Generalized Anxiety Disorder Questionnaire Research Articles

Lesson from the Covid-19 pandemic: do fear and anxiety lower vaccination hesitancy?

Abstract Background The prevalence of vaccination hesitancy has become one of the top ten global health problems. During the Covid-19 pandemic several studies reported negative correlation of vaccination hesitancy with fear of Covid-19 and anxiety. Therefore, the study aimed to explore how fear and anxiety can impact one’s intent to get vaccinated. Methods In 2021, data from 5999 post-secondary Slovenian students was gathered using a cross-sectional online survey. Binary logistic regression and the Sprearman correlation coefficient was used to explore the relation between Fear of Covid-19 Scale (FCOV), Generalized Anxiety Disorder Questionnaire (ANX) and a question regarding participants’ intentions to get vaccinated. Results Results showed that only 39.7% of students expressed intention to get vaccinated as soon as possible and 29.2% exhibited no intentions to do so. Logistic regression indicated that only FCOV had a mild and significant (p < 0.001) impact on students’ intentions to get vaccinated, whereas ANX was found to have only a weak significant (p < 0.01) effect on students’ intentions to do so. Similarly, ANOVA test showed significant differences with small to medium effect of FCOV on intentions to get vaccinated, but no significant differences were found for ANX. Conclusions A low percentage of Slovenian tertiary students expressed intentions to get vaccinated as soon as possible for Covid-19, with only fear having been found to have a small to mild effect on students’ intentions to do so. Anxiety, on the other hand, was found to have a small positively predictive effect on vaccination hesitancy, which could reflect affective forecasting error (i.e. believing that the negative consequences of getting vaccinated would be greater than they really are). Therefore, when considering strategies to address the increasing problem of vaccination hesitancy, one must keep in mind that the loss-framed messages might not be sufficient to prompt people to get vaccinated. Key messages • Fear of Covid-19 had only a small to medium significant positive effect on students’ expressed intentions to get vaccinated as soon as possible. • The loss-framed messages might not be sufficient to prompt people to get vaccinated.

Stress, anxiety, and burnout among educators during the COVID-19 pandemic

The occurrence of the COVID-19 pandemic in 2019 changed every individual’s way of living. The worldwide shift of educators toward online teaching brought to light various difficulties and challenges faced by educators. The present study was conducted to assess the stress, anxiety, and burnout among educators based in the Delhi-NCR region of India during the COVID-19 pandemic. A total of 77 educators participated in the web-based survey where they were assessed using the Perceived Stress Scale, Generalized Anxiety Disorder Questionnaire, and Maslach’s Burnout Inventory. The results revealed that stress experienced by them increased their anxiety. Anxiety increased the emotional exhaustion as well as depersonalization components of burnout whereas stress decreased the personal accomplishment component of burnout. Furthermore, the results indicated that female educators were more stressed compared to their male counterparts during this period. The findings showed how the mental health of educators was affected during the sudden shift to online teaching during the pandemic.

Treatment as a moderator and executive function as a mediator of the effect of a mindfulness ecological momentary intervention for generalized anxiety disorder.

Theory and research indicated that executive functioning (EF) correlated with, preceded, and stemmed from worry in generalized anxiety disorder (GAD). The present secondary analysis (Zainal & Newman, 2023b) thus determined whether EF domains mediated the effect of a 14-day (5 prompts/day) mindfulness ecological momentary intervention (MEMI) against a self-monitoring control (SM) for GAD. Participants (N = 110) diagnosed with GAD completed self-reported (Attentional Control Scale, GAD Questionnaire, Perseverative Cognitions Questionnaire) and performance-based tests (Letter-Number Sequencing, Stroop, Trail Making Test-B, Verbal Fluency) at baseline, post-treatment, and one-month follow-up (1MFU). Causal mediation analyses determined if pre-post changes in EF domains preceded and mediated the effect of MEMI against SM on pre-1MFU changes in GAD severity and trait repetitive negative thinking (RNT). MEMI was more efficacious than SM in improving pre-post inhibition (β = -2.075, 95% [-3.388, -0.762], p = .002), working memory (β = 0.512, 95% [0.012, 1.011], p = .045), and set-shifting (β = -2.916, 95% [-5.142, -0.691], p = .010) but not verbal fluency and attentional control. Within groups, MEMI but not SM produced improvements in all examined pre-post EF outcomes except attentional control. Only pre-post improvements in inhibition mediated the effect of MEMI against SM on pre-1MFU reductions in GAD severity (β = -0.605, 95% [-1.357, -0.044], p = .030; proportion mediated = 7.1%) and trait RNT (β = -0.024, 95% [-0.054, -0.001], p = .040; proportion mediated = 7.4%). These patterns remained after conducting sensitivity analyses with non-linear mediator-outcome relations. Optimizing MEMI for GAD might entail specifically boosting inhibition plausibly by augmenting it with dialectical behavioral therapy, encouraging high-intensity physical exercises, and targeting negative emotional contrast avoidance.

Comparison of Cannabis-Based Medicinal Product Formulations for Fibromyalgia: A Cohort Study

This cohort study aims to assess the outcomes of fibromyalgia patients enrolled in the UK Medical Cannabis Registry prescribed a homogenous selection of cannabis-based medicinal products (CBMPs). A cohort study of fibromyalgia patients treated with oils (Adven®, Curaleaf International, UK), dried flower (Adven®, Curaleaf International, UK) or both CBMPs was performed. Primary outcomes were changes from baseline at 1, 3, 6 and 12 months in validated patient-reported outcome measures. Secondary outcomes included descriptive analysis of adverse events. One hundred and forty-eight participants were treated with oils (n = 77; 52.03%), dried flower (n = 14; 9.46%) or both (n = 57; 38.51%). Improvements in the generalized anxiety disorder-7 questionnaire, single-item sleep quality scale, fibromyalgia symptom severity score and EQ-5D-5L Index values were observed at each follow up period compared to baseline (p < 0.050). Thirty-six (24.32%) patients experienced 648 adverse events. Improvements were observed across all primary outcomes with no differences observed across different formulations of CBMPs. Adverse events were reported by one-quarter of participants and were more likely to reported by cannabis naïve patients. This present work through focusing on a homogeneous group of CBMPs can help inform randomized controlled trials after observing signals of improvement associated with a specific cultivar of CBMPs.

Psychometric properties of the generalized anxiety disorder questionnaire (GAD-7) in a polish postpartum women sample

ObjectiveGeneralized Anxiety Disorder is an international mental health problem. Prevalence for anxiety disorders reported in perinatal period is high and related with adverse parental and child outcomes. Thus, the objective of this study was to investigate the psychometric properties and factorial validity of General Anxiety Disorder-7 questionnaire (GAD-7) in the context of postpartum mothers.MethodsIn this cross-sectional study, 278 mothers (mean age 31.09; SD = 4.42) were recruited at the Neonatology, Gynecology, and Obstetrics Ward. Generalized Anxiety Disorder was assessed with GAD-7, stress with Parental Stress Scale (PSS), while risk of depression with Edinburgh Postpartum Depression Scale (EPDS). Confirmatory factor analysis (CFA) was used to verify factor structure of GAD-7 and the internal consistency was evaluated using reliability coefficients: Cronbach’s Alpha and McDonald’s Omega.ResultsThe internal consistency of the GAD-7 was high (Cronbach’s Alpha = 0.90 and MacDonald’s Omega = 0.91). GAD-7 had significant correlations with the variables examined for construct validity, stress (PSS; r = 0.35, p < 0.01) and risk of depression (EPDS; r = 0.76, p < 0.01). The Confirmatory Factor Analysis results supported a good fit of the data to the model: χ²(df) = 14.19 (14), p = 0.44; Comparative Fit Index (CFI) = 0.99; Tucker-Lewis Index (TLI) = 0.99; Root Mean Square Error of Approximation (RMSEA) = 0.007 (90% C.I. 0.000; 0.059).ConclusionGAD-7 has satisfactory psychometric properties. GAD-7 had significant correlations with the variables examined for construct validity with PSS and EPDS. GAD-7 is a reliable instrument for screening anxiety symptoms in perinatal period in research and clinical setting.

Mindfulness-based stress reduction via mobile phone on female family caregivers' anxiety and sleep quality during COVID-19

Purpose This study aims to determine the effect of Mindfulness-Based Stress Reduction (MBSR) via mobile phone on female family caregivers during COVID-19. Design/methodology/approach In the experimental study, 81 female family caregivers were randomly divided into the experimental group (n = 40) and control group (n = 41). The experimental group received MBSR via mobile phone. Pittsburgh Sleep Quality Inventory and Generalized Anxiety Disorder Questionnaire - Seventh Edition were evaluated at the beginning of the study, week 3 and week 8, respectively. Findings In both groups, anxiety decreased over time, although the decrease in the experimental group was significantly higher than in the control group (F = 22.912 p &lt; 0.001). Sleep quality improved slightly in both groups over time; this improvement in the experimental group was significantly more than in the control group (F = 3.751 p = 0.035). Originality/value The MBSR via mobile phone helps to reduce anxiety and improve sleep quality in women caring for isolated patients at home.

Clinician- vs non-clinician-supported eTherapy for anxiety and depression

Purpose The efficacy of supported computerised therapy (eTherapy) for anxiety and depression is established; however, questions remain regarding supporter type. This paper aims to examine differences in client outcomes between clinician- (Psychological Wellbeing Practitioner) and non-clinician-supported, low intensity eTherapy. Standardised outcome measures were collected and analysed pre- and post-intervention in two eTherapy services as part of National Health Service (NHS) commissioned, Improving Access to Psychological Therapy provision – now known as NHS Talking Therapies for anxiety and depression (TT). Design/methodology/approach This study is a routine service evaluation comparing two eTherapy services. In total, 494 clients (including 455 clients meeting caseness) accessed the service over a year as part of routine care for anxiety and depression. The Patient Health Questionnaire and Generalised Anxiety Disorder Questionnaire scales were administered pre- and post-treatment as part of the TT data set (NHS England, 2024). Findings Following adjustment for demographics, baseline assessment scores and clinical variables, the authors found no evidence to support differences in the likelihood of recovery between clients in the non-clinician-supported site and clients referred to the clinician-supported site: OR = 1.24 [95%CI: 0.71 to 2.17] for TT recovery, OR = 0.83 [95%CI: 0.47 to 1.49] for TT reliable improvement and OR = 1.11 [95%CI: 0.65 to 1.92] for TT reliable recovery. Originality/value Non-clinician-supported eTherapy is as effective as clinician-supported eTherapy. This finding supports the case for expansion of non-clinician-supported eTherapy services in TT services.

Construction and evaluation of two nomograms for screening major depressive disorder and subthreshold depression individuals based on anxiety, depression, and sleep items

BackgroundCurrent evidence is insufficient to support specific tools for screening Major Depressive Disorder (MDD). Early detection of subthreshold depression (SD) is crucial in preventing its progression to MDD. This study aims to develop nomograms that visualize the weights of predictors to improve the performance of screening tools. MethodsParticipants were recruited from Peking University Sixth Hospital and Beijing Physical Examination Center between October 2022 and April 2024. The Mini-International Neuropsychiatric Interview (MINI) 5.0.0 was employed as the diagnostic gold standard, and Generalized Anxiety Disorder questionnaire-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), and Pittsburgh Sleep Quality Index (PSQI) were employed to assess anxiety, depression, and sleep state. The nomograms were constructed by incorporating optimal predictors, selected through the Least Absolute Shrinkage and Selection Operator (LASSO), into a multivariate logistic regression model to estimate the probability of MDD and SD. ResultsAfter matching age and education, 164 participants were included in each group for analysis. Both nomograms demonstrated superior discrimination, calibration, and clinical applicability compared to PHQ-9. Anxiety emerged as a most significant predictor for SD, while sleep problems exhibited high rankings for both SD and MDD. The two predictors subsequently affect concentration and daytime functioning. LimitationsWith a lack of external validation data, the performance of nomograms may be overestimated. ConclusionsThis study is the first attempt to develop a nomogram for predicting SD, while also providing a nomogram for MDD. The crucial predictors offer valuable insights into potential variables for clinical intervention.

Do acute mountain sickness and psychiatric disorders show overlapping symptoms?

The Lake Louise Score (LLS) is a common tool for diagnosing acute mountain sickness (AMS) after a recent gain in altitude. Required symptoms (headache, dizziness, fatigue or gastrointestinal symptoms) are unspecific, subjective and not detectable by physiological parameters. (Talks et al., 2022; Boos et al., 2018) This study aimed to enhance present knowledge concerning the impact of mental health on LLS. In a cross-sectional questionnaire study, we assessed 3 groups: 100 inpatients (Ward for psychosomatic medicine – Innsbruck, PSY), 73 mentally healthy individuals (Innsbruck, Austria at an altitude of 570 m, CO) and 223 mountaineers in Nepal (Pheriche 4,371 m and Dingboche 4,410 m, NEPAL). Beside social demographics and LLS 2018 (cutoff for LLS-positivity: LLS ≥ 3 including at least 1 point for headache), we examined symptoms of anxiety (Zung Self-Rating Anxiety Scale [SAS], General Anxiety Disorder Questionnaire 7 [GAD-7]), affective states (International Positive and Negative Affect Schedule Short form [I-PANAS-SF]) and sleep (Insomnia Severity Index [ISI]). In this preliminary analysis, the average age was 39 ± 16 years in PSY, 34 ± 16 years in CO and 40 ± 14 years in NEPAL. Gender distribution showed greater portion of women in PSY and CO (PSY: 72% female 24% male 3% non-binary, CO: 64% female 36% male) contrary to NEPAL (36% female 64% male). At sea level, 67% scored LLS-positive in PSY and 12% in CO (Fishers exact test, p &lt; 0.001). In NEPAL 25% met AMS-criteria by LLS. CO and NEPAL score significantly lower in LLS than PSY (ANOVA: diff = -3.70, p &lt; 0.0001; diff = -3.68, p &lt; 0.0001, respectively). PSY and CO showed significant weak to moderate correlations (Spearman-Rho, p &lt; 0.001) of anxiety (SAS, GAD), affective states (I-PANAS-SF) and sleep impairment (ISI) with LLS-sum. NEPAL showed significant very-weak to weak correlations of insomnia, anxiety and negative affect with LLS-sum. Using logistic regression analysis (Figure 1), higher odds of LLS-positivity are significantly associated with insomnia and anxiety (ISI, SAS) in PSY, with anxiety in CO (SAS) and insomnia and negative affect in NEPAL. While of course a recent gain in altitude is a prerequisite for the diagnosis of AMS this study shows that patients with pre-existing mental illness at low altitude score more frequently false-positive on the LLS than a mentally healthy cohort. Symptoms of anxiety, negative affect and sleep disturbance can affect the AMS-defining questionnaire of LLS both at sea level and at high altitude. There is still uncertainty on a possible common pathophysiological pathway of psychiatric diseases and AMS since there is no Gold Standard in diagnosing AMS. Concerning (well-)established risk-factors for AMS like speed of ascent (Berger et al., 2023) and female sex (Hou et al., 2019), we see no evident data. The data presented here suggest that strength of expression of negative affect can cause positive LLS scoring. Acute mountain sickness and psychiatric disorders show overlapping symptoms at sea level. At high altitudes, negative affect seems to be a possible cause for the development of AMS. Further research focus should be placed on mountaineers in high altitude with psychiatric disorders and their mental state.

Crowdsourcing integrated into a digital mental health platform for anxiety and depression: A pilot randomized controlled trial

BackgroundAnxiety and depression are major public health concerns. Digital mental health interventions (DMHIs) are effective at reducing anxiety and depression, especially when they leverage human support. However, DMHIs that rely on human supporters tend to be less scalable. “Crowdsourced peer support,” in which a “crowd” of many peers provides users support via structured and focused interactions, may enable DMHIs to provide some of human support's unique benefits at scale. ObjectiveTo conduct a pilot trial of two versions of a digital mental health intervention for anxiety and depression: one with crowdsourced peer support and one without. MethodsWe conducted a two-armed pilot randomized controlled trial examining two versions of the novel “Overcoming Thoughts” platform: crowdsourced (intervention) vs. non-crowdsourced (control). The crowdsourced version allowed participants to view and interact with other users' content. We randomly assigned 107 participants to use the crowdsourced (n = 56) or non-crowdsourced (n = 51) platform for 8 weeks. Participants completed assessments at baseline, 4 weeks, 8 weeks, and 16 weeks. At each time point, these assessments included measures of anxiety and depression, including the Depression, Anxiety, and Stress Scale (DASS, primary outcome), the Patient Health Questionnaire (PHQ-9, secondary outcome), and the Generalized Anxiety Disorder Questionnaire (GAD-7, secondary outcome). We also collected usage information, including the number of exercises started, and safety data. ResultsUsing mixed models controlling for demographic factors, we compared the conditions' effectiveness in reducing depression and anxiety over time. Although we found significant drops over time in the DASS at both Week 8 and Week 16 (ps < 0.01), we did not find significant treatment x time interactions (Week 8, p = 0.35; Week 16, p = 0.68). The PHQ-9 and GAD-7 showed similar results. The median number of times participants used the platform was 3 (mean = 6.99, SD = 9.78). Greater platform use was not associated with a different change in DASS total score, PHQ-9 score, or GAD-7 score over eight weeks (ps > 0.10). ConclusionsNeither version of the “Overcoming Thoughts” platform (crowdsourced or non-crowdsourced) reduced anxiety or depression significantly more than the other. Future work should investigate how digital platforms can better leverage crowdsourced support, and if crowdsourced support may be especially useful in certain kinds of systems, populations, or target areas. Optimizing intervention engagement and obtaining the large sample sizes needed for appropriate statistical power will be key challenges for similar studies.NCT: 04226742

Depression and Anxiety Screening of Patients With Type II Diabetes Mellitus Attending Primary Healthcare Centers in Saudi Arabia.

Diabetes mellitus is a chronic condition affecting both physical and mental health. High blood sugar levels can lead to serious complications if not managed properly. Individuals with diabetes are also at a higher risk of developing mental health disorders like depression and anxiety. The objective was to assess the prevalence of depression and anxiety among patients with type II diabetes attending primary healthcare centers in Makkah, Saudi Arabia. An analytical cross-sectional study design was employed, targeting adults with type II diabetes attending primary healthcare centers in Makkah. A total sample size of 412 participants was selected through systematic random sampling. Data were collected using validated Arabic versions of the patient health questionnaire (PHQ-9) and the general anxiety disorder (GAD-7) questionnaire, along with demographic information. Statistical analysis was conducted with non-parametric tests used to evaluate the significance of outcome variables. The median age of participants was 47 years, with 237 (57.5%) being male and 373 (90.5%) Saudi nationals. Neuropathy was the most prevalent complication, affecting 181 (43.9%) of participants. The median GAD-7 score was 5, and the median PHQ-9 score was 7. Mild to moderate depression was observed in 224 (54.4%), and 194 (47%) had mild-to-moderate anxiety. Significant associations were found between mental health outcomes and several factors: nationality (non-Saudis showed higher depression and anxiety scores, p = 0.010 and p = 0.020, respectively), marital status (divorced participants had the highest mean ranks for both conditions, p = 0.003 for depression and p < 0.001 for anxiety), and monthly income (p = 0.007 for depression and p = 0.008 for anxiety). Additionally, the presence of diabetes complications was strongly associated with higher depression and anxiety scores (p < 0.001 for both). The findings indicate a high prevalence of depression and anxiety among patients with type II diabetes in Makkah. These mental health issues are significantly associated with socio-demographic factors and diabetes complications. Integrated medical and psychological care is needed to improve the quality of life and treatment outcomes for diabetic patients.

A latent profile analysis and network analysis of anxiety and depression symptoms in Chinese widowed elderly

BackgroundWidowhood, as a traumatic event in the aging process, may lead to adverse psychological consequences such as anxiety and depression. However, the heterogeneity of anxiety and depression comorbidity patterns in widowed elderly and the interrelationships between symptoms have not been adequately studied. Method10,239 elderly aged 65 years and older were screened from the Chinese Longitudinal Healthy Longevity Survey (CLHLS 2017–2018), to assess depression and anxiety using the Center for Epidemiologic Studies Depression Scale (CESD) and the 7-item Generalized Anxiety Disorder Questionnaire (GAD). The subgroups of widowed elderly with similar patterns of symptoms were identified by latent profile analysis (LPA). The structure of anxiety-depressive comorbidity network was characterized using “bridge expected influence” as centrality indices. Network stability was tested using a case drop bootstrap program. A network comparison test (NCT) was performed to examine the differences in network characteristics across LPA subgroups. ResultLPA identified dichotomous profiles: low comorbid (n = 4457) and high comorbid (n = 692). NCT revealed a significant difference in the global strength between networks (S = 0.631, p < 0.001). GAD1 (Nervousness or anxiety) is the common bridging symptom for both networks, while the bridging symptom for the high comorbidity network also includes GAD3 (Generalized worry). LimitationsCross-sectional methods are unable to verify causal relationships, and further randomized controlled trials are warranted. ConclusionAnxiety-depressive pattern in Chinese widowed elderly can be categorized into a low comorbid or a high comorbid group. GAD3 (Generalized worry) can be used as the core intervention target during intervention.

Air Pollution Effects on Mental Health Relationships: Scoping Review on Historically Used Methodologies to Analyze Adult Populations

Air pollution’s effects on physical health, especially cardiovascular and respiratory, are well known. Exposure to air pollution may damage every organ and cell in the human body. New evidence is emerging showing that air pollution adversely affects human mental health. Current research suggests that high air pollution levels have long-term mental health effects, such as reduced mental capacity and increased cognitive decline, leading to increased stress, anxiety, and depression. Objectives: This scoping review aims to provide a comprehensive overview of the methods used in epidemiological literature to ascertain the existence of links between outdoor particulate matter (PM) and multiple adverse mental health (MH) effects (depression, anxiety, and/or stress). A better understanding of the practical research methodologies could lead to improved air quality (AQ) management and enhanced well-being strategies. Methods: This paper undertakes a scoping review. PubMed and EMBASE databases from 2010 to 2024 were searched for English-language human cohort observational studies stating methodologies used in analyzing the link between outdoor particulate matter (ultrafine (UFT) (&lt;0.1 μm), fine (&lt;2.5 μm), and course (&lt;10 μm)) and mental health outcomes (depression, anxiety, and stress) in adults (&gt;18 years), excluding vulnerable populations (i.e., elderly, children, and pregnant women). The study focuses on urban, suburban areas, and rural areas. Results: From an initial search of 3889 records, 29 studies met the inclusion criteria and were included in the review. These studies spanned various countries and employed robust quantitative methodologies to assess AQ and MH. All included studies investigated the impact of PM on mental health, with some (n = 19/65.52%) also examining nitrogen oxides (NOx), nitrogen dioxide (NO2), sulfur dioxide (SO2), ozone (O3), and carbon monoxide (CO). Depression was the most frequently studied outcome (n = 10/34.48%), followed by anxiety and depression (n = 6/20.69%), and anxiety, stress, and depression, and stress (n = 4/13.79%, each). Depression, anxiety, and stress together were examined in a single study (n = 1/3.45%). Standardized questionnaires involving psychological scales such as Patient Health Questionnaire (PHQ) (n = 7/24.14%) and The Center for Epidemiological Studies-Depression (CES-D) (n = 3/10.34%) for depression and Generalized Anxiety Disorder Questionnaire (GAD) (n = 2/6.90%) for anxiety were commonly used MH tools. 27 out of 29 studies found a significant negative impact of air pollution on mental health, demonstrating a solid consensus in the literature. Two studies did not find a significant correlation. The results consistently indicated that higher levels of air pollution were associated with increased symptoms of depression, anxiety, and stress. Conclusion: Of the 3889 identified studies, 29 were suitable for inclusion in the scoping review per inclusion criteria. The results show the most preferred methods in assessing air quality and mental health in relevant studies, providing a detailed account of each method’s strengths and limitations used in studies. This scoping review was conducted to assist future research and relieve the decision-making process for researchers aiming to find a correlation between air quality and mental health. While the inclusion criteria were strict and thus resulted in few studies, the review found a gap in the literature concerning the general adult population, as most studies focused on vulnerable populations. Further exploration of the methodologies used to find the relationship between air quality and mental health is needed, as reporting on these outcomes was limited.

Health screening clinic to reduce absenteeism and presenteeism among NHS Staff: eTHOS a pilot RCT.

Staff sickness absenteeism and presenteeism (attending work while unwell) incur high costs to the NHS, are associated with adverse patient outcomes and have been exacerbated by the COVID-19 pandemic. The main causes are mental and musculoskeletal ill health with cardiovascular risk factors common. To undertake a feasibility study to inform the design of a definitive randomised controlled trial of the effectiveness and cost effectiveness of a health screening clinic in reducing absenteeism and presenteeism amongst the National Health Service staff. Individually randomised controlled pilot trial of the staff health screening clinic compared with usual care, including qualitative process evaluation. Four United Kingdom National Health Service hospitals from two urban and one rural Trust. Hospital employees who had not previously attended a pilot health screening clinic at Queen Elizabeth Hospital Birmingham. Nurse-led staff health screening clinic with assessment for musculoskeletal health (STarT musculoskeletal; STarT Back), mental health (patient health questionnaire-9; generalised anxiety disorder questionnaire-7) and cardiovascular health (NHS health check if aged ≥ 40, lifestyle check if < 40 years). Screen positives were given advice and/or referral to services according to UK guidelines. The three coprimary outcomes were recruitment, referrals and attendance at referred services. These formed stop/go criteria when considered together. If any of these values fell into the 'amber' zone, then the trial would require modifications to proceed to full trial. If all were 'red', then the trial would be considered unfeasible. Secondary outcomes collected to inform the design of the definitive randomised controlled trial included: generalisability, screening results, individual referrals required/attended, health behaviours, acceptability/feasibility of processes, indication of contamination and costs. Outcomes related to the definitive trial included self-reported and employee records of absenteeism with reasons. Process evaluation included interviews with participants, intervention delivery staff and service providers. Descriptive statistics were presented and framework analysis conducted for qualitative data. Due to the COVID-19 pandemic, outcomes were captured up to 6 months only. Three hundred and fourteen participants were consented (236 randomised), the majority within 4 months. The recruitment rate of 314/3788 (8.3%) invited was lower than anticipated (meeting red for this criteria), but screening identified that 57/118 (48.3%) randomised were eligible for referral to either general practitioner (81%), mental health (18%) and/or physiotherapy services (30%) (green). Early trial closure precluded determination of attendance at referrals, but 31.6% of those eligible reported intending to attend (amber). Fifty-one of the 80 (63.75%) planned qualitative interviews were conducted. Quantitative and qualitative data from the process evaluation indicated that the electronic database-driven screening intervention and data collection were efficient, promoting good fidelity, although needing more personalisation at times. Recruitment and delivery of the full trial would benefit from a longer development period to better understand local context, develop effective strategies for engaging with underserved groups, provide longer training and better integration with referral services. Delivery of the pilot was limited by the impact of COVID-19 with staff redeployment, COVID-research prioritisation and reduced availability of community and in-house referral services. While recruitment was rapid, it did not fully represent ethnic minority groups and truncated follow-up due to funding limitations prevented full assessment of attendance at recommended services and secondary outcomes. There is both a clinical need (evidenced by 48% screened eligible for a referral) and perceived benefit (data from the qualitative interviews) for this National Health Service staff health screening clinic. The three stop/go criteria were red, green and amber; therefore, the Trial Oversight Committee recommended that a full-scale trial should proceed, but with modifications to adapt to local context and adopt processes to engage better with underserved communities. This trial is registered as ISRCTN10237475. This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 17/42/42) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 23. See the NIHR Funding and Awards website for further award information.

‘There’s more to life than staring at a small screen’: a mixed methods cohort study of problematic smartphone use and the relationship to anxiety, depression and sleep in students aged 13–16 years old in the UK

BackgroundDepression and anxiety are common in adolescents and have increased over the last decade. During that period, smartphone usage has become ubiquitous.ObjectivesThe study aim was to assess the association between...

The prevalence of anxiety in pregnant women at Chris Hani Baragwanath Academic Hospital.

Non-psychotic mental disorders are common during the perinatal period. In South Africa, there are few studies on antenatal anxiety and these results vary. Antenatal anxiety does not only add to the burden of perinatal co-morbidity but has subsequent immediate and long-term effects on the mother, birth outcomes and her offspring. The aim of this study was to determine the prevalence of anxiety symptoms in pregnant women during the antenatal period and to determine associated factors. The study was conducted at an antenatal clinic located in Chris Hani Baragwanath Academic Hospital (CHBAH), Soweto, Johannesburg. Data were collected from March to December 2022. This was a prospective, cross-sectional study in which 200 pregnant women were interviewed. A biographical questionnaire and the generalised anxiety disorder questionnaire (GAD-7) were administered. The prevalence of anxiety symptoms in pregnant women attending the antenatal clinic was 33%. Participants with anxiety were younger, employed and had lower perceived social support. Women with planned and wanted pregnancies had a lower prevalence of anxiety. One-third of the pregnant women screened positive for anxiety symptoms on the GAD-7. This is significantly higher compared to other studies carried out in the same facility previously. High-risk groups should be screened for anxiety. This study prompts further studies and guiding policies on routine screening of pregnant women for anxiety and other mental illnesses during pregnancy.

Residential natural hazard risk and mental health effects.

Mental health effects are frequently reported following natural disasters. However, little is known about effects of living in a hazard-prone region on mental health. We analyzed data from 9,312 Gulf Long-term Follow-up Study participants who completed standardized mental health questionnaires including the Patient Health Questionnaire-9 (depression=score≥10), Generalized Anxiety Disorder Questionnaire-7 (anxiety=score≥10), and Primary Care PTSD Screen (PTSD=score≥3). Geocoded residential addresses were linked to census-tract level natural hazard risk scores estimated using the National Risk Index (NRI). We considered an overall risk score representing 18 natural hazards, and individual scores for hurricanes, heatwaves, coastal flooding and riverine flooding. Log binomial regression estimated prevalence ratios (PR) and 95% confidence intervals (CI) for associations between risk scores (quartiles) and mental health outcomes. Increasing hurricane and coastal flooding scores were associated with all mental health outcomes in a suggestive exposure-response manner. Associations were strongest for PTSD, with PRs for the highest vs. lowest quartile of hurricane and coastal flooding risks of 2.29(1.74-3.01) and 1.59(1.23-2.05), respectively. High heatwave risk was associated with anxiety (PR=1.25(1.12-1.38)) and depression (PR=1.19(1.04-1.36)) and suggestively with PTSD (PR=1.20(0.94-1.52)). Results suggest that living in areas prone to natural disasters is one factor associated with poor mental health status.

Assessment of clinical outcomes in patients with inflammatory arthritis: analysis from the UK Medical Cannabis Registry.

The aim of this study was to assess changes in validated patient-reported outcome measures after initiation of cannabis-based medicinal products (CBMPs) and the safety of CBMPs in patients with inflammatory arthritis. A prospective case series from the UK Medical Cannabis Registry was analyzed. The primary outcomes changes were in Brief Pain Inventory, McGill Pain Questionnaire, EuroQol 5-dimension 5-level (EQ-5D-5L), Generalised Anxiety Disorder-7 questionnaire, and Single-Item Sleep Quality Scale at 1, 3, 6, and 12 months of follow-up compared with baseline. Adverse events were analyzed in accordance with Common Terminology Criteria for Adverse Events, v.4.0. Statistical significance was defined as a P-value less than 0.050. Eighty-two patients met the inclusion criteria. Initiation of CBMP treatment was associated with improvements in Brief Pain Inventory, McGill Pain Questionnaire, EQ-5D-5L, Generalised Anxiety Disorder-7 questionnaire, and Single-Item Sleep Quality Scale at 1, 3, 6, and 12 months compared with baseline (P < 0.050). There were 102 (44.35%) mild adverse events, 97 (42.17%) moderate adverse events, and 31 (13.48%) severe adverse events recorded by 21 (25.61%) participants. This study suggests that CBMP treatment is associated with pain improvement and increased health-related quality of life for inflammatory arthritis patients. While causality cannot be inferred in this observational study, the results support the development of randomized control trials for inflammatory arthritis pain management with CBMPs.

The relationship of peripheral blood cell inflammatory biomarkers and psychological stress in unmedicated major depressive disorder

BackgroundRecent research has explored the linkage between major depressive disorder (MDD) and inflammation, especially via altered peripheral blood immune markers. However, the relationship between several novel leukocyte-derived ratios (LDR) and psychological stress in MDD remains uncertain. This study aimed to explore the relationship between LDR, clinical characteristics, recent life events, and childhood maltreatment in MDD patients. MethodsA cross-sectional case-control study was conducted involving 59 healthy controls (HC) and 50 unmedicated MDD patients. Subjects underwent psychological assessments and peripheral blood measurements. LDR assessed in this study included neutrophil-to-lymphocyte ratio (NLR), derived NLR (dNLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), white blood cell-to-mean platelet volume ratio (WMR), systemic immune inflammation index (SII), multiplication of neutrophil and monocyte counts (MNM), and systemic inflammation response index (SIRI). ResultsMDD patients displayed significant alterations in WMR, PLR, and MNM compared to HC, as well as correlations between several LDR and various clinical features (duration of untreated psychosis and dNLR, the nine-item Patient Health Questionnaire and PLR, the 7-item Generalized Anxiety Disorder Questionnaire and SIRI (NLR and dNLR). There was a significant difference in the comparison of WMR in first-episode patients than in recurrent patients. Analyses further revealed an association between Life Event Scale total scores and NLR (dNLR). No correlation was found between Childhood Trauma Questionnaire total (or subscale) scores and LDR. Additionally, WMR and dNLR presented potential predictive value for distinguishing between MDD and HC. ConclusionThe study concludes that MDD and some clinical features are associated with alterations in some peripheral blood LDR. These findings emphasize the potential role of peripheral blood LDR in the pathogenesis and clinical heterogeneity of MDD.

Anxiety and depression in patients with non-site-specific cancer symptoms: data from a rapid diagnostic clinic.

Rapid diagnostic clinics (RDCs) provide a streamlined holistic pathway for patients presenting with non-site specific (NSS) symptoms concerning of malignancy. The current study aimed to: 1) assess the prevalence of anxiety and depression, and 2) identify a combination of patient characteristics and symptoms associated with severe anxiety and depression at Guy's and St Thomas' Foundation Trust (GSTT) RDC in Southeast London. Additionally, we compared standard statistical methods with machine learning algorithms for predicting severe anxiety and depression. Patients seen at GSTT RDC between June 2019 and January 2023 completed the General Anxiety Disorder Questionnaire (GAD-7) and Patient Health Questionnaire (PHQ-8) questionnaires, at baseline. We used logistic regression (LR) and 2 machine learning (ML) algorithms (random forest (RF), support vector machine (SVM)) to predict risk of severe anxiety and severe depression. The models were constructed using a set of sociodemographic and clinical variables. A total of 1734 patients completed GAD-7 and PHQ-8 questionnaires. Of these, the mean age was 59 years (Standard Deviation: 15.5), and 61.5% (n:1067) were female. Prevalence of severe anxiety (GAD-7 score ≥15) was 13.8% and severe depression (PHQ-8 score≥20) was 9.3%. LR showed that a combination of previous mental health condition (PMH, Adjusted Odds Rario (AOR) 3.28; 95% confidence interval (CI) 2.36-4.56), symptom duration >6 months (AOR 2.20; 95%CI 1.28-3.77), weight loss (AOR 1.88; 95% CI 1.36-2.61), progressive pain (AOR 1.71; 95%CI 1.26-2.32), and fatigue (AOR 1.36; 95%CI 1.01-1.84), was positively associated with severe anxiety. Likewise, a combination PMH condition (AOR 3.95; 95%CI 2.17-5.75), fatigue (AOR 2.11; 95%CI 1.47-3.01), symptom duration >6 months (AOR 1.98; 95%CI 1.06-3.68), weight loss (AOR 1.66; 95%CI 1.13-2.44), and progressive pain (AOR 1.50; 95%CI 1.04-2.16), was positively associated with severe depression. LR and SVM had highest accuracy levels for severe anxiety (LR: 86%, SVM: 85%) and severe depression (SVM: 89%, LR: 86%). High prevalence of severe anxiety and severe depression was found. PMH, fatigue, weight loss, progressive pain, and symptoms >6 months emerged as combined risk factors for both these psychological comorbidities. RDCs offer an opportunity to alleviate distress in patients with concerning symptoms by expediting diagnostic evaluations.