Anxiety Symptomology Research Articles

Social Inequalities in mental health service use and perceived helpfulness: A global analysis across 111 countries

Abstract Social inequalities in mental health are evident in the prevalence of mental health problems, but also the utilisation and patents’ perceived benefits of treatment. However, the extent of these disparities on a global scale and whether there are country-level differences in the predictors of mental health service use remain unknown. This study uses data from the Wellcome Global Monitor 2020, a nationally representative survey encompassing 111 countries and 117,088 individuals. We examine the association of socio-economic factors (such as household income and education), psycho-social factors (including stigma perception and trust in health professionals), and country-level variables (such as GDP, Gini coefficient, and health expenditure) with mental health service use and perceived effectiveness of treatment. Multi-level logistic regression models were employed for analysis. The utilisation of mental health professions of people with depression or anxiety symptomology is higher in HICs (predicted probability of 62% CI[0.60 - 0.65]) compared to LIMCs (predicted probability of 33% CI[0.31 - 0.34]). Higher country GDP (OR = 1.26 CI[1.08-1.47]) and health expenditure (OR = 1.11 CI[1.04-1.19] per percentage of health expenditure) are associated with higher treatment utilisation. On the individual level, those in the wealthiest quintile are more likely to engage with mental health professionals (OR = 1.25[1.14-1.36]) and perceive this treatment as highly beneficial (OR = 1.23[1.07-1.40]). Trust in healthcare practitioners and perceived stigma are also associated with mental healthcare use. This analysis shows strong patterns of mental healthcare use and perceived benefits depending on the wealth of the country, health expenditure and individual socio-economic status. Moreover, disparities in treatment utilization and effectiveness are also influenced by trust in healthcare professionals and perceived mental health stigma.

Anxiety, Self-Satisfaction and Self-Defining Events: Exploring the Inter-Related Dimensions of the Self

ABSTRACT Increasing self-satisfaction could reduce anxiety symptomology; however, strategies to enhance self-satisfaction are relatively unexplored. The primary aim of the present research was to examine the relationship between self-defining events (past and future), self-satisfaction, and anxiety. In total, 155 students (78.1% female, mean age = 20.54, SD = 5.49) were recruited from an English University. Participants were asked to record the content and valence of three self-defining memories and self-defining future-projections. Path analysis showed that past and future valence were positively related to self-satisfaction, which was negatively related to anxiety. Content analysis showed a significant positive relationship between self-satisfaction and the frequency of achievement-orientated past events and recreational future events. In addition, there was a significant negative relationship between self-satisfaction and the frequency of life-threatening past events. Overall, these findings present new avenues for future interventions designed to increase self-satisfaction through targeting the valence of self-defining past and future events. In addition, the findings from the content analysis could facilitate the development of more targeted interventions that for instance, focus on promoting achievement-oriented and recreational experiences while mitigating the impact of life-threatening events. These strategies could prove effective in enhancing self-satisfaction and subsequently reducing anxiety.

Impaired Social Attention and Cognitive Empathy in a Paediatric Sample of Children with Symptoms of Anxiety.

Impairments in social cognition, in particular empathy, have been associated with childhood psychopathology, though previous investigations have yielded inconsistent results. Measures of social attention can reveal processes involved in responses to emotional stimuli and highlight deficits in empathy, or emotional biases in those with anxiety. The current study examined symptoms of anxiety, cognitive and affective empathy scores, and eye-gaze patterns in a pediatric sample of children (n = 178; 51-98 months-old) referred by their teachers for emerging psychopathology symptoms at school. We used eye-tracking metrics to capture gaze patterns during a dynamic video task designed to elicit empathic responses. Anxiety symptomology was reported by parents using the Screen for Child Anxiety Related Disorders scale (SCARED). Associations between eye-tracking variables, cognitive and affective empathy, and anxiety scores were analysed dimensionally in accordance with the Research and Domain Criteria (RDoC) framework. Higher levels of anxiety were associated with lower cognitive empathy and shorter first and total fixation durations to the eyes, across emotions (happiness, sadness, fear). No such associations were found between affective empathy and anxiety. Hierarchical multiple regression analyses revealed that across emotion conditions, first fixation duration negatively predicted anxiety scores. Our results indicate that children high in anxiety display cognitive empathy impairments and shorter attention to the eyes. These findings could inform early intervention programs for individuals at risk of developing anxiety disorders, as educating those high in anxiety on ways to identify emotions in others through changes in social attention could help to reduce anxiety.

The long-term effect of surf therapy on posttraumatic stress, depression, and anxiety symptomology among current and former australian defence force members - A nonrandomised controlled longitudinal study in a community setting

BackgroundSurf therapy programs have demonstrated engagement among military samples, showing promising concurrent short-term reductions in symptoms of posttraumatic stress disorder, major depressive disorder, and generalised anxiety disorder; however, the long-term retained benefits of such programs have not been studied beyond three months. MethodsThis nonrandomised controlled longitudinal study recruited current and former Australian Defence Force personnel (N = 116) to examine the effect of a ten-session surf therapy program (n = 88) compared to a control group (no intervention; n = 28). Validated self-assessment measures of post-traumatic stress, depression and anxiety symptoms were recorded at pre and post intervention, and at one month, four months, and seven months follow up. ResultsLinear mixed model results reveal statistically significant post-program reductions in symptoms of posttraumatic stress (PCL-M; ß = −11.92, 95% CI [-17.44, −6.36]), depression (MDI; ß = −7.87, 95% CI [-12.35, −3.38]) and anxiety (GAD-7; ß = −4.02, 95% CI [-6.42, −1.57]), which were retained at 7-months follow-up. Clinically significant changes were also observed on all three outcomes. No changes were observed in the control group. Additional statistically significant beneficial effects for each model outcome were recorded for leisure surfing following the program. Most surf therapy participants continued surfing post program, indicating effective lifestyle change. ConclusionsThis is the largest quantitative surf therapy study among adults to date, and the first to follow up seven months post program. It confirms previous surf therapy findings of high engagement and transdiagnostic effects, and provides new clinically relevant knowledge by demonstrating retained beneficial effects regardless of continued surfing post program.

Concurrent Validity of the Anxiety Disorders Section of the Anxiety Disorder Interview Schedule- Autism Spectrum Addendum (ADIS-ASA) in Autistic Youth.

Examine the concurrent validity of specific Anxiety Disorders Section of the Anxiety Disorder Interview Schedule for DSM-IV-Autism Spectrum Addendum (ADIS-ASA)-Parent Interview in a sample of 167 autistic youth who met diagnostic criteria for an anxiety-related disorder (Mage = 9.91; 78.4% male; 82% non-Hispanic; 77.67% White). Concurrent validity of Diagnostic and Statistical Manual (DSM)-defined ADIS-ASA anxiety disorder diagnostic caseness was examined via relations with (a) parent-reported dimensions of youth anxiety symptomology and (b) dimensional measures of youth anxiety-related functional impairment, respectively, using logistic regression models and point-biserial correlations. Significant relations were found between separation anxiety disorder and social anxiety disorder (but not generalized anxiety disorder nor obsessive-compulsive disorder) caseness, respectively, and theoretically consistent facets of dimensional youth anxiety symptomology. Relations between ADIS-ASA diagnostic caseness and youth functional impairment-related variables revealed that only separation anxiety disorder demonstrated robust evidence of convergent validity. Despite mixed findings concerning relations between ADIS-ASA anxiety disorder diagnostic caseness and dimensional measures of anxiety severity and anxiety-related impairment, the present findings provide further support for the status of the ADIS-ASA as a gold standard for assessment of anxiety in autistic youth. This work also highlights the importance of continuing to improve precision in measurement of anxiety symptomology in autistic youth, with implications for clinical assessment.

Examining associations between mental health and Chronic Non-Communicable Diseases (C-NCDs) among older adults in Wakiso, Uganda.

Globally, the prevalence of chronic non-communicable diseases (C-NCDs) and occurrence of multi-morbidity specifically, has been increasing and will continue to rise as life expectancy increases. The burden of mental health disorders has also been rising globally. In sub-Saharan Africa (SSA), literature on these health issues, which are interrelated, is scarce. This study assesses the prevalence of C-NCDs, and depressive and anxiety symptomology and examines the relationship between these issues among a sample of older adults in Uganda. Between 2021-2022, 604 consenting adults aged 35 years and older were surveyed on a broad range of health issues for the ongoing AMBSO Population Health Surveillance (APHS) cohort study in Wakiso district. Descriptive analyses were performed to characterize the burden of C-NCDs (e.g. diabetes, hypertension), depression (PHQ-9 using a cutoff of <5 scores for minimal/no and 5+ for mild to severe symptomology) and anxiety (GAD-7 using a cutoff of 5+ scores for mild to severe symptomology). Bivariate analysis and multivariable logistic regression models were built using STATA software version 16.0 to examine associations between mental health disorders and having at least one C-NCD. Our exposures of interest were depressive and anxiety symptoms and our outcomes of interest was presence of C-NCDs. Majority of participants were females (63.6%), median age was 46 (IQR: 39-54). Any C-NCDs prevalence was 18.7%, while 18.9% and 11.4%, had screening scores indicative of depressive and anxiety symptomology, respectively. Three percent (3.2%) had PHQ-9 scores indicative of moderate to severe depressive symptomology. In models adjusted for sociodemographic characteristics, there was 12% increased odds of suffering from C-NCDs for every unit increase in PHQ-9 score (AOR = 1.12, 95% CI: 1.10-1.20). Participants with any anxiety symptoms had 2.1 greater odds of suffering from C-NCD compared to those who did not have anxiety symptoms (AOR = 2.10, 95% CI: 1.21-3.70). C-NCDs were prevalent in older adults, particularly among those experiencing mental health symptoms. Screening for C-NCDs and mental health disorders should be integrated into routine health care for older adults in the country. Early screening and identification of these health issues through primary health care could significantly reduce the public health burden attributable to mental health disorders and the incidence of multi-morbidity in Uganda.

Conflicting patterns of cardiovascular reactivity, self-report, and behavior associated with social anxiety during a conversation with a close friend.

Social anxiety (SA) is characterized by anxious symptomology and fear during social situations, but recent work suggests that SA may not necessarily be associated with negative interpersonal and intrapersonal outcomes in support contexts. The current research investigates the discrepancies between self-perceptions, behavior, and physiological responses associated with SA in social support conversations with close friends. Specifically, we examined the associations between SA and positive and negative affect, perceptions of demands and resources, and responsiveness. Additionally, we used the biopsychosocial model of challenge and threat to understand the physiological responses associated with SA. Participants (79.9% White, 9.8% Black or African American, 10.3% Multiple races or other; 78.7% Female), totaling 172 undergraduate friend dyads, completed self-report measures and had physiological responses recorded while they discussed a problem unrelated to the friendship. Trained coders rated responsive behaviors exhibited during the conversation. Results revealed that greater SA was associated with greater negative perceptions of social interactions (greater negative affect, fewer perceived resources, and greater perceived demands). However, cardiovascular reactivity and behavioral responses within the conversation, as well as perceptions of partners' behavior after the conversation, contrasted with these negative perceptions. Indeed, greater SA was associated with greater sympathetic arousal (indicative of greater task engagement), but not with greater challenge or threat, and SA was not associated with perceived partner responsiveness or responsive behaviors. These results add to the growing body of research that suggests people with greater SA show inconsistencies between their conscious appraisals of social situations and their physiological responses.

Expressive suppression mediates the relationship between sleep quality and generalized anxiety symptomology

Anxiety disorders are the most prevalent worldwide mental health disorder, resulting in high societal costs. Emotion regulation and sleep quality are associated with the development of psychopathologies including anxiety. However, it is unknown whether habitual emotion regulation strategy use can mediate the influence of sleep quality on anxiety symptomology. An opportunity sample in a healthy population completed the Pittsburgh Sleep Quality Index to provide a measure of sleep quality, the Emotion Regulation Questionnaire to assess habitual use of emotion regulation strategies, and the Generalized Anxiety Disorder Scale to record anxiety symptomology. Data were analysed using correlation and regression-based mediation analyses. Improved sleep quality was predictive of reduced habitual use of expressive suppression and reduced anxiety symptomology. Additionally, increased use of expressive suppression was predictive of greater anxiety symptomology. Cognitive reappraisal was not associated with sleep quality or anxiety severity. Further, novel findings using mediation analyses show that expressive suppression partially mediated the relationship between sleep quality and anxiety. Whilst longitudinal and experimental research are needed to establish causality, these findings suggest that simultaneously targeting improvements in sleep quality and the use of specific emotion regulation strategies, including expressive suppression, may improve the efficacy of interventions focussed on reducing anxiety-related symptomology.

Too depressed and anxious to speak up: The relationships between weekly fluctuations in mental health and silence at work.

While it is widely acknowledged that some employees are more prone to silence than others, emerging research suggests that silence is much more dynamic than previously indicated, as even the most vocal employee will withhold input in some situations. However, given scant empirical attention to intraindividual fluctuations in silence, several important questions remain regarding its etiological antecedents, the mechanisms underlying such effects, and potential factors mitigating them. We respond by integrating the silence and mental health literature to consider how fluctuations in employees' experiences of depression and anxiety relate to fluctuations in silence via distinct silence motives. Specifically, we propose that employees are likely to engage in silence while experiencing episodes of depression because depressive symptomology shifts perceptions toward voice being pointless (i.e., ineffectual silence motive). Likewise, we propose that employees are likely to engage in silence while experiencing flare-ups of anxiety because anxious symptomology shifts perceptions toward voice being dangerous (i.e., defensive silence motive). Finally, we argue that voice endorsement attenuates these relationships by interrupting the link between silence motives and behaviors, such that employees experiencing heightened ineffectual and defensive silence motives are less likely to remain silent during weeks in which they experience high voice endorsement. We find support for these predictions via an experience sampling methodology study conducted with 136 employees across 4 weeks. We discuss how these results enhance theoretical clarity on the dynamic links between mental health and silence and offer insights into how organizations can counteract intrapersonal variations in silence. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Poor Sleep Quality Contributes to Vascular Endothelial Dysfunction in Young Adults with Adverse Childhood Experiences

Introduction: Adverse childhood experiences (ACEs) represent severe psychosocial stressors during the first 18 years of life that promote a dose-dependent, lifetime increase in cardiovascular disease risk. ACEs have been associated with impaired vascular endothelial function and poor sleep quality in young adults. However, whether poor sleep quality influences the association between ACEs and vascular endothelial function is unclear. We hypothesized that sleep quality would mediate the association of ACE exposure with impaired vascular function. Purpose: To examine the contribution of sleep quality to ACEs-related impairments in vascular endothelial function in young adults. Methods: We used a cross-sectional cohort study (Study 1) and a single-arm intervention (Study 2) to test our hypothesis. Sleep quality was characterized as sleep effciency (SE%) and calculated as total sleep duration relative to time-in-bed. Vascular endothelial function was assessed using the brachial artery flow mediated dilation technique (FMD). In Study 1, we examined the mediation effect of SE% in the association of ACE exposure with FMD in a cohort of young adults (n=56; age = 25 ± 5 y, BMI = 26 ± 5 kg/m2) using the bootstrapped (1,000 replications) bias-corrected percentile confidence interval method adjusted for sex, and depression and anxiety symptomology. The variance accounted for (VAF) was calculated as the ratio of the indirect effect to total effect β-coeffcients. In Study 2, with a separate sample (n=12; age = 21 ± 2 y, BMI = 23 ± 4 kg/m2) of young adults with high ACE exposure (5 ± 2 ACEs) and poor sleep quality (SE ≤ 90%), we manipulated SE% using 6-weeks of cognitive-behavioral therapy for insomnia (CBTi) and measured FMD before (PRE) and after (POST) the intervention. Change in weekly SE% from daily consensus sleep diary entries was analyzed using a one-way ANOVA with Tukey post hoc comparisons. PRE to POST change in FMD was analyzed with a paired samples t-test. The association between the change (Δ; POST-PRE) in SE% and FMD was examined using a Spearman’s correlation coeffcient (ρ). Results: In Study 1, SE% significantly, partially mediated the association between ACE exposure and FMD (indirect effect standardized β-estimate = -0.11 [95% CI = -0.29 – -0.02]; VAF = 27.4%). In Study 2, there was a treatment effect of CBTi on SE% ( p &lt; 0.001) where SE% improved from baseline to weeks 3, 4, 5, and 6 (weekly improvement range = 8.8 – 10.1%; all p ≤ 0.002). FMD increased PRE to POST (2.85 ± 0.58 to 3.65 ± 1.0 %/SR AUC·104; p = 0.017). There was a moderate, non-significant association between ΔSE% and ΔFMD (ρ = 0.46, p = 0.13). Conclusions: Our findings provide initial evidence that poor sleep quality may contribute to the previously described impairment in vascular endothelial dysfunction observed with increasing ACE exposure in young adults. Funding provided by a grant from the Injury Prevention Research Center through the CDC (R49 CE003095; NDMJ). This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

The Friendship Gap: Investigating gender differences in adolescent friendships and mental health

Introduction Friendships are vital relationships throughout the lifespan, but become especially meaningful during adolescence. Adolescents between the ages of 10 and 18 name a friend as one of the most important people in their lives (Kiesner et al., 2004). Authentic social groups, defined as mutual social relationships that adolescents voluntarily engage in, are sources of support and companionship for adolescents, more than parents (Furman &amp; Buhrmester, 1992). Past research shows adolescents turn to their friends most for mental health support in a crisis, yet less than half report finding the support helpful (Geulayov et al., 2022). Thus, it’s crucial to understand friendship dynamics of adolescents in order to address an appropriate intervention. Past literature has demonstrated gender differences in how adolescents approach friendships and social relationships (Lempers &amp; Clark- Lempers, 1993).ObjectivesI aim to investigate whether girls, boys, and gender non-binary individuals differ in their perceptions of friendship quality and friendship dynamics (i.e. social support seeking) and whether these differences have implications for their mental health outcomes. By studying gender differences in friendship quality and mental health, I hope to shed light on potential avenues for promoting inclusivity and positive mental health outcomes for both gender binary and gender non-binary adolescents.MethodsA cross-sectional survey (OxWell) was administered online to students across secondary schools and further education colleges in England to assess their self-reported friendship quality. The RCADS and WEMWBS scales were used to assess depression and anxiety symptomology, and well-being, respectively. The results from the survey were analysed in R.ResultsGender-binary and gender non-binary adolescents differed in friendship quality, friendship dynamics, mental health scores, and help-seeking behaviours. Gender non-binary adolescents had the worst mental health scores and reported lowest friendship quality compared to girls and boys. Boys had the best mental health when compared to girls and gender non-binary adolescents, and were more likely to perceive support provided by their friends as helpful. Surprisingly, gender non-binary adolescents reached out to their friends the most (when compared to girls and boys) for mental health support, despite having proportionally lower quality friendships, and were the least likely to find support received from friends helpful.ConclusionsThis data presents evidence for the difference in social relationships across adolescents of all genders. It highlights the need for specialized and inclusive mental health support being made available for gender non-binary youth in England—a minoritized group in need of intervention. This data hopes to inform school-based friendship interventions targeted to improve friendships and mental health of gender non-binary youth.Disclosure of InterestNone Declared

Excitatory and inhibitory neurochemical markers of anxiety in young females

Between the ages of 10–25 years the maturing brain is sensitive to a multitude of changes, including neurochemical variations in metabolites. Of the different metabolites, gamma-aminobutyric acid (GABA) has long been linked neurobiologically to anxiety symptomology, which begins to manifest in adolescence. To prevent persistent anxiety difficulties into adulthood, we need to understand the maturational trajectories of neurochemicals and how these relate to anxiety levels during this sensitive period. We used magnetic resonance spectroscopy in a sample of younger (aged 10–11) and older (aged 18–25) females to estimate GABA and glutamate levels in brain regions linked to emotion regulation processing, as well as a conceptually distinct control region. Within the Bayesian framework, we found that GABA increased and glutamate decreased with age, negative associations between anxiety and glutamate and GABA ratios in the dorsolateral prefrontal cortex, and a positive relationship of GABA with anxiety levels. The results support the neural over-inhibition hypothesis of anxiety based on GABAergic activity.

Exploring the psychological inflexibility – Psychological distress relationship in Black veterans

Previous research has shown that veterans have higher rates of mental health concerns compared to non-veteran populations. A potential risk factor for the development of mental health concerns (i.e., depression & anxiety), particularly in Black veterans, is psychological inflexibility. Psychological inflexibility, a component of Acceptance & Commitment Therapy (ACT), is a process by which behavior is expressed in ways that attempt to control emotional and psychological reactions to uncomfortable stimuli and situations rather than by direct contingencies or personal values. The present study explored the relationship between psychological inflexibility, symptoms of depression, and symptoms of anxiety in a sample of 524 Black veterans in the United States. Results demonstrated that Black veterans who endorsed psychological inflexibility also endorsed higher levels of both depression and anxiety symptomology. These findings indicate the deleterious consequences of experiencing psychological inflexibility, which could be treated through ACT.

School distress and the school attendance crisis: a story dominated by neurodivergence and unmet need.

The Covid-19 pandemic has brought into sharp focus a school attendance crisis in many countries, although this likely pre-dates the pandemic. Children and young people (CYP) struggling to attend school often display extreme emotional distress before/during/after school. We term this School Distress. Here we sought to elucidate the characteristics of the CYP struggling to attend school in the United Kingdom. Using a case-control, concurrent embedded mixed-method research design, 947 parents of CYP with experience of School Distress completed a bespoke online questionnaire (February/March 2022), alongside an age-matched control group (n = 149) and a smaller group of parents who electively home-educate (n = 25). In 94.3% of cases, school attendance problems were underpinned by significant emotional distress, with often harrowing accounts of this distress provided by parents. While the mean age of the CYP in this sample was 11.6 years (StDev 3.1 years), their School Distress was evident to parents from a much younger age (7.9 years). Notably, 92.1% of CYP currently experiencing School Distress were described as neurodivergent (ND) and 83.4% as autistic. The Odds Ratio of autistic CYP experiencing School Distress was 46.61 [95% CI (24.67, 88.07)]. Autistic CYP displayed School Distress at a significantly earlier age, and it was significantly more enduring. Multi-modal sensory processing difficulties and ADHD (among other neurodivergent conditions) were also commonly associated with School Distress; with School Distress CYP having an average of 3.62 NDs (StDev 2.68). In addition, clinically significant anxiety symptomology (92.5%) and elevated demand avoidance were also pervasive. Mental health difficulties in the absence of a neurodivergent profile were, however, relatively rare (6.17%). Concerningly, despite the striking levels of emotional distress and disability reported by parents, parents also reported a dearth of meaningful support for their CYP at school. While not a story of exclusivity relating solely to autism, School Distress is a story dominated by complex neurodivergence and a seemingly systemic failure to meet the needs of these CYP. Given the disproportionate number of disabled CYP impacted, we ask whether the United Kingdom is upholding its responsibility to ensure the "right to an education" for all CYP (Human Rights Act 1998).

Evaluating the Effectiveness of a Codeveloped e-Mental Health Intervention for University Students: Protocol for a Randomized Controlled Trial.

University life typically occurs during a period of life transition, where the incidence of mental health and substance use problems and disorders peaks. However, relatively few students obtain effective treatment and support. e-Interventions have proven effective in improving the psychological outcomes of university students and have the potential to provide scalable services that can easily integrate into existing models of care. Minder is a mobile app codeveloped with university students that offers users a collection of evidence-based interventions tailored to help university students maintain their mental health and well-being and manage their substance use. This paper describes the protocol for a randomized controlled trial (RCT) that aims to assess the effectiveness of the Minder app in improving the mental health and substance use outcomes of university students. This study is a 2-arm, parallel assignment, single-blinded, 30-day RCT with 1 intervention group and 1 waitlist control group. Overall, 1496 (748 per trial arm) university students from the University of British Columbia Vancouver Campus (N=54,000) who are aged ≥17 years, have a smartphone with Wi-Fi or cellular data, and speak English will be recruited via a variety of web-based and offline strategies. Participants will be randomized into the intervention or control group after completing a baseline survey. Those randomized into the intervention group will gain immediate access to the Minder app and will be assessed at 2 weeks and 30 days. Those randomized into the control group will be given access to the app content after their follow-up assessment at 30 days. The primary outcomes are measured from baseline to follow-up at 30 days and include changes in general anxiety symptomology, depressive symptomology, and alcohol consumption risk measured by the General Anxiety Disorder 7-Item scale, Patient Health Questionnaire 9-Item scale, and US Alcohol Use Disorders Identification Test-Consumption Scale, respectively. Secondary outcomes include measures related to changes in the frequency of substance use, mental well-being, self-efficacy in managing mental health and substance use, readiness to change, and self-reported use of mental health services and supports (including referral) from baseline to follow-up at 30 days. Trial recruitment and data collection began in September 2022, and the completion of data collection for the trial is anticipated by June 2023. As of May 10, 2023, a total of 1425 participants have been enrolled. The RCT described in this protocol paper will assess whether the Minder app is effective in improving the mental health and substance use outcomes of a general population of Canadian university students. Additional secondary outcome research aims to explore additional outcomes of interest for further research and better understand how to support students' general mental well-being. ClinicalTrials.gov NCT05606601; https://clinicaltrials.gov/ct2/show/NCT05606601. DERR1-10.2196/49364.

Impact and centrality of attention dysregulation on cognition, anxiety, and low mood in adolescents

Functional impairments in cognition are frequently thought to be a feature of individuals with depression or anxiety. However, documented impairments are both broad and inconsistent, with little known about when they emerge, whether they are causes or effects of affective symptoms, or whether specific cognitive systems are implicated. Here, we show, in the adolescent ABCD cohort (N = 11,876), that attention dysregulation is a robust factor underlying wide-ranging cognitive task impairments seen in adolescents with moderate to severe anxiety or low mood. We stratified individuals high in DSM-oriented depression or anxiety symptomology, and low in attention deficit hyperactivity disorder (ADHD), as well as vice versa – demonstrating that those high in depression or anxiety dimensions but low in ADHD symptoms not only exhibited normal task performance across several commonly studied cognitive paradigms, but out-performed controls in several domains, as well as in those low in both dimensions. Similarly, we showed that there were no associations between psychopathological dimensions and performance on an extensive cognitive battery after controlling for attention dysregulation. Further, corroborating previous research, the co-occurrence of attention dysregulation was associated with a wide range of other adverse outcomes, psychopathological features, and executive functioning (EF) impairments. To assess how attention dysregulation relates to and generates diverse psychopathology, we performed confirmatory and exploratory network analysis with different analytic approaches using Gaussian Graphical Models and Directed Acyclic Graphs to examine interactions between ADHD, anxiety, low mood, oppositional defiant disorder (ODD), social relationships, and cognition. Confirmatory centrality analysis indicated that features of attention dysregulation were indeed central and robustly connected to a wide range of psychopathological traits across different categories, scales, and time points. Exploratory network analysis indicated potentially important bridging traits and socioenvironmental influences in the relationships between ADHD symptoms and mood/anxiety disorders. Trait perfectionism was uniquely associated with both better cognitive performance and broad psychopathological dimensions. This work suggests that attentional dysregulation may moderate the breadth of EF, fluid, and crystalized cognitive task outcomes seen in adolescents with anxiety and low mood, and may be central to disparate pathological features, and thus a target for attenuating wide-ranging negative developmental outcomes.

Physical activity and mental health during the COVID-19 pandemic among individuals with amputation.

The isolating nature of various COVID-19 mandates may have reduced physical activity (PA) and increased mental health symptomology among individuals with amputation. However, an investigation of mental health across PA levels before and after the onset of COVID-19 among this group has not been conducted. Therefore, the objective of this study was to investigate group differences in depression, anxiety, and post-traumatic stress symptomology among individuals with amputation who reported being physically "active," "somewhat active," or "inactivate" before and during the pandemic. Individuals with an amputation at any level (n = 91; 51% female; age = 52.5±15.5) completed an online questionnaire to assess demographic information, PA levels, and mental health throughout the pandemic. Group differences in self-reported PA before and after COVID-19 onset were assessed by the PA Guidelines for Americans recommendations. The Center for Epidemiologic Studies Depression Scale (CES-D), Generalized Anxiety Disorder (GAD-7), and Posttraumatic Stress Disorder Checklist (PCL-5) scales were used to assess group differences in mental health status. Before and after the onset of COVID-19, 33% and 42.9% of respondents reported that they were inactive, respectively. 58.2% of respondents reported decreased PA since the pandemic's onset. Prior to the pandemic, active individuals reported lower CES-D (14.21 vs. 19.07; Cohen's d: -0.414), GAD-7 (3.82 vs. 5.47; Cohen's d: -0.359), and PCL-5 (15.92 vs. 21.03; Cohen's d: -0.319) scores compared to inactive individuals. After the onset of COVID-19, scores remained lower for active respondents CES-D (12.67 vs. 20.03; Cohen's d: 0.-669), GAD-7 (3.17 vs. 5.87; Cohen's d: -0.598), and PCL-5 (13.39 vs. 19.90; Cohen's d: -0.430). Individuals with amputation reported decreased PA after the onset of COVID-19. Individuals reporting that they were "active" exhibited improved depression and anxiety symptomology scores compared to those reporting that they were "inactive."

Feasibility and Acceptability of a Novel Online Program for Mental Health Carers.

To evaluate the feasibility and acceptability of a new online program (Minds Together ) for carers of a person with depressive or anxiety symptoms. Using a two-arm randomised controlled trial design, 108 carers of a person with depressive or anxiety symptomology aged 16 years or over (89% female; mean age 50 years) received immediate or delayed access to the Minds Together program. Feasibility was measured using program activation and survey completion rates. Acceptability was measured using a project-specific satisfaction scale, semi-structured interviews, and program completion metadata. The study used intention-to-treat (ITT) analysis for participant-reported outcomes (carer burden, coping self-efficacy) across groups. Feasibility and acceptability thresholds were consistent with similar studies: 59% activated their program account, 47% met the program completion threshold, and almost all reported satisfaction with the program. The ITT indicated trends in increased coping self-efficacy and reduced carer burden for the Intervention group, compared to the Waitlist control. The Minds Together program is a feasible and acceptable program for carers supporting a person with depressive or anxiety symptomology. Results support exploration of the program's efficacy in a full-scale RCT.

Hearing loss and mental health issues in amateur and professional musicians

Musicians are at risk of developing music-induced hearing loss (MIHL) and also exhibit increased prevalence of depression, anxiety, and stress. However, the relationship between hearing loss and mental health issues in musicians has not yet been explored. This study conducted a cross-sectional analysis of 32 professional and 35 amateur musicians recruited from local bands and orchestras. KUDUwave software was used to obtain their overall hearing thresholds for both ears over three frequency ranges: 0.5 to 4, 6 to 8, and 9 to 16 kHz. Participants also completed a demographic questionnaire that contained questions related to musical exposure, type of music exposed, years of practice, and so on, and the DASS-21 questionnaire, which assesses the presence of depression, anxiety, and stress symptoms. Professional musicians had significantly greater music exposure compared with amateur musicians, but their hearing thresholds were not significantly different from amateur musicians in 0.5–4, 6–8, or 9–16 kHz frequency ranges. Professional musicians experienced greater symptoms of anxiety compared with amateur musicians, and this occurred independently of their hearing status. Further longitudinal studies are required to explore the causative factors resulting in increased mental health issues in professional musicians and what potential interventions may be implemented to address anxious symptomology in this population.

Factors Predicting Mental Health Among Women in Low-Income Communities of a Changing Society: A Mixed-Methods Study.

To explore women's mental health in India's rapidly changing society. A convenience sample of low-income women (N = 286) in a medium-sized city in South-India participated in a mixed-methods, exploratory study in 2022. Institutional Review Board (IRB) approval was received from Loma Linda University in the US, and Christian Medical College-Vellore in India, in accordance with the declaration of Helsinki, prior to data collection. All study materials were forward and back translated for Tamil, the local language. Phase 1(n = 25) involved audio recorded key-informant interviews and focus groups. Verbatim transcripts were inductively coded, and emerging themes identified. Phase 2 (n = 261) entailed a quantitative survey including demographics, health history, and validated scales measuring mental health symptoms, coping strategies, social support, living situation, and life satisfaction. Data collectors were gender and language matched, research trained, community health nurses. Qualitative themes included: 1) benefits of living in the city, 2) double duty for women doing household work and paid work, 3) challenges of living in the urban environment, 4) advantages of living in the village, 5) struggles associated with village life. Quantitative results: the average Hopkins Symptoms Checklist (HSCL) score of 1.82 (SD = 0.70) exceeded the 1.65 cut-off score for anxiety and depression symptomology. Among participants with elevated HSCL scores (n = 129) the average was markedly elevated (M = 2.39, SD = 0.56). These women were more likely to rely on wishful thinking, religious coping, and reported more post-migration living difficulties, less social support, and less satisfaction with life. Regression analysis further explored variables associated with participant HSCL scores. In this sample of low-income urban-dwelling women depression and anxiety symptomology was elevated. Given the limited mental health workforce and cultural stigmatization of mental health issues, further attention is required.