and management of cardiac distress. Methods The Cardiac Emotions Study is a multi-site, multi-component study of cardiac-related distress. The team first developed the 55-item Cardiac Distress Inventory (CDI), a comprehensive clinical assessment tool. A brief screening version, the 12-item Cardiac Distress Inventory Short Form (CDI-SF), was then developed. Patients referred to the specialist psychocardiology clinic over a 6-month period (N=113) were administered the CDI-SF, together with the Generalised Anxiety Disorder 7 (GAD7) and the Patient Health Questionnaire (PHQ9), with all measures re-administered at discharge. Results More than half the clients presented to the Clinic within the first 3 months post-event (58%), while 84% presented within the first year. At presentation, over half the clients were anxious (GAD7>10; 53%), depressed (PHQ9>10; 57%), or distressed (CDI-SF>13; 56.4%). Levels of particular aspects of cardiac distress are shown in the Figure. On completion of counselling, distress had resolved for the majority of clients, with the distress rate of 18.6% at discharge equivalent to that seen in a normative sample of cardiac patients. Rates of anxiety and depression also significantly decreased after counselling. Conclusion This study demonstrated that distressed cardiac patients could be appropriately identified in settings such as hospital, CR and primary care and referred for counselling, and that counselling resulted in significant reductions in rates of cardiac distress, anxiety and depression. Undergoing counselling through a specialist psychocardiology clinic assisted clients in obtaining normative rates of post-cardiac event distress. The analysis showed the necessity of having a clear clinical pathway from screening to psychological treatment, and the utility of having a validated measure of cardiac distress that is sensitive to change after intervention.

Evaluation of comparative efficacy of Celastrus paniculatus (Jyotishmati) capsule versus sertraline capsule in the management of Chittodvega (generalized anxiety disorder): protocol for a randomized controlled trial

Background Generalized anxiety disorder (GAD) (Chittodvega) is one among many types of mental disorders explained in Ayurveda. It can be defined as a Chitta (mind) + Udvega (anxiety)= Chittodvega- Anxious status of a mind. Celastrus paniculatus also known as Jyotishmati stimulates and improves the digestive fire and metabolism at a cellular level (Jatharagni and Majja dhatwagni). It can be correlated to GAD. GAD is characterized by feelings of threat, restlessness, irritability, sleep disturbance, and tension, and symptoms such as palpitations, dry mouth, and sweating. It affects women more frequently than men and prevalence rates are high in midlife (prevalence in females over age 35: 10%) and older subjects. In modern medicine the first-line psychological and pharmaceutical treatments are selective serotonin reuptake inhibitors (SSRIs) like sertraline (SNRIs). Aim and objectives To evaluate the comparative efficacy of Jyotishmati versus sertraline in the management of Chittodvega. Methods In this randomized active controlled double blind equivalence trial a total of 70 patients will be enrolled and divided into two equal groups. Patients between 20–50 years age of either gender having symptoms of Chittodvega and a Hamilton anxiety rating (HAM-A) scale score less than 24 (i.e., mild to moderate) will be selected for the study. In Group A, sertraline capsules 25 mg for first 7 days and then dose increased to 50 mg at bedtime for next 53 days and in Group B Jyotishmati Capsules 500 mg will be given twice a day after food with water for 60 days. Result and observation The patients will be assessed on the HAM-A scale, serum cortisol and WHO Quality of Life on day 0, 30, 60 and 90 and data will be analyzed using paired and unpaired t-tests for continuous variables and chi-square tests for categorical variables to evaluate whether treatments are equivalent. Trial registration CTRI No. REF/2023/07/069880 Date – 15/09/2023

Mental health of Finnish cis- and transgender youth before, during and after the COVID-19 pandemic

Abstract Background Transgender youth report more mental health problems than their cisgender peers, but little is known about their mental health during and after the COVID-19 pandemic. We studied symptoms of anxiety and depression among cis- and transgender youth before, during, and after the pandemic using large nationwide samples. Methods Data from the Finnish School Health Promotion survey from years 2019, 2021 and 2023 (461,249 students in total; mean age 15.7, SD 1.3) were used. Self-reports covered official gender, gender identity, symptoms of anxiety (Generalized Anxiety Disorder Scale-7 ≥10) and depression (Patient Health Questionnaire-2 ≥3). Categories of cisgender boy (officially boy; gender identity boy; N = 214,423), transfeminine youth (officially boy; gender identity girl, both, neither, or it varies; N = 5,069), cisgender girl (officially girl; gender identity girl; N = 224,753), and transmasculine youth (officially girl; gender identity boy, both, neither, or it varies; N = 14,508) were formed. Results In all timepoints, proportion of those with anxiety or depression was higher among transfeminine youth compared with cisgender boys and among transmasculine youth compared with cisgender girls. In all groups anxiety and depression increased significantly from 2019 to 2021 (ORs 1.4-1.8, p < 0.0001), with no significant differences in these changes between cis- and transgender groups. From 2021 to 2023, anxiety (OR 0.91, p = 0.015) and depression (OR 0.77, p < 0.0001) decreased among transmasculine youth but increased among cisgender girls (ORs 1.11 [p < 0.0001] and 1.07 [p < 0.0001], interactions p < 0.0001). Among transfeminine youth, generalized anxiety symptoms decreased from 2021 to 2023, whereas they remained at the level observed in 2021 among cisgender boys (interaction p = 0.0025). Conclusions In Spring 2023, we found still increasing mental health problems among cisgender girls, while among transgender youth the post-pandemic developments were more positive. Key messages • Post-pandemic, we found further increases in mental health symptoms in cisgender youth, while among transgender youth the development seemed more promising. • Transgender youth experience more anxiety and depression than their cisgender peers, thus gender diversity deserves still more attention in educational, social, and health care services.

Poor psychosocial status and cardiovascular risk factors are associated with depression or anxiety

Abstract Background Depression and anxiety are rising in South Africa but their associations with psychosocial and cardiovascular risk factors (CVRFs) remain under explored. This study determined the associations of depression and anxiety traits with poor psychosocial wellbeing, risky lifestyle behaviours and cardiometabolic diseases. Methods In a population-based cross-sectional study, data were collected via administered questionnaires, clinical examinations and biochemical assessments. Depression and anxiety traits were ascertained via the Patient Health Questionnaire-9 and Generalised Anxiety Disorder screening questions. Multivariable logistic regressions determined the associations with depression and anxiety traits; the basic model comprised sociodemographic factors, physical inactivity, tobacco smoking and alcohol misuse (CAGE ≥2). Psychosocial and cardiometabolic variables were entered individually in separate models. Results Among 678 participants, median age 52 years and mainly women (81%), prevalence of depression scores ≥10 were 14.2% (men:12.7%, women:14.6%, p = 0.498) and anxiety scores ≥10 were 10.2% (men:10.3%, women:10.2%). In the basic regression models, depression, but not anxiety, was associated with being separated, living as married/widowed vs. single (OR:2.01, 95%CI:1.02-3.94), and alcohol misuse (2.07, 1.13-3.78). Depression and anxiety were associated with decreasing social support (depression: 1.09, 1.04-1.12; anxiety: 1.09, 1.04-1.14), and increasing number of adverse life events. Hypertension (1.76, 1.07-2.90, p = 0.025), diabetes (1.98, 1.03-3.82, p = 0.041) and dyslipidaemia (1.97, 1.01-3.85, p = 0.048) were associated with depression but not anxiety. Conclusions The high burden and associations of depression and anxiety traits with poor psychosocial wellbeing suggest a need for holistic care approaches. The associations of depression traits with CVRFs warrant screening and care of depression in the presence of cardiometabolic diseases and alcohol misuse. Key messages • The high burden of depression and anxiety traits in South Africa is associated with poor social support and quality of life, and increasing adverse life events experienced. • The associations of depression traits with hypertension, diabetes, dyslipidaemia, and alcohol misuse highlight the need for integrated management strategies.

Lesson from the Covid-19 pandemic: do fear and anxiety lower vaccination hesitancy?

Abstract Background The prevalence of vaccination hesitancy has become one of the top ten global health problems. During the Covid-19 pandemic several studies reported negative correlation of vaccination hesitancy with fear of Covid-19 and anxiety. Therefore, the study aimed to explore how fear and anxiety can impact one’s intent to get vaccinated. Methods In 2021, data from 5999 post-secondary Slovenian students was gathered using a cross-sectional online survey. Binary logistic regression and the Sprearman correlation coefficient was used to explore the relation between Fear of Covid-19 Scale (FCOV), Generalized Anxiety Disorder Questionnaire (ANX) and a question regarding participants’ intentions to get vaccinated. Results Results showed that only 39.7% of students expressed intention to get vaccinated as soon as possible and 29.2% exhibited no intentions to do so. Logistic regression indicated that only FCOV had a mild and significant (p < 0.001) impact on students’ intentions to get vaccinated, whereas ANX was found to have only a weak significant (p < 0.01) effect on students’ intentions to do so. Similarly, ANOVA test showed significant differences with small to medium effect of FCOV on intentions to get vaccinated, but no significant differences were found for ANX. Conclusions A low percentage of Slovenian tertiary students expressed intentions to get vaccinated as soon as possible for Covid-19, with only fear having been found to have a small to mild effect on students’ intentions to do so. Anxiety, on the other hand, was found to have a small positively predictive effect on vaccination hesitancy, which could reflect affective forecasting error (i.e. believing that the negative consequences of getting vaccinated would be greater than they really are). Therefore, when considering strategies to address the increasing problem of vaccination hesitancy, one must keep in mind that the loss-framed messages might not be sufficient to prompt people to get vaccinated. Key messages • Fear of Covid-19 had only a small to medium significant positive effect on students’ expressed intentions to get vaccinated as soon as possible. • The loss-framed messages might not be sufficient to prompt people to get vaccinated.

Family function, psychological distress and burden in informal caregivers of people with dementia

Abstract Background Dementia presents a public health priority due to its high global prevalence, mortality, economic cost, and caregiver burden (CB). Dementia care can be stressful and may negatively influence the health of informal caregivers. This cross-sectional study aimed to identify psychological and social factors associated with subjective CB in informal home care providers of people with dementia (PwD), controlling for sociodemographic, clinical, and care-related variables. Methods We included 115 informal caregivers of PwD from community settings (mean age: 54.0±12.4 years; 81.7% women). Participants fulfilled the Zarit Burden Interview (ZBI-12), the Patient Health Questionnaire (PHQ-9), the Generalized Anxiety Disorder Scale (GAD-7), the Family APGAR, and the short IQCODE used to assess dementia severity. Multiple linear analyses were used to analyse the data. Results The mean caregiving duration was 4.8±4.8 years, and 55.7% of informal caregivers extend care for >40 hours/week. We found that a total of 52.5 % of informal caregivers experienced a high CB (ZBI-12 cut-off score: 17). Univariate analyses showed an association between depression (β = 0.36; p < 0.001), anxiety (β = 0.52; p < 0.001), family dysfunction (β = 0.36; p < 0.001), and CB. Regression analyses showed that CB was the most strongly associated with anxiety (β = 0.51; p < 0.001). This association weakened (0.47; p < 0.01) when family function was added to the final model (β=-0.22; p < 0.05). The final model explained 23.5% of the variance in CB. No associations between the caregiver's age, sex, caregiving duration, the extent of care per day, use of community care, dementia severity, and depression were identified. Conclusions Long-term care for people living with dementia can be very demanding. Thus, the implementation of tailored interventions to enhance family function and diminish psychological distress can mitigate level of caregiver burden. [Grant support: APVV-22-0587]. Key messages • Dementia caregiving is a global public health priority. • The caregiver’s burden and distress can be alleviated by the interventions focusing on family dysfunction.

Ketamine-induced altered states of consciousness: a systematic review of implications for therapeutic outcomes in psychiatric practices.

This systematic review aims to elucidate the nexus between ketamine's psychoactive properties and its efficacy in treating a broad spectrum of psychiatric disorders. We searched three databases and used citation tracking to include 29 studies. Predominantly, mood disorders, including bipolar disorder (BD) and major depressive disorder (MDD) (MDD + BD: + n = 25studies), a large part of them involve treatment-resistant patients (n = 14studies), substance use disorder (SUD, n = 3studies), and social anxiety disorder (SAD, n = 1study). From all included studies(n=29), 15 (51.72%) of themidentified a positive relation between ketamine-induced altered states of consciousness and clinical outcomes, while 13studies (44.83%)showed no linkage between them, and one study (3.45%)delineated a negative association. Focusing solely on intravenous (IV) ketamine infusions (n = 25), 14 studies(56%)reported a positive modulation of ketamine's psychoactive effects and therapeutic benefits, whereas 10 studies(40%)confirmed no relationship, and one study (4%)showed a negative association. The single study(33.34%) involving subcutaneous ketamine and allthree studies (66.6%)intranasal administration did not demonstrate a significant interaction between ketamine's psychoactive effects and therapeutic response. All three SUD studies reported a positive correlation between ketamine's psychoactive effects and therapeutic response. In contrast, the single SAD study did not find a relationship between these parameters. For studies involvingmood disorders (n = 25), 12 studies (48%)reported a positive relationship between psychoactive effects and therapeutic response.Others 12studies (48%)identified a null relationship, and one study (4%)found a significant negative association. Although we have found a larger association than previous studies between ketamine's psychoactive properties and its efficacy in treating a broad spectrum of psychiatric disorders, its topic remains indeterminate, mainly due to the high heterogeneity.

Latent class analysis of attitudes towards drug use and well-being among South Korean young adults

Abstract Background The surge in drug use and lack of awareness about drug-related dangers among young adults have become major public health concerns in South Korea. According to the Theory of Planned Behavior, understanding attitudes towards drugs is crucial, as permissive attitudes may lead to drug use. Thus, the study aims to identify latent classes of drug use attitudes among Korean young adults and evaluate how their well-being influences each class. Methods A total of 301 college students in Seoul, South Korea, participated in the study. Latent class analysis (LCA) was employed to identify unique patterns of attitudes towards drug use. Subsequently, we examined the relationships between auxiliary variables (i.e., well-being, including life satisfaction, self-control, quality of life, depression, generalized anxiety disorder, childhood trauma, self-esteem, stress, family strengths, perceived social support, and stigmatization) and latent classes (i.e., attitudes towards drug use subgroups) by conducting multivariate logistic regression analyses. Results LCA categorized attitudes towards drug use into three groups: Class 1 (Permissive Drug Attitude Group), Class 2 (Moderate Drug Attitude Group), and Class 3 (Critical Drug Attitude Group). Class 2 showed a particularly permissive view on marijuana legalization. In multivariate logistic regression, higher stigmatization (β = .900, p < .05) was associated with membership in Class 1 compared to Class 3. Furthermore, being male (β = 2.272, p < .001) and having higher self-esteem (β = .989, p < .05) were linked to membership in Class 2 compared to Class 3. Conclusions The study enhances understanding of the complex relationship between Korean young adults’ well-being and their drug use attitudes. Effective interventions by frontline social workers aimed at preventing drug use should continuously monitor and address social stigmatization and self-esteem while providing accurate information and education regarding drug use. Key messages • Latent Class Analysis sorted drug attitudes into three groups: ‘Permissive,’ ‘Moderate,’ and ‘Critical’ Attitude Groups. • Individuals experiencing social stigmatization had a higher risk of permissive attitudes, while higher self-esteem increased the likelihood of being in the moderate group over the critical group.

Quality of life, anxiety and mindfulness during the prevalence of COVID-19: a comparison between medical and non-medical students

BackgroundThe Covid-19 pandemic has affected all areas of society, including students. However, medical students have faced many challenges due to direct contact with patients. The present study was conducted with the aim of investigating and comparing the quality of life (QoL), anxiety and mindfulness between Iranian medical and non-medical students during the COVID-19 pandemic.MethodFive hundred and six students (both medical and non-medical students) participated in the study from August to October 2022 with a convenience sampling method. The data were collected using an online questionnaire including a demographic form, the QoL Questionnaire (WHOQOL- BREF), the Generalized Anxiety Disorder 7-item survey (GAD‐7) and the Relaxation/Meditation/Mindfulness Tracker t-Persian version survey (RMMt-P). Pearson correlation and independent t-test and multivariate linear regression were used to determine the relationship between the study variables.ResultsThe samples included 272 medical students and 234 non-medical students with a mean age of 21.99 ± 3.46 and 24.17 ± 6.54 years respectively. Most of the medical and non-medical students were female, single and had a bachelor’s degree. The mean scores of medical and non-medical students’ QoL during the COVID-19 pandemic were 57.86 ± 13.26 and 56.75 ± 14.42, respectively which indicates the higher quality of life of medical students. Anxiety and mindfulness predicted 29% of the variance of the QoL in the medical students, while anxiety and mindfulness and having a chronic disease predicted 30% of the variance of the QoL in the non-medical students. No significant difference existed in the QoL and its subscales during the COVID-19 pandemic between medical and non-medical students (p > 0.05). There was a significant difference in terms of anxiety (p = 0.02) and mindfulness (p = 0.03) between medical and non-medical students during the prevalence of COVID-19.Discussion and conclusionThe findings of the present study indicated that medical students exhibited lower levels of anxiety and higher levels of mindfulness. Therefore, interventions aimed at reducing anxiety and increasing mindfulness among non-medical students are necessary. It is recommended that preventive approaches and psychological interventions to improve students’ quality of life become an integral part of crisis response during the COVID-19 pandemic. Additionally, reducing anxiety and enhancing mindfulness can improve the quality of education and professional performance of medical students, while also contributing to their mental well-being and effective clinical communication.

Trends in the association between alcohol use and generalized anxiety in Finnish adolescents

Abstract Background During the past two decades, alcohol use has decreased among adolescents, but on the contrary, anxiety symptoms have increased (at least among females). These diverging trends set interesting opportunities to examine whether the strength of the well-known correlation/co-occurrence between alcohol use and anxiety has also changed. This study aims to examine changes in the co-occurrence and associations between heavy episodic drinking (HED) and generalized anxiety among adolescents in Finland from 2013 to 2023. Methods Data from the Finnish School Health Promotion Study between 2013-2023 covered 874 110 participants aged 13-20. Generalized anxiety was measured using Generalized Anxiety Disorder Scale (GAD-7) (range 0-21), and heavy episodic drinking was measured as reported heavy drunkenness once a month or more often versus less than once a month. Yearly prevalence estimates of co-occurrence were analyzed for those with moderate to severe anxiety symptoms (>10) and monthly or more frequent HED. Associations between anxiety and HED were analyzed using logistic regression and time-varying effect modelling. Interactions between time and anxiety predicting HED were also considered. Results The moderate to severe anxiety symptoms increased from 10.7% to 20.9% and HED decreased from 18.0% to 11.8% between 2013 and 2023. The proportion of those with both HED and moderate to severe anxiety increased from 2.9% in 2013 to 3.6% in 2023. The association between anxiety symptoms and HED was stable during the study period, with odds ratios ranging between 1.06 and 1.07. Conclusions During the past decade, diverging trends in generalized anxiety symptoms and heavy episodic drinking have not changed the association between them. The proportion of adolescents with these co-occurring health concerns has increased in females. This calls for continuous efforts to strengthen the integration of mental health and substance use prevention and services. Key messages • The association between generalized anxiety and heavy episodic drinking has not changed in adolescents in Finland between 2013 and 2023. • The proportion of those with both moderate to severe anxiety symptoms and heavy episodic drinking has increased in females and remained stable in males during the past decade (2.9% - 3.6%).