Depression Subscale Research Articles

The contribution of vulnerability to emotional contagion to the expression of psychological distress in older adults

This study examines the differential weight of a wide range of factors—sociodemographic factors, indicators of autonomy, social support, coping styles, vulnerability to emotional contagion, and empathy—in the presence of two profiles of psychological distress and in their absence. This cross-sectional study included 170 older adults. As assessed by the Hospital Anxiety and Depression Scale (HADS), 65.9% of the individuals in the sample had a clinical or subthreshold level of anxiety and depression (score > 1). Based on the HADS’s clinical cutoff scores for the anxiety and depression subscales, three profiles were created for the no distress, anxiety, and anxious depression groups. The profiles did not differ on demographic indicators except for sex. Vulnerability to emotional contagion, satisfaction with the social network and coping styles emerged as factors weighing the likelihood of being in either of the psychological distress groups relative to individuals with no distress. After controlling for adversity and psychotropic treatment, vulnerability to emotional contagion had the strongest relationship with both psychological distress profiles. Future research, such as a prospective longitudinal study, may provide an opportunity to explain the direction of the relationship between psychological distress and the factors studied, particularly vulnerability to emotional contagion.

Psychological conditions of caregivers of adult subjects with Prader-Willi syndrome

BackgroundPrader-Willi syndrome (PWS) is a rare genetic neurodevelopmental disorder. Individuals with PWS face a range of cognitive, behavioral, and emotional challenges that require comprehensive and lifelong care, posing significant demands on their caregivers. The study is not only aimed to assess the psychological conditions of caregivers of adult subjects with PWS focusing on psychological distress and coping, but also to shed light on a crucial yet often overlooked aspect of healthcare. This study aims to compare the psychological well-being of individuals with PWS and their caregivers, providing valuable insights that can potentially improve the quality of care for these individuals. The sample recruited at the Division of Auxology, IRCCS Istituto Auxologico Italiano, was composed of 30 adult subjects with PWS (11 men and 19 women; mean age ± SD: 36.4 ± 10.31 years; mean Body Mass Index (BMI): 35.7 ± 8.92: kg/m2) and their caregivers (10 men and 20 women). To assess the psychological condition of caregivers, the Italian-validated versions of the Depression Anxiety and Stress Scale (DASS-21) and the Coping Orientation to the Problems Experiences (COPE) were used, while to assess the psychological well-being of individuals with PWS and their caregivers, the Italian validated version of the Psychological General Well-Being Index (PGWBI) was used.ResultsDepression (p < 0.001), Stress (p = 0.050), and Total score (p = 0.009) of DASS 21 were higher in the caregivers of subjects with PWS than in the general population. PGWBI scores of caregivers were significantly lower than in individuals with PWS in Positive Well-being (p < 0.001), General Health (p = 0.006), Vitality (p = 0.004), and the total score (p = 0.006). The depression subscale of PGWBI was higher in caregivers than in subjects with PWS. Correlations between the subscales of COPE and the total score of PGWBI in caregivers revealed that the Avoidance subscale of COPE had a negative significant correlation with the total score of PGWBI (p = 0.003).ConclusionsOur results highlighted several critical insights into the profound emotional and psychological challenges faced by the caregivers of individuals with PWS.

Cognitive performance, mental health, and quality of life in β-thalassemia individuals: a comprehensive analysis

IntroductionBeta-thalassemia is a prevalent autosomal recessive haemolytic disorder, particularly in the Middle East. Patients with beta-thalassemia major (βTM) require iron chelation therapy and regular blood transfusions, while those with beta-thalassemia intermedia (βTI) exhibit milder symptoms. This study aimed to evaluate cognitive function, behavioural problems, quality of life, and related aspects in individuals with βTM and βTI.MethodsThe cross-sectional study included 20 βTM participants, 20 βTI participants, and 19 healthy controls. Participants underwent psychiatric interviews, the Wechsler Adult Intelligence Scale (WAIS-III), Symptom Checklist-90 Revised (SCL-90R), and Short-Form Health Survey (SF-36). Clinical data and laboratory investigations were also collected.ResultsβTM participants exhibited lower vocabulary and picture completion scores on the WAIS-III compared to other groups. βTI participants had significantly higher scores on SCL-90R subscales for somatization, depression, anxiety, paranoid ideation, and psychoticism. Both patient groups reported poorer quality of life across all SF-36 domains compared with controls. Longer disease duration correlated with lower levels of somatization, interpersonal sensitivity, depression, anxiety, and paranoid ideation. Less frequent blood transfusions were associated with better physical and mental health summary scores but also higher somatization. Elevated serum iron levels corresponded with increased anxiety, hostility, and psychoticism symptoms, while higher serum ferritin related to more obsessive–compulsive behaviours but less somatization and psychoticism.ConclusionsIndividuals with thalassemia exhibit cognitive deficits, psychological disturbances, and diminished quality of life, with distinct patterns depending on disease severity. Regular monitoring and appropriate interventions are crucial for optimizing their overall well-being and functioning.

The supervisory relationship as a predictor of mental health outcomes in doctoral students in the United Kingdom.

The process of a doctorate degree has been implicated in the onset and exacerbation of mental health problems among doctoral students. Previous studies have suggested that the student-supervisor relationship may predict emotional wellbeing and mental health outcomes in doctoral students in the UK. However, these studies were conducted before the COVID-19 pandemic and often used unstandardized measures to investigate supervisory styles. The present study was part of the Better Together project, a wellbeing initiative for doctoral students in the UK. It explored the predictive ability of aspects of the student-supervisor relationship with regards to doctoral students' mental health outcomes. The sample consisted of 141 students doing a research-based doctorate degree in the UK. The survey included demographic questions and questionnaires assessing supervisory styles, the discrepancy between actual and preferred supervisory relationship, depression, anxiety, and stress. A large proportion of participants fell in the severe and extremely severe categories in the depression, anxiety, and stress sub-scales. Multiple regression analyses indicated that both supervisory styles and discrepancy significantly predicted students' mental health outcomes. More specifically, higher scores in the uncertain supervisory style, which is characterized by indecisiveness and ambiguity, were linked with higher scores in depression, anxiety, and stress. The findings provided new insights concerning the aspects of the student-supervisor relationship that are related to the mental health issues of doctoral students in the UK. They have important implications for future research and supervision practice.

The relationship between smartphone overuse, anxiety, and depression among middle school adolescents in the city of Kenitra, Morocco: a cross-sectional study

BackgroundAdolescents face various addiction issues, including excessive smartphone use, which significantly impacts their mental health, leading to anxiety and depression. This study aimed to analyze the impact of smartphone use on the mental health of middle school adolescents in the city of Kenitra, Morocco, focusing particularly on the prevalence of depression and anxiety and to identify the factors influencing these behaviors. The present cross-sectional study included a sample of 341 middle school adolescents from Kenitra city, Morocco. Participants completed a comprehensive questionnaire covering various aspects, including sociodemographic information, smartphone addiction assessment using the Smartphone Addiction Scale (SAS), and mental health assessment using the Hospital Anxiety and Depression Scale (HADS). Descriptive statistics were performed, and Mann–Whitney U-test and chi-square test were both used for comparisons between the excessive and non-excessive group, respectively. A Spearman’s correlation analysis was performed to evaluate associations of smartphone overuse with depression and anxiety.ResultsAmong 341 participants, 37.4% demonstrated smartphone overuse. Males exhibited nonsignificantly higher scores on the SAS than females (p = 0.082). In addition, the mean psychological distress scores for the study participants were 7.62 ± 3.31 for anxiety and 7.75 ± 3.7 for depression. Males exhibited significantly lower scores on the HADS subscales in comparison with females (p < 0.001). Interestingly, the results of the study showed a statistically significant positive correlation between anxiety (r = 0.2441, p = 0.013) and depression (r = 0.4035, p < 0.0001) subscales of HADS and SAS.ConclusionsOur findings suggest that adolescent students exposed to smartphone overuse are vulnerable to mental disorders. The results will be useful in helping schools put in place efficient measures to prevent excessive use of smartphones.

The Effectiveness of Brief Multidisciplinary Outpatient Treatment for Functional Neurological Disorder: A Pilot Study

Background: Functional neurological disorder (FND) is a common, costly, and debilitating condition with a guarded prognosis. Limited evidence supports providers about which treatment approaches to undertake. Evidence-based care for FND is urgently needed to improve patient outcomes. The objective of this study was to evaluate functional and psychological outcomes associated with a novel outpatient multidisciplinary treatment program for adults with FND. Methods: Participants included 18 sequentially referred adults who attended the five-day FND treatment program, including those who completed ( N = 13) and who were available for follow-up at six months ( N = 9). Intervention included assessment and up to five consecutive days of treatment including two group-administered psychoeducation sessions. Primary measures included the Timed Up and Go (TUG), the EQ-5D-5L index score, and the visual analogue scale (VAS), and the Canadian Occupational Performance Measure (COPM). Secondary outcomes included Battery for Health Improvement-2 (BHI-2) Depression and Anxiety subscales. Results: Significant improvement observed on COPM performance and COPM satisfaction; EQ-5D-5L index (as well as VAS) and TUG (p = &lt; 0.05) immediately following five-day treatment. Improvement was gained at six months for BHI-2 Depression and Anxiety, and maintained for COPM performance, COPM satisfaction, EQ-5D-5L index, EQ-5D-5L VAS, and TUG. Conclusions: The findings of this preliminary work suggest that multidisciplinary treatment for FND has a positive impact on psychological and physical outcomes with results sustained up to six months.

Rasch analysis of the depression anxiety stress scales-21 (DASS-21) in a mild traumatic brain injury sample.

In this study, we evaluated the psychometric properties of the Depression Anxiety Stress Scales 21 items (DASS-21) in a mild traumatic brain injury (mTBI) sample. Treatment-seeking adults (n = 347) were recruited from outpatient rehabilitation services in New Zealand. Dimensionality, reliability, person separation index, and differential item functioning (DIF) of the DASS-21 were examined using Rasch analysis. Initial analysis of the complete 21-item DASS showed poor overall fit due to problems with individual items. Fit to the Rasch model was excellent when treated as three composite scores. The stress subscale demonstrated adequate model fit, dimensionality and good reliability. For anxiety, fit was not good, reliability was unsatisfactory and DIF was evident on one item. When this item was removed, fit to the model was still inadequate as was reliability. DIF was also evident for depression, but when this item was removed, fit to the model was adequate. The DASS-21 is a psychometrically sound measure of distress and stress for adults seeking treatment following mTBI. Ordinal to interval score conversion tables are provided to increase the precision of measurement. When assessing depression in a mTBI population, a 6-item depression subscale is recommended. Caution is advised in using the DASS-21 anxiety subscale alone.

Adaptation and Validation of the Pet Bereavement Questionnaire (PBQ) for Chinese Population

Despite the increasing prevalence of pet ownership in Chinese societies, standardized tools to assess grief from pet loss remain lacking. Research predominantly focuses on Western populations, creating a gap in understanding pet bereavement in Chinese cultural settings. This study aimed to adapt and validate the Pet Bereavement Questionnaire (PBQ-C) for a Chinese context to create a culturally appropriate assessment tool. A total of 246 participants with companion animal loss experiences were recruited through the university of the research team. They were invited to complete an online survey including the PBQ-C, the Depression subscale of the Depression Anxiety Stress Scales (DASS-21), and the Inventory of Complicated Grief (ICG). Both Exploratory Factor Analysis and Confirmatory Factor Analysis were conducted to examine the psychometric properties of the PBQ-C and the findings supported a three-factor structure—grief, anger, and guilt—aligned with the original PBQ, with three items reassigned to different factors. Despite these adjustments, the PBQ-C demonstrated strong internal consistency, reflecting the reliability of the questionnaire in measuring the same construct across its items; split-half reliability, indicating its ability to produce consistent results when divided into two parts; and concurrent validity, showing that the PBQ-C correlates well with other established measures of grief. The validated PBQ-C provides a culturally sensitive tool for assessing pet bereavement in Chinese society that can promote research and counselling support for this under-researched and under-recognized type of loss of human-animal relationships.

Personality in Alcohol and Opioid Use Disorder: A Multiphasic Personality Questionnaire Study

Background This study explored the relationship between personality attributes and substance use disorder (SUD). Research has identified specific personality dimensions, such as neuroticism, psychoticism, antisocial personality traits, paranoia, and anxiety, as contributing factors on the way to the initiation, continuation, and relapse of SUD. Purpose To explore this connection, we examined the personality profiles of subjects with alcohol use disorder (AUD) and opioid use disorder (OUD). Methods A total of 928 subjects, 320 with AUD, 490 with OUD and 118 healthy controls (HC), in the age range of 16–65 years were recruited in the study. The Clinical Profile Sheet and the Multiphasic Personality Questionnaire (MPQ) were administered to HC and patients who fulfil the diagnostic criteria for substance dependence as defined by ICD-10 (WHO-1992). Results We found significant differences in personality profiles between individuals with OUD and AUD. Patients with AUD scored higher than OUD on the MPQ subscales for depression, mania, paranoia, and antisocial personality traits. All subscales of the MPQ showed elevated scores in subjects with SUD compared to HC. Conclusion Elevated scores on the MPQ subscales suggest that personality factors may contribute to the pattern of substance use and misuse in this cohort.

Severe and unclassifiable tremor.

Patients often exhibit very severe or disabling forms of tremor that cannot be clearly characterized. To present a series of 37 cases of tremor considered unclassifiable. Patients diagnosed with essential tremor according to criteria of the International Parkinson Disease and Movement Disorder Society (IPDMDS), who had been previously studied, were included as controls. All patients underwent a battery of tests between 2019 and 2022, which enabled us to compare them. Relevant demographic and clinical information were collected. The following tools were applied: the Mini-Mental State Examination (MMSE); the Hospital Anxiety and Depression Scale (HADS); the Fahn-Tolosa-Marín Tremor Rating Scale (TRS); and the Quality of Life in Essential Tremor (QUEST). A simple brain magnetic resonance imaging (MRI) scan was performed for all patients. The categorical variables were compared using the Chi-squared test and the t-test with Fisher correction if appropriate, and the quantitative variables were compared through the two-tailed Student t-test. Values of p ≤ 0.01 were considered statistically significant. The cases presented higher scores on the anxiety and depression subscales of the HADS than the controls (p ≤ 0.006 and 0.000 respectively). In all domains of the TRS, the cases scored significantly higher, as well as in the QUEST. History of enolism was higher among the controls, and history of orthostasis and rest tremor was higher among the cases (p ≤ 0.000). Cerebellar atrophy was present in every patient in the case group, and in 24 subjects in the control group. Dystonia was observed in 7 subjects in the case group, and in none of the patients in the control group. There are patients with unclassifiable and extremely disabling tremors who respond poorly to the pharmacological therapy options.

Ten-year trajectories of postpartum depression of Japanese mothers and fathers

BackgroundPerinatal depression is a significant concern affecting both women and men during pregnancy and postpartum periods. While maternal postpartum depression has been extensively studied, paternal depression remains under-researched despite its prevalence and impact on family well-being. This study aimed to estimate the trajectories of perinatal and postpartum depression in Japanese parents over ten years and to determine the details of the symptoms of postpartum depression for each trajectory group, considering reciprocal effects between maternal and paternal depression. MethodsA total of 789 couples used the Edinburgh Postnatal Depression Scale to rate their depressive symptoms prenatally; at 5 weeks, 3 months, 6 months, and 1 year postpartum; and then yearly thereafter until the 10th year. Parallel-process latent class growth analysis was used to group participants according to their longitudinal patterns of depressive symptoms. ResultsFor both mothers and fathers, four depressive symptom trajectories fit the data best and were most informative (escalating: 6.5 %; mothers low and fathers moderate: 17.2 %; mothers high and fathers low: 17.9 %; low: 58.4 %). A variance analysis showed significant class-parent interactions across anhedonia, anxiety, and depression subscales, indicating distinct patterns of depressive symptomatology. DiscussionTailored mental health programs and universal screening using the Edinburgh Postnatal Depression Scale are recommended to address the specific needs of each trajectory class. This study contributes to the understanding of long-term depressive symptom trajectories in parents and emphasizes the necessity of comprehensive support strategies to enhance family well-being and resilience.

Depressive Symptoms and Gut Microbiota after Bowel Preparation and Colonoscopy: A Pre-Post Intervention Study.

Mechanical bowel preparation (MBP) is essential for visualisation of the colon during colonoscopy. Previous studies have identified changes in gut microbiota composition after MBP and colonoscopy. Considering the gut microbiota is increasingly implicated in psychiatry, we explored the potential impact of this intervention on mood and the microbiota-gut-brain axis. We conducted a pre-post intervention study in adults, with timepoints of one week before and one month after MBP and colonoscopy. Our primary outcome was change in average Hospital Anxiety and Depression Scale depression sub-scores. We examined changes in average anxiety, stress, and quality of life scores and gut microbiota composition using 16S rRNA sequencing. We further explored associations between changes in depressive symptoms and gut microbiota and conducted post hoc analyses to explore potential effect modifiers. Average depressive symptom scores decreased one month post-procedure compared to baseline (n = 59; adjusted β = -0.64; 95%CI: -1.18, -0.11). Irritable bowel syndrome (IBS) appeared to moderate this relationship (β = 1.78; 95%CI: 0.292, 3.26); depressive symptoms increased in those with, and decreased in those without, IBS. Reduced alpha diversity, modest effects on beta-diversity, and increases in health-associated genera were observed one month post-procedure. Increases in the CLR-transformed abundances of Ruminococcaceae UCG-009 were associated with improvements in depressive symptoms. There is preliminary evidence of a potential mental health effect of MBP and colonoscopy, particularly for those with IBS, which may be associated with changes to the gut microbiota. Further research is required to confirm these findings and their clinical relevance.

Dimensionality and psychometric properties of the Greek version of the Diabetes Impact and Device Satisfaction (DIDS) scale.

Type 1 diabetes mellitus (T1D) is a chronic condition with rising prevalence. The only treatment for individuals with T1D to prevent diabetes-related complications is exogenous insulin administration. Diabetes-related technology has significantly contributed to the management of T1D by reducing the burden of living with diabetes and providing greater flexibility in insulin management during daily activities. This study presents the psychometric properties of the Greek translation of the Diabetes Impact and Device Satisfaction (DIDS) Scale, which assesses satisfaction with the use of an insulin delivery device and the impact of diabetes management on individuals with T1D. A sample of 101 adults with T1D, mostly females (71.3%), with a mean age of 38.4 years (± 11.7), completed the translated Greek version of DIDS (DIDS-Gr). Exploratory factor analysis revealed three factors: 'Device Satisfaction', 'Diabetes Management Impact', and (new factor) 'Device Usability'. The internal consistency indices (Cronbach's alpha) for the subscales were 0.86, 0.71, and 0.60, respectively. Furthermore, convergent validity was demonstrated with moderate to high positive correlations between the DIDS-Grand the Diabetes Quality of Life Brief Clinical Inventory (DQoL-BCI) and its subscales, while divergent validity was also confirmed with weaker correlations with the depression subscale of the Hospital Anxiety and Depression Scale (HADS). Additionally, test-retest reliability and differential validity were present in our study. Therefore, DIDS-Gr is a valid and reliable measure for assessing the impact of diabetes on individuals with T1D and the satisfaction with the use of an insulin delivery device in Greece.

Long-Term Treatment for Unspecified Anxiety Disorders with Cannabidiol: A Retrospective Case Series from Real-World Evidence in Colombia

Introduction: Preclinical and clinical evidence has elucidated that cannabis-based medical formulations (CBMFs) may display anxiolytic, antidepressive, and neuroprotective properties. CBMFs are often considered as novel therapeutic anxiolytic agents that can be prescribed as pharmacotherapy for symptomatic domains in anxiety disorders (ADs). Our aim was to explore effectiveness and tolerability of enriched cannabidiol (CBD) oil extract formulations in adults with anxiety symptoms in an outpatient mental health program in Colombia during the COVID-19 pandemic. Methods: We conducted an observational, retrospective, real-world evidence case series from electronic health records at Zerenia Clinic in Bogotá, Colombia between June 2021 and December 2022. Our convenience sample consisted of people searching for CBMFs for the treatment of anxiety symptoms. A cohort of 24 adults was prescribed with enriched CBD in the form of non-sterile oral liquids suspended in sesame seed oil extracts for DSM-5 unspecified anxiety disorder and followed throughout the first year of treatment. CBMFs were prepared by dissolving full-spectrum cannabis extracts in sesame seed oil to a standardized concentration of active ingredients which is CBD-enriched. The oil extract contained 100 mg/mL of CBD and less than 1.9 mg/mL of THC. Primary outcome measures established were the anxiety subscale in the Hospital Anxiety and Depression Scale (HADS-A), and the clinical global impression scale with regard to severity (CGI-S) and improvement (CGI-I) at baseline, 6 months, and 12 months during follow-up. Secondary outcome measures established were HADS depression subscale (HADS-D) and the Epworth Sleepiness Scale (ESS), respectively. Participants also completed the patient-reported outcome measures (PROMs) during each visit throughout the 12-month follow-up. PROMs documented both participantʼs subjective improvement experience and progressive adverse effects. Results: After 6 months of treatment with sublingually administered enriched CBD oil extracts in a median dosage of 100 mg, more than half (54.17%) of the sample continued to report significant anxiety symptoms. After 12 months, only 37.50% persisted with significant anxiety symptoms with a median dose of 120 mg of enriched CBD oil extracts. Similar subjective improvements were reported with regard to sleep disturbances (SDs) as a secondary outcome. At baseline, less than half (46.83%) of the sample reported significant daytime sleepiness. After 6 months of enriched CBD oil extract treatment, less than one third (29.17%) continued to report SDs. At end point, a high proportion of the sample (87.50%) were considered to have normal daytime sleepiness. The cohort showed no clinically relevant depressive symptoms at baseline based on HADS-D scores; therefore, no improvement could be reported throughout the 12-month follow-up. Minimal gender differences with regard to HADS-D scores may be attributed to modifying effects of menopause-related symptoms. No significant adverse drug reactions or deaths were reported during the 12-month follow-up. Conclusions: Further research should determine the long-term efficacy, safety, and appropriate dosages of enriched CBD oil extracts in treating specific ADs rather than broad and unspecified anxiety symptoms. The state of the art of CBMFs for ADs should be warranted by future randomized controlled trials. The next stage for cannabis research should be focused in performing head-to-head trials comparing enriched CBD extracts or capsules versus first-line treatments proven to be effective in ADs.

Analysis of disease burden in patients with hereditary angioedema from Japan by patient-reported outcomes.

Hereditary angioedema (HAE) symptoms can vary greatly. Disease burden evaluation is essential for providing adequate treatments for patients. Patient-reported outcome measures (PROMs), including the 12-Item Short Form Health Survey (SF-12), the Angioedema Quality of Life (AE-QoL), the Hospital Anxiety and Depression Scale (HADS), and the Work Productivity and Activity Impairment: Specific Health Problem (WPAI:SHP) questionnaires, were collected in 2021, before modern medications for long-term prophylaxis (LTP) of HAE were licensed in Japan. Patients also reported their HAE attack frequency as "annual" (several attacks annually), "monthly" (several attacks monthly) or "weekly" (several attacks weekly). Multiple linear regression analyses were conducted on the relationship between independent parameters (sex, age, attack frequency, HAE type, and HADS scores) and dependent parameters (AE-QoL and SF-12 scores). Fifty-four patients reported PROMs. All PROMs showed substantial health-related quality of life (HRQoL) impairment. Overall, the higher the attack frequencies, the greater the reported impairment in the PROMs tended to be. In multiple linear regression analyses, higher AE-QoL Fatigue/Mood and Fears/Shame domain scores (greater impairment) were associated with higher HADS anxiety subscale scores; higher AE-QoL total scores (greater HRQoL impairment) and lower SF-12 Physical and Mental Health Composite scores (greater general health impairment) were associated with higher HADS depression subscale scores. Patients with monthly or weekly HAE attacks reported numerically low absenteeism and numerically high presenteeism and work productivity loss as measured by the WPAI:SHP questionnaire. In this study, conducted before modern LTP options were available in Japan, patients with HAE reported notable impairment in HRQoL and work productivity. Weekly or monthly HAE attack frequencies were associated with a high disease burden. Furthermore, a substantial number of patients reported notable fatigue/mood impairment as measured by the AE-QoL and depression as measured by the HADS regardless of attack frequency. These results provide a basis for future studies evaluating the effect of LTP on the clinical manifestations and HRQoL in patients with HAE.

Examining the overlap between tinnitus and depression questionnaires-protocol for an ICF based content analysis.

Tinnitus is a common phenomenon with an estimated prevalence of 14.4% in the adult population. The experienced severity of tinnitus varies significantly among this population. Psychological factors have been identified as major contributors to this perceived severity, and numerous studies have demonstrated a correlation between symptoms of depression and tinnitus severity. However, the assessment of tinnitus severity and depressive symptoms often relies on self-report questionnaires, which show content overlap. This can pose challenges in distinguishing both conditions and interpreting their relationship. To address these challenges, the proposed study aims to examine the overlap between tinnitus and depressive symptom questionnaires by analyzing their content based on the International Classification of Functioning, Disability and Health (ICF) framework. Six validated, multi-item, self-report questionnaires measuring perceived tinnitus severity (THI, TQ, mTQ, THQ, TRQ, TFI) and seven validated, multi-item, self-report, depressive symptom questionnaires (BDI-II, HADS-D, SDS, PHQ-9, CES-D, SCL-90-R depression subscale, DASS-42 depression subscale) will be included in the content analysis. The content of all items of these questionnaires will be linked to ICF categories and item overlap between the tinnitus and depressive symptom questionnaires will be analyzed. By exploring the overlap between depression and tinnitus questionnaires, this study seeks to gain a better understanding of the relationship between tinnitus and depression, by distinguishing between shared content and independent constructs of symptom scores and shedding light on the factors influencing their measured severity. Ethical approval is not required for this study, due to the characteristics of the study design. Findings will be disseminated through peer-reviewed open access publication and scientific conferences.

Factors associated with patient satisfaction after arthroscopic rotator cuff repair: do they differ by age?

Several studies have investigated factors affecting patient satisfaction after arthroscopic rotator cuff repair (ARCR); however, it is unknown if these factors vary according to age. Therefore, this study aimed to evaluate the factors associated with satisfaction of ARCR in individuals 70 years and older versus younger patients. Among 319 consecutive patients who underwent ARCR, 173 were included. Patients were divided into an old age group (≥70 years) and a young age group (<70 years), and the two age groups were further divided into satisfied and unsatisfied subgroups. Patient satisfaction was evaluated at the final follow-up visit using a binary question (yes or no). Clinical outcomes were assessed preoperatively and at the final follow-up. Satisfaction rates in the older and younger age groups were 75.41% and 79.47%, respectively. Mean changes in Constant and American Shoulder and Elbow Surgeons scores were significantly different between the satisfied and unsatisfied subgroups (P=0.031 and P=0.012, respectively) in the young patients. In the old patients, there was a significant difference in the mean change in depression subscale of the Hospital Anxiety and Depression Scale (P=0.031) and anxiety subscale of the Hospital Anxiety and Depression Scale (P=0.044) scores between the satisfied and unsatisfied subgroups. Factors affecting patient satisfaction after ARCR differed according to age. Psychological improvement was more important to elderly patients, whereas restoration of function was more important to younger patients. Pain relief was important for both age groups. Level of evidence: III.

Effects of the teach-back method on the health status of patients with chronic obstructive pulmonary disease: a real-world community-based cluster-randomized controlled trial.

The teach-back method (TBM), also known as the "show-me" method, is a technique for verifying patients' understanding of health-related information that has been recommended for improving health literacy. However, the research on TBM effect on the outcomes of chronic obstructive pulmonary disease (COPD) patients is limited. Therefore, the aim of this study was to examine the effect of a TBM intervention on the health status of COPD patients. This real-world community-based cluster-randomized controlled trial enrolled 1,688 patients with COPD from 18 communities in China. Participants received either TBM plus usual care (UC) or UC only. General practitioners were trained in TBM before the intervention. The primary outcomes were depression and anxiety symptoms, as measured by the Hospital Anxiety and Depression Scale (HADS). The secondary outcomes were health-related quality of life and dyspnea, as measured by the COPD Assessment Test (CAT). Dyspnea was assessed using the modified Medical Research Council (mMRC) dyspnea scale. Data on acute exacerbations and deaths were extracted from medical records. Lung function was expressed as the forced expiratory volume in 1 second as a percentage of the predicted value [FEV1 (% pred)]. In total, 336 of the 853 COPD patients in the intervention group (TBM plus UC) had comorbid depression, compared with 329 of the 835 in the control group (UC only). The TBM group showed a significantly greater improvement in HADS depression and anxiety subscale scores (HADS-D and HADS-A, respectively) than the UC group at12 months (t =8.34, P<0.001; t=12.18, P<0.001). The CAT and mMRC scores were significantly lower in the TBM than UC group at 12 months (t=8.43, P<0.001; t=7.23, P<0.001). The numbers of acute exacerbations and deaths were significantly lower in the TBM than UC group at 12 months (mean MCF values were 0.35 and 0.56, respectively [difference of 0.22; 95% confidence interval (CI): -0.41, -0.02; χ2=9.63, P<0.001]. The FEV1 (% pred) was significantly higher in the TBM than UC group at 12 months (t=7.45, P<0.001). General practitioners can use TBM interventions to effectively reduce anxiety, depression, and dyspnea symptoms, decrease the frequency of exacerbations and likelihood of death, and improve health-related quality of life and pulmonary function in patients with COPD. The trial was registered on the Chinese Clinical Trials Registry (reference: ChiCTR-TRC-12001958).

Effect of health education combined with biofeedback electrical stimulation on early pelvic floor function and psychology: A retrospective study.

To investigate the effects of health education combined with biofeedback electrical stimulation on maternal postpartum pelvic floor function and psychology. The clinical data of 80 patients with postpartum pelvic floor dysfunction (PFD) from May 2020 to May 2022 were selected as retrospective study subjects, and 40 cases were divided into the comparison group and the observation group according to the different intervention methods. Among them, the comparison group implemented biofeedback electrical stimulation and guidance, and the observation group implemented Greene health education and Kegel pelvic floor rehabilitation training intervention based on the comparison group. The differences in pelvic floor muscle strength, sexual quality of life, anxiety, and depression in the 2 groups with postpartum PFD were compared. Comparison of pelvic floor muscle strength: before the intervention (P > .05) and after the intervention, the anterior resting mean electromyography (EMG), slow muscle mean EMG, fast muscle maximum EMG, and mixed muscle mean EMG values of patients in the observation group were higher than those in the comparison group, and the posterior resting mean EMG values were lower than those in the comparison group (P < .05). There was no statistically significant difference in the Hospital Anxiety and Depression Scale (HADS) scores and anxiety and depression subscale scores between the 2 groups of patients before intervention (P > .05). After the intervention, the HADS scores and anxiety and depression subscale scores were lower than those before the intervention in both groups, and the differences were statistically significant in the intervention group than in the comparison group (P < .05). There was no statistically significant difference between The Chinese Female Sexual Life Quality Questionnaire scores of both groups before the intervention (P > .05). Sexual desire, vaginal lubrication, sexual arousal, sexual satisfaction, orgasm, and painful intercourse improved in both groups after the intervention, and the scores in the intervention group were higher than those in the comparison group (P < .05). Health education combined with biofeedback electrical stimulation can effectively improve the quality of patients' sexual life, improve the pelvic floor muscle strength of patients with postpartum PFD, enhance patients' confidence, reduce patients' anxiety and depression, and effectively improve patients' psychological status.

Psychological Risk Factors for Delayed Recovery Among Active Duty Service Members Seeking Treatment for Musculoskeletal Complaints at a Navy Shore-Based Military Medical Treatment Facility.

Musculoskeletal injuries (MSIs) are a leading cause of separation from the U.S. Navy. Data have shown that several psychological responses to MSI are associated with treatment outcomes. Yellow flags are maladaptive psychological responses to injury and predict delayed recovery, whereas pink flags indicate resilience after MSI and are associated with good treatment outcomes. Identifying these factors in patients with MSI would permit early targeted care to address factors that may delay their readiness for deployment and enhance factors that support recovery. Active duty service members with MSI who reported to physical therapy outpatient services at a naval hospital were recruited for the study. Yellow flags were assessed at baseline as part of a larger study. Participants completed the Fear Avoidance Beliefs Questionnaire (with two subscales, physical activity and work), the Pain Catastrophizing Scale, and the Hospital Anxiety and Depression Scale. Clinically relevant cut-off scores were used to indicate risk factors of delayed recovery. Pink flags were assessed with the Pain Self-Efficacy Questionnaire and a measure of positive outcome expectations for recovery. Two hundred and ninety participants responded to some or all of the questionnaires. Of these, 82% exceeded the cut-off scores on the physical activity subscale of the Fear Avoidance Beliefs Questionnaire, and 39% did so on the work subscale. Pain catastrophizing exceeded the cut-off in only 4.9% of the sample. Forty-three percent of these exceeded the cut-off for the anxiety subscale of the Hospital Anxiety and Depression Scale; 27% exceeded the cut-off on the depression subscale of the Hospital Anxiety and Depression Scale. Additionally, 54% endorsed scores greater than 40 on the Pain Self-Efficacy Questionnaire, and 53% endorsed a high score on the positive outcome expectations. A substantial portion of the sample endorsed elevated scores on one or more indicators of delayed recovery from MSI. Most participants showed a fear of physical activity, and approximately half reported pain-related distress (anxiety and depression). In addition, feelings of self-efficacy and positive outcome expectations of treatment were endorsed by only about half of the participants, indicating that the remaining half did not report adaptive responses to MSI. Early identification of these risk factors will allow for targeted treatment approaches that incorporate these yellow flags into treatment and support a psychologically informed approach to physical therapy. This approach is likely to reduce delayed recovery and improve deployment readiness.