Generalized Anxiety Disorder Scale Research Articles

Prevalence of Orthosomnia in a General Population Sample: A Cross-Sectional Study

Background/Objectives: Orthosomnia has become a concern in the field of sleep medicine. The purpose of this cross-sectional study was to estimate the prevalence of orthosomnia in the general population. Methods: We collected data from 523 participants via the Generalized Anxiety Disorder Scale, Anxiety and Preoccupation about Sleep Questionnaire, and Athens Insomnia Scale. Additionally, we gathered information about participants’ use of commercial sleep-tracking wearable devices. Results: We developed a four-criteria algorithm to identify cases of orthosomnia: ownership of a wearable sleep-tracking device, AIS score ≥ 6, GAD-7 score ≤ 14, and APSQ score ≥ 40 or APSQ score ≥ 35 or APSQ score ≥ 30, for conservative, moderate, and lenient prevalence estimates, respectively. One hundred seventy-six (35.8%) (95% CI 34.6–40.1%) participants regularly used sleep-tracking devices. The prevalence rates of algorithm-identified orthosomnia in the study sample were: 16 participants (3.0%, 95% CI 1.6–4.5%), 45 participants (8.6%, 95% CI 6.2–11.0%), 73 participants (14.0%, 95% CI 10.9–16.9%) for the for conservative, moderate, and lenient prevalence estimates, respectively. Individuals with orthosomnia were not significantly different in terms of age and sex. The cases consistently had higher AIS scores than non-cases across all APSQ cutoffs, indicating more severe insomnia symptoms, with significant differences observed at each cutoff point. Conclusions: This study offers initial insights into the prevalence of orthosomnia within our sample at a specific time. The findings reveal notable rates of orthosomnia among individuals using sleep-tracking devices; however, we must acknowledge the limitations inherent in a cross-sectional design.

Psychometric Properties of the Generalized Anxiety Disorder Scale (GAD-7) in Older Adults With Advanced Cancer.

Over half of new cancer diagnoses occur in patients aged 65 or older, with up to 40% experiencing anxiety. The American Society of Clinical Oncology recommends using the Generalized Anxiety Disorder Scale (GAD-7) for anxiety screening, but the GAD-7 psychometric properties in this population are unknown. This study examined the GAD-7's reliability, validity, and item parameters, comparing its utility with the GAD-2 in older adults with cancer. This cross-sectional secondary analysis of a nationwide multi-site two-arm cluster randomized trial in older adults (≥70)with advanced cancer. The GAD-7 was administered at baseline. Properties were evaluated with Cronbach's α, Pearson correlation coefficients, and a 2-parameter logistic model. Logistic regression models compared the GAD-2 and GAD-7. The sample included 718 participants (Mean age=77, SD=5) with mild anxiety (M=3.74, SD=4.74). Internal consistency was strong (Cronbach's alpha=0.89) and item-total correlations ranged 0.53 to 0.78. Item 2 (Not being able to stop or control worrying) was the most discriminating and item 5 (Being so restless that it is hard to sit still) was least discriminating. Area Under the Curve (AUC) analyses demonstrated the GAD-2 had a 0.93-0.96 AUC. Establishing the psychometric properties of anxiety screening measures is crucial in the older adults with cancer to maximize referral efficiency and accuracy. This study indicates that the GAD-7 is reliable and valid for older adults with cancer. Analyses suggest the GAD-2 may be as sufficient as the GAD-7 in identifying anxiety in older adults with cancer, thereby reducing assessment burden.

Frailty, cognition and patient-reported outcomes in middle-aged and older adults with congenital heart disease: insights from an international multicentric study

Abstract Background Prior research has demonstrated that a significant proportion of older patients with congenital heart disease (CHD) are frail or pre-frail and experience cognitive impairment. However, it remains unclear whether frailty and cognition are related to patient-reported outcomes (PROs) such as perceived health, anxiety and depression symptoms or quality of life in CHD. Purpose The objective of this study was to explore the relationships between frailty, cognitive function, and PROs in middle-aged and older adults with CHD ranging from mild to severe complexity. Methods As part of the cross-sectional ‘Assessment of Patterns of Patient-Reported Outcomes in Adults with Congenital Heart disease – International Study II’ (APPROACH-IS II), we enrolled 814 individuals aged 40 years and older (median age: 52.0 years [45.0-61.0]; 51.4% female; 12.7% mild, 70.1% moderate, 17.2% complex CHD; 41.9% pre-frail, 5.8% frail; 38.7% cognitively impaired) across 17 centers in 11 countries. Frailty status was assessed using the Fried criteria, which categorize individuals into robust, pre-frail, and frail based on five factors: weakness, slow gait, unintentional weight loss, exhaustion, and low physical activity levels. Cognitive function was determined using the Montréal Cognitive Assessment. Participants completed questionnaires to evaluate perceived health (RAND-12 Health Survey, yielding both Physical and Mental Component Summaries, and EuroQOL-5D Visual Analog Scale), depressive symptoms (Patient Health Questionnaire-8), anxiety symptoms (General Anxiety Disorder scale-7), and quality of life (QoL Linear Analog Scale). Results Frailty was significantly associated with all PROs, with frail and pre-frail individuals reporting less favorable outcomes (see Figure). Cognitive function was linked to perceived health and anxiety, with patients exhibiting cognitive impairments reporting poorer perceived health and more anxiety symptoms. Conclusion This study indicates that concepts of frailty, cognitive functioning and PROs are closely related in adults with CHD. Frailty and cognition thus represent important domains when developing strategies to optimize PROs in adults with CHD. Moreover, when working with patients who are frail or cognitively impaired, healthcare workers are encouraged to consider and inquire about potential impact on PROs. Longitudinal research is needed to explore the direction of the association.

Mental health of Finnish cis- and transgender youth before, during and after the COVID-19 pandemic

Abstract Background Transgender youth report more mental health problems than their cisgender peers, but little is known about their mental health during and after the COVID-19 pandemic. We studied symptoms of anxiety and depression among cis- and transgender youth before, during, and after the pandemic using large nationwide samples. Methods Data from the Finnish School Health Promotion survey from years 2019, 2021 and 2023 (461,249 students in total; mean age 15.7, SD 1.3) were used. Self-reports covered official gender, gender identity, symptoms of anxiety (Generalized Anxiety Disorder Scale-7 ≥10) and depression (Patient Health Questionnaire-2 ≥3). Categories of cisgender boy (officially boy; gender identity boy; N = 214,423), transfeminine youth (officially boy; gender identity girl, both, neither, or it varies; N = 5,069), cisgender girl (officially girl; gender identity girl; N = 224,753), and transmasculine youth (officially girl; gender identity boy, both, neither, or it varies; N = 14,508) were formed. Results In all timepoints, proportion of those with anxiety or depression was higher among transfeminine youth compared with cisgender boys and among transmasculine youth compared with cisgender girls. In all groups anxiety and depression increased significantly from 2019 to 2021 (ORs 1.4-1.8, p < 0.0001), with no significant differences in these changes between cis- and transgender groups. From 2021 to 2023, anxiety (OR 0.91, p = 0.015) and depression (OR 0.77, p < 0.0001) decreased among transmasculine youth but increased among cisgender girls (ORs 1.11 [p < 0.0001] and 1.07 [p < 0.0001], interactions p < 0.0001). Among transfeminine youth, generalized anxiety symptoms decreased from 2021 to 2023, whereas they remained at the level observed in 2021 among cisgender boys (interaction p = 0.0025). Conclusions In Spring 2023, we found still increasing mental health problems among cisgender girls, while among transgender youth the post-pandemic developments were more positive. Key messages • Post-pandemic, we found further increases in mental health symptoms in cisgender youth, while among transgender youth the development seemed more promising. • Transgender youth experience more anxiety and depression than their cisgender peers, thus gender diversity deserves still more attention in educational, social, and health care services.

Family function, psychological distress and burden in informal caregivers of people with dementia

Abstract Background Dementia presents a public health priority due to its high global prevalence, mortality, economic cost, and caregiver burden (CB). Dementia care can be stressful and may negatively influence the health of informal caregivers. This cross-sectional study aimed to identify psychological and social factors associated with subjective CB in informal home care providers of people with dementia (PwD), controlling for sociodemographic, clinical, and care-related variables. Methods We included 115 informal caregivers of PwD from community settings (mean age: 54.0±12.4 years; 81.7% women). Participants fulfilled the Zarit Burden Interview (ZBI-12), the Patient Health Questionnaire (PHQ-9), the Generalized Anxiety Disorder Scale (GAD-7), the Family APGAR, and the short IQCODE used to assess dementia severity. Multiple linear analyses were used to analyse the data. Results The mean caregiving duration was 4.8±4.8 years, and 55.7% of informal caregivers extend care for >40 hours/week. We found that a total of 52.5 % of informal caregivers experienced a high CB (ZBI-12 cut-off score: 17). Univariate analyses showed an association between depression (β = 0.36; p < 0.001), anxiety (β = 0.52; p < 0.001), family dysfunction (β = 0.36; p < 0.001), and CB. Regression analyses showed that CB was the most strongly associated with anxiety (β = 0.51; p < 0.001). This association weakened (0.47; p < 0.01) when family function was added to the final model (β=-0.22; p < 0.05). The final model explained 23.5% of the variance in CB. No associations between the caregiver's age, sex, caregiving duration, the extent of care per day, use of community care, dementia severity, and depression were identified. Conclusions Long-term care for people living with dementia can be very demanding. Thus, the implementation of tailored interventions to enhance family function and diminish psychological distress can mitigate level of caregiver burden. [Grant support: APVV-22-0587]. Key messages • Dementia caregiving is a global public health priority. • The caregiver’s burden and distress can be alleviated by the interventions focusing on family dysfunction.

Trends in the association between alcohol use and generalized anxiety in Finnish adolescents

Abstract Background During the past two decades, alcohol use has decreased among adolescents, but on the contrary, anxiety symptoms have increased (at least among females). These diverging trends set interesting opportunities to examine whether the strength of the well-known correlation/co-occurrence between alcohol use and anxiety has also changed. This study aims to examine changes in the co-occurrence and associations between heavy episodic drinking (HED) and generalized anxiety among adolescents in Finland from 2013 to 2023. Methods Data from the Finnish School Health Promotion Study between 2013-2023 covered 874 110 participants aged 13-20. Generalized anxiety was measured using Generalized Anxiety Disorder Scale (GAD-7) (range 0-21), and heavy episodic drinking was measured as reported heavy drunkenness once a month or more often versus less than once a month. Yearly prevalence estimates of co-occurrence were analyzed for those with moderate to severe anxiety symptoms (>10) and monthly or more frequent HED. Associations between anxiety and HED were analyzed using logistic regression and time-varying effect modelling. Interactions between time and anxiety predicting HED were also considered. Results The moderate to severe anxiety symptoms increased from 10.7% to 20.9% and HED decreased from 18.0% to 11.8% between 2013 and 2023. The proportion of those with both HED and moderate to severe anxiety increased from 2.9% in 2013 to 3.6% in 2023. The association between anxiety symptoms and HED was stable during the study period, with odds ratios ranging between 1.06 and 1.07. Conclusions During the past decade, diverging trends in generalized anxiety symptoms and heavy episodic drinking have not changed the association between them. The proportion of adolescents with these co-occurring health concerns has increased in females. This calls for continuous efforts to strengthen the integration of mental health and substance use prevention and services. Key messages • The association between generalized anxiety and heavy episodic drinking has not changed in adolescents in Finland between 2013 and 2023. • The proportion of those with both moderate to severe anxiety symptoms and heavy episodic drinking has increased in females and remained stable in males during the past decade (2.9% - 3.6%).

Investigating the Mental Health Outcomes and Treatment Gap Among Sexual Minorities in Czechia: A National Cross-Sectional Study

Abstract Aims This study aims to (1) estimate the prevalence and relative risk of mental disorders, (2) assess the severity of mental health symptoms, and (3) investigate the treatment gap for mental disorders within SM. Methods Data from a cross-sectional, nationally representative survey of 3,063 Czech adults (response rate = 58.6%) were utilized. The Mini-International Neuropsychiatric Interview was employed to screen for mental disorders. In those identified with mental disorders, help-seeking behaviors over the past 12 months were examined. The severity of mental health symptoms was evaluated using the 9-item Patient Health Questionnaire and the 7-item Generalized Anxiety Disorder scale. Prevalence rates of mental disorders associated treatment gaps, and relative risks of mental disorders were calculated. Results The prevalence of mental disorders among heterosexual, gay or lesbian, bisexual, and more sexually diverse individuals was 18.9% (17.4-20.3), 52.3% (36.9-67.6), 33.3% (19.5-47.2), and 25.9% (13.9-38), respectively. Suicidal thoughts and behaviors were reported in 5.7% (4.9-6.6) of heterosexual individuals compared with 25.0% (11.7-38.3) in gay or lesbian, 22.9% (10.6-35.3) in bisexual, and 11.1% (2.5-19.8) in more sexually diverse individuals. After adjusting for confounders, gay or lesbian individuals demonstrated an increased risk of having at least one current mental disorder compared with heterosexual people (OR = 3.5 95% CI(1.8-6.8)). Bisexual and more sexually diverse individuals demonstrated risks consistent with a null effect. No substantial differences in treatment gap were detected between heterosexuals and SM who scored positively for at least one current mental disorder. Conclusions The findings underscore the urgent need for systemic changes to improve the mental health outcomes of Czech SM. Addressing structural stigma and ensuring sensitive care are imperative to mitigate the health disparities faced by Czech SM.

Intervention Study on the Impact of Internet-Based Mindfulness Meditation on Depression and Anxiety among University Students

This study explores the effectiveness of internet-based mindfulness meditation interventions in mitigating depression and anxiety symptoms among college students. A total of 72 participants were randomly assigned to one of three groups: offline mindfulness intervention, online mindfulness intervention, and a control group. The intervention lasted for eight weeks, during which participants' mental health was assessed using the Patient Health Questionnaire (PHQ-9) and the Generalized Anxiety Disorder Scale (GAD-7). Findings revealed that both interventions significantly reduced depression and anxiety levels, with the offline group exhibiting the most pronounced improvement. The online intervention, while slightly less effective, demonstrated considerable potential, particularly in terms of accessibility and scalability. The study highlights the need for future research to refine online intervention techniques by incorporating greater opportunities for interaction, thereby enhancing participant engagement and intervention efficacy. These findings provide empirical support for the broader application of internet-based mindfulness practices in promoting mental well-being among university populations.

Using Technology to Support Measurement-Based Care: Design and Implementation of the Measurement-Assisted Care Program.

The authors aimed to increase measurement-based care in an outpatient academic psychiatry service. The Measurement-Assisted Care program (MAC) was implemented as a clinical quality-improvement effort that included 4,665 unique patients and 176 clinicians over 12 months. The Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder scale (GAD-7), PTSD Checklist for DSM-5, and Brief Inventory of Thriving were automatically included in the patient electronic check-in process for new visits; the PHQ-9 and GAD-7 were included for return visits. Patient responses were automatically routed to clinicians' electronic health record inboxes and documentation templates. MAC was rolled out in two phases, and clinicians were surveyed about their use of MAC data 3-6 months after the start of the program. After implementation of MAC, PHQ-9 completion rates increased from 5% to 66% of visits for phase 1 and from 5% to 60% for phase 2. Post-MAC completion rates were higher for telehealth (70%) than for in-person (40%) visits. More than 90% of clinicians reported that MAC was useful with at least one of their three most recent patients, and 51% reported that it was useful with all three of their three most recent patients. Clinician adoption was high, with 78% reporting that they use MAC data to guide care. MAC increased the completion rate of patient-reported outcome measures, especially for telehealth visits. Clinicians reported that they frequently use and discuss MAC data with patients, implying that technology-supported workflows can help systems with high telehealth utilization capture and use patient-reported outcomes.

Prevalence and associated factors of suicide-related behaviors in Iranian students: a large sample cross-sectional study

BackgroundAdmission to the university changes life conditions and thereby increases mental pressure. If the students cannot bear the psychological pressure of being a student, that may lead to suicide among the vulnerable persons. Therefore, in this research, we would like to investigate the prevalence and associated factors of suicide-related behaviors in Iranian students.MethodsThis online, cross-sectional survey was performed from March 18 to April 15, 2023, in Iran. The questionnaires were completed by 2181 students. In this study, Perceived Stress Scale (PSS-4), Meaning in Life Questionnaire (MLQ), Generalized Anxiety Disorder Scale (GAD-7), and Suicidal Behaviors Questionnaire-Revised (SBQ-R), and Oslo Social Support Scale (OSSS-3) were used. Finally, we identified the factors associated with suicide-related behaviors using univariate and multiple regression.ResultsThe prevalence of suicidal behaviors in students was 57.95%. According to the results, male gender, marriage, having meaning in life, occasional smoking, sleeping after 1 a.m., and having social support were associated with a reduced risk of suicide. In addition, a history of sexual abuse, more anxiety, and higher perceived stress were associated with an increased risk of suicide.ConclusionsThe prevalence of suicide-related behaviors in Iranian students was higher than expected. Urgent interventions should be considered to prevent students from committing suicide. Helping students find meaning in life, as well as eliminating the causes of students’ anxiety and stress, may be effective in this respect. Additionally, teaching students how to control anxiety and stress may be helpful.

Validation of a brief image elicitation task as an indicator of subjective wellbeing in the general population.

A novel image-based method (AgileBrain) demonstrates construct validity as a measure of wellbeing in the general working adult population. Analysis of data from four large nationally representative samples of American full-time workers employed by mid-to-large size companies conducted in November 2021 (n = 812), May 2022 (n = 810), June 2023 (n = 986), and January 2024 (n = 1,179). Across all four studies, AgileBrain demonstrates convergent validity across multiple established indicators of subjective wellbeing including the Patient Health Questionnaire (PHQ-9), Center for Epidemiological Studies Depression Scale (CESD-10), Generalized Anxiety Disorder Scale (GAD-7), Neuroticism (BFI-S), UCLA Loneliness Scale, Perceived Stress Scale (PSS-10), Coping Styles (Brief COPE-28), self-reported diagnosed neurodiversity conditions and symptoms, and trauma history. Results across these studies suggest that AgileBrain is useful as a screening tool for detecting compromised wellbeing in terms of construct validity. Given strong preferences for brief, gamified assessments, the validity advantages stemming from less consciously controllable responses, and the statistical advantages of measures associated with high response rates and normal distributions, AgileBrain emerges as strong tool for assessing subjective wellbeing at the population level and offers a promising approach to monitoring treatment effectiveness.

Exploding Head Syndrome among Patients Seeking Help for Tinnitus and/or Hyperacusis at an Audiology Department in the UK: A Preliminary Study.

Exploding head syndrome (EHS) is characterized by hearing a sudden loud noise or experiencing a sense of explosion in head during the transition of sleep-wake or wake-sleep. The experience of EHS shares similarities with tinnitus, where an individual perceives a sound without any external sound source. To the authors' knowledge, the possible relationship between EHS and tinnitus has not been explored. Preliminary assessment of prevalence of EHS and its related factors among patients seeking help for tinnitus and/or hyperacusis. Retrospective cross-sectional study. A total of 148 consecutive patients who sought help for tinnitus and/or hyperacusis at an audiology clinic in the United Kingdom. The data regarding demographics, medical history, audiological measures, and self-report questionnaires were collected retrospectively from the patients' records. Audiological measures comprised of pure-tone audiometry and uncomfortable loudness levels. The self-report questionnaires which were administered as a part of standard care comprised of the Tinnitus Handicap Inventory, numeric rating scale of tinnitus loudness, annoyance, and effect on life, hyperacusis questionnaire, Insomnia Severity Index, Generalized Anxiety Disorder scale 7, and Patient Health Questionnaire (PHQ-9). To establish presence of EHS, participants were asked "Do you ever hear a sudden, loud noise, or feel a sense of explosion in your head at night?" EHS was reported by 8.1% of patients with tinnitus and/or hyperacusis (12 out of 148). The patients with and without EHS were compared, but no significant relationships were found, between the presence of EHS and age, gender, tinnitus/hyperacusis distress, symptoms of anxiety or depression, sleep difficulties, or audiological measures. The prevalence of EHS in a tinnitus and hyperacusis population is similar to that in the general population. While there does not seem to be any association with sleep or mental factors, this might be due to the limited variability in our clinical sample (i.e., most patients exhibited high level of distress regardless of EHS). Replication of the results in a larger sample with more variety of symptom severity is warranted.

Correlation Between Anxiety, Depression and Hemodynamic Changes in Office-Based Laryngeal Surgery.

To investigate the correlation between anxiety, depression, and hemodynamic changes during office-based laryngeal surgery (OBLS). All patients undergoing OBLS between February 2024 until July 2024 were invited to participate in the study. Participants had their vital signs recorded throughout the procedure at a 5-min interval. They also had to fill the Generalized Anxiety Disorder scale-7 (GAD-7) to assess anxiety severity and the Patient Health Questionnaire-9 (PHQ-9) to assess depression severity. Demographic data included age, gender, history of smoking, history of reflux disease, history of cardiovascular diseases, type and duration of procedure. A total of 45 patients were recruited in the study. During OBLS, 35.5% of patients developed hypertension and 28.9% developed tachycardia. There was a significant increase in mean systolic blood pressure (SBP) by 30.16 mmHg (p < 0.001), in mean diastolic blood pressure (DBP) by 31.44 mmHg (p < 0.001), and in mean heart rate (HR) by 14.2 beats per minute (p < 0.001). There was also a significant decrease in the mean O2 saturation by 0.4% (p = 0.001). There was no correlation between anxiety and SBP, DBP, HR, and O2 (r < 0.1). There was also no correlation between depression levels and SBP, DBP, HR, O2 (r < 0.1). There was a significant increase in the mean SBP, DP, and HR and a significant decrease in the O2 saturation in patients undergoing OBLS. However, there was no correlation between anxiety, depression and the changes in these vital signs. Future investigations are needed to understand the causes of hemodynamic instability in OBLS. 2 Laryngoscope, 2024.

Psychological Impact of Covid-19 Pandemic on Health Care Workers of a Field Hospital in UN Peacekeeping Mission

Background: The Covid-19 pandemic has significantly affected the healthcare system worldwide as well as the psychological state of all. The objective of the current study was to assess the psychological conditions of the healthcare workers in Enhanced Level 1+ Hospital, Bouar, Central African Republic (CAR). This assessment can help in the guideline development and implication psychological interventions which in turn can improve the quality of life, working environment and decision-making capabilities of health care workers during widespread pandemic. Methods: This descriptive cross-sectional study was conducted on 40 medical personnel working in Enhanced Level 1+ Hospital, Bouar, Central African Republic. The study was performed from June 2022 to August 2022. Assessment of psychological status of military healthcare providers was done by analyzing the results derived from the Mental health survey, Perceived Stress Scale (PSS-10), Generalized Anxiety Disorder scale (GAD-7) and Patient Health Questionnaire (PHQ-9). Hospital records were analyzed to assess the changes in workload. Results: The working hour increased significantly from Pre Covid to Post Covid period (1920±34.1 hours/week to 2120±67.3 hours/week) although the number of weekly patients in OPD and Emergency decreased slightly from 51.9 to 40.6. Elevated mental stress was observed during outbreak (average PSS-10 score in June 22 was 20.4 which reduced to 9.7 in August). The same pattern was observed in case of GAD-7 score (15.6 to 10.8) and PHQ-9 score (12.4 to 6.1). The percentage of concerns regarding Covid19 was high during the outbreak, 37/40 (92.5%), which decreased after wards to 18/40 (45%). Conclusion: The UN field hospitals are inadequate to support mass outbreak like COVID 19 in the context of both staff and medical supplies. During Covid 19 outbreak, sharp rise of workload and difficulties in restocking of essential medical items played a vital role in the mental state of the medical professionals. The field hospitals in UN peacekeeping missions require intensive effort especially on disaster and epidemic management during pre-deployment training. Moreover, reconsidering distribution of human resources in field hospitals is also required. Bangladesh Armed Forces Med J Vol 57 No (1) June 2024, pp 35-42

Were there any missing mediators between visual impairment and anxiety symptoms? Results from Chinese Longitudinal Healthy Longevity Survey.

Visual impairment, encompassing low visual acuity and visual field loss, significantly impacts the older adult population worldwide, leading to increased disability and mortality risks. Recent studies suggest a strong association between visual impairment and anxiety, particularly among older adults. This study aims to explore the relationship between visual impairment and anxiety symptoms in older adult individuals in China, and to investigate potential mediating factors. Data for this study were derived from the 2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS), including 11,702 participants aged 65 and older. Visual impairment was assessed through self-reported visual function, while anxiety symptoms were measured using the 7-item Generalized Anxiety Disorder scale (GAD-7). Additional assessments included sleep quality and duration, exercise status, and dietary diversity. Logistic regression models and mediation analysis were employed to explore associations and mediating effects. The findings indicate that visual impairment is significantly associated with increased anxiety symptoms among the older adult (OR = 1.51, 95% CI: 1.32-1.72, p < 0.001). Mediation analysis revealed that sleep quality, dietary diversity score (DDS), and plant-based DDS significantly mediated the relationship between visual impairment and anxiety. In contrast, sleep duration, exercise, and animal-based DDS did not show significant mediating effects. Visual impairment is a crucial predictor of anxiety symptoms in the older adult. Improving sleep quality and promoting a diverse plant-based diet may mitigate anxiety symptoms in this population. Interventions targeting these areas could enhance the mental health and quality of life of older adult individuals with visual impairment.

Anxiety, depression, and post-traumatic stress disorder in nurses exposed to horizontal violence: a network analysis

BackgroundHorizontal violence can cause serious mental health problems for nurses, particularly anxiety, depression, and post-traumatic stress disorder. However, the intrinsic linkage mechanism between mental symptoms of anxiety, depression, and post-traumatic stress disorder in nurses exposed to horizontal violence is unclear. This study aims to elucidate the characteristics of anxiety, depression, and post-traumatic stress disorder networks among nurses with horizontal violence exposure.MethodsData for this cross-sectional study were obtained from the baseline portion of a short longitudinal survey conducted at four tertiary hospitals in Shandong Province, China. A total of 510 nurses with horizontal violence exposure completed the General Information Scale, the Negative Acts Questionnaire, the Seven-item Generalized Anxiety Disorder Scale, the Nine-item Patient Health Questionnaire, and the Four-item SPAN. The network model was constructed using network analysis. The expected influence and the bridge expected influence of nodes were calculated. The stability and accuracy of the network were estimated.ResultsThe results show that A4 (Trouble relaxing) and P1 (Startle) had the highest expected influence in the network. D9 (Suicidality ideation) and A5 (Restlessness) were the key bridge symptoms.Conclusions“Trouble relaxing”, “Startle”, “Suicidality ideation”, and “Restlessness” are all mental symptoms that need to be urgently improved the most in nurses exposed to horizontal violence. Nursing administrators and policymakers should implement mental health intervention programs for these symptoms as early as possible to maximize nurses’ mental health.

Validation of the Patient Activation Measure (PAM-13) among individuals with chronic spinal cord injury in mainland China

Context/objective: The 13-item Patient Activation Measure (PAM-13) is the most widely used generic patient activation measure, but spinal cord injury (SCI) related psychometric evaluation of PAM-13 has not been explored globally. This study aimed to assess the validity of the Chinese version of the PAM-13 (PAM-13-C) for individuals with chronic spinal cord injury (CSCI). Design: Cross-sectional study. Setting: Shanghai Sunshine Rehabilitation Center, and some participants were recruited in a WeChat group (the most commonly used social media platform in China). Participants: 284 individuals with spinal cord injury who had lived with the injury for ≥0.5 year. Interventions: NA. Outcome measures: The PAM-13-C, global QoL, seven-item generalized anxiety disorder scale (GAD-7) and nine-item patient health questionnaire (PHQ-9), and General Self-Efficacy Scale (GSES) were used. Results: The mean (SD) PAM-13-C score was 57.4 (16.5). The highest percentage of NA could be observed in item 9 (12.0%). Floor and ceiling effects of the total scores of PAM-13-C were small (0.7% and 6.7%), but a ceiling effect could be observed among all items. Exploratory Factor Analysis supported a one-factor model of the PAM-13-C (CFI = 0.97; RMSEA = 0.07). Construct validity was established through correlation analysis among the PAM-13-C, GAD-7/PHQ-9, global QoL, and GSES. The PAM-13-C demonstrated excellent internal consistency (Cronbach’s α = 0.95) and acceptable test-retest reliability. Conclusion: The PAM-13-C is a reliable and valid measure of patient activation for individuals with CSCI in China.

The association between physical activity and anxiety in college students: parallel mediation of life satisfaction and self-efficacy.

To explore the functions that physical activity (PA), life satisfaction, and self-efficacy have in the process of coping with anxiety among Chinese college students, and to explore the mediating role of life satisfaction and self-efficacy in this process. Participants were 358 college students (186 males, 172 females, mean age 20.88, SD = ±1.80). Psychosocial tests including the Physical Activity Rating Scale (PARS-3), College Student Life Satisfaction Scale (CSLSS), General Self-Efficacy Scale (GSES), and Generalized Anxiety Disorder Scale (GAD-7) were completed. Correlations between variables were calculated using Pearson's test. The mediation model was tested using the SPSS 26.0 PROCESS macro and regression bootstrap. Physical activity showed a negative correlation with anxiety (β = -0.1617, p < 0.001., life satisfaction and self-efficacy played a role in the relationship between physical activity and anxiety. More importantly, physical activity was associated with anxiety through parallel mediating effects of life satisfaction and self-efficacy, with a total mediating effect of 55.34%. By increasing college students' participation in physical activity, it helps to promote the growth of their life satisfaction and self-efficacy, which is the key to reducing anxiety and promoting college students' mental health.

Methodology for the generation of normative data for the U.S. adult Spanish-speaking population: A Bayesian approach.

Hispanics are the largest growing ethnic minority group in the U.S. Despite significant progress in providing norms for this population, updated normative data are essential. To present the methodology for a study generating normative neuropsychological test data for Spanish-speaking adults living in the U.S. using Bayesian inference as a novel approach. The sample consisted of 253 healthy adults from eight U.S. regions, with individuals originating from a diverse array of Latin American countries. To participate, individuals must have met the following criteria: were between 18 and 80 years of age, had lived in the U.S. for at least 1 year, self-identified Spanish as their dominant language, had at least one year of formal education, were able to read and write in Spanish at the time of evaluation, scored≥23 on the Mini-Mental State Examination, <10 on the Patient Health Questionnaire- 9, and <10 on the Generalized Anxiety Disorder scale. Participants completed 12 neuropsychological tests. Reliability statistics and norms were calculated for all tests. This is the first normative study for Spanish-speaking adults in the U.S. that uses Bayesian linear or generalized linear regression models for generating norms in neuropsychology, implementing sociocultural measures as possible covariates.

Impact of healthy lifestyles on mental health indicators in adolescents after the COVID-19 pandemic

ObjectiveHealthy lifestyles are extremely important since they are one of the main protective factors in adolescence, especially after the COVID-19 pandemic. However, no explanatory models have been found that study the impact of healthy lifestyles on levels of anxiety, depression, and psychological well-being. The study's objective was to test a model that allows determining the impact of healthy lifestyles on mental health indicators in adolescents in a post-COVID-19 pandemic period. MethodNon-probabilistic sampling was used to collect the participants. The sample included 1515 Peruvian adolescents of both sexes (53.4% men and 46.6% women) from 12 to 18 years of age (M = 14.5; SD = 1.5). The WMS Healthy Lifestyle Scale, the Generalized Anxiety Disorder Scale, the Patient Health Questionnaire, and the General Well-being Index were used to measure the variables. ResultsThe study results show that the proposed explanatory model presents adequate fit indices (χ2 = 4280.30; df = 1113; P < 0.001; RMSEA = 0.043 [IC90% 0.042 – 0.045]; CFI = 0.94; TLI = 0.94; SRMR = 0.064). Specifically, it was found that the practice of healthy lifestyles negatively predicts the level of anxiety (-0.37; P < 0.001) and depression (-0.47; P < 0.001). On the other hand, it positively predicts the level of psychological well-being (0.74; P < 0.001) experienced by adolescents. The study also found that an important group of adolescents present anxiety symptoms (38.6%) and depression (38.3%). ConclusionHealthy lifestyles are important for the mental health of adolescents since they manage to predict the level of anxiety, depression, and, above all, the level of psychological well-being of adolescents after the COVID-19 pandemic.