Generalized Anxiety Disorder-7 Scores Research Articles

Morning Salivary Cortisol Has a Positive Correlation with GAD-7 Scores in Patients with Ulcerative Colitis

Objectives: Inflammatory bowel diseases (IBDs) are chronic inflammatory conditions of the gastrointestinal tract, comprising ulcerative colitis (UC) and Crohn’s disease (CD). Earlier onset of IBD symptoms has been linked to a higher prevalence of depression and anxiety. Evidence supports that cortisol abnormalities correlate with the development and severity of autoimmune diseases. The primary aim of this study was to investigate the correlation of morning salivary cortisol levels with self-reported mood (depression and anxiety) and quality of life in patients with IBD. Methods: This was a prospective, single-center study including outpatients with IBD. Enrolled patients provided a one-time morning salivary cortisol sample and electronically completed a one-time survey encompassing self-reported quality of life (Short Inflammatory Bowel Disease Questionnaire (SIBDQ)) and mood (Patient Health Questionnaire 8 (PHQ-8), General Anxiety Disorder-7 (GAD-7)). Results: A total of 36 patients (UC, n = 21) were included in the study. There was no correlation between morning salivary cortisol and depressive symptoms (PHQ-8: r = 0.007, p = 0.968) or quality of life (SIBDQ: r = −0.095, p = 0.606). However, there was a trend towards a positive correlation between self-reported anxiety symptoms by GAD-7 and salivary cortisol (r = 0.347, p = 0.052). A subgroup analysis showed a positive correlation between morning salivary cortisol and GAD-7 scores in patients with UC (r = 0.535, p = 0.015), but not in patients with CD (r = 0.064, p = 0.843). Conclusions: This pilot study is the first to associate cortisol with anxiety symptom severity in UC. Further research is needed to investigate the link between salivary cortisol, neuropsychiatric disease, and IBD outcomes.

Assessing Mental Health During an Extreme Weather Event in Southern Brazil.

This study aimed to evaluate mental health factors in individuals affected by the floods in Rio Grande do Sul from May 10 to June 6, 2024. A real-time survey was conducted with 1,552 participants. The Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and Acute Stress Disorder (ASD) symptom checklist were used to assess mental health outcomes. Sociodemographic factors, trauma exposure, rescue participation, and psychological support were evaluated. Statistical analyses included t-tests, ANOVA, linear regression, and MANCOVA. High rates of depressive and anxious symptoms were found, with over half of the individuals with moderate to severe symptoms reporting no prior history of these conditions. Participants directly affected by the floods, and those with close ones affected, had higher PHQ-9, GAD-7, and ASD scores compared to the unaffected group. Moreover, younger age, female sex, lower family income, participation in rescues, and unmet psychological support needs were correlated with worse mental health outcomes. Individuals who participated in rescues had significantly higher rates of suicide ideation. Notably, psychological support had the largest effect size in mitigating mental health symptoms, regardless of trauma exposure status, when controlled for age, sex, and income according to MANCOVA. The findings highlight the critical role of psychological support in disaster response and the importance of community resilience. Real-time data collection during crises can inform targeted interventions, emphasizing the need for robust mental health services and community support networks. These efforts are essential to reduce long-term psychological morbidity and foster recovery in vulnerable populations.

Edinburgh postnatal depression scale score elevation in caregivers of infants with cystic fibrosis.

The diagnosis of cystic fibrosis (CF) can impact the mental health of caregivers. This study aimed to explore prevalence of postpartum depression (PPD) symptoms in caregivers of infants with CF or CFTR-related metabolic syndrome (CRMS). This prospective, observational study was conducted in a CF clinic at a tertiary hospital over 4 years. Caregivers of infants with CF/CRMS completed serial surveys over the first year of life. Surveys included the Edinburgh Postnatal Depression Scale (EPDS), Patient Health Questionnaire-9 (PHQ-9) and the General Anxiety Disorder-7 (GAD-7). A control group of healthy infant caregivers was used for comparative analysis of EPDS scores. Analyses were conducted on 55 caregivers of 42 infants with CF/CRMS and 915 caregivers of healthy infants. Caregivers of infants with CF/CRMS had a significantly higher prevalence of elevated EPDS scores and higher mean EPDS scores for visit 1 (age 1-2mo) and visit 3 (age 6-9mo) compared to healthy controls (p < 0.001 for both). There was a higher prevalence of caregivers identifying thoughts of self-harm in the CF/CRMS cohort (8.3%) compared to caregivers of healthy controls (1.2%) at visit 1 (p = 0.015) and at visit 3 (CF/CRMS 8.8%; control 1.7%; p = 0.030). EPDS scores correlated with PHQ-9 and GAD-7 scores, particularly earlier in the infant's life. Caregivers of infants with CF/CRMS may be at higher risk of PPD and thoughts of self-harm when compared to healthy controls. Given what is known about the impact of PPD on mental and physical health of children, early identification is vital for this population.

Assessing the impact of implantable loop recorder placement on anxiety level

Abstract Background Anxiety is a prolonged state of apprehension or worry that can be an independent predictor of cardiovascular events, associated with a 48% increased risk of cardiac death. About one-third of patients with arrhythmias present with high anxiety levels, and subsequently worse quality of life. In our experience of patient care, many patients feel anxious about the possibility of an arrhythmia that could lead to their demise, especially if their symptoms are undiagnosed. Purpose Our project aims to explore the change in patients’ anxiety levels following implantable loop recorder (ILR) placement. Methods This is a survey-based observational study that was performed in an outpatient clinic and hospital using validated General Anxiety Disorder-7 (GAD-7) questionnaires. Individuals who met indications to undergo ILR implantation including palpitations, syncope, subclinical atrial fibrillation, and cryptogenic stroke underwent baseline assessment of anxiety prior to implantation. Individuals had repeat assessments at 6 weeks and 12 weeks post-implantation to evaluate the effect of ILR placement. Results Our study included 50 individuals. Out of the initial subjects, 10/25 females and 11/25 males were lost to follow-up. The average initial GAD-7 score was 3.3 (Range 0, 15), average 6-week score was 1.6 (Range 0, 14), and average 12-week score was 0.9 (Range 0, 10). Total decrease in GAD-7 score after 6 weeks of having ILR was 50%. Total decrease in GAD-7 score after 12 weeks of ILR was statistically significant at 73% (P=0.03). Females showed greater improvement of GAD-7 scores in comparison to males at 6 weeks (67% vs 36%) and 12 weeks (81% vs 66%). Conclusion Studies have suggested an overall decreased level of anxiety in patients receiving implantable devices that have the potential to treat arrhythmias such as implantable cardiac defibrillators and pacemakers. Our results suggest that the benefit may extend to implantable devices that seek to provide further diagnostic information and aid in the prognostication of disease burden. As seen in our study population, GAD-7 scores showed dramatic improvement with greater percentage in female than male population. After the placement of loop recorders, many patients experience a sense of security with having a device that monitors them. Our study is the first to address the association between ILR and anxiety. Future studies evaluating this association would help increase the power of the study.Figure 1:Bar graph of GAD-7 Scores

Restless sleep is associated with increased anxiety in physical therapy students: a cross sectional survey study

BackgroundSleep and mental health are intimately related and shown to impact graduate students enrolled in health sciences programs, including physical therapy education. Doctorate of Physical Therapy (DPT) students’ attitudes and behaviors surrounding sleep and whether these factors are associated with mental health are unknown. This study aimed to describe sleep behaviors and attitudes of entry-level DPT students and to explore the relationship between subjectively reported sleep quality and self-reported symptoms of anxiety in these students.MethodsA cross-sectional online survey consisting of the Sleep Practices and Attitudes Questionnaire (SPAQ), the Generalized Anxiety Disorder-7 (GAD-7) questionnaire, and demographic questions were used. Analyses investigated sleep behaviors and attitudes, along with the relationship (unadjusted odds ratio) between restless sleep and anxiety in DPT students in hybrid and traditional DPT programs across the United States (US).ResultsA total of 271 DPT students completed the survey. A majority of students reported feeling tired during most days (80.8%, n = 219), a quarter of participants (24.7%) reported having a history of trouble sleeping and four (1.5%) reported being diagnosed with a sleep disorder. Of those who reported their sleep duration, participants slept an average of 6.86 h. The mean GAD-7 score was 7.68 (SD = 4.90), suggestive of mild anxiety. Sixty-seven (24.7%) reported having a diagnosed anxiety disorder, with generalized anxiety being the most common diagnosis. Those who reported having restless sleep were 4.09 times more likely to have moderate to severe anxiety [unadjusted odds ratio = 4.09 (95% CI 2.27,7.35; p < 0.001)] compared to those who reported restful sleep.ConclusionsDPT students who rated sleep as restless exhibit signs of poor subjective sleep quality associated with an increased risk of experiencing moderate to severe anxiety compared to students who had restful sleep. Students reported behaviors surrounding sleep that may contribute to anxiety. These findings have implications for including sleep and mental health education and practices within DPT programs.

Effect of Age at Liver Transplant on Anxiety, Depression, and Quality of Life Among Adolescents.

Introduction: Life expectancy for pediatric liver transplant patients has increased over the past decade. Different stages of the transplant process can impact patients' quality of life (QOL) and create psychological and physical stressors. This study explored whether age at transplant affected adolescents' feelings of anxiety, depression, and QOL. Design: In this cross-sectional quantitative study, data were collected on 22 adolescent patients aged 13-18 who received a transplant at least 12 months before enrollment. This cohort was divided into 2 groups based on their age at transplant: Group 1 (0-5 years) and Group 2 (6-18 years). To assess transplant-related anxiety, depression, and QOL, participants completed 3 surveys: the Generalized Anxiety Disorder-7 (GAD-7), the Patient Health Questionnaire-9 (PHQ-9), and the Pediatric Quality of Life Inventory™ Transplant Module (PedsQL TM). Results: Group 1 experienced less anxiety and fewer problems based on GAD-7 scores but reported stronger feelings of depression based on PHQ-9 scores. Based on the PedsQL TM scale, Group 1 had higher mean scores compared to Group 2 across all components (mean difference range: 7.2- 27.3; Cohen's d range: 0.27 - 1.13). The largest difference between the 2 groups was observed on the PedsQL TM scale's How I Look (Group 1 mean 81.1 vs. Group 2 mean 53.8; Cohen's d: 1.13; P = 0.015), Conclusion: In this cohort, age at transplant affected adolescents' feelings of anxiety, depression, and QOL. Awareness of these findings can help clinicians screen for and address mental health issues.

Clinical characteristics of 2378 patients presenting with headache disorders to headache clinics in Japan: A clinic-based multicenter study

BackgroundThere are reports from single-center studies on patients visiting headache clinics; however, few multicenter studies have been conducted in Japan. This study aims to address this gap by conducting a multicenter analysis of the clinical characteristics, headache types, severity, and psychiatric comorbidities of patients attending headache clinics. MethodsWe prospectively evaluated the clinical characteristics of 2378 patients with headache disorders visiting three headache clinics. Baseline demographics, such as the visual analog scale (VAS), and psychiatric assessments, such as the Generalized Anxiety Disorder-7 (GAD-7) and the Patient Health Questionnaire-9 (PHQ-9), were evaluated. Headache types were classified as migraine, tension-type headache (TTH), trigeminal autonomic cephalalgias (TACs), other primary headache disorders (OPHDs), and secondary headache. Parameters were compared between headache types using the Kruskal–Wallis test or analysis of covariance, as appropriate. ResultsThe most common headache type was migraine (78.8 %), followed by TTH (12.2 %), secondary headache (5.5 %), OPHDs (2.1 %), and TACs (1.6 %). Patients with migraine were significantly younger at first consultation (median age 32.0) than those with other headache types (TTH; 47.0, TACs; 39.0, OPHDs; 49.5, and secondary headache; 47.0). Patients with TACs exhibited the highest severity and psychiatric symptoms, with VAS (median 90.0), GAD-7 (7.0), and PHQ-9 (7.5) scores significantly higher than those of other headache type (migraine; 70.0, 5.0, 5.0, TTH; 50.0, 4.0, 4.0, OPHDs; 65.0, 4.0, 3.5, and secondary headache; 60.0, 3.0, 3.5: p<0.001, p=0.019, p<0.001). ConclusionMost patients visiting headache clinics had migraine; patients with TACs showed significantly higher headache severity and psychiatric symptoms than those with other headache types.

Evaluation of serum irisin level and severity of erectile dysfunction in diabetic males: a cross sectional prospective study

BackgroundIrisin is an exercise-induced myokine that alleviates endothelial dysfunction and reduces insulin resistance in type 2 diabetes mellitus (T2DM). The current study aimed to assess the serum level of irisin in T2DM men with erectile dysfunction (ED) compared to T2DM patients with normal erectile function and healthy controls, as well as investigate the association between serum irisin level and the severity of ED in T2DM patients.Patients and methodsA cross-sectional study was conducted on 90 males, divided into three groups: 32 T2DM patients with ED, 24 T2DM patients without ED, and 34 healthy controls. Socio-demographic characteristics and scores of the validated Arabic version of the international Index of Erectile Function-5 (ArIIEF-5), Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9) were obtained. Furthermore, routine laboratory tests employed for diabetes monitoring and serum levels of total testosterone and irisin were assessed within these groups.ResultsT2DM men with ED had significantly lower serum levels of irisin and testosterone, as well as a lower ArIIEF-5 score, but their GAD-7 and PHQ-9 scores were significantly higher than those without ED or controls (p < 0.001). Among T2DM men, serum irisin levels positively associated with ArIIEF-5 scores and serum testosterone (r = 0.413, p = 0.002; r = 0.936, p < 0.001, respectively) but negatively associated with glycosylated hemoglobin levels (r = -0.377, p = 0.004). Multivariate regression analysis to predict ED in T2DM patients found that GAD-7 score was the only most significant predictor for ED (ꞵ = − 1.176, standard error = 0.062, p < 0.001).ConclusionThe current study had demonstrated that irisin positively correlated with the ArIIEF-5 and serum testosterone but negatively correlated with HbA1c in T2DM men. Nevertheless, further validation of these findings is necessary through cohort studies.

NeuroCARE: A Randomized Controlled Trial of a Psychological Intervention for Caregivers of Patients With Primary Malignant Brain Tumors.

Caregivers of patients with primary malignant brain tumors (PMBT) experience significant psychological distress. We assessed the effect of a psychological intervention (NeuroCARE) on anxiety symptoms among PMBT caregivers. We conducted a randomized trial of NeuroCARE versus usual care in PMBT caregivers with elevated anxiety (Generalized Anxiety Disorder-7 score ≥5) within 6 months of the patient's diagnosis. NeuroCARE was developed for PMBT caregivers and consists of six telehealth sessions with a behavioral health specialist. Participants completed surveys at baseline, 11-week (postintervention), and 16-week (1-month postintervention) time points. The primary outcome was 11-week anxiety symptoms (Hospital Anxiety and Depression Scale [HADS]-Anxiety Subscale). We also measured depression symptoms (HADS-Depression Subscale), quality of life (QOL; Caregiver QOL survey), caregiver burden (Caregiver Reaction Assessment), self-efficacy (Lewis Cancer Self-Efficacy Scale), coping (Measure of Current Status), and post-traumatic stress disorder (PTSD) symptoms (PTSD Checklist for DSM-5). We conducted analysis of covariance and linear mixed-effects regression analyses to examine intervention effects on study outcomes. We enrolled 120 caregivers (60/group) between October 2019 and June 2022; 105 were evaluable for the primary outcome. At 11 weeks, NeuroCARE participants reported significantly lower anxiety symptoms than usual care participants (M, 8.87 v 10.69; P = .008). NeuroCARE caregivers also reported significantly lower depression symptoms (M, 6.08 v 7.77; P = .004), and better self-efficacy (M, 128.81 v 111.17; P < .001) and coping (M, 32.25 v 25.65; P < .001) at 11 weeks. Study groups did not differ significantly in 11-week QOL, caregiver burden, or PTSD symptoms. In longitudinal analyses, intervention effects on depression symptoms, self-efficacy, and coping were sustained. A novel, population-specific psychological intervention led to improved anxiety and depression symptoms, self-efficacy, and coping among PMBT caregivers.

Comparison of the GAD-7 and ImPACT symptom cluster scores in measuring anxiety among college athletes

Assessing mental health needs among college athletes is important given the frequency of symptoms of depression and anxiety and associated complications that may arise after a sports-related concussion. The purpose of this study was to explore the utility of the General Anxiety Disorder-7 (GAD-7) as an independent measure of anxiety symptoms among Division II collegiate athletes (n = 568) during baseline concussion assessments, which also included the post-concussion symptom scale (PCSS) and a measure of depression, the Patient Health Questionnaire-9 (PHQ-9). While only 31 athletes (5.5%) fell above the established GAD-7 cutoff score of 5 or more, a sizable proportion of them (13 or 41.9%) endorsed 0 items on the PCSS affective symptom cluster. Additionally, ∼2% of athletes reported elevated symptoms of anxiety but not depression. These findings support the incorporation of a brief stand-alone anxiety screening tool during concussion baseline evaluations to ensure better detection of student athletes with elevated anxiety symptoms who might otherwise be overlooked, so they may be referred for further diagnostic assessment.

Comparing Email Versus Text Messaging as Delivery Platforms for Supporting Patients With Major Depressive Disorder: Noninferiority Randomized Controlled Trial.

The prevalence of major depressive disorder (MDD) poses significant global health challenges, with available treatments often insufficient in achieving remission for many patients. Digital health technologies, such as SMS text messaging-based cognitive behavioral therapy, offer accessible alternatives but may not reach all individuals. Email communication presents a secure avenue for health communication, yet its effectiveness compared to SMS text messaging in providing mental health support for patients with MDD remains uncertain. This study aims to compare the efficacy of email versus SMS text messaging as delivery platforms for supporting patients with MDD, addressing a critical gap in understanding optimal digital interventions for mental health care. A randomized noninferiority pilot trial was conducted, comparing outcomes for patients receiving 6-week daily supportive messages via email with those receiving messages via SMS text message. This duration corresponds to a minimum of 180 days of message delivery. The supportive messages maintained consistent length and structure across both delivery methods. Participants (N=66) were recruited from the Access 24/7 clinic in Edmonton, Alberta, among those who were diagnosed with MDD. The outcomes were measured at baseline and 6 months after enrollment using the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and the World Health Organization Well-Being Index (WHO-5). Most of the participants were females (n=43, 65%), aged between 26 and 40 years (n=34, 55%), had high school education (n=35, 58%), employed (n=33, 50%), and single (n=24, 36%). Again, most participants had had no history of any major physical illness (n=56, 85%) and (n=61, 92%) responded "No" to having a history of admission for treatment of mood disorders. There was no statistically significant difference in the mean changes in PHQ-9, GAD-7, and WHO-5 scores between the email and SMS text messaging groups (mean difference, 95% CI: -1.90, 95% CI -6.53 to 2.74; 5.78, 95% CI -1.94 to 13.50; and 11.85, 95% CI -3.81 to 27.51), respectively. Both supportive modalities showed potential in reducing depressive symptoms and improving quality of life. The study's findings suggest that both email and SMS text messaging interventions have equivalent effectiveness in reducing depression symptoms among individuals with MDD. As digital technology continues to evolve, harnessing the power of multiple digital platforms for mental health interventions can significantly contribute to bridging the existing treatment gaps and improving the overall well-being of individuals with depressive conditions. Further research is needed with a larger sample size to confirm and expand upon these findings. ClinicalTrials.gov NCT04638231; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8552095/.

Exploring the relationship between earthquake exposure and severity of erectile dysfunction in southern part of Türkiye.

This study aimed to explore the impact of psychological stress on erectile dysfunction (ED) in male patients following the Gaziantep-Kahramanmaras earthquake. The investigation aimed to establish correlations between earthquake-induced stress and changes in sexual function using International Index of Erectile Function (IIEF), Patient Health Questionnaire-9 (PHQ-9), and Generalized Anxiety Disorder-7 (GAD-7) scores. A retrospective analysis was conducted on male ED patients from a Gaziantep urology clinic post-earthquake (March to August 2023). Patients with deteriorated erectile function post-earthquake (group 1) and those with pre-existing ED experiencing worsened symptoms post-earthquake (group 2) were included. Data collected encompassed sexual histories, IIEF scores, laboratory tests, and PHQ-9/GAD-7 evaluations. Patients were also evaluated mild and mild to moderate ED, moderate and severe ED according to IIEF erectile function. Seventy-six patients were evaluated (24 in group 1 and 52 in group 2). Significant reductions in total IIEF scores (58 to 40 in group 1 and 49 to 33 in group 2) were observed post-earthquake in both groups (p<0.001). PHQ-9/GAD-7 scores was 11.12±3.79/9.34±3.11 in mild and mild to moderate ED and 13.17±3.05/12.14±3.17 in moderate and severe ED (p=0.011, p<0.001, respectively). Negative correlations existed between PHQ-9/GAD-7 scores and IIEF erectile function (p<0.05) and total IIEF (p<0.05). This research suggests a plausible connection between the Gaziantep-Kahramanmaras earthquake and heightened ED cases. Psychological stress post-earthquake may contribute to worsened ED symptoms. Further investigations are warranted to comprehensively understand the interplay between natural disasters and sexual dysfunction, essential for optimizing patient care in challenging situations.

Gamma-aminobutyric acid and glutamate/glutamine levels in the dentate nucleus and periaqueductal gray in new daily persistent headache: a magnetic resonance spectroscopy study

BackgroundMagnetic resonance spectroscopy (MRS) studies have indicated that the imbalance between gamma-aminobutyric acid (GABA) and glutamate/glutamine (Glx) levels was the potential cause of migraine development. However, the changes in the GABA and Glx levels in patients with New daily persistent headache (NDPH) remain unclear. This study aimed to investigate the changes in GABA and Glx levels in the periaqueductal gray (PAG) and dentate nucleus (DN) in patients with NDPH using the MEGA-PRESS sequence.MethodsTwenty-one NDPH patients and 22 age- and sex-matched healthy controls (HCs) were included and underwent a 3.0T MRI examination, using the MEGA-PRESS sequence to analyze GABA and Glx levels of PAG and DN. The correlations between these neurotransmitter levels and clinical characteristics were also analyzed.ResultsThere were no significant differences in the GABA+/Water, GABA+/Cr, Glx/Water, and Glx/Cr levels in both PAG and DN between the two groups (all p > 0.05). Moderate-severe NDPH patients had lower levels of Glx/Water (p = 0.034) and Glx/Cr (p = 0.012) in DN than minimal-mild NDPH patients. In patients with NDPH, higher Glx/Water levels in the PAG (r=-0.471, p = 0.031, n = 21) and DN (r=-0.501, p = 0.021, n = 21) and higher Glx/Cr levels in DN (r=-0.483, p = 0.026, n = 21) were found to be correlated with lower Visual Analogue Scale scores. Additionally, a positive correlation was observed between the GABA+/Cr levels in the DN and the Generalized Anxiety Disorder-7 scores (r = 0.519, p = 0.039, n = 16).ConclusionsThe results of this study indicated that the GABA and Glx levels in the PAG and DN may not be the primary contributor to the development of NDPH. The correlations between certain clinical scales and the neurotransmitter levels may be derived from the NDPH related symptoms.

Analysis of Depression and Anxiety Scores Following Initiation of Elexacaftor/Tezacaftor/Ivacaftor in Adults With Cystic Fibrosis.

Elexacaftor/tezacaftor/ivacaftor (E/T/I) has provided life-changing pharmacotherapy for many people with cystic fibrosis (CF), but conflicting literature exists regarding the effect on mental health. While some reports suggest E/T/I may induce adverse psychiatric symptoms, others report improvements in mental health symptoms. To add to this growing body of knowledge, we retrospectively analyzed depression and anxiety symptoms before and after E/T/I initiation in adults with CF at a single large US CF center. Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) scores recorded in a database were studied. Patients with scores collected before and after E/T/I initiation were included. Regression analyses described associations between score changes and age, race, ethnicity, sex, CFTR variant, and prior depression and/or anxiety diagnoses. Secondary analyses examined possible confounding effects of the COVID-19 pandemic. There was no change in mean GAD-7 (0.5 ± 5.3, p = 0.41) or PHQ-9 (-0.02 ± 6.0, p = 0.97) scores following initiation of E/T/I (N = 86). A trend between a prior diagnosis of depression and worsening in PHQ-9 post-E/T/I was observed (OR 3.58; p = 0.054). Treatment with E/T/I does not lead to changes in depression or anxiety symptoms at the population level in this single center cohort study. A prior diagnosis of depression trended towards an increased odds of worsening PHQ-9 scores after E/T/I initiation.

Intravenous patient-controlled analgesia with esketamine improves early depressive symptoms in patients with postherpetic neuralgia: a single-center retrospective cohort study

ObjectivePatients with Postherpetic Neuralgia (PHN) often exhibit depressive-like symptoms, significantly impacting their quality of life. Esketamine, known for its analgesic properties, has also been recognized for its rapid antidepressant effects. However, its efficacy in the treatment of PHN requires further exploration. This study aims to evaluate the impact of intravenous patient-controlled analgesia(PICA) with esketamine on depressive mood in PHN patients.MethodsThis retrospective study analyzed PHN patients hospitalized and treated at the affiliated hospital of Southwest Medical University from June 2021 to March 2023. Patients were divided into the esketamine group (E group) and the sufentanil group (S group) based on their treatment regimens. Primary outcomes included pain numerical rating scale(NRS), depression patient health questionaire-9(PHQ-9), and anxiety generalized anxiety disorder-7(GAD-7) scores measured before treatment, and at 3 days, 7 days, 1 month, 2 months, and 3 months post-treatment.ResultsA total of 83 patients were included in the analysis. Before treatment, there were no statistically significant differences in pain NRS, depression PHQ-9, and anxiety GAD-7 scores between the two groups (P > 0.05). Compared to before treatment, significant reductions in pain NRS scores were observed at all post-treatment time points in both groups (P < 0.05), with no differences between groups (P > 0.05). The E group exhibited significantly lower depression PHQ-9 scores than the S group at 3 days and 7 days post-treatment (P < 0.05), but no significant differences were observed at 1 month, 2 months, and 3 months (P > 0.05). Anxiety GAD-7 scores were significantly lower in the E group compared to the S group at 3 days, 7 days post-treatment (P < 0.05), with no statistical differences at 1 month, 2 months, and 3 months post-treatment (P > 0.05).ConclusionBoth PICA with esketamine and sufentanil alleviated pain equally in PHN patients. However, PICA with esketamine specifically improved early symptoms of anxiety and depression.

Efficacy of cognitive behavioral therapy for menopausal symptoms and quality of life in Korean perimenopausal women: A pilot randomized controlled trial

ObjectivesTherapeutic interventions are crucial for perimenopausal women, given the challenging physical and psychological symptoms they face. This study focused on the development and verification of the efficacy of a cognitive behavioral therapy (CBT) protocol designed specifically for Korean perimenopausal women. Study designA CBT protocol for perimenopausal women was newly developed based on theory and evidence. Forty menopausal women were randomly assigned to either the CBT group (n = 19) or treatment-as-usual (TAU) group (n = 21). Participants in the CBT group underwent 60-min weekly sessions for eight weeks. The TAU group received standard care from gynecologists. Main outcome measuresAt baseline and follow-up, participants completed the Menopausal Rating Scale (MRS), World Health Organization Quality of Life Brief Version (WHOQOL-BREF), Patient Health Questionnaire-9, Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-15 (PHQ-15), Menopause Emotional Symptom Questionnaire (MESQ), and Subjective Memory Complaints Questionnaire. ResultsThe CBT group showed significant changes in their MRS (F = 4.18, p = .048), WHOQOL-BREF (7.60, 0.009), GAD-7 (4.61, 0.038), PHQ-15 (5.49, 0.025), and MESQ scores (7.19, 0.011) compared to the TAU group. In the CBT group, changes in GAD-7 scores were correlated with PHQ-15 (ρ = 0.57, p < .05), MESQ (0.57, < 0.05), and WHOQOL-BREF scores (−0.53, < 0.05). ConclusionCBT prevents the worsening of menopausal and emotional symptoms, anxiety, and quality of life. CBT may have had a therapeutic effect through the following mechanisms: managing anxiety by changing perceptions of menopause through education and training for coping with various menopausal symptoms and improving self-efficacy in symptom management. Clinical trial registration numberKCT0007517.

The impact of prenatal mental health on birth outcomes before and during the COVID-19 pandemic in Anhui, China.

Adverse birth outcomes remain challenging public health problems in China. Increasing evidence indicated that prenatal depression and anxiety are associated with adverse birth outcomes, highlighting the importance and severity of prenatal depression and anxiety in China. The COVID-19 pandemic is likely to further exacerbate prenatal mental health problems and increase the risk of adverse birth outcomes. The aim of this study is to assess and compare the impacts of prenatal mental health issues on birth outcomes before and during the COVID-19 pandemic in Ma'anshan, Anhui, China. Participants in this study were women who visited local maternal and child health hospitals in Ma'anshan, Anhui, China. Two independent sets of individual maternal data (npre-pamdemic = 1148; npandemic = 2249) were collected. Prenatal depression and anxiety were measured online using the Edinburgh Postnatal Depression Scale (EPDS) and the General Anxiety Disorder-7 (GAD-7). Adverse birth outcomes were determined using hospital-recorded infant birth weight and gestational age at delivery. In this study, we found that the pandemic cohort had lower mean EPDS and GAD-7 scores than the pre-pandemic cohort. The prevalence of prenatal depression (14.5%) and anxiety (26.7%) among the pandemic cohort were lower than the pre-pandemic cohort (18.6% and 36.3%). No significant difference was found in the prevalence of adverse birth outcomes comparing the two cohorts. Prenatal depression was associated with small gestational age only in the pandemic cohort (OR = 1.09, 95% CI 1.00-1.19, p = 0.042). Overall, this study highlighted an association between prenatal depression and small for gestational age in Anhui, China. Addressing prenatal depression may thus be key in improving birth outcomes. Future studies could focus on potential causal relationships.

Anxiety and depression are common in surgical oncology patients: Results of a prospective cohort study

BackgroundThe oncology patient population is vulnerable to elevated levels of anxiety and depression. These states of psychological distress have been associated with negative effects on treatment course and outcomes, but reported prevalence rates are varied. The General Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9) questionnaires are screening tools that can be utilized to assess the levels of anxiety and depression, respectively. MethodsThis prospective, surgeon-blinded study assessed the preoperative prevalence of anxiety and depression in patients with abdominal malignancies who underwent curative-intent resection. Postoperative outcomes and survival were assessed. ResultsOverall, 218 patients were enrolled and included in the final analysis. Patients were stratified into groups by severity of anxiety and depression. 67 (31 %) patients reported at least mild anxiety as defined by GAD-7 score of 5 +, and 74 (34 %) patients reported at least mild depression, as defined by PHQ-9 score of 5 +. Functional status as defined by Eastern Cooperative Oncology Group scores was associated with anxiety (P = 0.003) and depression (P = 0.024). Depression was associated with race and ethnicity (P = 0.014) and marital status (P = 0.021), with Hispanic/Latino and unpartnered patients reporting higher rates of depression. ConclusionAnxiety and depression are common in the surgical oncology population, affecting a third of the patient population in this prospective study. In addition to a thorough social assessment, the GAD-7 and PHQ-9 questionnaires can be utilized preoperatively to identify patients with psychological distress. SynopsisAnxiety and depression were assessed preoperatively in patients with abdominal malignancies who underwent curative-intent resection. These states of psychological distress were highly prevalent, affecting a third of the population, and significantly associated with certain vulnerable groups.

Impact of Dialectical Behavioral Therapy on Anxiety Levels Among African American Adolescents.

Anxiety and depression among adolescents in the United States has steadily increased. In addition, significant disparities in access to mental health care exist for African Americans. The purpose of the current project was to support the mental health of African American adolescents involved in faith-based youth groups through implementation of dialectical behavioral therapy (DBT). The community partner was an African American church in Southwest Georgia. Mindfulness training modules are offered in monthly sessions. Pre- and post-intervention surveys and the Generalized Anxiety Disorder-7 (GAD-7) were analyzed, comparing mean GAD-7 scores before and after participation. Nurse-led quality improvement initiatives support adolescent mental health and provide sustainable resources for mental health in rural areas. Results of the quality improvement project reveal improvement in self-reported anxiety symptoms among participants after the 4-month DBT intervention. [Journal of Psychosocial Nursing and Mental Health Services, 62(8), 7-10.].

Medical Debt and the Mental Health Treatment Gap Among US Adults

Medical debt is common in the US and may hinder timely access to care for mental disorders. To estimate the prevalence of medical debt among US adults with depression and anxiety and its association with delayed and forgone mental health care. Cross-sectional, nationally representative survey study of US adult participants in the 2022 National Health Interview Survey who had current or lifetime diagnoses of depression or anxiety. Self-reported lifetime clinical diagnoses of depression and anxiety; moderate to severe symptoms of current depression (Patient Health Questionnaire-8 score ≥10) and anxiety (Generalized Anxiety Disorder-7 score ≥10) irrespective of lifetime diagnoses; and past-year medical debt. Self-reported delaying and forgoing mental health care because of cost in the past year. Among 27 651 adults (15 050 [54.4%] female; mean [SD] age, 52.9 [18.4] years), 5186 (18.2%) reported lifetime depression, 1948 (7.3%) reported current depression, 4834 (17.7%) reported lifetime anxiety, and 1689 (6.6%) reported current anxiety. Medical debt was more common among adults with lifetime depression (19.9% vs 8.6%; adjusted prevalence ratio [aPR], 1.97; 95% CI, 1.96-1.98), lifetime anxiety (19.4% vs 8.8%; aPR, 1.91; 95% CI, 1.91-1.92), current depression (27.3% vs 9.4%; aPR, 2.34; 95% CI, 2.34-2.36), and current anxiety (26.2% vs 9.6%; aPR, 2.24; 95% CI, 2.24-2.26) compared with adults without the respective mental disorders. Medical debt was associated with delayed health care among adults with lifetime depression (29.0% vs 11.6%; aPR, 2.68; 95% CI, 2.62-2.74), lifetime anxiety (28.0% vs 11.5%; aPR, 2.45; 95% CI, 2.40-2.50), current depression (36.9% vs 17.4%; aPR, 2.25; 95% CI, 2.13-2.38), and current anxiety (38.4% vs 16.9%; aPR, 2.48; 95% CI, 2.35-2.66) compared with those without these diagnoses. Medical debt was associated with forgone health care among adults with lifetime depression (29.4% vs 10.6%; aPR, 2.66; 95% CI, 2.61-2.71), lifetime anxiety (28.2% vs 10.7%; aPR, 2.63; 95% CI, 2.57-2.68), current depression (38.0% vs 17.2%; aPR, 2.35; 95% CI, 2.23-2.48), and current anxiety (40.8% vs 17.1%; aPR, 2.57; 95% CI, 2.43-2.75) compared with those without the diagnoses. Medical debt is prevalent among adults with depression and anxiety and may contribute to the mental health treatment gap. In the absence of structural reform, new policies are warranted to protect against this financial barrier to mental health care.