Baseline Anxiety Levels Research Articles

Anxiety during the COVID-19 pandemic in prisoners who had high risks to suffer from mood disorders: A longitudinal study before and during the COVID-19.

We compared the anxiety levels in prisoners before and after the COVID‐19 outbreak and analyzed the causes of the changes in anxiety. The first survey was conducted in October 2019 (T0), and the second was conducted in March 2020 (T1). Generalized anxiety disorder‐7 (GAD‐7), Patient Health Questionnaire‐9, and Insomnia Severity Index scales were selected to assess the quality of emotion and sleep among prisoners (N = 803). Three subjective questions were asked to evaluate prisoners' personal feelings on the COVID‐19. Paired Samples T‐test, Binary, and Multivariate Logistic Stepwise Regression were used to analyze the data. GAD‐7 scores decreased at T1 (p < 0.001). For the prisoners without anxiety at T0 (n = 480), GAD‐7's mean value at T1 raised (p < 0.001), whereas the mean value decreased (p < 0.001) for the prisoners with anxiety at T0 (n = 323). For the prisoners without anxiety, shorter years of education (OR = 0.843), COVID‐19 (OR = 4.936), severer depression at T1 (OR = 1.683), and severer insomnia at T1 (OR = 1.134) were associated with the new onset of anxiety. For the prisoners with anxiety, anxiety was alleviated in 71.2% and exacerbated in 10.5% at T1. For the alleviators, severer depression at T1 (OR = 0.667) and COVID‐19 (OR = 0.258) were associated with anxiety unrelief; severer anxiety at T0 (OR = 1.343) was associated with anxiety alleviation. For the exacerbators, severer anxiety at T0 (OR = 0.517) was associated with anxiety unaggravation; severer depression at T1 (OR = 1.196), COVID‐19 (OR = 22.882), and severer depression at T0 (OR = 1.181) were associated with anxiety exacerbation. At the outbreak of COVID‐19, prisoners' anxiety was reduced. The main factor was the baseline anxiety levels. That may be related to prison management and the Downward Social Comparison.

0257 Testing the directionality of sleep and stress during the perinatal period: what's the impact on perinatal depression?

Abstract Introduction Pregnancy is a time of pronounced sleep disturbance, with a majority (~85%) of women endorsing shorter, more fragmented sleep as gestation progresses. While new-onset antenatal depression (AND) is a known risk factor for postpartum depression, its etiology remains less understood, despite well-established evidence that incidence is the same among healthy first-time mothers as compared to women with established riskfactors inclusive of family or personal history of psychopathology. Heightened daily stress appraisals may be one critical pathway through which disrupted sleep gives rise to AND. The current study tested the directionality of the relationship between habitual nighttime sleep parameters and daytime stress ratings using a prospective amulatory field study design. Methods Fifty primiparous women (38% White; 32% Black; 30% Other race/ethnicity; mean age = 32 years, 28 weeks gestation) without a history of sleep disorders nor psychopathology completed 10-days (9-nights) of actigraphy and sleep diaries. They also engaged in 3-days of superimposed ecological momentary assessments (EMA) rating stress, positive, and negative affect at four intervals throughout the day. Analyses examined negative affective responses to social conflict and task-based demand througout days of EMA, at the within-person and between-women levels. Sleep variables explored included total sleep time (TST), sleep efficiency (SE; log-transformed), sleep onset latency (SOL) and sleep quality as measured by the Pittsburgh Sleep Quality Index. Cross-lagged hierarchical mixed models tested directionality of sleep-stress relationship. Time-varying covariates included time-of-day, previous day stress for sleep outcomes, and previous night sleep for stress outcomes, at the within-person levels. Results After days of greater stress (demand and conflict), women experienced significantly shorter, less efficient sleep and took longer to fall asleep (by both diary and actigraphy; [Beta(SE)=-6.3(1.4); 1.2(.12,), R^2=.27, .32, respectively; ps&amp;lt;.01]. Following nights of shorter sleep, women endorsed greater negative affective responses to stress (Beta=.12, SE=.01, p&amp;lt;.001; R^2=.27). Over the assessment period, women who had shorter, less efficient sleep experienced greater frequency, higher severity stressors, after adjusting for time-of-day, and baseline sleep characteristics, depression and anxiety levels (Betas = -7.4(2.6); .14(.01), ps&amp;lt;.001, respectively). Given this bidirectional support, stress was examined as a moderator of the relationship between TST and depression severity at 34-36 weeks gestation, indicating that greater stress explained the relationship between shorter TST and heightened AND after adjustment for baseline measures. Conclusion This is the first study to explore directionality of sleep-stress relationships in a perinatal sample; results provide support for the idea that heightened daily stress engenders greater sleep disturbance (difficulty initiating and maintaining sleep; shorter duration). Bidirectional support for shorter sleep duration and increased stress appraisal was also found. The current project provides preliminary evidence for stress "spill-over" effects (i.e., stress transmission) as a potential mechanism for heightened antenatal depression symptoms. Support (If Any) NIMH 1R36MH118000-01, CTSI89431, SRS Mentor/Mentee Grant; T32 HL007713

Symptoms of anxiety but not depression before start of taxane-based chemotherapy are associated with peripheral neuropathy: a multicenter study in women with breast cancer

BackgroundChemotherapy-induced peripheral neuropathy (CIPN) is a common side effect of chemotherapy, especially after taxane-based therapy. This study aimed to examine the relationship between symptoms of anxiety and depression before the start of taxane-based chemotherapy and the development of CIPN in women with breast cancer.MethodsIn this prospective study, women with breast cancer receiving taxane-based (neo)adjuvant chemotherapy were recruited from four hospitals in the Netherlands. Patients completed questionnaires assessing anxiety and depressive symptoms before treatment and CIPN before treatment (T0), 6 weeks after start of treatment (T1), after the last cycle of chemotherapy (T2), and 6 months after the end of treatment (T3). Mixed model analyses were used to investigate whether medium/high levels of anxiety or depression at baseline are associated with the level of CIPN during and after treatment.ResultsAmong the 61 participating women, 14 (23%) reported medium/high levels of anxiety and 29 (47.5%) reported medium/high levels of depressive symptoms at baseline. The group of women with medium/high baseline levels of anxiety showed a significantly higher increase in CIPN during and after chemotherapy than women with low baseline levels of anxiety (p < .001). No relationship between depressive symptoms at baseline and the development of CIPN was found.ConclusionThis study showed that baseline medium to high levels of anxiety but not depressive symptoms impacted the development of CIPN during and in the 6 months after treatment.

P635. Post-Traumatic Stress in Older Adults with Hypertension During the Early Phase of the COVID-19 Pandemic: Prevalence, Correlates, and Pro-Inflammatory Biomarkers

BackgroundPost-traumatic stress symptoms include intrusion phenomena, hypervigilance, avoidance, and negative alterations in mood and cognition and are associated with increased risk for cardiometabolic and neurodegenerative disorders, especially in older adults. As higher proinflammatory marker levels are shown in PTSD, immune dysregulation may underlie these associations. Cytokine dysregulation could underlie onset of neuropsychiatric symptoms in COVID-19 survivors.MethodsAdults aged 60-90 years with hypertension completed hemodynamic testing, plasma biomarker measurements, and psychological and cognitive assessments. Prevalence of PTSS was determined based on a PC-PTSD cut-off score of 3. Group comparisons were conducted using Wilcoxon rank sum or Chi-squared tests. Binary and ordinal logistic regression analyses were used to test whether pre-pandemic measures predicted PTSS group status and PC-PTSD scores.ResultsNinety-five subjects completed the study. Pre-COVID-19, the two PTSS groups did not differ by age, anti-hypertensive medication usage, Framingham Risk Score, or inflammatory biomarker levels. Framingham risk scores were marginally correlated with inflammatory biomarkers and MoCA scores. Prevalence of PTSS in this cohort of older adults with hypertension during the pandemic was 7.4%, greater than the pre-pandemic prevalence of PTSD in the general population of 4.7% but lower than 15-23% reported in other adult samples during the pandemic. Female sex and baseline anxiety levels predicted PTSS during the pandemic. The inflammation index odds ratios were 1.21 and 1.17.ConclusionsUnderstanding pandemic PTSS in aging adults with chronic conditions that increase risk for COVID severity will aid in developing targeted prevention and mitigation strategies to decrease the psychological and physiological burden for vulnerable aging populations.Supported ByR01HL126056, R03AG063328KeywordsInflammatory Biomarkers, Posttraumatic Stress Symptoms, Hypertension BackgroundPost-traumatic stress symptoms include intrusion phenomena, hypervigilance, avoidance, and negative alterations in mood and cognition and are associated with increased risk for cardiometabolic and neurodegenerative disorders, especially in older adults. As higher proinflammatory marker levels are shown in PTSD, immune dysregulation may underlie these associations. Cytokine dysregulation could underlie onset of neuropsychiatric symptoms in COVID-19 survivors. Post-traumatic stress symptoms include intrusion phenomena, hypervigilance, avoidance, and negative alterations in mood and cognition and are associated with increased risk for cardiometabolic and neurodegenerative disorders, especially in older adults. As higher proinflammatory marker levels are shown in PTSD, immune dysregulation may underlie these associations. Cytokine dysregulation could underlie onset of neuropsychiatric symptoms in COVID-19 survivors. MethodsAdults aged 60-90 years with hypertension completed hemodynamic testing, plasma biomarker measurements, and psychological and cognitive assessments. Prevalence of PTSS was determined based on a PC-PTSD cut-off score of 3. Group comparisons were conducted using Wilcoxon rank sum or Chi-squared tests. Binary and ordinal logistic regression analyses were used to test whether pre-pandemic measures predicted PTSS group status and PC-PTSD scores. Adults aged 60-90 years with hypertension completed hemodynamic testing, plasma biomarker measurements, and psychological and cognitive assessments. Prevalence of PTSS was determined based on a PC-PTSD cut-off score of 3. Group comparisons were conducted using Wilcoxon rank sum or Chi-squared tests. Binary and ordinal logistic regression analyses were used to test whether pre-pandemic measures predicted PTSS group status and PC-PTSD scores. ResultsNinety-five subjects completed the study. Pre-COVID-19, the two PTSS groups did not differ by age, anti-hypertensive medication usage, Framingham Risk Score, or inflammatory biomarker levels. Framingham risk scores were marginally correlated with inflammatory biomarkers and MoCA scores. Prevalence of PTSS in this cohort of older adults with hypertension during the pandemic was 7.4%, greater than the pre-pandemic prevalence of PTSD in the general population of 4.7% but lower than 15-23% reported in other adult samples during the pandemic. Female sex and baseline anxiety levels predicted PTSS during the pandemic. The inflammation index odds ratios were 1.21 and 1.17. Ninety-five subjects completed the study. Pre-COVID-19, the two PTSS groups did not differ by age, anti-hypertensive medication usage, Framingham Risk Score, or inflammatory biomarker levels. Framingham risk scores were marginally correlated with inflammatory biomarkers and MoCA scores. Prevalence of PTSS in this cohort of older adults with hypertension during the pandemic was 7.4%, greater than the pre-pandemic prevalence of PTSD in the general population of 4.7% but lower than 15-23% reported in other adult samples during the pandemic. Female sex and baseline anxiety levels predicted PTSS during the pandemic. The inflammation index odds ratios were 1.21 and 1.17. ConclusionsUnderstanding pandemic PTSS in aging adults with chronic conditions that increase risk for COVID severity will aid in developing targeted prevention and mitigation strategies to decrease the psychological and physiological burden for vulnerable aging populations. Understanding pandemic PTSS in aging adults with chronic conditions that increase risk for COVID severity will aid in developing targeted prevention and mitigation strategies to decrease the psychological and physiological burden for vulnerable aging populations.

Fear of prognosis? How anxiety, coping, and expected burden impact the decision to have cytogenetic assessment in uveal melanoma patients

BackgroundCytogenetic testing (CGT) in uveal melanoma patients reveals prognostic information about the individual risk of developing distant metastasis with dismal prognosis. There is currently no medical intervention strategy with proven effect on the prognosis, rendering the result of the cytogenetic testing purely informative. We explored patients’ socio-demographic backgrounds, psychological preconditions, coping strategies, external influences, and concerns about “knowing their fate” to study their possible interactions with decision-making for CGT.MethodsUveal melanoma patients were asked to complete questionnaires on their interest in undergoing CGT for prognostication and the factors influencing their decision. Data were collected on socio-demographics, baseline anxiety (GAD-7), depression (PHQ-9), coping strategies (Brief COPE), and assumed future concerns regarding the CGT result. Data were analyzed by using multiple ordinal logistic regression and exploring estimated marginal effects.ResultsQuestionnaires were returned by 121 of 131 (92.4%) patients. Fifty-two patients (43%) had no interest in CGT, 34 (28.1%) were undecided, and 35 (28.9%) were interested. We observed no significant differences regarding age, sex, partnership, education, occupation, baseline anxiety, or depression. Decision-making favoring CGT was influenced by the treating physicians, internet resources, and level of baseline anxiety. Patients were likely to reject CGT when they worried that “knowing the result will have an unintended influence” on their life.ConclusionDecision-making about CGT for prognostication in uveal melanoma is burdensome to many patients and in general not guided by medical advice regarding further treatment and screening procedures. The psychological impact of the decision is therefore unique and requires careful support by psycho-oncologists considering the patient’s fears and expectations.

Abstract P045: Self-reported Anxiety And Patient Activation Among Smartwatch Users Monitored For Atrial Fibrillation Post-stroke: The Pulsewatch Study

Introduction: Wearable devices such as smartwatches are emerging as convenient and accurate means of post-stroke atrial fibrillation (AF) detection, however little is known about how the use of smartwatches for this purpose affects patients’ anxiety or engagement with their medical care. Hypothesis: Use of a smartwatch for atrial fibrillation monitoring will not significantly increase anxiety or affect engagement with medical care in post-stroke patients. Methods: We analyzed data from a randomized controlled trial, the Pulsewatch study, which included patients (&gt;=50 years) who presented to the UMass Memorial Health system with an ischemic stroke in the past decade, and/or had a CHA2DS2-VASc score &gt;2, with no contraindications to anticoagulation. Participants were randomized to either wear a Samsung smartwatch for AF monitoring (intervention) or not wear a smartwatch (control) for 30 days. Participants completed the General Anxiety Disorder-7 (GAD7) and the Consumer Health Activation Index (CHAI), which examined anxiety and patient activation (i.e. personal healthcare knowledge and management ability), prior to and after the 30-day period. Logistic regression was used to examine the association between smartwatch use and changes in anxiety and patient activation before and after the 30-day period. Results: Participants in the control group (N=56) had a mean age of 66, were 43% female, and 88% white, compared to the intervention group (N=54) which had a mean age of 64, were 41% female, and 91% white. There were no significant differences in baseline levels of anxiety (control 15% vs intervention 20%, P=0.3) and patient activation (control 12% vs intervention 10%, P=0.7) between the groups. After 30 days of rhythm monitoring, smartwatch users, as opposed to participants without a smartwatch, did not have a higher odd of having increased anxiety (38.9% vs 29.1%; aOR 1.37; 95% CI 0.45-4.15) or patient activation (20.4% vs 35.7%; aOR 0.62; 95% CI 0.18-2.17), adjusting for baseline anxiety, patient activation, valvular disease, diabetes, beta blocker use, and anticoagulant use. Conclusion: To the best of our knowledge, this is among the first studies to demonstrate a lack of difference in anxiety or patient activation in older stroke survivors who were prescribed a smartwatch for AF monitoring as compared to controls. Further studies are needed to elucidate the benefits and pitfalls related to the use of wearables as an alternative for post-stroke arrhythmia monitoring.

An informative video before planned cesarean delivery and maternal anxiety—a multicenter randomized controlled trial

Cesarean delivery is one of the most common procedures performed in obstetrics, and although cesarean delivery is a blissful occasion, it is commonly associated with fear and anxiety for the new mother. We aimed to study the impact of watching a detailed, informative video on maternal anxiety levels, childbirth experience, and patient satisfaction in patients undergoing a primary cesarean delivery. We performed a multicenter randomized control trial. Women scheduled to undergo a primary nonemergent cesarean delivery were recruited. All participants in the intervention group watched an informative video on recruitment. This 4-minute video described in detail the expected cesarean delivery process: preparations before entering the operation room, regional anesthesia administration, sterile covering, the surgical procedure itself, and recovery (including mobilization and lactation). Situation-specific anxiety was measured at recruitment, before exposure to the video (S1), at the day of the operation (S2), and at postpartum day 1 (S3) using the State-Trait Anxiety Inventory score. In addition, participants answered a 10-item Childbirth Experience Questionnaire. A sample size of 63 per group was planned to achieve 80% power to detect a difference of 5 points in the primary outcome (State-Trait Anxiety Inventory score on the day of the operation). Overall, 154 participants from 4 medical centers were randomized, and 132 participants were analyzed after completing all questionnaires, 64 participants in the video group and 68 participants in the control group. The groups did not differ in demographics and delivery characteristics and had similar baseline anxiety levels (S1). On operation day (S2, the primary outcome), significantly lower anxiety levels were reported in the video group than in the control group (State-Trait Anxiety Inventory scores, 41.3±9.5 vs 49.3±10.3; P<.001). Moreover, anxiety levels in postpartum day 1 (S3) remained significantly lower in the video group (P<.001). No difference between the groups in childbirth experience score or patient satisfaction was demonstrated. A detailed informative video shown to patients before primary cesarean delivery decreased maternal anxiety levels before and after the procedure.

Efficacy of Deep TMS with the H1 Coil for Anxious Depression.

(1) Background: While the therapeutic efficacy of Transcranial Magnetic Stimulation (TMS) for major depressive disorder (MDD) is well established, less is known about the technique’s efficacy for treating comorbid anxiety. (2) Methods: Data were retrospectively analyzed from randomized controlled trials (RCTs) that used Deep TMS with the H1 Coil for MDD treatment. The primary endpoint was the difference relative to sham treatment following 4 weeks of stimulation. The effect size was compared to literature values for superficial TMS and medication treatments. (3) Results: In the pivotal RCT, active Deep TMS compared with sham treatment showed significantly larger improvements in anxiety score (effect size = 0.34, p = 0.03 (FDR)) which were sustained until 16 weeks (effect size = 0.35, p = 0.04). The pooled effect size between all the RCTs was 0.55, which compares favorably to alternative treatments. A direct comparison to Figure-8 Coil treatment indicated that treatment with the H1 Coil was significantly more effective (p = 0.042). In contrast to previously reported studies using superficial TMS and medication for which anxiety has been shown to be a negative predictor of effectiveness, higher baseline anxiety was found to be predictive of successful outcome for the H1-Coil treatment. (4) Conclusions: Deep TMS is effective in treating comorbid anxiety in MDD and, unlike alternative treatments, the outcome does not appear to be adversely affected by high baseline anxiety levels.

A PROSPECTIVE RANDOMIZED SINGLE-BLIND STUDY COMPARING ALPRAZOLAM VERSUS CLONIDINE AND PREGABALIN AS PREANAESTHETIC MEDICATION IN PATIENTS UNDERGOING ELECTIVE LOWER LIMB SURGERIES

Objective: The objective of the study was to study comparison of alprazolam versus clonidine and pregabalin as pre-anesthetic medication in patients undergoing elective lower limb surgeries. Methods: The present study was undertaken to compare the effects of alprazolam 0.5 mg, clonidine 100 μg, and pregabalin 75 mg as premedicant drugs for the reduction of pre-operative anxiety. 90 patients of ASA Grades I and II, between 18 and 60 years, of either sex, undergoing elective lower limb surgery were divided into three groups of 30 patients each. Baseline anxiety level and level after 2 h of the drug were assessed. Side effects due to drugs were noted before going to OT (Post drug, i.e., 2 h after drug administration), after the completion of the surgery, and at 24 h. Results: There is a significant post-drug reduction in s-STAI score, t-STAI score, and CGI score when compared to baseline values in all the Group’s A, C, and P. Side effects were mild and there were no serious adverse effects observed in all three groups. In Group A, 10% of patients complained of fatigue while in Group C, 13.3% of patients complained of dryness of mouth, and 10% of patients complained of headache 2 h post drug administration but in Group P, no side effect was noted. Conclusion: Premedication with 0.5 mg alprazolam, 100 μg clonidine, and 75 mg pregabalin for control of pre-operative anxiety was comparable though pregabalin offered a significant advantage in terms of less side effects.

The effect of eye mask and selected music on the level of anxiety and hemodynamic parameters in patients undergoing cardiac angiography

Context: Anxiety is common among patients undergoing coronary angiography.Aims: The aim of this study was to examine the comparative effects of eye masks and music on anxiety levels and hemodynamic indices of patients undergoing coronary angiography.Setting and Design: This is a single-blind randomized clinical trial conducted on 300 patients undergoing coronary angiography.Materials and Methods: Patients were recruited using convenience sampling and then randomly allocated to one of the four groups. Ten minutes before the coronary angiography, baseline anxiety levels were measured using the state-trait anxiety inventory. Patients' hemodynamic indices were also measured and recorded immediately before they entered the cath-lab operating room, as soon as, they were in bed in the cath-lab operating room, 5 min after the start of coronary angiography, and immediately and 20 min after the completion of coronary angiography. Anxiety levels were measured again 20 min after coronary angiography.Statistical Analysis Used: All statistical analyses were conducted using SPSS 22 Software. Mean and SD indices were used. The normality of both overt and covert anxiety variables was confirmed using Kolmogorov–Smirnov test. The presence of intervening variables was examined using analysis of variance, the final analysis was performed using analysis of covariance. For all analyses, a P < 0.05 was considered to be statistically significant.Results: The mean scores on overt and covert anxiety decreased after intervention. A statistically significant difference was observed among the four groups on overt and covert anxiety (P < 0.001). Compared to before coronary angiography (P < 0.001) and routine care only group (P < 0.001), hemodynamic indices had a decreasing trend during coronary angiography in the intervention groups.Conclusion: The results of the present study revealed that nonverbal, relaxing, and classical music significantly reduced anxiety and hemodynamic indices of patients undergoing coronary angiography. Future studies should examine the effectiveness of other music genres on anxiety and hemodynamic indices in patients undergoing coronary angiography.

Do baseline anxiety symptoms impact response to IV Ketamine in treatment resistant depression?

• We examined if anxious depression impacts Ketamine outcomes. • Forty-three patients received six IV Ketamine infusions over a three-week period. • Patients with anxious depression at baseline had comparable levels of improvement. • Improvement in anxiety was about half the magnitude of improvement in depression. • Depressed patients who present with anxiety may be appropriate for IV Ketamine. In a retrospective study, we analyzed if anxious depression impacts outcomes in patients with treatment resistant depression (TRD) receiving IV Ketamine infusions at an academic center Ketamine clinic. Forty-three patients with TRD received six IV Ketamine infusions over a three-week period. Anxious depression (ANX-TRD) was defined as a Hamilton Depression Rating Scale Anxiety/Somatization factor score of ≥ 7 at the baseline evaluation. Beck Depression Inventory (BDI-II) and Generalized Anxiety Disorder-7 (GAD-7) scales were used through the infusion course to assess symptom change. Twenty-three patients were categorized as ANX-TRD and 20 as non-anxious TRD. Generalized estimating equation (GEE) models revealed BDI-II and GAD-7 scores for ANX-TRD and NANX-TRD groups did not differ significantly during any time point. Symptoms of anxiety and depression improved after treatment in both groups, though the degree of change was significant and greater for depression. This was a naturalistic, retrospective study, without a control group. Symptoms of depression show greater improvement than symptoms of anxiety. IV Ketamine is effective in the treatment of depression, regardless of the baseline anxiety level.

Investigating the effect of anxiety on pain scores in dogs

ObjectiveTo investigate the relationship between anxiety and pain scores using the Glasgow Composite Measure Pain Scale–Short Form (CMPS-SF) in dogs. StudyProspective observational study. AnimalsA group of 18 dogs undergoing surgical management of stifle disease. MethodsPreoperatively dogs were scored using the CMPS-SF, the anxiety behaviour-based Reactivity Evaluation Form (REF), a Visual Analogue Scale (VAS) for anxiety and a sedation score. Assessments of pain, anxiety and sedation were repeated approximately 2–6 hours postoperatively. Dogs were divided into groups based on preoperative REF (‘Low REF’ and ‘High REF’), and VAS scores (‘Low VAS’ and ‘High VAS’). Scores (CMPS-SF, REF, VAS and sedation) were compared between groups using Mann–Whitney U tests. Preoperative and postoperative CMPS-SF, REF and VAS scores were compared using Wilcoxon signed-rank tests. Relationships between anxiety and CMPS-SF scores were assessed using a Spearman rank correlation coefficient. Scores are presented as median (range). A p value of < 0.05 was considered significant. ResultsWhen divided based on REF, CMPS-SF scores did not differ between groups preoperatively [Low REF: 2 (0–3), High REF: 2 (1–3); p = 0.509] or postoperatively [Low REF: 3 (2–5), High REF: 3 (2–5); p = 0.624]. When divided based on VAS, CMPS-SF scores did not differ between groups preoperatively [Low VAS: 2 (0–2), High VAS: 2 (1–3); p = 0.215] or postoperatively [Low VAS: 3 (2–5), High VAS: 3 (2–5); p = 1]. Postoperative REF [pre: 4.5 (2–8), post: 5 (4–10); p = 0.0105] and CMPS-SF scores [pre: 2 (0–3), post: 3 (2–5); p = 0.0318] increased significantly compared with preoperative scores. Conclusions and clinical relevanceNo apparent relationship exists between baseline anxiety levels and CMPS-SF scores. Understanding the influence of anxiety when using the CMPS-SF is important when assessing pain in dogs. Anxiety and pain may increase postoperatively in dogs undergoing orthopaedic surgery.

The effect of the family presence on anxiety and agitation of patients under mechanical ventilation after open heart surgery: a randomized clinical trial

BackgroundFamily-centered care has been considered as a philosophy of care. Family presence in intensive care units (ICUs), especially in the acute phase of the disease is controversial. This study has been carried out in order to determine the effect of the family presence on anxiety and agitation in patients undergoing coronary artery bypass grafting (CABG).Materials and methodsIn a clinical trial, 70 patients were randomly allocated into groups of experimental and control. In the experimental group, during the weaning process from the mechanical ventilation, a family member was present at the bedside. The degree of anxiety and Richmond’s Agitation and Sedation Scale (RASS) were compared in seven consecutive time stages, including the time of entry into the ICU, the first respiratory drive, the family entrance, 20 min and 1 h after the presence of the family member, the time of extubation, and 1 h after extubation.ResultsThere was a significant difference between the two groups in the mean scores of the anxiety scale in the first (P =0.008), second (P=0.002), and third stages (P =0.005). This difference was not significant in the fourth to seventh stages (P>0.05). As the baseline anxiety levels were different, a covariate adjustment was used for comparisons between treatments, adjusting the main analyses for baseline anxiety levels. Analysis showed that groups were not different. Also, there was no significant difference in the mean scores of RASS between the two experimental and control groups at any of the seven stages (P> 0.05).ConclusionAccording to the findings of the present study, the presence of a family member does not reduce the level of anxiety and agitation of patients undergoing cardiac surgery. However, it can be concluded that this intervention is feasible in acute and complex situations after open heart surgeries.Trial registrationThis study has been registered in the Iranian Registry of Clinical Trials with the code IRCT201609014299N4.

Exploring the effectiveness of a patient-tailored integrative oncology program on emotional distress during chemotherapy for localized cancer.

There is a need to explore how patient-tailored integrative oncology (IO) programs reduce emotional distress. This study set out to bridge the IO research gap between non-specific, quality of life-related and specific emotional-related concerns in chemotherapy-treated patients. This pragmatic, prospective and preference-controlled study examined patients attending an integrative-physician consultation and weekly IO treatments during adjuvant/neo-adjuvant chemotherapy for localized cancer. Patients choosing to attend ≥4 IO sessions (highly adherent to integrative care, AIC) were compared to low AIC patients using the ESAS (Edmonton Symptom Assessment Scale) anxiety, depression and sleep; and the EORTC QLQ-C30 (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire) emotional functioning scale, at baseline, 6 and 12weeks. Emotional distress was assessed by ESAS anxiety and depression, considered as the primary study outcomes. Of 439 participants, 260 (59%) were high-AIC and 179 low-AIC, both with similar baseline demographic and cancer-related characteristics. At 6 weeks, high-AIC patients reported greater improvement on ESAS sleep (p=0.044); within-group improvement on ESAS anxiety and; and EORTC emotional functioning. Compared with low-AIC, high-AIC patients showed greater improvement on ESAS depression (p=0.022) and sleep (p=0.015) in those with high baseline ESAS anxiety scores (≥7); and ESAS anxiety (p=0.049) for patients moderately anxious (4-6) at baseline. High-AIC was associated with significantly reduced anxiety, depression and sleep severity at 6 weeks, especially those with high-to-moderate baseline anxiety levels. These findings reduce the research gap, suggesting specific emotional-related effects of IO.

Effect of an Immersive Virtual Reality Intervention on Pain and Anxiety Associated With Peripheral Intravenous Catheter Placement in the Pediatric Setting

The inclusion of digital therapeutics (eg, virtual reality [VR] systems) for the management of pain and anxiety associated with routine acutely painful medical procedures may have a substantial impact on treatment adherence and improve long-term health outcomes among young patients. To determine whether a VR intervention decreases pain and anxiety among patients undergoing peripheral intravenous catheter (PIVC) placement compared with standard care in the pediatric setting. This randomized clinical trial was conducted from April 12, 2017, to July 24, 2019, among 107 patients aged 10 to 21 years who were undergoing PIVC placement in 2 clinical settings (a radiology department and an infusion center) at an urban pediatric academic medical center in the US. Patients, caregivers, and clinicians completed pre-PIVC and post-PIVC placement questionnaires measuring patient pain, anxiety, and anxiety sensitivity; only participants with complete data from before and after PIVC placment were included in the analyses. Patients were randomized to receive standard care (simple distraction techniques [eg, music, coloring, singing, and talking] and the application of numbing cream) or a VR intervention using a balanced computer-generated randomization scheme stratified by sex. All patients who received the VR intervention were offered concurrent standard care; however, VR plus standard care was not specifically examined. Primary outcomes were patient pain (measured by the Faces Pain Scale-Revised) and anxiety (measured by a visual analogue scale) reported by the patient, caregiver, and clinician after PIVC placement. Outcomes were analyzed using generalized linear modeling with backward stepwise selection for final model building. A total of 107 patients (median age, 14.7 years [interquartile range, 12.8-16.9 years]; 63 male participants [58.9%]) completed the clinical trial; 54 patients received standard care, and 53 patients also received the VR intervention. Patients who received the VR intervention compared with standard care had significantly lower mean post-PIVC anxiety scores when patient-reported (1.85 points [95% CI, 1.28-2.41 points] vs 3.14 points [95% CI, 2.59-3.68 points]; P < .001) and clinician-reported (2.04 points [95% CI, 1.37-2.71 points] vs 3.34 points [95% CI, 2.69-3.99 points]; P = .002). Patients in the VR group vs the standard care group also had significantly lower mean post-PIVC pain scores when patient-reported (1.34 points [95% CI, 0.63-2.05 points] vs 2.54 points [95% CI, 1.78-3.30 points]; P = .002), caregiver-reported (1.87 points [95% CI, 0.99-2.76 points] vs 3.01 points [95% CI. 1.98-4.03 points]; P = .04), and clinician-reported (2.05 points [95% CI, 1.47-2.63 points] vs 3.59 points [95% CI, 2.97-4.22 points]; P < .001). Aside from lower levels of baseline pain and anxiety, no demographic variables among patients in the VR group were associated with lower levels of post-PIVC pain and anxiety. In this randomized clinical trial, patients undergoing PIVC placement who received a VR intervention experienced significantly less anxiety and pain compared with those who received standard care. The use of patient, caregiver, and clinician data provided a variety of subjective information, as well as observable and objective data regarding perceived pain and anxiety beyond patient reporting alone. ClinicalTrials.gov Identifier: CHLA-15-00549.

Psychological impact of COVID-19 lockdowns among adult women: the predictive role of individual differences and lockdown duration

ABSTRACT COVID-19 pandemic has altered women’s mental health as a consequence of the global threat and the lockdown measures adopted by public health policies. It has been suggested that women are at a higher risk for mood alterations, but most of the studies are cross-sectional or have only considered the first days of the confinement in their longitudinal designs. The present study was aimed at evaluating temporal changes in anxiety and depression in a general sample of 155 non-infected adult Spanish women after a complete quarantine. It also explored the predictive role of personality, the establishment of new routines and physical activity during lockdown in a pre-post design assessing temporal and clinical mood changes after 5 weeks of lockdown. Logistic regression analyses showed that higher neuroticism and depressive levels at baseline, lower routines engagement, and lower physical activity during lockdown predicted depression caseness, whereas anxiety caseness was best predicted by higher neuroticism, more days of lockdown and greater anxiety symptoms at baseline. It is concluded that lockdown duration, increased neuroticism and baseline levels of anxiety and depression are risk factors for women’s mental health, while routines and physical activity emerge as protective factors for managing psychological wellbeing during the pandemic lockdowns.

Prenatal Yoga and Mental Health During the COVID-19 Pandemic: A Randomized-Control Trial.

Studies have demonstrated that new and expectant mothers experience increased levels of stress and anxiety during the COVID-19 pandemic. Though prenatal yoga is an effective mode of improving mental health during pregnancy, no research has evaluated its effect on mental health during times of extreme stress, such as a global pandemic. The purpose of this study was to determine the influence of a single session and a 10-week prenatal yoga intervention on the mental health of pregnant women during the COVID-19 pandemic. Women (n = 19; 28.52 ± 3.74 years; 20.94 ± 4.69 weeks gestation; BMI 29.33 ± 9.08) were randomized into a yoga or a non-yoga control group. There were no differences in demographic factors or depression/anxiety scores between groups at baseline. Baseline levels of anxiety and depression were high, with an average depression score of 8.10 ± 4.85 (scores > 8 represent possible depression) and an average anxiety score of 39.26 ± 12.99 (scores ≥ 39 represent a clinically significant anxiety). After just one session of yoga, women reported feeling less depressed (p = 0.028), tense (p < 0.001), and fatigued (p = 0.004). After 10 weeks, the yoga group had lower anxiety (p = 0.002), depression (p = 0.032), and total mood disturbance (p = 0.002) scores when compared to the control group. Yoga appears to benefit the mental health of expectant mothers, even in times of extreme stress. The findings of this study provide clinicians with valuable information regarding alternative exercise options for mental health during pregnancy during the COVID-19 pandemic.

Hormonal Differences in Intimate Partner Violence Perpetrators When They Cope with Acute Stress: A Pilot Study.

Background: Only a few studies have paid attention to the ability of perpetrators of intimate partner violence (IPVAW) against women to cope with acute stress, including hormonal parameters. In fact, previous studies assessed how salivary testosterone (Tsal) and cortisol (Csal) changed after coping with an acute emotional stressor (directly related to IPVAW), and they concluded that an imbalance between the two hormones might be characteristic of these men. Nevertheless, they neglected to examine the role of other hormones, such as salivary oxytocin (OXsal), which also seemed to play an important role in behavioral regulation, and whether this response could be generalized to other types of stress not directly related to IPVAW. Methods: This study aims to assess whether IPVAW perpetrators (n = 19) present differential hormonal (Tsal, Csal, OXsal and their ratios) and psychological state (anxiety, anger, and general affect) responses when coping with an acute cognitive laboratory stressor (a set of neuropsychological tests performed in front of an expert committee) in comparison with non-violent men (n = 16). This quasi-experimental study also assessed whether the psychological state variables drive this different hormonal response. Results: Our results revealed that IPVAW perpetrators had lower Csal and higher Tsal/Csal ratio levels during the post-task period, as well as higher total levels (average) of OXsal than controls. We also found that, only in IPVAW perpetrators, high levels of baseline anxiety and negative affect were related to high rises in Csal during the stress task. Conclusions: These data present a background showing that IPVAW perpetrators and non-violent men cope differently with stress. These findings might help to identify idiosyncratic profiles of IPVAW perpetrators that can then be employed to establish their therapeutic needs. Moreover, we reinforced the importance of combining biological markers with self-reports, thus increasing the reliability of these forensic assessments.

The unbearable burden of endometriosis: Results from a large cohort about anxiety reduction during the first outpatient evaluation

ObjectiveTo evaluate the impact of the first outpatient evaluation on anxiety levels in women with suspected endometriosis. Secondarily, we investigated which individual characteristics exerted the greatest influence on distress levels. MethodsWomen referred to our academic center between January 2019 and March 2020 on the suspicion of endometriosis were enrolled in this prospective, observational study. Before the visit, participants answered questionnaires such as the Generalized Anxiety Disorder-7 (GAD) and the Spielberg State Trait Anxiety Inventory (STAI) Y6. After the visit, the STAI-Y6 was resubmitted to each woman, along with the Patient Global Impression of Improvement (PGII) questionnaire. Women's and physicians' satisfaction with the visit were also evaluated using a 5-point scale. ResultsOne hundred and four women were enrolled. Anxiety levels decreased after the evaluation (STAI-Y6 60.0 ± 15.0 vs 40.8 ± 14.2, P < .001). Higher reductions were noted in patients who had higher baseline anxiety levels (est. change −24.3; 95% CI –29.2, −19.5; P < .001), had previously sought information online (est. change −15.9; 95% CI –21.4, −10.5; P < .001), and when endometriosis was not confirmed, but not in those waitlisted for surgery (est. change 1.7; 95% CI –5.9, 9.2; P 0.659). Most patients' mood improved after the examination (67%) and were satisfied with the visit (98%). ConclusionsAnxiety levels are reduced after medical examination in women with higher baseline distress and who sought information online. To create a trustful relationship with women, providing them with tailored counselling, seems essential to improve their psychological wellbeing.

The impact of foot shock-induced stress on pain-related behavior associated with burn injury

Acute pain is prevalent following burn injury and can often transition to chronic pain. Prolonged acute pain is an important risk factor for chronic pain and there is little preclinical research to address this problem. Using a mouse model of second-degree burn, we investigated whether pre-existing stress influences pain(sensitivity) after a burn injury. We introduced a contribution of stress in two different ways: (1) the use of foot-shock as a pre-injury stressor or (2) the use of A/J mice to represent higher pre-existing stress compared to C57Bl/6 mice. C57Bl/6 and A/J mice were exposed to repeated mild foot shock to induce stress for 10 continuous days and mice underwent either burn injury or sham burn injury of the plantar surface of the right hind paw. Assessments of mechanical and thermal sensitivities of the injured and uninjured paw were conducted during the shock protocol and at intervals up to 82-day post-burn injury. In both strains of mice that underwent burn injury, thermal hypersensitivity and mechanical allodynia appeared rapidly in the ipsilateral paw. Mice that were stressed took much longer to recover their hind paw mechanical thresholds to baseline compared to non-stressed mice in both burn and non-burn groups. Analysis of the two mouse strains revealed that the recovery of mechanical thresholds in A/J mice which display higher levels of baseline anxiety was shorter than C57Bl/6 mice. No differences were observed regarding thermal sensitivities between strains. Our results support the view that stress exposure prior to burn injury affects mechanical and thermal thresholds and may be relevant to as a risk factor for the transition from acute to chronic pain. Finally, genetic differences may play a key role in modality-specific recovery following burn injury.