Generalized Anxiety Disorder-7 Scores Research Articles

Validation of the Generalized Anxiety Disorder-7 in patients with COPD: a cross-sectional study

BackgroundPatients with chronic obstructive pulmonary disease (COPD) often have comorbid generalized anxiety disorder (GAD), which requires early screening in respiratory clinics. The Generalized Anxiety Disorder-7 (GAD-7) questionnaire is a brief and commonly used screening tool for GAD but has not been validated among patients with COPD in China.MethodsStable patients with COPD from a cross-sectional observational study were assessed using the GAD-7 questionnaire and then assessed by a senior psychiatrist to confirm a diagnosis of GAD according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Demographic characteristics, spirometry, and patient-reported outcomes were collected. Cronbach’s α coefficient was calculated, and receiver operating curve (ROC) analysis was performed to validate the GAD-7.ResultsA total of 226 patients with COPD were enrolled, and 50 (22.1%) of these patients were diagnosed with GAD. The Cronbach’s α coefficient for the GAD-7 was 0.869, which indicated good internal consistency. ROC curve analysis showed that the GAD-7 had an area under the curve (AUC) value of 0.829 (95% CI: 0.774–0.876) for identifying GAD. The optimal cut-off score was ≥ 4, with a sensitivity of 66.0% and a specificity of 89.2%. Higher GAD-7 scores were significantly associated with health-related quality of life and the symptom burden of COPD. The discriminatory power of GAD-7 did not differ statistically when stratified by COPD severity.ConclusionsThe GAD-7 was shown to be a reliable and valid screening tool for patients with COPD in China, and its screening performance for GAD was not influenced by disease severity.

Evaluation the validity and reliability of the perceived medical school stress scale in Turkish medical students.

Medical education can be a challenging and stressful process. Additional stressors can make the medical education process even more complex and impair a student's attention and concentration. To the authors' knowledge, there is no valid and reliable scale to measure medical school stress in Turkish medical students. Therefore, this study aimed to determine the validity and reliability of the Perceived Medical School Stress (PMSS) Scale in Turkish medical students. The Perceived Medical School Stress Scale is a self-assessment tool developed to measure medical school-induced stress in medical students. It consists of 13 items divided into two subdimensions. Scale items are answered using a four-point (0-4) Likert system The total score that can be obtained from the PMSS ranges from 0 to 52, with higher scores indicating higher levels of perceived stress. First, the scale was applied as a pilot to 52 students by performing the scale's back-and-forth translation into Turkish. Then, the scale was applied to 612 volunteer medical students to ensure validity. Convergent validity and confirmatory factor analysis are used to assess the construct validity of a scale. Test-retest, item correlations, and Cronbach's alpha coefficients are used to evaluate the reliability of a scale. As a result of confirmatory factor analysis, the two-factor structure of the original scale was confirmed. The fit indices of the model obtained showed excellent fit. The Generalized Anxiety Disorder-7 (GAD-7) Scale was used for convergent validity. The GAD-7 is a self-assessment tool that measures the level of generalized anxiety. It is answered with a four-point Likert scale for the last two weeks. The score that can be obtained from the scale is between 0-21. A score of ten or more indicates possible anxiety disorder. The students' mean perceived medical school stress score was 39.80±8.09, and their GAD-7 score was 11.0±5.5. A significant positive relationship was found between the total scores of the scales (r = .48, P < .001). The Cronbach's alpha value of the scale was .81, and test-retest reliability was significant for all scale items (P < .001 for all). No item was deleted according to Cronbach's alpha values and item-total correlations. There was no significant relationship between Turkish version of the PMSS and GAD-7 scores and age, sex, income status, tobacco use, or exercise (P>.05). The Turkish version of the Perceived Medical School Stress Scale is a valid and reliable scale that can be used to investigate the medical school-specific stress of students.

A Prospective Study of Social Needs Associated with Mental Health among Postpartum Patients Living in Underserved Communities.

Given the rising rates of maternal morbidity and mortality in the United States and the contribution of mental illness, especially among individuals living in underresourced communities, the objective was to evaluate the prevalence of unmet health-related social needs and their impact on perinatal mental health outcomes. This was a prospective observational study of postpartum patients residing within regions with increased rates of poor perinatal outcomes and sociodemographic disparities. Patients were enrolled in a multidisciplinary public health initiative "extending Maternal Care After Pregnancy (eMCAP)" between October 1, 2020 and October 31, 2021. Unmet health-related social needs were assessed at delivery. Symptoms of postpartum depression and anxiety were evaluated at 1 month postpartum utilizing the Edinburgh Postnatal Depression Scale (EPDS) and Generalized Anxiety Disorder-7 (GAD7) screening tools, respectively. Mean EPDS and GAD7 scores and odds of screening positive (scoring ≥ 10) were compared among individuals with and without unmet health-related social needs with p < 0.05 considered significant. Of participants enrolled in eMCAP, 603 completed at least one EPDS or GAD7 at 1 month. Most had at least one social need, most commonly dependence on social programs for food (n = 413/603; 68%). Individuals lacking transportation to medical (odds ratio [OR]: 4.0, 95% confidence interval [CI]: 1.2-13.32) and nonmedical appointments (OR: 4.17, 95% CI: 1.08-16.03) had significantly higher odds of screening positive on EPDS while participants lacking transportation to medical appointments (OR: 2.73, 95% CI: 0.97-7.70) had significantly higher odds of screening positive on GAD7. Among postpartum individuals in underserved communities, social needs correlate with higher depression and anxiety screening scores. This highlights the need to address social needs to improve maternal mental health. · Social needs are prevalent among underserved patients.. · Needs can be assessed in a structured or freeform manner.. · Unmet needs correlate with poor mental health outcomes.. · Similar needs correlate with depression and anxiety..

Effectiveness of Daily Mindfulness Meditation App Usage to Reduce Anxiety and Improve Well-Being During the COVID-19 Pandemic: A Randomized Controlled Trial.

Introduction This study examined the effect of 10-minutedaily meditation app usage for 30 days on adult anxiety and mental well-being during the first year of the COVID-19 pandemic. Methods Participants were randomized into intervention (10 minutes of daily usage of the Insight Timer app) or control groups. Participants completed surveys to assess anxiety and well-being pre- and post-study. Data were analyzed using t-tests, analysis of variance (ANOVA), or nonparametric equivalents. Results Pre-study results were comparable between groups. The pre- vs. post-study General Anxiety Disorder-7 (GAD-7) scores for anxiety decreased in the intervention group (n=18, median 5.5 vs. 3.0 (pre vs. post), p=0.0233, d=0.50), but not in the control group (n=28). The intervention group had a lower median GAD-7 score than the control group post-study (3.0 vs. 8.0, p=0.0223, d=0.35). Pre- vs. post-study mean 5-item World Health Organization Well-Being Index (WHO-5) scores were improved in both the control (11.6 vs. 12.9 (pre vs. post), p=0.0408, d=0.36) and intervention groups (12.0 vs. 16.3 (pre vs. post), p=0.0001, d=0.77), although it was higher in the intervention group (16.3 vs. 12.9, p=0.0056, d=0.88). Conclusion Ten minutes of daily meditation app usage for 30 days may reduce anxiety and improve well-being in adults during the COVID-19 pandemic.

Influences of High School Physical Learning Environments on Students' Anxiety in China.

High school students are at an increased risk of developing generalized anxiety disorder (GAD) due to significant pressure to achieve academic success. Although it is known that a school's physical learning environment can influence students' GAD, there is limited research examining this relationship. To fill this knowledge gap, a cross-sectional study was conducted among 230 students from two high schools in China. A survey questionnaire captured students' GAD self-evaluations (dependent variables), perceptions/preferences of their school physical environment (independent variables), and social and personal conditions (confounding variables). Bivariate analysis showed that students' GAD scores were associated with multiple factors related to the learning environment, physical activities, and personal characteristics. The multivariate analysis examined the relationship between GAD scores and physical learning environment variables while controlling for confounding variables. The results indicated that adequate lighting (B = -0.154, p = .029) and perceived effectiveness of using self-service cafeterias in reducing anxiety (B = -0.138, p = .044) were significantly associated with GAD scores. These findings provide evidence for the importance of designing high schools with students' mental health in mind. Specifically, school administrators and designers should consider how to improve the physical learning environment by incorporating natural light, a self-service cafeteria, and spaces for physical activities to promote students' mental well-being.

The prevalence of undiagnosed anxiety: A national survey

Generalized anxiety disorder (GAD) is a chronic condition characterized by excessive, unrealistic worry and anxiety about multiple events or activities and leads to significant impairment in daily functioning and quality of life. Effective treatments for GAD exist, but the first step is identification of the disorder. The current study aims to document the frequency of GAD symptoms amongst the general US population. A web-based survey was conducted to assess the frequency of daily anxiety symptoms amongst adults residing in the United States. Questions from the GAD-7 were used to be able to quantify the burden of diagnosed and undiagnosed generalized anxiety disorder. JMP 16.0 for Mac OS was used to perform statistical analyses. Institutional Board Review gave the study an exempt determination (#2022–569). The median GAD-7 score was 16 (IQR 12–19) with a range from to 7 to 28. GAD-7 scores stratified by diagnosed (median=14) vs. undiagnosed (median =18) demonstrated a significant difference (P<0.0001) with a robust goodness-of-fit coefficient (R2= 14.3%).Persons who were retired (p = 0.0262) or older (p = 0.0356) were significantly less likely to experience GAD symptoms. Conversely, sex, age, income and the use of depressants, stimulants or benzodiazepines were not significantly correlated with a GAD score of ≥15. The present findings are based on cross-sectional survey data. This study suggests that more than 50% experience symptoms concerning for GAD, without a formal diagnosis. The relevance of this research is it underscores the importance of mental health outreach, and removal of stigma surrounding mental health.

Longitudinal mental health trends in cystic fibrosis

BackgroundMental health screening in accordance with consensus guidelines became routine clinical practice in our cystic fibrosis (CF) Center in 2015. We hypothesized improvement in anxiety and depression symptoms over time and associations between elevated screening scores and disease severity. We aimed to observe the impact of the COVID-19 pandemic and modulator use on mental health symptoms. MethodsRetrospective chart reviews were conducted for people 12 years and older with at least one Generalized Anxiety Disorder-7 (GAD-7) or Patient Health Questionnaire-9 (PHQ-9) screening for six years. Descriptive statistics were used to summarize demographic variables and logistic regression and linear mixed models were used to evaluate the relationship between screening scores and clinical variables. ResultsAnalyses included 150 participants (ages 12–22 years). The percentage of minimal to no symptom scores increased over time for anxiety and depression. Increased mental health visits and CFRD were associated with higher PHQ-9 and GAD-7 scores. Higher FEV1pp was associated with lower GAD-7 and PHQ-9 scores. More effective modulator use was associated with lower PHQ-9 scores. Mean PHQ-9 and GAD-7 scores were not significantly different when comparing pre-pandemic and pandemic scores. ConclusionDisruptions in screening during the pandemic were minimal and symptom scores remained stable. Individuals with higher mental health screening scores were more likely to have CFRD and utilization of mental health services. Consistent mental health monitoring and support is needed so individuals with CF can endure anticipated and unanticipated stressors including changes in physical health, healthcare, and societal stressors such as COVID-19 pandemic.

Self-reported depression and anxiety rates among females with cutaneous leishmaniasis in Hubuna, Saudi Arabia.

Cutaneous leishmaniasis (CL) is a parasitic disease transmitted through the bite of infected sandflies, causing disfiguring skin lesions and a range of physical symptoms. However, the psychological impact of CL is often overlooked despite the significant burden it imposes on the affected individuals and communities. This is especially true in Saudi Arabia, where limited research exists on the psychological consequences of CL, particularly among females. This study aimed to address this knowledge gap by investigating the perceived psychological problems associated with CL among females living in the Hubuna area of Saudi Arabia. This cross-sectional study recruited 213 females with CL in the Hubuna area of Saudi Arabia using purposive sampling. Data was collected using a self-administered electronic questionnaire that included socio-demographic characteristics and measures of depression and anxiety using the BDI and GAD-7 tools. Descriptive analysis was used to determine the psychological impact of CL, including means and standard deviations for the BDI and GAD-7 scores, as well as frequencies and percentages for other variables of interest. Logistic regression was performed to identify independent predictors of anxiety and depression, including variables such as age, marital status, education, occupation, number and location of lesions. The significance level for all statistical tests was set at p < 0.05. The study was carried out between September and December of 2022. The study found that the mean Beck Depression Inventory (BDI) and Generalized Anxiety Disorder-7 (GAD-7) scores among the participants were 8.67 ± 4.82 out of 63 and 8.20 ± 7.08 out of 21, respectively. Furthermore, the prevalence of depression and anxiety was 55.9% and 68.1%, respectively, indicating a significant psychological burden associated with CL in the study population. The results of the logistic regression analysis showed that anxiety and depression were significantly associated with age, marital status, number of lesions, and location of the lesions on the body, highlighting the importance of considering these factors when designing interventions aimed at improving the mental health of CL patients. In conclusion, this study highlights the significant psychological impact of CL among females in the Hubuna area of Saudi Arabia, calling for urgent action to address this neglected aspect of the disease. By integrating mental health considerations into CL prevention and management efforts, healthcare providers can improve the overall well-being of affected individuals and contribute to the broader goal of eliminating CL as a public health concern.

The Prevalence of Anxiety and Depressive Symptoms Among Patients With Celiac Disease in Jordan.

Background Celiac disease is an immune-mediated intestinal disorder with a global prevalence of 1% that results from gluten sensitivity in a genetically susceptible person. It presents with gastrointestinal symptoms, consequences of malabsorption, and/or extraintestinal manifestations that include neuropsychiatric symptoms. Aim The aim of this study was to measure the frequency of anxiety and depressive symptoms in Jordanian patients with celiac disease. Methods This was a cross-sectional study. A questionnaire was sent electronically to celiac disease patients who were members of the Friends of Celiac Disease Patients Association through WhatsApp using Google Forms (Google, Mountain View, California). The questionnaire contained demographic and disease-related questions, in addition to questions that assessed anxiety and depressive symptoms using validated Arabic versions of the Generalized Anxiety Disorder-7 score and Patient Health Questionnaire-9, respectively. Results A total of 133 patients answered the questionnaires. Of the respondents, 82.7% were females, and the mean age was 33.9 +/- 11.22 years; 31.6% of patients were non-compliant witha gluten-free diet, and 56.4% were symptomatic at the time of the questionnaire. The prevalence of anxiety and depressive symptoms were 85% and 82.7%, respectively. There was no correlation between any of the variables and the presence of anxiety or depressive symptoms. Conclusion A significant proportion of celiac disease patients in Jordan have evidence of anxiety and depressive symptoms. Given this high prevalence and the possible impact on the quality of life, physicians need to screen patients for the presence of psychiatric comorbidities and refer those who have symptoms for further evaluation.

0932 Sleep Difficulties: Prevalence, relationship with psychological outcomes, and interindividual differences in student-athletes

Abstract Introduction Mental health issues are a leading cause of decreased academic and athletic performances when left untreated. Recently, the International Olympic Committee (IOC) and the National Collegiate Athletic Association (NCAA) have highlighted the fundamental importance of mental health among young athletes. Sleep represents a core feature of mental health, and student-athletes represent a vulnerable population for sleep restriction and disruption due to the demands of their courseload and training schedule. This investigation was performed to identify differences in sleep and mental health across gender, race/ethnicity, and sport type. Methods Data were obtained throughout the academic semester from Canadian institutions, with student-athletes completing the Athlete Sleep Screening Questionnaire (ASSQ), General Anxiety Disorder-7 (GAD-7), and Patient Health Questionnaire (PHQ-9). ASSQ captured sleep and circadian health, while GAD-7 and PHQ-9 assessed anxiety and depressive symptoms, respectively. Linear regression determined gender, race/ethnicity, and sport type differences across ASSQ sleep problems score, ASSQ sleep items, GAD-7 score, PHQ-9 score, and PHQ-9 item #9 (suicidal ideation). Results Final sample (N=559) was 53.0% female, 79.1% white, comprised of young individual (Mean Age = 18.9 ± 3.21), and included student-athletes from basketball, field-hockey, football, ice-hockey, soccer, volleyball, track &amp; field and swimming. Females reported more overall sleep difficulties (p=0.01), medication use (p=0.04) and WASO (p=0.001) compared to males. Females also reported higher anxiety (p &amp;lt; 0.0001), depression (p&amp;lt; 0.0001), and suicidal ideation (p=0.03). Significant variance in total sleep time (TST) (p=0.001) and sleep satisfaction (p=0.04) was observed across race/ethnicity, with student-athletes identifying as Black or African American reporting the lowest TST, while Asian or Pacific Islander student-athletes reported the lowest sleep satisfaction. Significant variance in sleep difficulties score (p&amp;lt; 0.0001), TST (p &amp;lt; 0.0001), and satisfaction (p&amp;lt; 0.0001), as well as anxiety (p &amp;lt; 0.0001) and depression (p&amp;lt; 0.0001) was observed across sport type. Football student-athletes reported the highest sleep difficulties score, and lowest TST satisfaction. Field-hockey student-athletes reported the highest anxiety and depression. Conclusion Results suggest that sleep and mental health challenges present differently across gender, race/ethnicity, and sport type. Clarifying these unique and specific challenges to student-athlete sleep and mental health is necessary to enhance and personalize interventions. Support (if any) Mitacs #IT23469

0172 Canadian varsity athletes’ sleep and mental health: preliminary analyses

Abstract Introduction Because of their double reality of university student and athlete, varsity athletes are particularly at risk of having sleep difficulties, but also depression and anxiety symptoms. To this day, there is almost no data available characterizing the sleep of Canadian varsity student-athletes, while these athletes must often combine their studies and sports practice with a job to support themselves. As part of a larger study, the aim of the present study was to investigate the relationship between sleep and well-being in young Canadian varsity athletes at the beginning of their sports season. Methods A team of 16 Canadian varsity basketball players that will undergo a sleep management program completed a modified version of the Pittsburgh Sleep Index Quality (PSQI), the insomnia severity index (ISI), the Epworth Sleepiness Scale (ESS), the Generalized Anxiety Disorder-7 (GAD-7), the Patient Health Questionnaire-9 (PHQ-9), and the Athlete Burnout Questionnaire (ABQ) before the intervention at the start of the season. The relationships between scores on each well-being questionnaire and scores on the sleep questionnaires were investigated using Pearson product moment correlations. Results Total GAD-7 scores were significantly associated with PSQI scores (r=.666, p=.005) and ISI scores (r=.755, p&amp;lt;.001). Total PHQ-9 scores were significantly associated with PSQI scores (r=.844, p&amp;lt;.001) and ISI scores (r=.855, p&amp;lt;.001). Total ABQ scores were significantly associated with PSQI scores (r=.592, p=.016). There was no other significant correlation found. Conclusion These preliminary results suggest that sleep disturbances, such as insomnia symptoms and poor sleep quality are closely associated with anxiety, depression, and athlete burnout symptoms in varsity athletes. Future analyses of this study will allow us to verify whether participation in a program aimed at improving sleep can have an impact on their mental health, as well as on other aspects related to the practice of their sport. Support (if any)

The impact of resilience on headache disability as measured by the Migraine Disability Assessment (MIDAS).

Our objectives were to examine cross-sectional correlations of headache disability with measures of resilience, anxiety, and depression, and to determine if resilience modified the association between headache severity/frequency and disability. Resilience is associated with quality of life and functioning among patients with chronic conditions. We investigated whether resilience strongly mitigates headache-related disability as measured by the Migraine Disability Assessment (MIDAS). We prospectively recruited 160 patients with primary headache disorders seen in a tertiary headache medicine program between February 20, 2018 and August 2, 2019. Each participant completed the MIDAS, Conner Davidson Resilience Scale (CDRS-25), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and WHO-5 Well-Being Index. The CDRS-25 score was negatively correlated with the total MIDAS (r = -0.21, p = 0.009), GAD-7 (r = -0.56, p < 0.001), and PHQ-9 scores (r = -0.34, p < 0.001). Well-being inversely correlated with disability (r = -0.37, p < 0.001). Increases in anxiety and depression increased the odds of disability. A 1 point increase in the CDRS-25 score decreased the odds of being severely disabled by 4% (OR = 0.96, 95% CI: 0.94 to 0.99, p = 0.001). However, the CDRS-25 score did not significantly moderate the association between headache days and disability. Traits associated with resilience decreased the odds of severe disability from headaches, whereas anxiety, depression, and headache frequency were strongly associated with higher disability from headache.

Adherence to the MIND diet is inversely associated with odds and severity of anxiety disorders: a case–control study

BackgroundThe association between the Mediterranean-DASH diet Intervention for Neurodegenerative Delay (MIND) diet, odds, and severity of anxiety disorders (AD) is still unclear. We aimed to investigate whether adherence to MIND diet is associated with odds and severity of AD.MethodsThe present case–control study carried out on 85 patients who were group matched by gender with 170 healthy subjects. Data for dietary intake was assessed by using a 147-item validated food frequency questionnaire (FFQ). Anthropometric measures were collected using standard methods. The MIND diet score was calculated using FFQ. We assessed anxiety disorder severity using the Generalized Anxiety Disorder-7 (GAD-7) questionnaire. Multivariate odds ratios (OR) with 95% confidence intervals (CI) were used to investigate the association of MIND diet and anxiety disorder.ResultsWe observed that higher adherence to MIND diet was associated with the lower GAD-7 score (p < 0.001). Individuals in the top category of MIND diet score were 97% less likely to have AD compared with those in the bottom category (OR: 0.03, 95% CI: 0.01, 0.09). There was significant reverse linear association between MIND diet score and AD (β = -3.63, p < 0.001).ConclusionsIn conclusion, we provided some evidence indicating negative association between adherence to MIND diet, odds, and severity of AD. Finally, due to the probable preventive role of diet, it is vital to clarify the association between diet and AD through large-scale prospective cohort studies in the future.

Impact of COVID-19 on medical care conduct and psychological burden among patients with psoriasis: real-world data from a tertiary hospital in China

Objective: The ongoing coronavirus disease 2019 (COVID-19) epidemic has caused extensive damage worldwide. We explored whether the medical care conduct of patients with psoriasis has changed and whether the COVID-19 epidemic has placed more psychological pressure on these patients. Methods: A questionnaire survey was administered to patients with psoriasis in the Dermatology Department of Peking University Third Hospital in July 2022. Information about the patients’ general demographics, psoriasis condition, mental state of anxiety [Generalized Anxiety Disorder-7 (GAD-7) score], changes in medical care conduct, and Concerns about COVID-19-Related Risk Score for Psoriasis (CCRSP, a self-designed questionnaire) was collected. Univariate analysis with the Mann–Whitney U test for continuous variables was used in the estimation of statistical differences. Results: A total of 112 patients with psoriasis completed the survey. Purchasing medicine was the factor that added difficulty for most participants (32.1%). Fewer participants (26.8%) encountered medical registration difficulties than economic and transportation difficulties. Nearly three-quarters of participants (73.2%) reported at least one medical care conduct change resulting from the COVID-19 epidemic. A small proportion of participants (12.5%) thought that COVID-19 prevented them from seeking medical services for psoriasis. The top three items that caused the most concern were psoriasis aggravation resulting from drug reduction and withdrawal because of COVID-19 (44.7%), psoriasis aggravation after infection with COVID-19 (38.4%), and psoriasis-related side effects of the COVID-19 vaccine (35.7%). The GAD-7 score of patients with a high CCRSP (score of &gt;10) was significantly higher than that of patients with a low CCRSP (score of ≤10) (non-parametric test, P = 0.047). Conclusion: COVID-19 poses challenges and places a mental burden on patients with psoriasis. Doctors should regulate the medical behavior of patients with psoriasis according to their specific COVID-19 situation and help patients ease their anxiety to maintain the stability of their psoriasis condition.

PO-02-194 CHANGES IN ANXIETY AND DEPRESSION IN ATRIAL FIBRILLATION PATIENTS AFTER RECEIVING MULTIDISCIPLINARY CARE AT AN ATRIAL FIBRILLATION CENTER OF EXCELLENCE

Anxiety and depression are known to occur in over one third of patients with atrial fibrillation (AF) and may negatively affect quality of life (QoL) and AF symptom severity. Though highly prevalent, the relationship between anxiety and depression with AF care remains poorly defined. The goal of an Atrial Fibrillation Center of Excellence (AFCoE) is to improve outcomes by delivering team-based multidisciplinary care to streamline risk factor modification while incorporating performance -measures and ongoing quality improvement to facilitate data-driven delivery of high-quality, guideline directed care. In the pilot phase of the AFCoE at the Inova Heart and Vascular Institute, an AF care coordinator and specialists from electrophysiology and sleep medicine were included based on patient need. To investigate changes in mental health status following multidisciplinary AF care received in an AFCoE in patients with AF. 138 patients were referred to the Inova AFCoE pilot between 10/2021 and 4/2022. Demographic and clinical comorbidities were ascertained. The frequency and severity of anxiety and depression were measured in a subset of participants (n=41) using the General Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9) tools administered at baseline and again between 3 to 6 months after their initial AFCoE visit. Baseline and follow-up summed GAD-7 and PHQ-9 scores were compared using the Wilcoxon test. Additional analyses were performed among patients with clinically significant baseline anxiety (GAD-7 score ≥5 points) or depression (PHQ-9 score ≥5 points). A total of 12/41 (29%) patients had clinically significant depression or anxiety (scores ≥5 points) at baseline. Among patients with clinically significant depression or anxiety at baseline, the median [interquartile range] summed score improved at follow-up from 13[11–15] to 6[1–9] points (p=0.005, score reduction 8[2–14] points). Nearly one third of patients referred to the Inova AFCoE pilot phase had clinically significant anxiety and/or depression at baseline. Multidisciplinary AF treatment without specific behavioral health intervention was associated with clinically significant improvements in anxiety and depression.

Association of mental health status between self-poisoning suicide patients and their family members: a matched-pair analysis

BackgroundThe objective of this study was to examine the relationship of mental health status between self-poisoning suicide patients and their family members, and it also sought to identify potential patient’s risk and parental factors for the prediction of suicide attempt, anxiety, and depression.MethodsIn this study, 151 poisoned patients were prospectively included, and they were matched 1:1 with 151 family members. We gathered information on patient’s and their matched family member’s demographics, lifestyle choices, mental health status, level of intimacy, and history of psychiatry disease. The relationship of patient’s and their family member’s mental health state was investigated using a correlation matrix. Multivariable analyses (multiple logistic regression) were conducted among patients and their matched family members, to identify potential risk factors for self-poisoning suicide, anxiety, and depression.ResultsOf the total patients, 67.55% (102/151) attempted self-poisoning suicide. Poisoned patients had more severe anxiety and depression symptoms than their matched family members, and this difference was even more pronounced among patients with self-poisoning suicide. Generalized anxiety disorder-7 (GAD-7) score for family members was significantly and favorably correlated with patient’s GAD-7 score after eliminating non-suicide patients and their matched family members. The patient health questionnaire-9 (PHQ-9) score showed a similar pattern, and the family member’s PHQ-9 score was strongly and favorably associated with patient’s PHQ-9 and Beck hopelessness scale-20 (BHS-20) score. Multivariable analysis showed that married marital status (P = 0.038), quitting smoking (P = 0.003), sedentary time of 1 to 6 h (P = 0.013), and participation in a sports more than five times per week (P = 0.046) were all significantly associated with a lower risk of suicide by self-poisoning, while a more serious anxiety state (P = 0.001) was significantly associated with a higher risk of self-poisoning suicide. Multivariable analysis demonstrated that, specifically among self-poisoning suicide patients, married marital status (P = 0.011) and no history of psychiatry disease (P < 0.001) were protective factors for anxiety, while divorced or widowed marital status (P = 0.004), a sedentary time of 1 to 3 h (P = 0.022), and a higher monthly income (P = 0.027) were significant contributors to anxiety. The propensity of additional family-matched characteristics to predict patient’s suicidality, anxiety, and depression was also examined.ConclusionsSelf-poisoning suicide patients have severe mental health issues. Patients who self-poison have a close connection to their family member’s mental health, particularly their levels of anxiety and depression. According to the findings, being married and adopting healthy lifestyle habits, such as quitting smoking and drinking, increasing their physical activity levels, and managing their idle time, are able to help patients with mental health concerns and even suicidal thoughts.

Mental Health Trajectories of Children and Caregivers Using School-Based Health Centers During the COVID-19 Pandemic

This wasa prospective study of children registered at school-based health centers (SBHCs) in Canada. The objectives were to compare mental health trajectories of children and parents/caregivers who accessed SBHCs during the pandemic relative to those who did not. Parents/caregivers of children who attended SBHCs completed the Strengths and Difficulties Questionnaire (SDQ) and the Generalized Anxiety Disorder-7 (GAD-7) at three time points during the pandemic. The primary analysis used linear mixed models to examine the relationship between SBHC visits during the pandemic and children's SDQ score trajectories.The secondary analysis was the same for parents'/caregivers' GAD-7 scores. There were 435 children included. SDQ and GAD-7 scores worsened over time for children and parents/caregivers who attended SBHCs during the pandemic compared to those who did not. Children and parents/caregivers with worsening mental health symptoms may have sought care at SBHCs since they were accessible during the pandemic.

Lower serum insulin-like growth factor 1 concentrations in patients with chronic insomnia disorder.

Insulin-like growth factor 1 (IGF-1) is a crucial neurotrophin that is produced in the brain and periphery and may play an important role in insomnia and mood disorders. We aimed to analyze its serum concentrations in patients with chronic insomnia disorder (CID). Patients with CID were enrolled in this study and divided into the CID group [Generalized Anxiety Disorder-7 (GAD-7) score < 10] and the CID with anxiety group (GAD-7 score ≥ 10). Age-and sex-matched healthy volunteers were recruited as controls. The Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality and the GAD-7 and the Patient Health Questionnaire-9 to assess emotional status. All subjects were monitored via polysomnography, and the serum IGF-1 concentrations in their peripheral blood were detected via enzyme-linked immunosorbent assays. We enrolled 65 patients with CID (of whom 35 had anxiety) and 36 controls. The PSQI score and IGF-1 concentration in the CID and CID with anxiety groups were higher than those in the control group. The apparent difference in IGF-1 concentration between the CID and CID with anxiety groups was not statistically significant. The IGF-1 concentration in patients with CID was linearly correlated with the GAD-7 score, PSQI score, and stage 3 non-rapid eye movement (stage N3) time. The serum IGF-1 concentration in patients with CID was lower than that of participants without CID, negatively correlated with anxiety score and sleep quality, and positively correlated with stage N3 time.

Management of neuropsychiatric symptoms in adults treated with elexacaftor/tezacaftor/ivacaftor.

Reports of neuropsychiatric symptoms proximal to cystic fibrosis transmembrane conductance regulator (CFTR) modulator initiation are emerging, but their prevalence and management remain poorly characterized. Retrospective chart review was used to categorize symptom trajectories of all adults at a single CF Center who initiated elexacaftor/tezacaftor/ivacaftor (ETI) before March 2022 and subsequently had ≥1 outpatient visit with the consulting CF psychiatrist. For those who developed neuropsychiatric symptoms probably related to ETI and modified treatment in response, the strategy resulting in greatest improvement with acceptable physical course and tolerability was identified. Ratings were made by a psychiatrist not involved in clinical care. Of 148 adults initiating ETI, 31 were psychiatrically evaluated, 16 of whom developed new/worsening and unexpected neuropsychiatric symptoms probably related to ETI, including neurocognitive (word finding, brain fog, memory, attention/concentration), insomnia, depression, anxiety, fatigue/low energy, mania/hypomania, other distress. This group had higher maximum lifetime Generalized Anxiety Disorder-7 scores (14.42 ± 0.96; p = 0.05) than those with improved, unchanged, or worsening/possibly related symptoms (N = 15; 9.9 ± 1.82). Treatment strategies resulting in much/very much improvement included pharmacologic interventions, psychotherapy, and dose reduction/discontinuing ETI. Although many people initiating ETI experience improved physical and mental health and quality of life, a subset report worsening neurocognition, mood, and anxiety. As novel therapies are developed, ascertaining and evaluating neuropsychiatric symptoms in clinical and research settings is advisable. Larger studies are needed to characterize prevalence, course, and risk factors (e.g., age, gender, clinical status, pharmacokinetics/pharmacogenomics, drug-drug interactions) for neuropsychiatric adverse events related to CFTR modulators and guide effective management.

Feasibility and impact of a mental health chatbot on postpartum mental health: a randomized controlled trial

Perinatal mood disorders are common yet underdiagnosed and un- or undertreated. Barriers exist to accessing perinatal mental health services, including limited availability, time, and cost. Automated conversational agents (chatbots) can deliver evidence-based cognitive behavioral therapy content through text message-based conversations and reduce depression and anxiety symptoms in select populations. Such digital mental health technologies are poised to overcome barriers to mental health care access but need to be evaluated for efficacy, as well as for preliminary feasibility and acceptability among perinatal populations. To evaluate the acceptability and preliminary efficacy of a mental health chatbot for mood management in a general postpartum population. An unblinded randomized controlled trial was conducted at a tertiary academic center. English-speaking postpartum women aged 18 years or above with a live birth and access to a smartphone were eligible for enrollment prior to discharge from delivery hospitalization. Baseline surveys were administered to all participants prior to randomization to a mental health chatbot intervention or to usual care only. The intervention group downloaded the mental health chatbot smartphone application with perinatal-specific content, in addition to continuing usual care. Usual care consisted of routine postpartum follow up and mental health care as dictated by the patient's obstetric provider. Surveys were administered during delivery hospitalization (baseline) and at 2-, 4-, and 6-weeks postpartum to assess depression and anxiety symptoms. The primary outcome was a change in depression symptoms at 6-weeks as measured using two depression screening tools: Patient Health Questionnaire-9 and Edinburgh Postnatal Depression Scale. Secondary outcomes included anxiety symptoms measured using Generalized Anxiety Disorder-7, and satisfaction and acceptability using validated scales. Based on a prior study, we estimated a sample size of 130 would have sufficient (80%) power to detect a moderate effect size (d=.4) in between group difference on the Patient Health Questionnaire-9. A total of 192 women were randomized equally 1:1 to the chatbot or usual care; of these, 152 women completed the 6-week survey (n=68 chatbot, n=84 usual care) and were included in the final analysis. Mean baseline mental health assessment scores were below positive screening thresholds. At 6-weeks, there was a greater decrease in Patient Health Questionnaire-9 scores among the chatbot group compared to the usual care group (mean decrease=1.32, standard deviation=3.4 vs mean decrease=0.13, standard deviation=3.01, respectively). 6-week mean Edinburgh Postnatal Depression Scale and Generalized Anxiety Disorder-7 scores did not differ between groups and were similar to baseline. 91% (n=62) of the chatbot users were satisfied or highly satisfied with the chatbot, and 74% (n=50) of the intervention group reported use of the chatbot at least once in 2 weeks prior to the 6-week survey. 80% of study participants reported being comfortable with the use of a mobile smartphone application for mood management. Use of a chatbot was acceptable to women in the early postpartum period. The sample did not screen positive for depression at baseline and thus the potential of the chatbot to reduce depressive symptoms in this population was limited. This study was conducted in a general obstetric population. Future studies of longer duration in high-risk postpartum populations who screen positive for depression are needed to further understand the utility and efficacy of such digital therapeutics for that population.