7-item Generalized Anxiety Disorder Research Articles

Testing the Feasibility, Acceptability, and Potential Efficacy of an Innovative Digital Mental Health Care Delivery Model Designed to Increase Access to Care: Open Trial of the Digital Clinic.

Mental health concerns have become increasingly prevalent; however, care remains inaccessible to many. While digital mental health interventions offer a promising solution, self-help and even coached apps have not fully addressed the challenge. There is now a growing interest in hybrid, or blended, care approaches that use apps as tools to augment, rather than to entirely guide, care. The Digital Clinic is one such model, designed to increase access to high-quality mental health services. To assess the feasibility, acceptability, and potential efficacy of the Digital Clinic model, this study aims to conduct a nonrandomized open trial with participants experiencing depression, anxiety, or both, at various levels of clinical severity. Clinicians were trained in conducting brief transdiagnostic evidence-based treatment augmented by a mental health app (mindLAMP); digital navigators were trained in supporting participants' app engagement and digital literacy while also sharing app data with both patients and clinicians. Feasibility and acceptability of this 8-week program were assessed against a range of benchmarks. Potential efficacy was assessed by calculating pre-post change in symptoms of depression (Patient Health Questionnaire-9; PHQ-9), anxiety (7-item Generalized Anxiety Disorder; GAD-7), and comorbid depression and anxiety (Patient Health Questionnaire Anxiety and Depression Scale; PHQ-ADS), as well as rates of clinically meaningful improvement and remission. Secondary outcomes included change in functional impairment, self-efficacy in managing emotions, and flourishing. Of the 258 enrolled participants, 215 (83.3%) completed the 8-week program. Most were White (n=151, 70.2%) and identified as cisgender women (n=136, 63.3%), with a mean age of 41 (SD 14) years. Feasibility and acceptability were good to excellent across a range of domains. The program demonstrated potential efficacy: the average PHQ-9 score was moderate to moderately severe at baseline (mean 13.39, SD 4.53) and decreased to subclinical (mean 7.79, SD 4.61) by the end of the intervention (t126=12.50, P<.001, Cohen d=1.11). Similarly, the average GAD-7 score decreased from moderate at baseline (mean 12.93, SD 3.67) to subclinical (mean 7.35, SD 4.19) by the end of the intervention (t113=13, P<.001, Cohen d=1.22). Participation in the program was also associated with high rates of clinically significant improvement and remission. Results suggest that the Digital Clinic model is feasible, acceptable, and potentially efficacious, warranting a future randomized controlled trial to establish the efficacy of this innovative model of care.

Anxiety among cancer patients: A cross-sectional study at The University of Gondar comprehensive specialized hospital.

Anxiety is a prevalent psychological issue among cancer patients, significantly affecting their quality of life and potentially influencing treatment outcomes. This study aims to investigate the prevalence and associated factors of anxiety among cancer patients at the University of Gondar Comprehensive Specialized Hospital in Northwest Ethiopia. A cross-sectional study design was used, involving 384 cancer patients, selected by systematic random sampling technique, from the oncology ward. Data were collected using the Generalized Anxiety Disorder 7-item (GAD-7) scale and the Oslo Social Support Scale (OSS-3). Descriptive and inferential statistics, including bi-variable and multi-variable logistic regression analyses, were employed to analyze the data. The prevalence of anxiety was 88.3%, with 34.4% of patients experiencing severe anxiety, 29.2% moderate anxiety, and 24.7% mild anxiety. Significant predictors of anxiety included participants age>= 61years (AOR = 2.99, 95% CI = 1.31-6.79), participants age 30-60 years (AOR = 4.13, 95% CI = 1.53-11.07), female sex (AOR = 2.04, 95% CI = 1.02-4.07), advanced cancer stage (AOR = 3.08, 95% CI = 1.11-8.53), and ongoing treatment (AOR = 2.40, 95% CI = 1.14-5.10). The study found a high prevalence of anxiety among cancer patients, compared to the previous studies, highlighting the need for integrated psycho-oncology services. Specific interventions are necessary for high-risk groups, including older patients, females, and those with advanced-stage cancer.

Challenges of poor sleep quality and mental health issues among Syrian medical residents in 22 major hospitals across Syria.

A nationwide survey in the USA reported that healthcare workers had the highest prevalence of short sleep duration compared with other professions. Moreover, several studies have reported poor sleep quality among healthcare professionals and described insufficient sleep as a potential driver of reduced physician well-being. This study aims to explore sleep quality and mental health issues among Syrian medical residents, with the goal of informing targeted interventions to enhance their well-being and professional performance. This cross-sectional study in Syria involved 2071 residents from 22 major hospitals. Conducted between 27 October 2023 and 4 April 2024, it used face-to-face interviews with validated questionnaires following STROBE guidelines. Hospitals were categorized for comparative analysis. Measures included demographics, Pittsburgh Sleep Quality Index, Patient Health Questionnaire for depression, and Generalized Anxiety Disorder 7-item. In a study involving 2071 hospital residents across Syria's major hospitals, significant findings reveal a high prevalence of poor sleep quality (67.7%), depressive symptoms (46%) and anxiety symptoms (42.2%). Analysis by hospital categories highlighted varied rates, with Damascus and Hama General Hospitals showing notably higher incidences. Females exhibited higher rates of depressive and anxiety symptoms compared with males, with predictors including gender, age and marital status. The relatively high prevalence of poor sleep quality, depressive symptoms and anxiety symptoms among Syrian medical residents necessitates proper action, which will probably include limits on work hours, to enhance mental health outcomes and ensure proper patient care.

Serum levels of thyroxine, thyroid-stimulating hormone, and anti-thyroid peroxidase antibodies and their association with anxiety in environmentally exposed populations in Kazakhstan.

Little is known about the impact of environmental pollution on thyroid function in the non-occupationally exposed population of Kazakhstan. This study aimed to investigate serum levels of thyroxine (T4), thyroid-stimulating hormone (TSH), and anti-thyroid peroxidase (TPO) antibodies in the environmentally exposed population of Kazakhstan in relation to symptoms of anxiety. A total of 1,388 nominally healthy individuals residing in areas exposed to three major types of environmental pollution prevalent in Kazakhstan-non-ferrous metallurgy, condensate gas extraction, and activities of the Semipalatinsk Nuclear Test Site (SNTS)-were enrolled. All comparisons were made with 493 individuals residing in settlements without industrial or military pollution. Serum-free T4, TSH, and anti-TPO levels were tested using a solid-phase chemiluminescent immunoassay. The Generalized Anxiety Disorder 7-item (GAD-7) inventory was utilized to screen for anxiety symptoms. The prevalence of subclinical hypothyroidism was significantly higher in residents of settlements near the condensate gas field than in control sites (20.3 vs. 15.0%). In comparison, the prevalence of overt hypothyroidism was insignificantly higher (0.7 vs. 0.6%). The prevalence of subclinical hyperthyroidism was insignificantly higher in residents of settlements around the SNTS. The prevalence of overt hyperthyroidism was insignificantly higher in residents of areas proximal to the condensate gas field compared to the controls. The prevalence of both normal and elevated serum levels of anti-TPO antibodies did not differ significantly between different sites. Moderate and severe anxiety symptoms were the least common in residents of the two control sites (5.9%). This study carries potential implications for tailored public health interventions and policies.

Mental health and psychological resilience amid the spread of the Omicron variant: a comparison between China and Korea.

Besides physical health risks, large public health events also exert negative impacts on people's mental health. We aimed to explore the prevalence and correlates of mental distress and its association with psychological resilience among countries amid the Omicron wave. We conducted cross-sectional surveys simultaneously in China and South Korea from March 15 to 30, 2023. Brief Resilience Scale (BRS), Generalized Anxiety Disorder 7-item (GAD-7) scale, and Patient Health Questionnaire-9 (PHQ-9) scale were used to measured psychological resilience and mental distress. Self-reported rates of anxiety and depressive symptoms in 3,000 Chinese participants were 24.5% and 30.5%, while the above-mentioned rates were 17.2%and 34.4% in 1,000 Korean participants. Chinese participants had a marginally higher BRS score. Psychological resilience was inversely associated with the prevalence of anxiety symptoms and depressive symptoms. Similar results can be observed in Korea. Results remained robust in all models. Chinese and Korean populations reported a high prevalence of mental distress with variations in different characteristics, indicating practical implications for developing tailored mental health policies and services in the context of large public health events.

Prevalence of Anxiety and Depressive Disorders in a Sample of Moscow Residents: Comparison of the GAD-7 and HADS Results with a Clinical Assessment

BACKGROUND: Anxiety and depressive disorders are the most common mental disorders. Detecting a disorder at an early stage can prevent the development of severe disorders and preserve the patient’s functioning ability. Simple and reliable screening tools based on self-completion of questionnaires can be used for this purpose. However, it is not always the case that the scores of the self-questionnaire align with those of the clinician. AIM: To estimate the prevalence of anxiety-depressive disorders using the GAD-7 and HADS self-report questionnaires compared to psychiatrist assessment. METHODS: The study included individuals aged 18 to 65 years, living in Moscow, Russia, without psychiatric disorders, who participated in an online study using the HADS (Hospital Anxiety and Depression Scale, HADS-A and HADS-D) and GAD-7 (Generalized Anxiety Disorder 7-item scale). Anxiety disorder was diagnosed when the total score was ≥10 on the GAD-7 and/or ≥10 on the HADS-A scale, and depression was defined when the total score was ≥9 on the HADS-D scale. Then, 82 randomly selected participants attended an anonymous consultation with a psychiatrist. RESULTS: The study included 1,097 individuals (72% female), median age 29 (23; 37) years. As a result of testing, anxiety disorder was found in 168 (15%); depressive disorder — in 152 (14%) respondents. At medical verification, anxiety was diagnosed in 18 (22%); depression — in 19 (23%) people. The sensitivity of the HADS-D subscale for physician-diagnosed cases of depression was 61%, and specificity was 73%. The sensitivity of the HADS-A and GTR-7 subscale in identifying cases of anxiety disorder was 58%, specificity 59%. Sixteen percent were first diagnosed with a personality disorder or schizotypal disorder. CONCLUSION: The level of anxiety and depression in our sample of the population of Moscow, Russia, was higher than the global level. Self-assessment based on the questionnaire seems to not fully reflect the real state of a patient, as evidenced by the differences with the psychiatrist’s assessment.

Region of Chief Complaint is Associated With Aesthetic Expectation in Prosthodontic Patients: A Cross‐Sectional Study

ABSTRACTObjectiveThis study aims to explore the association between aesthetic expectation and possible variables such as region of chief complaint, gender, age, chief complaint, duration and its influencing mechanism.Subjects and MethodsOne hundred and ninety‐four patients seeking prosthodontic treatment were recruited and completed the questionnaires including the Oral Health Impact Profile 5‐item (OHIP‐5), the Stigma Scale for Chronic Illness 8‐item (SSCI‐8), the Generalised Anxiety Disorder 7‐item (GAD‐7), the Psychosocial Impact of Dental Aesthetics Questionnaire 23‐item (PIDAQ‐23), aesthetic expectation and other demographic and disease‐related information.ResultsAesthetic expectation showed significant correlations with region of chief complaint (r = 0.363, p &lt; 0.001). Multiple linear regression analysis after stratified analysis showed that aesthetic expectation was significantly positively related to social impact (1.10, 95% CI [0.30, 1.91], p = 0.009), aesthetic concern (1.29, 95% CI [0.19, 2.40], p = 0.025) and dental self‐confidence (0.94, 95% CI [0.35, 1.54], p = 0.003) while presenting a negative correlation with psychological impact (−1.24, 95% CI [−2.53, 0.05], p = 0.065) only in prosthodontic patients of aesthetic zone. Mediation analysis revealed a significant direct association between aesthetic expectation and the aesthetic zone (0.77, 95% CI [0.03, 1.53]), as well as between the aesthetic zone and the nonaesthetic zone (1.17, 95% CI [0.33, 2.00]) via PIDAQ‐23. A significant indirect association between aesthetic expectation and the aesthetic zone (0.76, 95% CI [0.41, 1.17]) as well as between the aesthetic zone and the nonaesthetic zone (1.06, 95% CI [063, 1.56]) via PIDAQ‐23 was also observed.ConclusionRegion of chief complaint is associated with aesthetic expectation via PIDAQ‐23 in prosthodontic patients. Researchers and dentists should take region of chief complaint and psychosocial impact into account when using aesthetic expectations for aesthetic analysis.

Risk Factors for Postoperative Nausea and Vomiting After TACE: A Prospective Cohort Study.

Objective: Postoperative nausea and vomiting (PONV) was one of the common complications in patients with HCC who had undergone TACE. This study was a prospective analysis of patient data to investigate risk factors for PONV in patients after TACE. Material and Methods: Data were collected from 212 patients undergoing TACE in the interventional department between August 2022 and August 2023. Including: gender, age, education, BMI, operation time, concomitant underlying diseases and drugs, preoperative limosis, history of nausea and vomiting, history of kinetosis, history of smoking or drinking, and occurrence of PONV. A visual analog scale was used to measured pain. Neuropsychological status was also assessed, using the 7-item Generalized Anxiety Disorder Questionnaire (GAD-7) and the Patient Health Questionnaire-9(PHQ-9). To identify risk factors for PONV, multiple logistic regression analysis was used. The receiver operating characteristic (ROC) curve was plotted to assess the regression model. The clinical trial number did not apply in the study. Results: In this study, 212 out of a total of 904 patients with HCC undergoing TACE during their hospital stay were included for analysis. Among the included patients, the incidence of PONV was as high as 42% (89/212). Multiple logistic regression analysis showed that chronic gastritis (odds ratio [OR] = 10.350; p = 0.020), VAS (OR = 3.835; p = 0.003), epirubicin (OR = 26.685; p < 0.001), and the dosage of lipiodol (≥5 mL) (OR = 1.385; p < 0.001) were independent risk factors of PONV after TACE. The ROC curve demonstrated that the AUC was 0.902, the sensitivity was 84.3%, and the specificity was 87%. Conclusions: PONV is highly prevalent among patients with HCC after TACE. Chronic gastritis, pain, epirubicin, and the dosage of lipiodol were independent risk factors for PONV. The risk prediction model that was constructed according to the aforementioned factors demonstrated good discriminatory capacity for predicting the risk of post-TACE PONV, which can improve the recognition of medical providers, and has a good ability to prevent and treat nausea and vomiting.

Therapeutic Effect of Yu Melody Relaxation Training Combined with Jianpi Jieyu Decoction in Insomnia Patients: A Randomized Controlled Trial.

To evaluate the therapeutic effect of Yu Melody relaxation training (YMRT) combined with Jianpi Jieyu Decoction (JJD) in treating patients with insomnia disorders (ID). In this randomized controlled study, 94 ID patients were included from Xiyuan Hospital, China Academy of Chinese Medical Sciences from September 2022 to January 2024. They were randomly assigned to the YMRT group (47 cases, YMRT plus JJD) and the control group (47 cases, oral JJD) using a random number table. Both treatment administrations lasted for 4 weeks, with a 2-week follow-up. The primary outcome was change in Insomnia Severity Index (ISI) scores from baseline to 4 weeks of intervention. Secondary outcomes included ISI response at week 4, as well as ISI, Patient Health Questionnaire-9 (PHQ-9), and Generalized Anxiety Disorder 7-item (GAD-7) scores at baseline and weeks 1, 2, 3, 4, and 6. Additionally, Pittsburgh Sleep Quality Index (PSQI) scores were evaluated at baseline and weeks 4 and 6. Adverse events (AEs) were recorded and compared between groups. Five patients in each group did not complete the protocol requirements. The overall dropout rate was 10.64%. The full analysis set included all 47 cases in each group. The ISI score decreased significantly at week 4 from baseline in the YMRT group compared with the control group, with a between-group difference of -3.2 points [95% confidence interval (CI): -5.08 to -1.34; P<0.05]. The ISI response at week 4 in the YMRT group was significantly higher than that in the control group (85.11% vs. 51.06%), with a between-group difference of 34.05% (95% CI: 13.77% to 50.97%; P<0.05). At week 6, the YMRT group demonstrated greater reductions from baseline than the control group, with between-group differences of -2.1 points (-95% CI: -3.49 to -0.64; P<0.05) for PHQ-9 scores, -3.5 points (95% CI: -5.21 to -1.85; P<0.05) for PSQI scores, and -1.9 points (95% CI: -3.47 to -0.28; P<0.05) for GAD-7 scores. Moreover, at weeks 4 and 6, the ISI and PSQI scores in the YMRT group were significantly lower than those in the control group (P<0.05); and at week 6, the PHQ-9 score in the YMRT group was significantly lower (P<0.05). There was no significant difference in the incidence rates of AEs between the two groups (8.51% vs. 4.26%, P>0.05). YMRT combined with oral JJD could improve sleep quality and alleviate depressive and anxiety symptoms in patients with ID. This combined therapy was effective and safe, and its effect was superior to oral JJD alone. (Registration No. ChiCTR2200063884).

A Convenience Sample Looking at Microbiome Differences Between Anxious and Non-Anxious Patients in a GI Clinic

Background: The gut–brain axis, significantly influenced by the gut microbiome, is a growing focus in mental health research. This study aimed to investigate gut microbiome differences between anxious and non-anxious participants. Methods: A convenience sample of 119 participants consisted of 56 participants with self-assessed low to zero levels of anxiety and 63 with self-assessed mild to severe levels of anxiety, using the self-rated Generalized Anxiety Disorder 7-item (GAD-7) test. Fresh stool samples were collected for bacterial DNA extraction. DNA library preparation was performed using shotgun methodology, sequenced with the NextSeq 500/550 High Output v2.5 300 cycle kit, and mapped using minimap2. Bioinformatics analysis was conducted using One Codex. Results: The study participants were all of white race/ethnicity and the mean age, 54 (anxious group) vs. 55 (non-anxious) yr old, was not different between groups (p = 0.75). In the anxious group, 33% were females versus 25% in the non-anxious group, p = 0.46. Six percent of the anxious group reported a prior diagnosis of depression and 8% had irritable bowel syndrome, compared to none in the non-anxious group (p = 0.02, p = 0.006, respectively). Mann–Whitney tests revealed higher relative abundances of the genera Clostridioides (p = 0.011) and Bacteroides (p = 0.002) in the anxious group. Conversely, the anxious group had lower levels of the genera Bifidobacterium (p = 2.118 × 10−10), Faecalibacterium (p = 0.020), and the Phylum Actinobacteria (p = 1.516 × 10−8). Conclusions: Our findings corroborate previous studies, showing significant gut microbiome differences between anxious individuals and their non-anxious counterparts. These results support further exploration of microbiome-centric anxiety research.

A digital therapy targeting anxiety in pulmonary fibrosis: A decentralized randomized controlled trial.

Pulmonary fibrosis, a manifestation of interstitial lung disease, is frequently associated with anxiety. The objective of this study, COMPANION, was to assess the anxiolytic efficacy of Almee, a digital cognitive behavioural therapy for patients with pulmonary fibrosis, compared to treatment as usual. COMPANION was a randomized, controlled, open-label and partly reader-blinded, decentralized, clinical trial conducted in the United States. Eligible patients had radiology-confirmed pulmonary fibrosis and a Generalized Anxiety Disorder 7-item (GAD-7) score of ≥5 (possible range 0-21). Participants were randomized 1:1 to Almee or no intervention for 9 weeks, with block stratification by anxiety severity. The primary endpoint was change in GAD-7 score from baseline to week 9. Between 20 December 2022 and 14 August 2023, 108 participants were randomized, 54 to Almee and 54 to treatment as usual. In each arm, 46 participants completed the study; 108 cases were analysed as intention-to-treat. By week 9, average GAD-7 score had improved by 1.8 points (SEM = 2.1) in the Almee group (n = 54) and deteriorated by 0.9 points (SEM = 2.2) in the control group (n = 54), a 2.7-point difference (95% confidence interval: 1.2-4.2, p = 0.0006). Treatment with Almee was well-tolerated and showed clinically meaningful improvement in pulmonary fibrosis-related anxiety. Almee shows promise as a personalized intervention for management of the psychological burden related to living with pulmonary fibrosis.

Intention to Seek Mental Health Services During the 2022 Shanghai COVID-19 City-Wide Lockdown: Web-Based Cross-Sectional Study.

The implementation of COVID-19 lockdown measures had immediate and delayed psychological effects. From March 27, 2022, to June 1, 2022, the Shanghai government enforced a city-wide lockdown that affected 25 million residents. During this period, mental health services were predominantly provided through digital platforms. However, limited knowledge exists regarding the general population's intention to use mental health services during this time. This study aimed to assess the intention of Shanghai residents to use mental health services during the 2022 Shanghai lockdown and identify factors associated with the intention to use mobile mental health services. An online survey was distributed from April 29 to June 1, 2022, using a purposive sampling approach across 16 districts in Shanghai. Eligible participants were adults over 18 years of age who were physically present in Shanghai during the lockdown. Multivariable logistic regression was used to estimate the associations between demographic factors, lockdown-related stressors and experiences, physical and mental health status, and study outcomes-mobile mental health service use intention (mobile applications and WeChat Mini Programs [Tencent Holdings Limited]). The analytical sample comprised 3230 respondents, among whom 29.7% (weighted percentage; n=1030) screened positive for depression or anxiety based on the 9-item Patient Health Questionnaire or the 7-item Generalized Anxiety Disorder Scale. Less than one-fourth of the respondents (24.4%, n=914) expressed an intention to use any form of mental health services, with mobile mental health service being the most considered option (19.3%, n=728). Only 10.9% (n=440) used digital mental health services during the lockdown. Factors associated with increased odds of mobile mental health service use intention included being female, being employed, being a permanent resident, experiencing COVID-19-related stressors (such as loss of income, food insecurity, and potentially traumatic experiences), and having social and financial support. Individuals with moderate or severe anxiety, as well as those with comorbid anxiety and depression, demonstrated a higher intention to use mobile mental health services. However, individuals with depression alone did not exhibit a significantly higher intention compared with those without common mental disorders. Despite a high prevalence of common mental disorders among Shanghai residents, less than one-fourth of the study respondents expressed an intention to use any form of mental health services during the lockdown. Mobile apps or WeChat Mini Programs were the most considered mental health service formats. The study provided insights for developing more person-centered mobile mental health services to meet the diverse needs of different populations.

Fatigue Syndrome among Medical Students in Saudi Arabia: A Cross-Sectional Study on Depression and Anxiety

ABSTRACT Objective: This cross-sectional investigation aimed to determine fatigue syndrome (FS) prevalence and its association with depression and anxiety among medical students in Saudi Arabia. Materials and Methods: An online survey was performed using a pretested questionnaire comprising four sections: sociodemographic information, the 11-item Chalder Fatigue Questionnaire (CFQ), the 9-item Patient Health Questionnaire (PHQ-9), and the Generalized Anxiety Disorder 7-item (GAD-7) scale. A total of 740 medical students participated in the cross-sectional study. Results: The study found that 56.4% of the students met the diagnostic criteria for FS, with female students (69.7%) showing higher FS prevalence compared to male students (30.3%). FS was significantly associated with symptoms of depression (r = 0.68, P &lt; 0.001) and anxiety (r = 0.54, P &lt; 0.001). Other factors associated with higher FS scores included higher body mass index, lack of physical activity, and a history of substance use. Conclusion: FS is highly prevalent among medical students in Saudi Arabia, particularly among females. The association between FS and mental health symptoms underscores the need for targeted interventions to manage FS and its psychological impact in this population.

Physical Activity Self-Efficacy Among Pregnant Women at High Risk for Gestational Diabetes Mellitus in China: A Cross-Sectional Study.

Physical activity could decrease the odds of pregnant women at high risk for gestational diabetes mellitus (GDM) developing GDM. Physical activity self-efficacy was the key predictor of physical activity. This study aimed to examine physical activity self-efficacy and identify its predictors among pregnant women at high risk for GDM in mainland China. A cross-sectional study was conducted in Zhengzhou, China, from October 2021 to February 2022. Two hundred fifty-two pregnant women at high risk for GDM completed the Pregnancy Physical Activity Self-efficacy Scale, the Social Support for Physical Activity Scale, the Knowledge of Physical Activity Questionnaire, the 7-item Generalized Anxiety Disorder Scale, the Edinburgh Postnatal Depression Scale, and a socio-demographic data sheet. Multiple linear regression was used. Chinese pregnant women athigh risk for GDM reported a moderate level of physical activity self-efficacy. The best-fit regression analysis revealed four predictors. Social support for physical activity was the strongest predictor, followed by knowledge of physical activity, intention to do physical activity, and anxiety symptoms. The study found that Chinese pregnant women at high risk for GDM had a moderate level of physical activity self-efficacy, which had 4 predictors. Healthcare professionals should make efforts to enhance pregnant women's social support, knowledge, andintention to do physical activity and decrease their anxiety symptoms to improve their physical activity self-efficacy.

The association between repeated abortions during childbearing age and the psychological well-being of postmenopausal women in Southwest China: an observational study

BackgroundThe issue of whether abortion increases the risk of future mental health problems for women remains a debated topic, and there is a lack of evidence from large-scale studies conducted in China. This study aimed to investigate the potential associations between abortions, particularly repeated abortions, and the mental health status of postmenopausal women in Southwest China.MethodsThe data were obtained from the baseline survey of a multi-center natural population cohort study in cooperated with medical consortia in Southwest China. A standard structured questionnaire was used to assess abortion status among women of childbearing age. The 7-item Generalized Anxiety Disorder Scale (GAD-7) and the Patient Health Questionnaire-9 (PHQ-9) were used to evaluate psychological well-being. Subsequently, multiple logistic regression analysis was employed to examine the associations between the quantity and reasons for abortions and the mental health status of postmenopausal women.ResultsA total of 9991 postmenopausal women were enrolled (mean age: 60.51 years), of whom 11.09% (1108 individuals) reported mental health problems (5.54% for depression and 8.27% for anxiety). Multiple logistic regression analysis revealed that, compared with women without any history of abortion, postmenopausal women who reported three or more abortions during their childbearing years were likely to have worse mental health conditions (OR [95% CI]: 1.37 [1.13, 1.67]). Additionally, women who reported a history of abortions for socio-economic reasons were also correlated with an increased risk of mental health issues after menopause (OR [95% CI]: 1.34 [1.08, 1.66]).ConclusionsWomen who reported a history of three or more abortions were at an increased risk of experiencing mental health issues after menopause. Reproductive-age women should enhance their contraceptive awareness to prevent unintended pregnancies and subsequent abortions. Healthcare institutions are recommended to strengthen psychological counseling for women who have undergone abortions.

Virtual Reality Exposure Therapy Protocol for Post-Traumatic Stress Disorder Treatment in Military Veterans: Cross-Cultural Adaptation of Virtual Exposure Therapy in Ukraine

Introduction. The integration of virtual reality technologies into PTSD treatment in Ukraine presents new opportunities for enhancing the mental health of military personnel, veterans, and individuals affected by war-related trauma. During military operations, soldiers often experience intense stress, anxiety, and intrusive memories, which can lead to PTSD. VR therapy uses fully and partially immersive technologies to create a safe virtual environment where patients can explore and process traumatic experiences under the guidance of a qualified specialist. The use of VR technologies for PTSD treatment during the ongoing conflict in Ukraine may become a crucial tool for addressing and healing trauma in both military personnel and civilians. This method provides a structured setting that fosters emotional processing and therapeutic engagement, aiming to alleviate psychological burdens and improve mental health outcomes. Purpose: To conduct a cross-cultural adaptation of the physiologically facilitated Virtual Reality Exposure Therapy (VRET) protocol with gradually increasing exposure, develop a Ukrainian version of the protocol tailored to the specific needs of Ukrainian PTSD patients, create VR technology and content that reflect the unique aspects of the Ukrainian war experience, and pilot test this protocol with a focus group of Ukrainian war veterans diagnosed with PTSD and carrying war-related traumatic memories. Methodology: For the cross-cultural adaptation of the Virtual Reality Exposure Therapy (VRET) protocol, a physiologically facilitated version with gradually increasing exposure was selected. This protocol was translated by two independent translators, followed by synthesis into a single version, back-translation, analysis, and final approval by a working group. The finalized Ukrainian version was prepared for field studies with a focus group of Ukrainian war veterans (n=50). All veterans underwent diagnostic assessments both before and after the VRET intervention, using the following standardized scales: the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) for PTSD evaluation, the Generalized Anxiety Disorder 7-item (GAD-7) scale for anxiety disorders, the Patient Health Questionnaire-9 (PHQ-9) for depression, the Columbia-Suicide Severity Rating Scale (C-SSRS) for suicidal intentions, the Short Form Survey (SF-36) for quality of life, and the Alcohol Use Disorders Identification Test (AUDIT) for alcohol dependence. A series of VR scenarios were developed specifically to address the needs of Ukrainian war PTSD patients, designed to trigger common PTSD responses. A unique administrative panel was also created for therapists to adjust the presence and intensity of various triggers in real time, allowing for personalized tuning of the VR experience throughout the session. Results: Over a 6-month period, 50 Ukrainian war veterans participated in the study to assess the effectiveness of the adapted Ukrainian version of the VRET protocol for PTSD treatment. Comparison of baseline and post-intervention assessments showed significant improvements in clinical outcomes, including reductions in PTSD symptoms, anxiety, depression, and an overall improvement in quality of life. Conclusions: The cross-cultural adaptation and testing of the Virtual Reality Exposure Therapy protocol with a focus group of Ukrainian veterans with PTSD demonstrated reductions in PTSD symptoms, anxiety, and depression, alongside improvements in quality of life. Virtual reality allowed veterans to safely re-experience traumatic events under professional supervision, with gradually increased realism, enhancing the therapy's effectiveness. This method also reduces stigma by offering a confidential setting for therapist interaction, showing substantial promise in helping veterans manage their mental health more effectively

Gender disparities in physical, psychological, and cognitive multimorbidity among elderly hypertensive populations in rural regions

BackgroundThe prevalence of gender disparities in physical, mental, and cognitive disorders among elderly hypertensive individuals in rural areas remains unclear. This study evaluates these disparities and the factors contributing to multimorbidity in this demographic.MethodsA face-to-face survey was conducted from July 1 to August 31, 2023, involving the hypertensive population registered with the National Basic Public Health Service Program in Jia County. Physical disorder was defined as having one or more self-reported chronic conditions other than hypertension. Participants experiencing anxiety or depression were as having a psychological disorder. The 9-item Patient Health Questionnaire (PHQ-9) was used to assess depression symptomatology, and anxiety symptoms were evaluated using the 7-item Generalized Anxiety Disorder questionnaire (GAD-7). Cognitive disorders were assessed using the Brief Mental Status Examination Scale (MMSE). Multifactorial logistic regression models were used to analyze factors affecting different disorder combinations in both genders. The net difference in multimorbidity prevalence between genders was determined using the propensity score matching (PSM).ResultsOut of 18,447 hypertensive individuals aged 65 years and above (42.28% men), the prevalence of multimorbidity was 30.64% in men and 38.67% in women. Outcomes included seven categories: physical disorders, psychological disorders, cognitive disorders, and four different combinations of these disorders. The primary outcome was the presence of two or more disorders. The prevalence of physical, psychological, and cognitive disorders and their four combinations were higher in women than in men; Key factors influencing multimorbidity risk included subjective health status, illness duration, medication history, blood pressure control, and lifestyle behaviors in both men and women. Post-PSM analysis revealed that women had a 6.74% higher multimorbidity prevalence than men.ConclusionsPhysical, psychological, and cognitive disorders, along with their various multimorbid combinations, significantly impact the elderly hypertensive population. Prioritizing a healthy lifestyle is essential to mitigate multimorbidity risks. Considering that the prevalence of multimorbidity is higher in women than in men with hypertension, sufficient sleep, maintaining a healthy waist circumference, and medication adherence are vital for managing blood pressure and reducing multimorbidity risks.

A Multisite, Longitudinal Study Assessing Prevalence of Anxiety in Student Pharmacists

ObjectiveConduct a multisite, survey-based study assessing rates of self-reported anxiety symptoms among student pharmacists enrolled in the first 3 professional years (PY1 to PY3) of a 4-year Doctor of Pharmacy (PharmD) curricula. MethodsThis study followed a cross-sectional observational design conducted at Washington State University, College of Pharmacy and Pharmaceutical Sciences (WSU) and the University of Arkansas for Medical Sciences, College of Pharmacy (UAMS). Student pharmacists in PY1 to PY3 of the PharmD curricula were invited to voluntarily complete the Generalized Anxiety Disorder 7-item (GAD-7) scale in order to self-report measures of anxiety. The GAD-7 is a validated 7-item instrument using a 4-point Likert scale. ResultsA total of 2022 surveys were evaluated from PY1-PY3 students at WSU and UAMS over a 5-year period (2019 to 2023). Overall, 882 (43.6%) completed surveys indicated the presence of moderate to severe anxiety according to the GAD-7. When asked about the difficulty of doing work, taking care of things at home, or getting along with other people, 487 (24.1%) respondents indicated “very” or “extremely” difficult using a 4-point Likert scale. ConclusionBehavioral and mental health support appears to be needed to support students living with symptoms of anxiety that are impacting life activities. Pharmacy educators should consider proactive approaches to improve mental well-being and support skill development related to anxiety management for student pharmacists. Future studies may include measuring change in student pharmacist anxiety over time with targeted interventions and studies to determine impact on reported levels of anxiety.

The Association Between Temporomandibular-Related Quality of Life and Oral Behaviours: A Cross-Sectional Study in Patients With Temporomandibular Disorders.

Oral behaviours (OB) are some oral overuse behaviours which could be observed in patients with temporomandibular disorders (TMD). This study aims to investigate the association between TMD-related quality of life and OB to enhance understanding of these behaviours. A total of 319 participants diagnosed with TMD were included in this research. According to the diagnostic criteria for TMD, patients were divided into three subgroups: pain-related TMD (PT, n = 71), intra-articular TMD (IT, n = 91) and combined TMD (CT, n = 157). Participants completed the oral behaviour checklist (OBC), the oral health impact profile for TMD (OHIP-TMD), the generalised anxiety disorder 7-item (GAD-7) and the patient health questionnaire 9-item (PHQ-9), and demographic characteristics were collected from medical records. TMD patients with high OBC scores (25-84 points) had higher scores in six of the seven OHIP-TMD domains (all p < 0.05). Logistic regression analysis indicated that OHIP-TMD scores (OR = 1.03), younger age (OR = 0.95), education (OR = 2.80-3.10), and PHQ-9 scores (OR = 1.14) were significantly positively correlated with OBC scores (p < 0.05). After adjusting for confounding factors, the psychological discomfort (OR = 1.09) and psychological disability (OR = 1.10) domains of the OHIP-TMD were identified as independent factors associated with higher OBC scores. Patients with more frequent OB exhibited a lower quality of life across nearly all OHIP-TMD domains. Higher OHIP-TMD scores and specific psychological domains were independently associated with a higher frequency of OB. The causal relationship between quality of life and OB in TMD patients requires further investigation.

Gout Flare Burden in the United States: A Multiyear Cross-Sectional Survey Study.

The objective of this study was to assess the burden of gout flares and examine associated patient characteristics and outcomes in a sample of US adults. Data were collected via an online survey of US adults ≥18 years using a random stratified sampling framework. Participants with gout completed questions about treatments, serum urate (SU) levels, severity, satisfaction with control, and gout flares. All participants completed the Veterans RAND 12-Item Health Survey, the Generalized Anxiety Disorder 7-Item Scale, and the Patient Health Questionnaire 9-Item Scale. Data were summarized using descriptive statistics. Multivariable-adjusted logistic regression analyses examined factors predictive of reporting gout flares to a physician. A total of 933 participants met the study criteria for having gout. Those with gout tended to be older (58.3 [SD 13.3] years vs 45.4 [SD 16.1] years; P < 0.001), male (76.3% vs 46.9%; P < 0.001), White (80.5% vs 76.8%; P = 0.01), and married or living with their partner (58.9% vs 52.8%; P < 0.001) compared with those without gout (n = 30,146). The total gout flare burden for those with gout was 6.6 gout flares per year. Nearly 72% of gout flares were either not reported to physicians or pretreated or prevented. Characteristics of those who were less likely to report gout flares included being younger, being less educated, having a lower Charlson Comorbidity Index score, not being diagnosed with gout by their doctor, and not taking a urate-lowering therapy. This study confirmed that gout flares are common in US adults with gout and found that gout flares are underreported. Reliance on clinical documentation of physician-reported gout flares is insufficient to assess the true patient burden of gout.