Depression , Anxiety And Stress Scale Research Articles

Prevalence and Level of Depression, Anxiety and Stress Among Frontliners Using the Depression, Anxiety and Stress Scale (DASS)-21 in a Tertiary Hospital in Manila, Philippines During the COVID-19 Pandemic: a Cross-Sectional Study

Background: COVID-19 was declared as a pandemic by the World Health Organization (WHO) in March 2020. It has affected millions globally and remains as a public health concern until today. Objectives: The study aims to identify the prevalence of depression, anxiety and stress among UST hospital frontliners during the COVID-19 pandemic using the Depression, Anxiety and Stress Scale (DASS)-21 scale. Methods: A cross-sectional study was conducted among 272 frontliners in a tertiary hospital in Manila, Philippines using the DASS-21 scale. Results: Based on data gathered from the responses of participants using the DASS-21 scale, the prevalence of depression, anxiety and stress among the frontliners were 28.68%, 35.66% and 14.71%, respectively. Being single, living alone, higher degree of educational attainment (postgraduate), trainees (residents and fellows) and those having pulmonary comorbidities were associated with increasing level of depression and stress. Respondents who had less work experience (less than 5 years) had significant depression; being single presented with higher anxiety; and those who had a previous COVID-19 infection had higher degree of stress. Conclusion: Several demographic and occupational characteristics, in accordance to the COVID-19 pandemic, yielded significant results regarding the presence of depression, anxiety and stress. The study recommends closer follow-up of participants which recorded high severity scores in the DASS-21 scale as well as regular psychological briefing and counseling to assess if there are other contributory factors to such responses. Ultimately, this may enlighten us on how to provide holistic care to our own hospital staff. Keywords: COVID-19, Depression, Anxiety, Stress, DASS-21 scale

Embracing the New Normal or Clinging to the Past? Digital Anxiety Among Elementary School Teachers in Post-COVID Taiwan

AbstractThis study investigates the extent of digital anxiety among elementary school teachers in Hsinchu City, Taiwan, in the context of the post-COVID new normal. Specifically, the study employs the Depression, Anxiety, and Stress Scale-21 (DASS-21) to measure the level of anxiety experienced by teachers in adapting to digital teaching methods. The online survey was conducted in November 2021, and 358 valid responses were obtained from Hsinchu City. The results of the survey provides insights into the challenges that teachers face in adapting to the new normal and the impact of digital anxiety on their change of teaching. Result reveals that when going back to teaching face-to-face, teachers’ levels of depression, anxiety, and stress soon returned to normal. However, the stress of teachers without kids and special education teachers dropped dramatically. Overall, this research provides a comprehensive analysis of digital anxiety among elementary school teachers in Hsinchu City and offers recommendations for supporting teachers' well-being and promoting effective digital teaching practices in the post-COVID era.

The interplay among burnout, and symptoms of depression, anxiety, and stress in Chinese clinical therapists

Burnout, depression, anxiety, and stress negatively impact the well-being and retention of healthcare professionals. The interplay of these symptoms is understudied. Utilizing network analysis, this study examined the interrelationships among these symptom clusters in clinical therapists in China. An anonymous survey was conducted among clinical therapists from 41 tertiary psychiatric hospitals in China. Burnout was assessed using the Maslach Burnout Inventory-Human Service Survey (MBI-HSS), while symptoms of depression, anxiety, and stress were assessed via the Depression, Anxiety, and Stress Scale-21 (DASS-21). Analyses were performed to identify central symptoms and bridge symptoms of this network. A total of 419 participants were included in this survey. The prevalence rate for burnout, depression, anxiety, and stress was 19.8%, 22.2%, 17.9%, and 8.6%, respectively. Network analysis indicated that stress symptoms had the highest expected influence values, closely followed by emotional exhaustion from MBI-HSS. Notably, emotional exhaustion emerged as the strongest bridge of expected influence. The stability of the expected influence and bridge expected influence was robust, with coefficients at 0.75. The study’s findings underscore the importance of recognizing the central symptoms and bridge symptoms, which could lead to more effective early detection and intervention for burnout, depression, anxiety, and stress among clinical therapists.

A multi-criteria decision-making method based on discrete Z-numbers and Aczel-Alsina aggregation operators and its application on early diagnosis of depression

In mental health diagnostics, the questionnaire is an effective and cost-effective method. However, the traditional questionnaire test methods for depression and anxiety have great ambiguity. The discrete Z-numbers (DZs) provide solutions for describing and resolving complex fuzzy issues in the intelligent multi-criteria decision-making (MCDM) process. However, large-scale datasets are not suited for the present MCDM techniques due to their extremely high computational cost. Additionally, these techniques are less stable and flexible. To address the above issues, a novel MCDM method is introduced, which is based on the DZs theory and the Aczel-Alsina (AA) aggregation operator (AO) for large-scale datasets. To begin with, centroid points are calculated for DZs, and a series of novel AOs are introduced. And then a score function with a parameter is introduced to balance the influence between the possibility restriction and the fuzzy restriction of DZs. Thirdly, a new MCDM method under DZs is presented based on the proposed AA AOs and score function. Finally, to support the early diagnosis of depression and anxiety, we apply our method to the real-life online Depression, Anxiety, and Stress Scale (DASS) which can be transformed into DZs by our proposed preprocessing method. According to experimental results, our method is applicable to large-scale datasets and has much lower complexity as well as higher flexibility and stability.

Keadaan Psikologis Mahasiswa Kedokteran Gigi Universitas Sumatera Utara yang Sedang Melaksanakan Pembelajaran Daring

This study aims to identify the characteristics of students during online learning, as well as evaluate their state and level of stress, anxiety, and depression using the Depression Anxiety and Stress Scale (DASS). This research is a descriptive survey research, namely to find out the psychological state of students of the Faculty of Dentistry, University of North Sumatra who are carrying out online learning using the depression anxiety stress scale questionnaire (DASS-42) which consists of stress, anxiety, and depression. This research was conducted at the Faculty of Dentistry, University of North Sumatra which is located in Medan City, North Sumatra Province. This research was carried out from June 2021 to July 2021. Results, In terms of anxiety, 74.5% did not have difficulty swallowing, and moderate anxiety was the highest (31.2%). For depression, 66.8% did not feel that their lives were meaningless, with normal depression being the highest (50.6%). Stressors include learning tasks (72.5%), unavailability of practical tools (64.4%), limited internet quota (61.1%), and boredom with online learning (48.2%).

Depression, Anxiety, and Stress Symptoms Among Students in Croatia During the COVID-19 Pandemic: A Systematic Review.

Background: The COVID-19 pandemic has led to an increased fear of infection, social isolation, financial concerns, and feelings of loneliness and uncertainty. Studies reveal that the pandemic has had a significant negative impact on mental health. This systematic review aimed to investigate the prevalence of depression, anxiety, and stress symptoms among students in Croatia during the COVID-19 pandemic. Methods: A systematic review was conducted following PRISMA guidelines. A literature search was performed on August 5, 2024, using the electronic databases Scopus, PubMed, Web of Science, and PsycINFO. The search utilized the Boolean logical operator expression ('depression' AND 'anxiety' AND 'stress' AND 'COVID-19' AND 'Croatia' AND 'student'). Results: Out of one hundred and fifty-four identified studies, five met the inclusion criteria and were included in the review. The studies used the Generalized Anxiety Disorder 7-item scale (GAD-7), the Patient Health Questionnaire-9 (PHQ-9), and the Depression, Anxiety, and Stress Scale-21 (DASS-21) to assess mental health. The results indicate a high prevalence of symptoms of depression, anxiety, and stress among students in Croatia during the pandemic. Conclusion: A high prevalence of negative affective emotions was observed among students in Croatia during the pandemic. This finding underscores the importance of developing effective strategies for the early identification and management of mental disorders among students, irrespective of the pandemic's conclusion.

Effects of probiotic and vitamin D co-supplementation on clinical symptoms, mental health, and inflammation in adult patients with migraine headache: a randomized, triple-blinded, placebo-controlled trial

BackgroundMigraine headache is a major public health problem. Routine medications for migraine treatment are not useful in treating all patients and may have some side effects. The present study aimed to investigate the effect of vitamin D and probiotic co-supplementation on clinical characteristics of migraine, daily functioning, mental health outcomes, and serum levels of high-sensitivity C-reactive protein (hs-CRP).MethodsIn this randomized, triple-blinded, placebo-controlled trial, patients aged 18 to 55 years diagnosed with migraine based on the International Classification of Headache Disorders-3 (ICHD-3) were randomized to either vitamin D (50,000 IU every 2 weeks) plus probiotic (4.5 × 1011 CFU per day) or placebo for 12 weeks. The Headache Impact Test (HIT-6) and Depression, Anxiety, and Stress Scale (DASS) questionnaires were administered to patients at baseline and after 12 weeks. In addition, the frequency, duration, and severity of migraine headaches per month were assessed using a self-administered 30-day headache diary at baseline and the end of the intervention. Anthropometric indices, blood pressure, and serum levels of 25-hydroxy vitamin D and hs-CRP were also examined at first and the end of the study.ResultsSeventy-two migraine patients with a mean age of 37.46 ±\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\pm$$\\end{document} 8.32 years were included in this trial. Probiotic and vitamin D co-supplementation compared to placebo resulted in a significant increase in serum levels of vitamin D (+ 12.86 ±\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\pm$$\\end{document} 1.64 vs. + 1.12 ±\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\pm$$\\end{document} 0.80 ng/mL, P < 0.001). The between-group analysis in the adjusted model showed a significantly greater reduction in migraine headache frequency (− 3.17 ±\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\pm$$\\end{document} 0.84 vs. − 1.25 ±\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\pm$$\\end{document} 0.34; P = 0.031) and severity (− 1.55 ±\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\pm$$\\end{document} 0.35 vs. + 0.67 ±\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\pm$$\\end{document} 0.29; P = 0.017) in the probiotic and vitamin D group than the placebo group. No significant difference was found between the two arms of the intervention regarding the change in headache duration, hs-CRP, scores of DASS, and HIT-6 questionnaires (P > 0.05).ConclusionsThis trial showed that probiotic and vitamin D co-supplementation for 12 weeks has beneficial effects on migraine headache characteristics. Further research is needed to confirm this finding.

Effectiveness of a package of community-based mental healthcare services to address perinatal mental disorders in Bangladesh: A cluster-randomized controlled trial

BackgroundPerinatal mental disorders of women have an impact on their pregnancy and their child’s brain development across low and middle-income countries. However, to address this issue, there are no specific guidelines for community-level service providers in Bangladesh. Therefore, we aimed to develop a community-based mental healthcare (CBMHC) service package and test its effectiveness in reducing depression, anxiety, and stress among mothers during the perinatal period. MethodsA cluster-randomized controlled trial (cRCT) was applied to test the CBMHC package in 2017 and 2018. It was provided to one group of mothers along with routine maternal care while another group received only routine maternal care. Paired sample t-test was applied to assess mean changes at baseline and endline in the Depression, Anxiety, and Stress Scales-21 (DASS-21) and EuroQol-5 Dimension and 3 Level (EQ5D3L) scales. A linear mixed-effects model was used to assess the relationship between the DASS-21 score and EQ5D3L. Results1,215 participants were enrolled, including 605 in the intervention group and 610 in the control group. Measures of depression, anxiety, and stress were significantly decreased in both groups. Reduction in the levels of stress, as measured by changes in the stress score, were significantly greater in the intervention than in the control group (diff: 1.2, 95% CI: 0.1, 2.2). The EQ5D3L index improved significantly, 0.02 units more at endline in the intervention group than in the control group (diff: 0.02, 95% CI: 0.007, 0.03). The levels of mobility, usual activities, pain or discomfort, depression, and anxiety improved by 1.4%, 7.6%, 4.4%, 2.6%, and 0.4% more, respectively, in the intervention group compared to the control groups. These improvements were statistically significant. The DASS-21 score was negatively and significantly correlated with both the EQ-5D3L index and the Visual Analogue Scale (VAS) score for the intervention group as well as for the usual care group, indicating that EQ5D3L improved when common mental disorders decreased. ConclusionAlthough the improvements were modest, a CBMHC service package was effective in reducing perinatal levels of stress among Bangladeshi rural women. Trial registrationClinicalTrials.gov ID: NCT03678415

Internalized weight stigma and psychological distress mediate the association of perceived weight stigma with food addiction among young adults: A cross-sectional study

BackgroundPerceived weight stigma (PWS) and internalized weight stigma (IWS) are both associated with psychological distress and food addiction (FA). Using the previously proposed ‘cyclic obesity/weight-based stigma’ (COBWEBS) model, the present study extended the framework to investigate the mediating effects of IWS and psychological distress in the association between PWS and FA among young adults. Given that individuals who are overweight/have obesity have different vulnerabilities, this population was separately analyzed alongside the total study population.MethodsAn online survey comprising the Perceived Weight Stigma Scale, Weight Bias Internalization Scale (WBIS), Depression, Anxiety and Stress Scale-21 (DASS-21), and modified Yale Food Addiction Scale Version 2 was completed by 601 participants (59.6% females; mean age 29.3 years [SD = 6.07]). A total of 219 participants were categorized as being overweight/having obesity.ResultsA direct correlation was found between PWS and FA (standardized coefficient [β] = 0.28, p < 0.001) among both populations, and was mediated by IWS and psychological distress (β [95% CI] = 0.03 [0.01, 0.05] for WBIS score and 0.10 [0.06, 0.14] for DASS-21 score) among the total participants, but only mediated by psychological distress among participants who were overweight/had obesity (β [95% CI] = 0.14 [0.06, 0.24]).ConclusionsThe results demonstrated novel perspectives by showing the direct association between PWS and FA and the mediating roles of IWS and psychological distress. Treatment strategies such as psychological acceptance and psychoeducation could be used to reduce weight stigma, which could have positive downstream benefits of ameliorating FA. Future research may seek to study strategies for reducing weight stigma and psychological distress, to investigate their efficacy in improving disordered eating.

Perceived parental rearing styles and depression in Chinese adolescents: the mediating role of self-compassion.

Adolescence is a period characterized by rapid biological and psychological change, and adolescents have a heightened risk of depression. Parental rearing is an important influencing factor for depression in adolescence. However, the mechanism of influence needs further exploration. A total of 1839 adolescents were recruited from a junior and a senior high school in Zhongshan City, Guangdong Province, China. They were requested to completed the Parental Bonding Instrument (PBI), Self-Compassion Scale (SCS), and Depression Anxiety and Stress Scale-21(DASS-21). Adolescents recalled their mothers as being more caring and controlling than their fathers. Parental care (maternal care, paternal care) and parental encouragement of autonomy (maternal encouragement of autonomy, paternal encouragement of autonomy) were both negative predictors of depression, while parental control (maternal control, paternal control) was positive predictor of depression. Self-compassion mediated all relationships between parental rearing styles (parental care, parental encouragement of autonomy, and parental control) and depression but played different mediating roles (complete or incomplete mediating role) in different relationships. Self-compassion plays a mediator role in all relationships between perceived parental rearing styles (parental care, parental encouragement of autonomy, and parental control) and depression. Adolescents who grown up with less parental care, less parental encouragement of autonomy, and high parental control deserve special attention. Educators and clinicians could help those adolescents reduce the occurrence of depression by increasing their level of self-compassion.

Acceptance and commitment therapy for people with depressive and anxiety symptoms following acquired brain injury: Results of the BrainACT randomized controlled trial

ObjectiveThis study aimed to investigate the effectiveness of an adapted ACT intervention (BrainACT) in people who experience anxiety and/or depressive symptoms following acquired brain injury. MethodsThe study is a multicentre randomized controlled two-arm parallel trial. In total, 72 people who survived a stroke or traumatic brain injury were randomized into an eight-session ACT or control (i.e. psycho-education and relaxation) intervention. The primary outcome measures were the Hospital Anxiety and Depression Scale (HADS) and the Depression Anxiety and Stress Scale (DASS). Secondary outcomes were ACT process measures, participation, and quality of life. Outcome assessments were performed by trained assessors, blinded to treatment condition, pre-treatment, during treatment, post-treatment, and at 7 and 12 months follow-up. ResultsThere were no differences between groups on any outcome measure. Participants in both groups significantly improved on all outcome measures, except for participation frequency. More clinically relevant long-term improvements (i.e. recovered or reliable changes on the HADS) were found in favour of ACT for depressive and anxiety symptoms. ConclusionThe study was negative on the primary outcome measures. On an individual level, this study showed that especially on the long term ACT seems to show a more clinically relevant decrease in anxiety and depressive symptoms compared to an active control intervention. However, ACT was not superior in improving ACT-related processes such as psychological flexibility, cognitive defusion, and valued living nor in increasing participation or quality of life. Further large-scale group studies are warranted. Trial registrationThe study was originally registered in the Dutch Trial Register (now Clinical Trial Registry Platform), NL-OMON50203. Registered on 18/07/2018 and now to be found under https://trialsearch.who.int/Trial2.aspx?TrialID=NL-OMON50203.

Assessing the effects of spontaneous intracranial hypotension on quality of life, work ability and disability.

Spontaneous intracranial hypotension (SIH), characterized by headaches due to cerebrospinal fluid leaks or low pressure, is achallenging condition to diagnose and treat and affects the quality of life. An 8‑week online survey was conducted to assess the impact of SIH on symptoms, sociodemographics and quality of life. The cohort was comprised of patients who had a self-reported diagnosis of SIH and were divided into two groups: those with radiological evidence of SIH and those with clinical suspicion but no radiological evidence. Mental health and disability were evaluated using the Depression, Anxiety and Stress Scale-21 (DASS-21) and the Henry Ford Hospital Headache Disability Inventory (HDI). A total of 86 participants were included in the study, 59with radiological evidence and 27without. Most participants were female (84.9%) with amean age of 44.8 years. Orthostatic headache was more common in participants without radiological evidence (74.1% vs. 42.4%). The severity in those with radiological evidence was 27.1% mild, 27.1% moderate, 30.5% severe and 15.3% extremely severe, while those without had 7.4% mild, 18.5% moderate, 63.0% severe and 11.1% extremely severe headaches. Mental health assessment using the DASS-21 scale showed that 77.9% of all participants reported signs of depression, 96.5% reported anxiety and 89.5% reported stress. The HDI showed 2.3% total disability, 40.7% severe, 19.8% moderate and 37.2% mild. The impact on employment was significant: 15.1% were able to work full-time, 48.8% part-time, 30.2% were unable to work and 5.8% retired early due to SIH. The study demonstrates the broad impact of SIH affecting physical health, mental well-being, and socioeconomic status, and calls for multifaceted and robust management approaches to address its complex effects on patients.

A Cross-Sectional Study of the Prevalence of Irritable Bowel Syndrome and Its Association With Anxiety and Depression Among Nurses in the Al-Qassim Region of Saudi Arabia.

Introduction Irritable bowel syndrome (IBS) is a prevalent functional gastrointestinal disorder frequently associated with psychological conditions such as stress, anxiety, and depression. Given the high-stress work environments of nurses and the lack of studies on this topic in the Al-Qassim region, this cross-sectional study aimed to investigate the prevalence of IBS and its association with anxiety and depression among nurses in this area of Saudi Arabia. The research hypothesis was that nurses with IBS would report higher levels of anxiety and depression compared to those without IBS. Methods This cross-sectional study was conducted among 96 nurses working at King Fahd Specialty Hospital (KFSH) in the Al-Qassim region. Nurses were selected using systematic sampling, with a total sample size initially calculated to be 189, but only 96 participated. Data were collected using a validated self-administered questionnaire, which included sociodemographic information and psychological assessments based on the Rome III criteria for IBS diagnosis and the Depression, Anxiety, and Stress Scales-21 (DASS-21) to measure psychological distress. Descriptive and inferential statistics were applied, with significance set at p < 0.05. Results In a sample of 96 nurses, the prevalence of IBS was found to be 19.8%, indicating a notable presence within this population. The majority of participants were female. No significant associations were observed between IBS and demographic or lifestyle factors. However, a higher prevalence of IBS was noted among nurses with more than 10 years of experience (27.3%, n=21) compared to those with less experience (10.5%, n=two), although this difference did not reach statistical significance (p=0.126). This study also revealed a high prevalence of stress, anxiety, and depression in the nurse population. Moreover, nurses diagnosed with IBS reported significantly higher levels of stress, depression, and anxiety compared to their counterparts without IBS (all p-values < 0.05). Conclusion There was a high prevalence of IBS among nurses, particularly those with higher levels of psychological distress. This study highlights the importance of developing targeted mental health interventions for nurses. However, the small sample size and cross-sectional design limit the generalizability and causality of the findings. Future studies should include larger, more diverse samples, and longitudinal designs to further explore these associations.

Examining the Resilience of University Students: A Comparative Mental Health Study.

This cross-sectional study aimed to investigate the resilience levels and mental health outcomes among university students, specifically those in the science and non-science fields. Mental well-being varies widely among individuals, particularly among university students.Thus, the aim of this study was to examine and compare the level of depression, anxiety, and stress betweenundergraduate students of the Faculty of Bio-Resources and Food Industry (FBIM) and Faculty of Social Sciences and Humanities (FSSG) from Universiti Sultan Zainal Abidin (UniSZA), Terengganu, Malaysia, as well as to identify the correlations between resilience and their mental health status. This study was conducted among FBIM and FSSG students of UniSZA starting from March 18, 2024, to May 31, 2024. A total of 329 students were assessed for this purpose. All participants answered questionnaires that were prepared based on the Depression, Anxiety, and Stress Scale-21 (DASS-21) and the Connor and Davidson Resilience Scale (CD-RISC) through a Google Form (Google Inc., Mountain View, CA). Results: The Pearson's chi-square test, Mann-Whitney U test, and Kruskal-Wallis H test were used to analyze the data in this study. This study showed that the students from FBIM had poorer mental health than those from the FSSG (p<0.001). The results revealed statistically significant differences between the levels of depression, anxiety, and stress between students of the two faculties. Moreover, the research correlated the level of depression, anxiety, and stress with the resilience level to examine how individuals cope with psychological challenges. This outcome might be connected to students' resilience to overcome mental health issues. This research could potentially assist students in identifying their mental health status, as some may not be aware of their underlying brain conditions.

Effectiveness of a cognitive behavioural therapy (CBT)-based intervention for reducing anxiety among adolescents in the Colombo District, Sri Lanka: cluster randomized controlled trial

Anxiety disorders are found to be the most prevalent psychological problems among children and adolescents. Cognitive behaviour therapy (CBT) was found to be effective at reducing anxiety. The purpose of this study was to assess the effectiveness of a universal school-based intervention for reducing anxiety among Grade 9 schoolchildren. A randomized controlled cluster trial was conducted by randomly assigning 36 schools in the Colombo district in Sri Lanka into study and control arms, each comprising 18 schools with 360 students. The levels of anxiety, self-esteem and depression status were assessed using the validated Screen for Child Anxiety Related Disorders (SCARED) tool and the Rosenberg self-esteem scale, respectively, and the Depression, Anxiety and Stress Scale 21 (DASS-21) at baseline, after intervention, and after 3 months. A CBT-based universal intervention package was administered weekly by a trained teacher for eight weeks with a one-month self-practice period to a randomly selected Grade 9 class in each school in the study arm. The control arm received routine care. Anxiety and self-esteem scores and depression status were compared between the two arms after the intervention and at 3 months of follow-up using the generalized estimation equation (GEE), controlling for confounding and clustering. The nonresponse and loss to follow-up rates were < 1%. When comparing the study arm with the control arm using GEE, anxiety levels were significantly lower [β = (-0.096), 95% CI = (-0.005) − (-0.186), p = 0.038] at follow-up but not postintervention [β = (-0.024), 95% CI = 0.006 − (-0.055), p = 0.115]. There were no significant differences in depression status after intervention (OR = 0.257, 95% CI =0.052–1.286; p = 0.098) or follow-up (OR = 0.422, 95% CI 0.177–1.008; p = 0.052), and self-esteem significantly increased after intervention (β = 0.811, 95% CI = 0.314–1.309; p = 0.001) but not at follow-up [β=0.435, 95% CI=(-0.276)-1.145, p=0.231]. This study revealed that the universal package based on CBT is effective at reducing anxiety and improving self-esteem among adolescents. The trial registration number and date were SLCTR/2018/018 and 19th of June 2018 respectively.

Repetitive transcranial magnetic stimulation for major depression and obsessive-compulsive disorders in Singapore.

Repetitive transcranial magnetic stimulation (rTMS) is used for treatment-resistant major depressive disorder (MDD) and obsessive-compulsive disorder (OCD), but there are few studies on patient outcomes in Southeast Asia. In this study, we describe the clinical profile and outcome of patients with MDD and OCD treated with rTMS in Singapore. A naturalistic retrospective study of 71 patients (inpatient and outpatient) who received rTMS treatment between June 2018 and April 2023 was conducted. The depressive and obsessive outcome rating scales used were clinician-rated Montgomery-Åsberg Depression Rating Scale (MADRS), Yale-Brown Obsessive Compulsive Scale (Y-BOCS), Clinical Global Impressions-Severity (CGI-S) and self-rated Depression Anxiety and Stress Scale-21 (DASS-21). Clinician-rated and self-rated mood and general condition improved significantly. MADRS mean score improved from 28.1 (standard deviation [SD] 7.3) to 20.7 (SD 10.1) (P<0.0001) (20.8% response rate/17% remission rate). CGI-S mean 4.6 (SD 0.8) improved to 3.3 (SD 1.2) (P<0.0001). DASS-21 total mean improved from 67.3 (SD 24.6) to 49.6 (SD 28.0) (P<0.0001). Y-BOCS mean score displayed a trend towards improvement from 30.1 (SD 7.5) to 27.2 (SD 6.9) (P=0.799). However, 44.4% of patients with OCD responded with a minimal 20% reduction in baseline Y-BOCS. Moreover, the subgroup of 35.8% of patients with less than 30 rTMS sessions had contributed disproportionately to nonresponse (85.7%). Patients who received rTMS treatment (>30 sessions) had a trend of larger improvement of MADRS score when compared to patients with (≤30 sessions) (9.4 [SD 9.7] versus 3.8 [SD 12.3] [P=0.078]). Response and remission rates for MDD and OCD suggest patients have a good response to rTMS treatment. Dosing longer rTMS sessions after an acute course helps to maximise effectiveness. Further research to determine predictors of outcome and characterise clinical features of late responders to target treatment more effectively is recommended.

Factors Associated with Psychological Distress during COVID-19: A Cross-Sectional Study of Sub-Saharan African Migrant Workers across Australia and Canada.

Objective: Ensuring the sustainability of the migrant workforce requires a comprehensive understanding of the psychological challenges faced by this sub-population due to concerns about the wellbeing and financial situation of family members in their home countries. Therefore, this study investigates the factors associated with psychological distress among sub-Saharan Africa (SSA) migrant workers across Australia and Canada during the COVID-19 pandemic. Method: Data were collected from 378 first-generation migrant workers with SSA ancestry residing in Australia and Canada using the Depression Anxiety and Stress Scale 21 (DASS-21). Multivariate logistic regression analysis was used to determine socio-demographic factors associated with depression, anxiety, and stress among SSA migrants' populations. Results: Across both countries, migrants with lower levels of education were more prone to reporting feelings of depression, anxiety, and stress during the pandemic. Female participants in Australia were more likely to report feeling of depression. Participants in Australia and Canada who were separated/divorced/widowed were less likely to report stress and depression, respectively. Participants in Australia who had lived in Australia between 11 and 20 years and those between 36 and 50 years old were more likely to report feelings of depression. Participants residing in Australia whose SSA ancestry was Southern Africa/Central Africa were more likely to report anxiety. Participants in Australia who worked as part-time permanent workers and those who worked as fixed-term workers/short-term/casual workers were less likely to report anxiety. Finally, participants in Canada who reported two or more people living with them had higher odds of reporting anxiety. Conclusions: The findings from this study highlight key factors associated with SSA migrant workers' psychological distress during the pandemic. The results can inform policies and provide insight to the development of mental health intervention strategies for migrant workers to minimize similar distress during pandemics.

Stress-induced increase in heart-rate during sleep as an indicator of PTSD risk among combat soldiers.

Discerning the differential contribution of sleep behavior and sleep physiology to the subsequent development of posttraumatic-stress-disorder (PTSD) symptoms following military operational service among combat soldiers. Longitudinal design with three measurement time points: during basic training week (T1), during intensive stressed training week (T2), and following military operational service (T3). Participating soldiers were all from the same unit, ensuring equivalent training schedules and stress exposures. During measurement weeks soldiers completed the Depression Anxiety and Stress Scale (DASS) and the PTSD Checklist for DSM-5 (PCL-5). Sleep physiology (sleep heart-rate) and sleep behavior (duration, efficiency) were monitored continuously in natural settings during T1 and T2 weeks using wearable sensors. Repeated measures ANOVA revealed a progressive increase in PCL-5 scores from T1 and T2 to T3, suggesting an escalation in PTSD symptom severity following operational service. Hierarchical linear regression analysis uncovered a significant relation between the change in DASS stress scores from T1 to T2 and subsequent PCL-5 scores at T3. Incorporating participants' sleep heart-rate markedly enhanced the predictive accuracy of the model, with increased sleep heart-rate from T1 to T2 emerging as a significant predictor of elevated PTSD symptoms at T3, above and beyond the contribution of DASS stress scores. Sleep behavior did not add to the accuracy of the model. Findings underscore the critical role of sleep physiology, specifically elevated sleep heart-rate following stressful military training, in indicating subsequent PTSD risk following operational service among combat soldiers. These findings may contribute to PTSD prediction and prevention efforts.

Comorbidity of Body Dysmorphic Disorder and Obsessive-Compulsive Disorder in Orthognathic Surgery Patients

Objective: Body dysmorphic disorder (BDD) is a mental health disorder in which a person believes that their actual physical features appear worse than they truly are. The aim of this study is to examine the presence of BDD and its comorbidity with anxiety, depression, and obsessive-compulsive disorder (OCD) in patients with planned orthognathic surgery for dentofacial deformities. Methods: In this study conducted on patients scheduled for orthognathic surgery, the presence of BDD, OCD, depression, anxiety, and stress was determined by administering the Florida Obsessive-Compulsive Inventory (FOCI), Depression, Anxiety, and Stress Scale-21 (DASS-21), and Body Image Disturbance Questionnaire (BIDQ) prior to the surgery. An independent samples t-test evaluated differences between group means, Pearson's correlation coefficient demonstrated the linear relationship between two variables, and the chi-square test assessed the relationship between two categorical variables. A p-value below 0.05 was deemed statistically significant. A total of 108 patients were included in the study, with 54 patients Class 2 and 54 patients Class 3. Results: BIDQ, FOCI, depression, anxiety, and stress, males showed statistically significant higher results compared to females (p &lt;0.05). There were no statistically significant differences in BIDQ, FOCI, depression, and stress between Class 2 and Class 3 patients (p&gt;0.05). Of the 108 patients included in the study, a total of 20.4% (n=22) were found to be BDD positive. Among the female patients, 10% (n=6) were BDD positive, while among the male patients, 33.3% (n=16) were BDD positive. When evaluated in terms of skeletal classification, 14.8% (n=8) of Class 2 patients were BDD positive, while 25.9% (n=14) of Class 3 patients were BDD positive. Conclusions: Surgeons performing orthognathic surgery should be familiar with common and often severe body image disturbances. When evaluating patients seeking orthognathic surgery, their psychological conditions should be carefully considered.

The Impact of Physical Activity on Depression, Anxiety, and Stress during Pregnancy in Saudi Arabia: A Cross-Sectional Study.

Background and Objective: This study aimed to explore the impact of physical activity on depression, anxiety, and stress among pregnant women in the Jazan region of Saudi Arabia. Materials and Methods: A descriptive cross-sectional study was conducted among pregnant women attending randomly selected prenatal clinics in primary healthcare hospitals in Jazan, Saudi Arabia. The calculated sample size was 350. Data were collected conveniently through a semi-structured questionnaire covering demographic details, pregnancy-related characteristics, physical activity assessed using the Pregnancy Physical Activity Questionnaire (PPAQ), and mental health parameters evaluated by the Depression, Anxiety, and Stress Scale-21 (DASS-21). The statistical analyses included descriptive statistics and Wilcoxon and Kruskal-Wallis rank sum tests, with significance levels set at p < 0.05. Results: The study involved 406 pregnant females. Nearly a third (31%) had a family history of depression, anxiety, or distress. The prevalence of depression, anxiety, and stress was 62.6%, 68.7%, and 38.4%, respectively. The mean sedentary, light, moderate, vigorous, and total energy expenditures were 1.512, 24.35, 22.32, 4.84, and 53.02 metabolic equivalent tasks/day. Anxious females exhibited higher light activity (median 24, p = 0.033), while stressed ones showed higher light (median 25, p = 0.039), moderate (median 20, p < 0.001), and vigorous activity (median 3, p < 0.001). A significant association was observed between total energy expenditure and stress levels (p < 0.001). Conclusions: This study underscores the importance of physical activity in managing depression, anxiety, and stress among pregnant women in Jazan, Saudi Arabia. The findings suggest a need for tailored interventions to promote physical activity to improve mental well-being during pregnancy.