Depression , Anxiety And Stress Scale Research Articles

Efficacy of online psychoeducation and relaxation training program (OnPR) on mental health problems in COVID-19 patients: A randomized controlled trial

PurposePrior studies found that the prevalence of anxiety, depression, stress and insomnia were relatively high in COVID-19 patients. This study aimed to explore the efficacy of OnPR on mental health outcomes in patients with asymptomatic or mildly symptomatic COVID-19. Patients and methodsWe employed a randomized controlled trial following the CONSORT guidelines. The Thai Clinical Trials Registry identification number of this study is TCTR20220729003. We used a block of 4 randomizations generated by a computer program. The intervention group (n = 38) received the OnPR program, and the control group (n = 36) received care as usual. OnPR was an online psychological intervention comprising psychoeducation, sleep hygiene education and relaxation techniques. OnPR was provided by qualified therapists trained with a standard protocol. The primary outcomes were depression, anxiety, and stress, which were determined by the Depression Anxiety and Stress Scale-21 (DASS-21). Sleep quality was measured by the Pittsburgh Sleep Quality Index (PSQI). Outcomes were compared between groups at pre-intervention and post-intervention at 1, 4, and 12 weeks using paired t-test or Wilcoxon signed-rank test. In addition, a linear mixed model was employed to demonstrate the effect changes of OnPR over time. All analyses were two-tailed, with a significance level of 0.05. ResultsOf 74 Thai participants, 89.2 % were female, and 11.8 % were male. The average age was 31 years. Participants' baseline characteristics were not statistically significant between the intervention and control groups except for depression and stress scores from DASS-21. OnPR resulted in significantly better improvement in depression, anxiety, stress, and sleep quality. The mean differences between groups of DASS-21 scores in depression, anxiety and stress at 7-day follow-up were −4.69, −3.29, and −5.50 respectively. The differences continue to be significant at 4-week and 12-week follow-ups. The mean difference between groups of PSQI at 7-day follow-up is −0.91. ConclusionOnPR improved mental health outcomes, and the effect on depression, anxiety and stress lasted for at least a 12-week follow-up period. In addition, it could enhance sleep quality after the intervention.

The Pregnancy Tele-yoga Module to Combat Stress, Anxiety, and Depression Associated with Pregnancy: An Exploratory Open-label Multicentric Study.

Untreated stress, anxiety, and depression during the perinatal period can lead to adverse maternal and infant outcomes. Yoga, the practice of body-mind-spirit techniques has been shown to reduce stress, anxiety, and depression. The aim of the study was to examine the feasibility and limited efficacy of the 4-week practice of pregnancy tele-yoga module (PTYM) delivered and monitored through an online platform. A multicentric, open-label, exploratory study was conducted in the antenatal clinics (ANCs) of three tertiary care hospitals in India. Pregnant women between 13 and 32 weeks of gestation were invited to participate. PTYM was taught by the trained research staff. A YouTube link demonstrating the PTYM developed by the researchers was shared with consenting participants. Using the Yoga Performance Assessment (YPA), research staff monitored the online performance of the PTYM. Pre- and postintervention, women were assessed using the Depression, Anxiety, and Stress Scale-21 (DASS-21). Preintervention, among 162 consented pregnant women, anxiety (62.34%) was the most common mental health condition, followed by stress (55.55%) and depression (45.67%). YPA at the end of week 1, week 2, week 3, and week 4 was 19.45, 21.35, 24.15, and 28.45, respectively. Postintervention anxiety, stress, and depression persisted in 19.78%, 11.44%, and 10.41% of women. Pregnant women with stress (DASS-21 ≥15; n = 90), anxiety (DASS-21 ≥8; n = 101), and depressive (DASS-21 ≥10; n = 74) symptoms after undergoing 4 weeks of PTYM reported significant reduction in the scores. The current study demonstrated the feasibility and limited efficacy of PTYM in ANCs of a tertiary care hospital in India.

Mood and Sleep Quality in Peruvian Medical Students During COVID-19 Pandemic

IntroductionThe prolongation and consequences of the COVID-19 pandemic have led to an uncertain and devastating panorama in many populations, and the evidence shows a high prevalence of mental health problems in medical students. The objective was to evaluate the association between mood disorders and sleep quality (SQ) in Peruvian medical students during the COVID-19 pandemic. MethodsA cross-sectional study was conducted on 310 medical students from a private university in Peru. The SQ was measured using the Pittsburgh Sleep Quality Index (PSQI), while mood disorders were evaluated using the Depression Anxiety and Stress Scale-21 (DASS-21). All information was collected by online surveys and then analysed in the R programming language. ResultsThe SQ results measured by PSQI were poor in 83.9% of the medical students. In the Poison regression analysis, the results of the bivariate analysis in men show that all mood disorders found the prevalence of poor SQ. However, in the multivariate analysis only stress (PRa=1.30; 95% CI, 1.08-1.57; P<0.01) and anxiety (PRa=1.34; 95% CI, 1.09-1.56; P <0.01) increased the prevalence of poor SQ. Women had a similar pattern in bivariate analysis, whereas in multivariate analysis, only severe stress (PRa=1.15; 95% CI, 1.01-1.29; P <0.05) increased the prevalence of poor SQ. ConclusionsThis study allows us to observe the consequences that the COVID-19 pandemic is having on medical students in Peru. It also revealed a population group vulnerable to poor quality of sleep and bad mood, which in the future will impact on health. It is suggested to educate medical students about the importance of proper sleep hygiene and the consequences of poor sleep hygiene practices.

Introducing semantic loadings in factor analysis: Bridging network psychometrics and cognitive networks for understanding depression, anxiety and stress

A psychometric scale reports experiences in terms of items/sentences rated by individuals. We investigate whether psychometric item ratings reflect semantic/syntactic associations between concepts in items. To this aim, we introduce semantic loadings as a semantic counterpart of psychometric factors, i.e. clusters of items obtained by correlations between item ratings. Semantic loadings quantify how clusters of semantically related concepts, as expressed in the texts of items, are allocated across psychometric factors as identified by ratings. As a case study, we focus on 39775 individual responses to the Depression Anxiety and Stress Scale (DASS) with 42 items on a 4-point Likert scale. To identify communities of semantically related concepts, we exploit the cognitive network framework of Textual Forma Mentis Networks (TFMNs), which reconstruct semantic/syntactic links encoded in the texts of items (e.g. "feel" and "sad" in the item "I usually feel sad"). To identify factors we compare eigenvector-based exploratory analysis with Graph Exploratory Analysis (EGA), which can both cluster items (and their texts) according to user ratings. We find that EGA is better at reconstructing the psychological organisation of DASS along the dimensions of anxiety, stress and depression. Following dual coding theory and the Deep Lexical Hypothesis, we posit that the act of reading items activates interconnected concepts and this influences user ratings and their expressed psychological constructs. Our results show a quantitative match: TFMN-based semantic loadings can identify specific aspects of emotional dysregulation, emotional exhaustion, physical distress and tension states of EGA-based psychometric factors, in non-random ways (up to p &lt; 0.001). We discuss our results in view of relevant mental distress literature, psychometric scale designing and links with episodic and semantic memories.

Evaluation and comparative assessment of clear aligners and conventional appliances on oral health-related quality of life in pediatric populations: a cross-sectional study.

This study was designed to evaluate and compare the usefulness of clear aligners and conventional appliances on Oral Health-Related Quality of Life (OHRQoL) in pediatric population. Emphasis was placed on the relative benefits and implications of employing clear aligners owing to their escalating prevalence and acceptability. The study participants were divided into four groups: Clear Aligner Group (CAG), Conventional Appliance Group (ConAG), Malocclusion Control Group (MCG), and Normal Control Group (NCG). Parameters including sociodemographic indicators and daily routines were assessed. OHRQoL was evaluated via the Child Perceptions Questionnaire (CPQ). Psychological conditions were assessed through the Depression, Anxiety and Stress Scale (DASS). Statistical differences were found between the four groups regarding CPQ subscales and total scores (p < 0.05). CAG was better than ConAG (p < 0.05) regarding the scores of functional limitations, emotional and social well-being, and total score, however no significant difference was discovered in the oral symptoms scores (p = 0.62). Moreover, all the treatment groups had worse OHRQoL compared to NCG (p < 0.05). Malocclusions and their treatments did not increase the psychological distress as per the DASS results. A novel correlation between the excessive tooth brushing and reduced OHRQoL was also observed (p < 0.05). The study herein emphasized the benefits of clear aligners in children and adolescents with OHRQoL. It was highlighted that the clear aligners had potential and were preferred for the adolescent orthodontic treatment.

Avoidance and Endurance Responses to Pain Before and with Advanced Chronification: Preliminary Results from a Questionnaire Survey in Adult Patients with Non-Cancer Pain Conditions.

The Avoidance-Endurance Model postulates fear-avoidance responses and endurance responses as important psychological mechanisms in the development and maintenance of chronic pain. The present study aims to investigate potential differences in avoidance and endurance responses to pain before and with advanced chronification. Two samples of adults with non-cancer pain at two different stages of chronicity were compared: One with pain and risk factors for chronicity (n=26, part of the PAIN2020 project) and one with chronic pain (n=33 from a pain day care clinic). The German Pain Questionnaire, the Graded Chronic Pain Scale (GCPS) and medical reports were used to measure duration and severity of pain. Responses to pain were assessed with the Avoidance-Endurance Questionnaire (AEQ) and psychological strain with the Depression, Anxiety and Stress Scales (DASS). Both groups were primarily affected by musculoskeletal pain. Although not yet chronified, the risk group reported comparable GCPS levels of pain intensity and disability. Depression and stress ratings were also similar, except for anxiety, which was significantly elevated in the chronic pain sample (p<.001). The AEQ scales did not differ between groups, neither on any of the fear-avoidance- nor endurance-related dimensions. A post-hoc regression analysis revealed a significant prediction of fear-avoidance by pain-related disability (p<.001). The regression model for endurance responses was not significant. Patients with risk factors of chronification experience substantial pain-related burden. Responses to pain in the realm of the Avoidance-Endurance model do not appear to vary as a function of chronification. While fear-avoidance and pain-related disability correlate positively, endurance could not be associated to any of our variables.

The Group-based Compassion-focused Intervention on Academic Procrastination, Anxiety, and Quality of Life of University Students: A Controlled Trial With 3-month Follow-up

Objectives Procrastination is one of the critical issues for university students and is associated with various psychological problems. This study examined the effectiveness of group compassion-focused intervention on procrastination, anxiety, and quality of life of (QoL) university students. Methods This research is an experimental study of clinical trial type. The study participants were 40 students of Iran University of Medical Sciences selected by a convenience sampling method. After obtaining informed consent, they completed the demographic questionnaire; academic procrastination questionnaire; depression, anxiety, and stress scale-21 (DASS-21); and personal wellbeing index–adult (PWI-A), before, immediately after, and three months after the intervention. The experimental group received eight 120-minute sessions of group compassion-focused therapy once a week, while the control group received no intervention. The data were compared using GLM repeated measures analysis of variance (GLMRM). Results Regarding procrastination, there is no significant difference between the average preparation for assignments and the tendency to change people›s procrastination at different evaluation times. However, the interaction effect of time and group has a significance level smaller than 0.05, indicating a significant difference between the average preparation for the tasks of the experimental and control groups at different evaluation times (F=4.439, P=0.043). The effect size of 0.115 indicates a moderate effect. There is also a significant difference between the procrastination tendency of the experimental and control groups at different evaluation times (F=8.348, P=0.007). The effect size of 0.197 indicates a moderate effect. Also, there is a significant difference between the experimental and control groups› average anxiety (F=35.62, P=0.000) and quality of life (F=14.57, P=0.001) at different evaluation times. The size of the effect indicates its strength. Conclusion Group compassion-focused intervention can be used as an effective therapy in working with students. However, more studies are needed to examine and compare other variables with other evidence-based treatments.

Dose-response effects of exercise on mental health in community-dwelling older adults: Exploration of genetic moderators

Background/Objective(1) Examine the role of exercise intensity on mental health symptoms in a community-based sample of older adults. (2) Explore the moderating role of genetic variation in brain-derived neurotrophic factor (BDNF) and apolipoprotein E (APOE) on the effects of exercise on mental health symptoms. MethodThis study is a secondary analysis of a three-arm randomized controlled trial, comparing the effects of 6 months of high-intensity aerobic training vs. moderate-intensity aerobic training vs. a no-contact control group on mental health symptoms assessed using the Depression, Anxiety, and Stress Scale (DASS). The BDNF Val66Met polymorphism and APOE ε4 carrier status were explored as genetic moderators of exercise effects on mental health symptoms. ResultsThe exercise intervention did not influence mental health symptoms. The BDNF Val66Met polymorphism did not moderate intervention effects on mental health symptoms. APOE ε4 carrier status moderated the effect of intervention group on perceived stress over 6 months, such that APOE ε4 carriers, but not non-carriers, in the high-intensity aerobic training group showed a decline in perceived stress over 6 months. ConclusionsAPOE ε4 carrier status may modify the benefits of high-intensity exercise on perceived stress such that APOE ε4 carriers show a greater decline in stress as a result of exercise relative to non-APOE ε4 carriers.

Stress depression and anxiety with xerostomia among young Indian adults.

The relationship of Oral health related quality of life (OHRQOL), stress, depression, anxiety, with xerostomia, un-stimulated salivary flow rate among young Indian adults is of interest. The first phase involved xerostomia along with salivary flow rate measurements. The Depression, Anxiety and Stress Scale (DASS) the standard questionnaire in this field, was used to assess depression, anxiety, and stress in the second part of the study. Xerostomia has a stronger effect on OHRQOL. Anxiety, stress, and depression are examples of psychological factors that significantly impact xerostomia and the reduction of salivary flow rate.

Psychometric Properties of the Patient Health Questionnaire-9 for Saudi Caregivers: A Cross-Sectional Study in Saudi Arabia.

To evaluate the psychometric properties of the Arabic-language Patient Health Questionnaire-9 (PHQ-9) among Saudi caregivers of patients with chronic diseases. Using a cross-sectional design, 94 Saudi caregivers (37 male and 57 female) in the medical city participated in the study. A comparative assessment was conducted on 4 models proposed in the existing PHQ-9 literature to gauge their compatibility through confirmatory factor analyses. This study evaluates convergent validity through a correlation analysis, examining the relationship between the PHQ-9 and the Depression, Anxiety, and Stress Scale-21 (DASS-21). Among the various models we examined, the single-factor structure of the PHQ-9 displayed the best fit with the data we gathered. Notably, the Cronbach alpha coefficient for the PHQ-9 registered at .81, indicating a high level of internal consistency. Factor loadings spanned a range from .39 to .76. The convergent validity of the PHQ-9 and DASS-21 was deemed satisfactory. It is established that the PHQ-9 serves as an effective tool for depression screening among Saudi caregivers in Saudi Arabia. Its strengths lie in its demonstrated validity, dependability, brevity, and convenience of administration, positioning it as a valuable resource for preventative measures and performance assessment within mental health settings.

Internet Addiction among Undergraduate Medical Students and Its Relationship with Alexithymia, Stress, Anxiety, and Depression in an Indian Medical College: A Cross-sectional Study

Abstract Context: Internet addiction (IA) is a rising issue, particularly among university students. The presence of comorbid psychiatric distress can worsen the impact of IA on academic and social functioning. Alexithymia, difficulty recognizing and expressing emotions may play a role in this relationship. Aims: This study aimed to assess the severity and association of IA, psychological distress, and alexithymia among undergraduate medical students in India. Settings and Design: This was a cross-sectional study of 380 undergraduate medical students following convenience sampling, studying in Mysore Medical College and Research Institute (MMCRI), Mysuru. Subjects and Methods: Sociodemographic details were collected, and participants completed the Young’s Internet Addiction Test (IAT-20), Depression, Anxiety, and Stress Scale-21 (DASS-21), and Toronto Alexithymia Scale-20 (TAS-20). Statistical Analysis: Statistical analysis was performed using SPSS-20. Descriptive statistics expressed as frequencies, means, and percentages. Qualitative data were analyzed using the Chi-square test to find out the association between two categorical variables. Spearman’s rank correlation test was used to find the correlation involving ordinal variables. Statistical significance was set at p&lt;.05. Results: About 45.7% were aged 18–20 years, male (58.4%), and from urban areas (54.2%). On IAT, 26.6% showed mild addiction, 11.6% had moderate addiction, and 1.3% had severe dependence. Psychological distress with 42.1% experienced depression, 42.4% anxiety, and 20.0% stress symptoms. In addition, 25.0% were classified as alexithymia. Significant correlations were found between grades of depression, anxiety, stress, and alexithymia with gender, residence, psychiatric illness in family, substance, and Internet use. Conclusions: The study population revealed a high prevalence of IA and psychiatric distress among undergraduate medical students. These findings highlight the need for interventions and support services targeting IA and related psychological distress among medical students.

Status of Anxiety, Depression, and Stress among the Pre-Clinical Students of Dentistry in Jamshoro, Sindh, Pakistan

Background: Mental health issues such as stress, anxiety, and depression are increasingly recognized as significant challenges among dental students globally. These issues can impact their academic performance and overall well-being, necessitating a deeper understanding within the context of dental education. Objective: This study aimed to assess the prevalence of depression, anxiety, and stress among pre-clinical dental students at the Institute of Dentistry, Liaquat University of Medical and Health Sciences, Jamshoro, and to explore any potential gender differences in these mental health parameters. Methods: A cross-sectional study was conducted using convenience sampling to recruit first and second-year BDS students, both male and female, aged 18-22 years. The Depression, Anxiety, and Stress Scale-21 (DASS-21) was employed to evaluate the participants. Data was collected through Google's online software, ensuring confidentiality of participants' information. Descriptive statistics and chi-square tests were utilized for data analysis, using SPSS version 24. Results: The study included 186 students, with an average age of 20.73±1.24 years. The gender distribution was 41% male and 59% female. The findings revealed that 87% of students had extremely severe anxiety levels, 45% had extremely severe depression, and 31% experienced extreme levels of stress. However, there was no statistically significant relationship between gender and levels of depression (P=0.333), anxiety (P=0.786), or stress (P=0.363). Conclusion: The study highlighted a high prevalence of mental health issues among pre-clinical dental students, with particularly severe levels of anxiety. Despite no significant gender differences, the overall elevated levels of stress, anxiety, and depression point to the need for targeted mental health interventions in dental education programs.

Mediating Effects of Fear on Mental Health among Undergraduate Students during Open Distance Learning.

Online distance learning (ODL) known as the flexible learning environment can trigger a negative impact on students' mental health. The study aimed to identify the influence of fear as mediator between mental health problem and university students' perception on ODL. This is a cross-sectional study involving a convenient sampling of 258 undergraduate students. Self-administered structured questionnaires adapted from the Depression, Anxiety and Stress Scale-21 (DASS-21) and the Fear of COVID-19 Scale (FCV-19S), were used to assess the severity of psychological symptoms (depression, anxiety and stress) and fear. The perception towards ODL is also designed to assess the students' perception related to ODL implementation. The data were analysed using descriptive statistics and Structural Equation Modelling-Partial Least Square (SEM-PLS). Overall, 84.2%, 95.0% and 67.4% of the participants experienced moderate to very severe level of depression, anxiety and stress, respectively. In addition, 82.6% of them suffering with moderate to extreme level of fear, of which 81.8% of participants had a negative view on ODL. The results of SEM-PLS revealed that there are complementary partial mediation effects of fear on the relationship between depression and students' perception during ODL (β = 0.502, t-value = 0.828, P-value = 0.017). The anxiety (β = 0.353, t-value = 5.401, P-value = 0.000) and stress (β = 0.542, t-value = 8.433, P-value = 0.000) have directly influenced on fear. This study demonstrated that university students had the prevalence of psychological symptoms and fear during ODL. In line with this, fear contributes significantly to the mental health status of university students and has negatively impacted the students' perception during ODL implementation.

Smartphone addiction, stress, and depression among university students

BackgroundSmartphones represent a fundamental part of daily life. Smartphone overuse may cause psychological problems such as stress, anxiety, depression, cognitive decline, and adverse effects on students’ academic activities. ObjectivesThis study assessed the relationship between problematic smartphone use among university students, stress and depression levels, and other risk factors. MethodA descriptive cross-sectional study was conducted among undergraduate students at (KSAU-HS) in Jeddah from 2019 to 2020. Data was collected using questionnaires containing the Smartphone Addiction Scale short-version to assess problematic smartphone use (PSU) and the Depression, Anxiety, and Stress Scale-21 (DASS-21). ResultThe study included 235 students; 64.3 % were female, the mean age was 21.5 years, and the majority were medical students. Problematic smartphone use was significantly more among female students (76.2 %) compared to males (62.8 %). There was a significant increase in the Smartphone Addiction scores with increased depression and stress levels. Female students had significantly higher stress and depression levels, which were significantly associations with PSU. Female medical students had statistically significantly higher PSU (83.5 %) compared to females from other colleges (68.8 %). Depression was significantly more common among students during their first clinical year compared to their preclinical years. ConclusionThe study found high prevalences of smartphone overuse, depression, and stress among university students, particularly female medical students. Positive correlations were found between stress and depression levels and PSU. PSU can be a risk factor or a consequence that worsens preexisting psychiatric problems. Early psychological support with an emphasis on addressing PSU may improve students' mental and psychological well-being.

Impact of Quiet Time on Psychological Outcomes of Neonatal Intensive Care Unit Nurses in Jeddah, Saudi Arabia: A Cross-Sectional Study.

Although quiet time is implemented in neonatal intensive care units (NICUs) for the benefit of infants, it may also positively impact the psychological outcomes of healthcare professionals. Several studies have examined the impact of quiet-time implementation on patients; however, there is a paucity of research assessing its impact on the psychological outcomes of NICU nurses, particularly in Saudi Arabia. This study aimed to assess the impact of quiet time on the psychological outcomes (stress, anxiety, and depression) of NICU nurses in Jeddah, Saudi Arabia. A cross-sectional design was used for this study. A total of 87 NICU nurses from two hospitals participated in this study. One group did not practice quiet time, while the second group did. A questionnaire survey assessed participants' demographic characteristics, and their depression, anxiety, and stress were assessed using the depression, anxiety, and stress scale-21 (DASS-21). The data were analyzed for frequency, percentage, mean, and standard deviation (SD). Bivariate analysis, independent t-tests, and one-way analysis of variance were used to test the differences between variables and groups. Pearson's correlation coefficient (r) was used to analyze the relationships between continuous variables and perceived stress, anxiety, and depression. A substantial number of NICU nurses perceived stress, anxiety, and depression; however, there were no significant differences in perceived stress, anxiety, and depression between the nurses who worked in NICUs that applied quiet time and NICUs that did not (P≤ 0.05). This study found no statistically significant relationship between quiet-time implementation and perceived stress, anxiety, or depression among NICU nurses. Further research with a larger sample size or increased quiet-time implementation may be required.

Impact of COVID-19 pandemic on the physical, mental and social health of the suburban and rural adult population in Bangladesh

Background and objectives: The COVID-19 pandemic caused a significant impact on health worldwide. Adverse effect of COVID-19 on health-related quality of life is significant. This study aimed to find out the impact of COVID-19 on the physical, mental and social health of suburban and rural adult population in Bangladesh. Methods: A suburban and a rural community were purposively selected. The suburban and rural areas were located about 40 km and 130 km north and north-east of Dhaka city respectively. People aged ≥20 years in the selected communities were enrolled in the study. The investigation procedure included socio-demographic and clinical history, anthropometry, and clinical examination and laboratory investigations. Depression, Anxiety and Stress Scale-21 (DASS-21) and 36-Item Short Form Health Survey (SF-36) questionnaires were used for assessing mental and social health respectively. Knowledge, attitude and practice (KAP) regarding the prevention and transmission of COVID-19 was assessed by a validated questionnaire and interview. Results: Total 385 individuals (suburban=201, rural=184) were enrolled in the study. Out of 385, 116 and 269 were male and female, respectively. Out of total 385 participants, depression, anxiety and stress were present in 113 (29.4%), 144 (37.4%) and 70 (18.2%) respectively, while 210 (54.5%) were normal. Extremely severe depression, anxiety and stress were present in 3.6%, 6% and 0.5%, respectively. Depression and anxiety did not differ between suburban and rural populations, though stress was significantly higher among the suburban (p&lt;0.05) population. Social functioning was limited in more than 50% as opposed to excellent (5.5%) or good (39.8%). Almost 60% of the participants had to cut-down schedule of heavy work. Moderate to minimal physical activities were less affected, though weakness and nervousness predominantly hindered socialization. About the prevention and transmission of COVID-19, awareness and attitude were found satisfactory (≥45%), though practice was neglected (&lt;30%). Conclusions: This is the first study in Bangladesh to report the impact of the COVID-19 pandemic on the physical, mental, and social health of adult suburban and rural populations. Physical and mental disabilities were evident among the studied people. Social functioning was affected by COVID-19 equally in suburban and rural participants. A well-designed cohort study is needed to obtain a real picture of the impact of COVID-19 pandemic on human health and society. IMC J Med Sci. 2024; 18(1):007. DOI: https://doi.org/10.55010/imcjms.18.007 *Correspondence: MA Sayeed, Department of Community Medicine and Public Health, Ibrahim Medical College, 1/A Ibrahim Sarani, Segunbagicha, Dhaka 1000, Bangladesh; Email: sayeed1950@gmail.com

Behavioural Deficits and Regional Cerebral Perfusion Map in Cognitively Normal and Pre‐Dementia Stages

AbstractBackgroundOur previous work has shown increased presence of early behavioural impairment in Asian than Western cohorts(Soo et al.,2021). Such impairments include mild behavioural changes, sleep disruptions and higher depression, anxiety and stress, in turn representing an at‐risk state which may predict later development of dementia(Müller‐Spahn,2003;Soo et al.,2021). Additionally, growing evidence illustrates that cerebrovascular changes are a key component in the pathological sequelae and may be detectable years before clinical presentation of dementia (de la Torre,2018). However, the influence of cerebral perfusion on behaviour, especially in pre‐dementia stages remains to be elucidated. Thus, we examined the association between regional grey matter perfusion and behaviour in cognitively normal(CN) and subjects with mild cognitive impairment(MCI) or subjective cognitive decline(SCD). We hypothesized that grey matter perfusion deficits would be related to behaviour impairment even in early stages of SCD/MCI.MethodWe studied 35 CN and 248 pre‐dementia (MCI/SCD) from a community‐based research cohort from the Dementia Research Centre (Singapore) with neuroimaging, neuropsychological and behavioural assessments(Table 1). We investigated the association between regional grey matter perfusion across 31 regions of interest spanning frontal, parietal, temporal and occipital lobes using 2D pulsed Arterial Spin Labelling and performance on the mild behaviour impairment‐checklist(MBI‐C), Pittsburgh Sleep Quality Index(PSQI) and Depression, Anxiety and Stress Scale(DASS). These associations were examined in CN and MCI/SCD groups separately and respective Pearson’s correlation matrices were derived.ResultOverall, greater behavioural impairment on the MBI‐C, DASS and PSQI was associated with hypoperfusion across multiple grey matter regions. This association was stronger in CN than in the pre‐dementia group. Specifically, among CN, hypoperfusion in the frontal, parietal and occipital lobes related most strongly to greater behavioural impairment, especially MBI‐C and DASS depression(Fig.1). In the MCI+SCD group, only hypoperfusion in the frontal and temporo‐occipital regions related to worse behavioural impairment across the MBI, PSQI and DASS(Fig.2).ConclusionIn this study, we illustrate differential associations between cerebral hypoperfusion and behavioural impairment in CN and MCI/SCD groups, with CN individuals showing more widespread and stronger associations between behavioural impairment and hypoperfusion across the brain. In SCD/MCI, hypoperfusion in frontal and temporo‐occipital regions were associated with behavioural impairment.

Prevalence and factors associated with depression, anxiety, and stress symptoms among home isolated COVID-19 patients in Western Nepal.

Globally, COVID-19 pandemic has a significant impact on mental health. In Nepal, COVID-19 positive cases have to self-isolate at home in multi-generational and multi-family households. This could be strongly associated with depression, anxiety, and stress-related health outcomes. Additionally, COVID-19 related stigma and fear of transmission may intensify depression, anxiety, and stress symptoms. This study determined the prevalence of depression, anxiety, and stress symptoms and their association with presence of COVID-19 symptoms and comorbid conditions among home isolated COVID-19 positives in the Karnali province, Nepal. We conducted a cross-sectional study to assess depression, anxiety, and stress symptoms among 402 home isolated COVID-19 patients of Karnali province from January to May 2021 using "Depression, Anxiety and Stress Scale-21 (DASS-21)". We interviewed patients to collect socio-demographic, DASS-21, COVID-19 symptoms, comorbid conditions, and self-treatment. We conducted a telephonic interview using a standardized questionnaire using Kobotoolbox. We calculated the prevalence of depression, anxiety, and stress symptoms. We utilized univariate and multivariate logistic regression to determine their association with the presence of COVID-19 symptoms and comorbid conditions. In multivariate logistic regression, we adjusted sociodemographic factors (age, gender, ethnicity, marital status, monthly family income, education level), smoking status and history of self-treatment. We reported adjusted odds ratios (aOR) with 95% confidence intervals. All analyses were conducted in R (version: 4.0.3). The prevalence of depression, anxiety and stress symptoms among home isolated COVID-19 patients were 8.0% (95% CI: 5.5 to 11.1), 11.2% (95% CI: 8.3 to 14.7), and 4.0% (95% CI: 2.3 to 6.4) respectively. Higher odds of depression symptoms (aOR: 2.86; 95% CI: 1.10-7.44,p= 0.03), anxiety symptoms (aOR: 3.81; 95% CI: 1.62 to 8.93;p= <0.01) and stress symptoms (aOR: 7.78; 95% CI: 1.43 to 42.28;p= 0.02) were associated significantly with presence of COVID-19 symptoms in past week. Higher odds of anxiety symptoms were associated with the presence of comorbid conditions (aOR = 2.92; 95% CI: 1.09 to 7.80;p= 0.03). Depression, anxiety, and stress symptoms were present in a significant proportion of home isolated COVID-19 patients in western Nepal and positively associated with the presence of COVID-19 symptoms. In this global COVID-19 pandemic, it is important to provide timely counseling to high-risk groups like those with comorbidities and COVID-19 symptoms to maintain a high level of mental health among home isolated COVID-19 patients.

Survey on the Psychological Impact of Movement Restriction During the Covid-19 Outbreak Among UTHM Pagoh

The outbreak of Covid-19 has impacted many people around the globe with the new norm that people need to adapt, including the Movement Control Order (MCO) that the Malaysian Government imposed. As one of the students in Universiti Tun Hussein Onn Malaysia (UTHM), Pagoh, it is a big responsibility to hold onto to know about the students' mental health state and the psychological impacts of the MCO in Malaysia. The objectives of this study are to investigate students' current mental health state in UTHM Pagoh, identify the psychological impacts that affected the students during the MCO period, and identify the factors that can be perceived as the sources of stress towards students. A survey on the Psychological Impact of Movement Restriction during the Covid-19 Outbreak among UTHM Pagoh students was conducted via an online questionnaire. A cross-sectional, web-based survey was conducted, and the instruments consisted of three sections, i.e., demographics, Depression, Anxiety and Stress Scale-21 (DASS-21), and Covid-19 Student Stress Questionnaire (CSSQ). The methodology started by distributing the questionnaire to all the students of UTHM Pagoh. Then, all the data were recorded and analysed by using Statistical Package for the Social Sciences (SPSS) software. The results analysed from SPSS software were then concluded and a conclusion was made from the results obtained. Both DASS-21 and CSSQ items played essential roles in the survey questionnaires to achieve the objectives of this survey. At the end of this survey, it is found that the current mental health of the UTHM Pagoh students is mild anxiety and an average level of stress.

Associations of self‐reported psychological stress with memory and cerebrospinal fluid biomarkers of Alzheimer’s disease in middle‐aged adults

AbstractBackgroundSelf‐reported psychological stress is associated with an increased risk of cognitive decline and dementia. However, it remains unclear whether stress is related to key biomarkers of Alzheimer’s disease (AD). This cross‐sectional study examined the relationship of psychological stress with memory and cerebrospinal fluid (CSF) biomarkers of AD in middle‐aged adults without dementia.MethodThe Healthy Brain Project (HBP) is a prospective web‐based study of adults aged between 40 and 70 years. A total of 2208 participants (76% female) completed the Depression, Anxiety, and Stress Scale (DASS) and Paired Associates Learning subtest of the CANTAB unsupervised on the HBP web platform. Additionally, a sub‐group of participants (n = 67; 41% APOE e4 carriers) attended an in‐person assessment where CSF samples were obtained to measure levels of amyloid‐beta (Aβ42), total tau (t‐tau), phosphorylated tau 181 (p‐tau), and neurofilament light chain (NFL). Separate linear regression analyses investigated associations of the DASS‐Stress score with memory performance and AD biomarkers. All analyses were adjusted for age, sex, education, and race.ResultIn the web‐based cohort, higher levels of self‐reported psychological stress were significantly associated with poorer memory (unstandardised β = ‐0.014, standard error [SE] = 0.004, p &lt;.001). However, there were no significant associations between psychological stress and CSF levels of Aβ42, t‐tau, p‐tau, and NFL (all p &gt; .05), with small effect sizes (Cohen’s f2 ≤ 0.05).ConclusionHigher levels of self‐reported psychological stress were associated with poorer memory in a large middle‐aged cohort but were not associated with AD biomarkers in a subset of participants with available CSF. One potential explanation is that non‐AD pathologies may underlie the relationship between stress and poorer memory; for example, poor coping strategies (e.g., smoking, overeating, and physical activity) might increase the risk of vascular cognitive impairment. However, it is also likely that the small sample size of the in‐clinic cohort was insufficient to detect any subtle relationships between stress and AD pathologies. Further research is needed to determine the associations between stress and the development of the clinical and biological manifestations of AD.