Generalized Anxiety Research Articles

Implementation of a Collaborative Practice Agreement for Depression and Anxiety in the Primary Care Setting

BackgroundThere is a lack of appropriate access to mental health care in the United States, particularly in the underserved community. Data shows that individuals living below the poverty level are 2.5 times more likely to develop depression and similar trends have been reported for anxiety. However, socioeconomic status and these conditions are not mutually exclusive and occur throughout the general population. To expand patient access, a collaborative practice agreement for major depressive disorder (MDD) and generalized anxiety disorder (GAD) was developed and implemented within a network of primary care clinics. ObjectivesThis study aimed to (1) describe the development of a pharmacist-led collaborative practice agreement for MDD and GAD within an outpatient primary care clinic and (2) describe the growth of the depression and anxiety CPA service after implementation. Practice DescriptionThis intervention was completed at a network of 7 primary care clinics associated with a large academic medical center in Columbus, Ohio. Practice InnovationA collaborative practice agreement for MDD and GAD was created and implemented in November 2021. Evaluation MethodsAn electronic health record-generated report was used to identify patients for which a referral to pharmacy for MDD or GAD was placed between November 1, 2021 and March 1, 2023. Retrospective chart review was utilized to collect information to describe the growth of the service. Data were analyzed using descriptive statistics. ResultsA total of 308 patients were appropriately referred to the pharmacist-led service for MDD and GAD between November 1, 2021 and March 1, 2023. Of the patients that established care with the pharmacist, 35% (54/155) experienced improvement in symptoms and 29% (45/155) achieved remission. ConclusionThe implementation of a pharmacist-led CPA for MDD and GAD in a primary care setting improved patient access to pharmacotherapy management for depression and anxiety.

Prevalence of anxiety disorders among visitors at a military primary health center in UAE

ABSTRACT Background: Anxiety disorders are common. However, individuals suffering from anxiety disorders often do not seek treatment. These disorders impose a high individual and societal burden, especially on military personnel and their families, and place a significant burden on healthcare systems as care is often sought from primary care physicians rather than specialized professionals. This study was undertaken to determine the prevalence and correlates of anxiety among visitors at a Military Primary Health Center. Results: Anxiety disorders were high in our study population. Generalized Anxiety Disorder (GAD) was the most common, while social phobia was less prevalent. 72.5% were 18-40 years old and 63.5% were males. 68% were military personnel, 23% were military personnel family, and the rest were retired. The most common symptoms were sleep disturbances (60.4%), irritability (55%), and restlessness (51.4%). GAD, specific phobia, and panic disorder were more likely in divorced people, and chronic diseases were more likely in people suffering from GAD. Conclusions: The prevalence of anxiety disorders was considerably higher among visitors at a Military Primary Health Center due to the high stress levels and occupational difficulties associated with an unstable social and family life. Counseling services and follow-up of diagnosed cases should be available at the primary health care level for improved healthcare delivery by the primary care or family health physicians.

Effectiveness of 8-week TReatment with vortioxetine on depressive symptoms in major depressive disorder patients with comorbid generalized anxiety disorder in UAE (TRUE)

BackgroundMajor Depressive Disorder (MDD) is a leading cause of disability and results in excessive utilization of healthcare resources worldwide. The Middle East and North Africa (MENA) region shows a high prevalence of depressive disorders. Generalized Anxiety Disorder (GAD) and MDD have the highest rate of comorbidity of all mood and anxiety disorders, ranging from 40 to 98% in drug studies. Comorbid GAD results in more significant impairment in MDD and increases the severity of symptoms. Although several clinical trials supported the safety and effectiveness of vortioxetine, no data regarding these aspects has been revealed in the MENA region. This study aimed to assess the safety and efficacy of vortioxetine in patients with comorbid GAD in the United Arab Emirates (UAE).MethodIn a multicenter observational study, 118 patients with confirmed anxiety and depressive disorders were evaluated over four visits (baseline visit, two weeks, four weeks, and eight weeks) using MADRS and HAM-A scales to assess depression and anxiety severity, respectively by calculating mean change and the percent using Kendall’s W test.ResultsA significant mean difference in MADRS score was observed, with a gradual decrease of mean MADRS total scores over the assessment weeks (p < 0.001) as well as in HAM-A scores, from severe to moderate-severe anxiety through the four visits (p < 0.001). Furthermore, only one case was reported as a serious side effect. Nausea and insomnia were the most predominant side effects reported among the studied population.ConclusionVortioxetine was found effective and safe among patients with MDD and comorbid GAD.

Effectiveness of Drama and music therapies as health communication interventions for reducing anxiety and posttraumatic disorders among children-victims of flood

This study examined the usefulness of drama and music therapies as communication strategies for reducing symptoms of post-traumatic stress disorder (PTSD) and generalised anxiety disorder (GAD) among school children (aged 10-16) who were victims of the 2022 floods in Nigeria. The researchers randomly assigned the children to control (n=122) drama therapy (n=120) and music therapy (n=120) groups. The result of the study revealed that after the intervention, school children in the drama and music therapies (unlike those in the control group) reported a significant reduction in their PTSD and GAD symptoms; the reduction achieved statistical significance (p=0.001, ηp2 =.48). Further results revealed a significant interactive effect of gender (p=0.001) with boys reporting a significant reduction more than girls. The results showed that drama therapy contributed more to reducing PTSD symptoms, while music therapy contributed more to reducing GAD symptoms. The difference did not achieve statistical significance (p=0.23). The researchers conclude that both drama and music therapies were associated with reduced symptoms, indicating the interventions may be beneficial therapies.

Protocol for a randomized controlled trial to evaluate the effectiveness of a telehealth group intervention to reduce perinatal depressive symptoms

BackgroundPerinatal depression and anxiety (PDA) affect approximately 20 % of individuals and are associated with adverse outcomes, including preterm birth, low birth weight, and impaired cognitive development of the child. Telehealth may reduce access barriers to needed mental health services. However, lack of disseminated, standardized study protocols aimed at investigating the role of telehealth in reducing PDA symptoms limits the ability to compare findings across studies. The purpose of this paper is to provide a conceptual framework and a randomized controlled trial protocol (RCT) for use in future studies. Methods and analysisAn RCT was designed to evaluate the effectiveness of a group videoconference intervention (VCI) to reduce PDA symptoms across pregnancy and postpartum period. Participants are randomly assigned to study groups: VCI + standard of care, or attention control (AC) + standard of care. Both groups have weekly one-hour group videoconference sessions for 9 weeks. The VCI groups are facilitated by a mental health professional using a manualized program based on mindfulness-based practices and cognitive behavioral therapy (MBCT). The AC groups are facilitated by a registered nurse using a manualized program for childbirth and parenting education. The primary outcomes are depressive symptoms as measured by the Edinburgh Postnatal Depression Scale (EPDS) and anxiety symptoms as measured by the Generalized Anxiety Disorder (GAD-7). ConclusionThis RCT study protocol can be used as a standard approach to improve the ability to compare findings across studies, applied in any setting (e.g., rural or urban), and adapted to diverse communities.Trial Registration:ClinicalTrials.govNCT03932760

Validation of the Integrated Palliative Care Outcome Scale (IPOS) in adults with cystic fibrosis.

A primary palliative care model for cystic fibrosis (CF) recommends using the Integrated Palliative Care Outcome Scale (IPOS) for screening. Validation of the IPOS is needed. This secondary analysis utilized baseline data from a multisite trial of the palliative care model, Improving Life with CF. Adults with CF completed the IPOS, the Memorial Symptom Assessment Scale-CF (MSAS-CF), the CF Questionnaire-Revised (CFQ-R), the Patient Health Questionnaire (PHQ-8), the Generalized Anxiety Disorder (GAD-7), and the Perceived Stress Scale (PSS). IPOS structure was assessed using Cronbach α coefficients and a factor analysis. Construct validity was evaluated through bivariate relationships between IPOS scores and other questionnaire scores, and linear regressions assessing the extent to which the IPOS explains variance in quality-of-life domains. The sample comprised 256 adults with complete IPOS data. α coefficients were .86 for the IPOS total score, .81 for the Physical Symptoms subscale, .79 for the Emotional Symptoms subscale, and .63 for the Communication/Practical Issues subscale. A two-component factor structure best aligned with the current subscales. IPOS scores were significantly associated with other measures; associations with MSAS-CF and CFQ-R subscales differentiated the IPOS Physical and Emotional subscales. The IPOS total score provided unique information about the variance in the CFQ-R Physical Functioning and Respiratory Symptoms domain scores. In adults with CF, the IPOS has acceptable internal consistency and there is evidence of construct validity. These findings support adoption of the IPOS in the primary palliative care model for CF.

The multifaceted effects of migraine on Syrian society: insights from a multicenter cross-sectional study

BackgroundMigraine is the most common primary headache. It’s alone responsible for 1.3% of disability in the world. Migraine both worsen quality of life of individuals and place a significant burden on the society. Despite this, there exists a knowledge gap regarding its repercussions on the Syrian population.MethodsThis cross-sectional study enrolled 679 migraine-diagnosed patients from all over Syria through electronic questionnaires disseminated on official social media platforms. Depending on demographic characteristics, physical and mental debility assessed using the Chalder scale, the Migraine Specific Quality of Life Questionnaire (MSQ) and the Generalized Anxiety Disorder 2-item (GAD_2) scale.ResultsOur study included 679 participants (mean age: 29.49 years; BMI: 24.55). The sample was predominantly female (74.7%) and mostly single (52%). Females reported higher fatigue (mean = 21.48) than males (mean = 19.22; p < .001). However, Males had better Migraine-Specific Quality of Life (MSQ) scores (mean = 49.90) compared to females (mean = 42.27; p < .001). Females scored higher on anxiety (GAD-2: mean = 2.99 vs. mean = 2.35; p < .001). Moreover, urban residents had higher scores on the Role Preventive (RF-P) subscale of the MSQ than rural residents (mean = 49.93 vs. mean = 44.82; p = .014). Higher fatigue and anxiety levels were associated with lower quality of life scores.ConclusionsThis study aimed to elucidate the multifaceted impact of migraines on daily life, considering diverse demographic variables to enhance diagnostic accuracy, treatment efficacy, and disease management strategies.

The psychological impact of disaster on first responders in the aftermath of Bahanaga train tragedy: A mixed methods approach

Background: First responders are at high risk for adverse mental health outcomes following trauma exposure during disaster response. This mixed methods study aimed to quantify psychological impacts and explore personal experiences among first responders after the Bahanaga train accident that killed 294 passengers in the month of June 2023. Methods: For qualitative data, in-depth interviews (IDIs) were conducted, and quantitative data was collected using the PTSD checklist for DSM-5 (PCL-5), generalized anxiety disorder scale (GAD-7), and patient health questionnaire (PHQ-9) for symptoms of post-traumatic stress disorder (PTSD), depression, and anxiety. The study was conducted over one month during July 2023. Results: Among 225 responders, alarming rates of symptoms of probable PTSD (10.2%), anxiety (11.6%), and depression (24.9%) were noted. Those with no prior exposure to disasters and those with no formal training in disaster response scored higher in measures for PTSD. IDIs were conducted with 22 first responders, including various stakeholders. Qualitative analysis identified themes of preoccupation with witnessing trauma, feeling overwhelmed, scary and terrible emotions, avoidance, guilt, hypervigilance, intrusive memories, emotional numbing, unmet needs for mental health support, worsening physical health, re-emergence of past traumas, compounding impact of graphic images in the media, certain positive impact, including increased empathy, resilience and finding purpose, and the beneficial role of peer support. Conclusion: Significant psychological impacts are noted with elevated rates of probable PTSD, anxiety, and depressive symptoms among first responders one month after the Bahanaga train tragedy. These results underscore the vulnerability of first responders to mental health challenges following disaster response in India.

Association between temporomandibular joint dysfunction signs and symptoms, mental health indices, and MRI diagnoses: should we scan patients?

Temporomandibular joint dysfunction (TMD) is a common condition; yet multifactorial in nature. Our understanding of the interplay between clinical symptoms in relation to Magnetic resonance imaging (MRI) findings and quality of life is limited. Our primary objective was to identify features of TMD contributing to anxiety and depression. Our secondary objective was to determine whether clinical symptoms, baseline characteristics, and mental health outcomes are associated with underlying disease severity, as determined by MRI. A retrospective analysis of 202 TMD patients was performed. Mental health outcomes were quantified using the IMPARTS psychometric questionnaire (Visual Analog Score, VAS; Generalised Anxiety Disorder Assessment, GAD7;, Patient Health Questionnaire, PHQ-9), and patients were categorised based on temporomandibular joint pathology severity (normal, anterior disc displacement with reduction, anterior disc displacement without reduction and severe degeneration). On multivariable analyses, both higher anxiety (p<0.001) and depression (p<0.001) scores on IMPARTS assessment were associated with worst perceived pain (on VAS). Unilateral joint involvement (OR2.48[95%CI 1.20;5.46],p=0.018), locking (OR4.28[95%CI 1.63;13.63],p=0.006) , and clicking (OR2.14[95%CI1.05;4.60],p=0.006) were significantly associated with increased odds of an abnormal TMJ on MRI, whereas higher anxiety scores (OR0.93[95%CI 0.88;0.99],p=0.006) and male gender (OR0.35[95%CI 0.15;0.79],p=0.012) were significantly predictive of a normal joint morphology on MRI. Our findings support a complex interplay between patient symptomology, mental health outcomes and objective radiologically-defined joint pathology in the TMD patient population.

FREQUENCY OF GENERALIZED ANXIETY DISORDER IN HOSPITALIZED COVID-19 PATIENT

The COVID-19 pandemic has had a profound impact on mental health, with anxiety disorders being particularly prevalent among hospitalized patients. Identifying and addressing mental health issues like generalized anxiety disorder (GAD) is crucial for improving patient outcomes and providing holistic care. Objective: To determine the frequency of generalized anxiety disorder (GAD) among hospitalized COVID-19 patients at MTI-Hayatabad Medical Complex, Peshawar, and to explore its association with gender and socioeconomic status. Methods: A cross-sectional study was conducted in the Department of Psychiatry at MTI-Hayatabad Medical Complex, Peshawar, over six months, from October 16, 2021, to April 16, 2022. A total of 179 hospitalized COVID-19 patients, aged 25 years and above, were included. Patients presenting with symptoms of anxiety were assessed using the Generalized Anxiety Disorder-7 (GAD-7) scale. Unstable patients, who had a history of other mental disorders or were receiving treatment for depression and anxiety were excluded. Data were analyzed using statistical methods to explore associations between GAD and demographic factors such as gender and socioeconomic status. Results: The study included 179 COVID-19 patients, with a mean age of 43.50 ± 10.18 years. Generalized anxiety disorder was identified in 62 patients, representing 34.6% of the total population. GAD prevalence was significantly higher among female patients (p &lt; 0.001) and those from lower socioeconomic backgrounds (p = 0.002). Conclusion: This study highlights a high prevalence of generalized anxiety disorder among hospitalized COVID-19 patients, particularly among females and those of lower socioeconomic status. The findings underscore the need for routine mental health screening and targeted interventions to address anxiety in this vulnerable population.

The Correlation of Coping Strategies, Perceived Social Support, and Self-Reported Anxiety among Nursing Students during the COVID-19 Outbreak

Aims: This study aims to investigate the correlation between coping strategies, perceived social support, and anxiety among nursing students during the COVID-19 pandemic. Methods: A descriptive, correlational, cross-sectional study. Total sampling technique was used to recruit 106 nursing students. Data were collected using the Coping Strategies Inventory Short-Form (CSI-SF), the Multidimensional Scale of Perceived Social Support (MSPSS), and the Generalized Anxiety Disorder-7 (GAD-7). Pearson correlation was employed to examine the relationships between key variables. Results: Anxiety was significantly correlated with engagement (r = 0.192, p = 0.049), disengagement (r = 0.264, p = 0.006), emotion-focused engagement (r = 0.222, p = 0.022), and emotion-focused disengagement (r = 0.325, p = 0.001). However, social support and its subscales were not significantly correlated with anxiety (r = -0.007 to 0.147, p &gt; 0.05). Conclusions: The study suggests that students with higher anxiety tend to adopt more coping strategies, suggesting that targeted training, social support networks, and personalized interventions can improve their mental health.

The effectiveness of Reconsolidation of Traumatic Memories for Complex PTSD – A pilot quasi-experimental study from a wellness centre in India

Complex Post-Traumatic Stress Disorder (CPTSD), based on ICD-11 guidelines, is differentiated from PTSD by several unique characteristics. Prolonged or frequent exposure to an event or series of events of extremely threatening or horrific nature increases the risk for CPTSD in adults. For PTSD, Reconsolidation of Traumatic Memories (RTM) has emerged as an effective intervention. There are limited studies on how to address CPTSD. Hence, RTM's effectiveness for CPTSD has not yet been established. In India, there are very few studies on PTSD (focusing mainly on natural disasters and violence), none on CPTSD and none on the effectiveness of RTM. Unfortunately, India, with >400 million young individuals and with high prevalence and limited identification of mental health issues, has a major gap in this area. This quasi-experimental pilot study aimed to assess the effectiveness of the RTM intervention for individuals with CPTSD at a wellness centre in India.The participants (>18 years, n = 107) who reached out to a wellness center for help were assessed by two trained therapists (including a psychologist) based on the presenting problems for CPTSD using the International Trauma Questionnaire. Additional assessments included Major Depression Inventory and Generalized Anxiety Disorder-7. Based on the index-trauma framework, RTM intervention was delivered. Post-measurements were done (a) after one month or at least after five sessions and (b) after three months.After one month (or five sessions), the CPTSD status changed to “none” (no diagnosis) for 80 and “PTSD” for 2 individuals. The results were sustained post-three months (n = 30). The paired t-test confirmed the overall reduction in CPTSD score after one month compared to baseline and even after three months compared to after one month, based on statistical significance (p < .01). The findings confirmed the effectiveness of RTM intervention for individuals with CPTSD. The study's limitations (quasi-experimental design, urban, English-speaking Indians) could be addressed in future work.

Prevalence of anhedonia, anxiety, and their impact on food consumption among postgraduate Qassim University students.

A prevalent symptom of many mental health issues, such as depression, is anhedonia, which is the inability to feel joy or pleasure. Tension-induced sensations, anxious thoughts, and bodily alterations are the hallmarks of anxiety. One known environmental factor that affects mental health is diet. In this implication, eating appetizing meals has been proposed to reduce unpleasant feelings like worry. This study aimed to indicate whether eating habits among postgraduate students are related to symptoms of anhedonia and/or anxiety. In a cross-sectional study, responses were collected from a total of 393 postgraduate students. Each student self-answered the General Anxiety Disorder-7, Snaith-Hamilton Pleasure Scale for Anhedonia, and the Food Consumption Questionnaire and reported the body weight. The prevalence of anhedonia was 28%, moderate anxiety and severe anxiety were 15.7 and 10.9%, respectively. In this research, results showed that sugary foods, fast food, and fried foods were positively associated with anxiety and anhedonia. However, fruits and vegetables were negatively associated with anxiety and anhedonia. Linear regression showed that fruit and drinking water consumption was significant with the number of meals/day. There was no significance between the number of meals per day and anhedonia; however, there was statistical significance with the total GAD-7 scale score regarding the number of meals/per day. Anhedonia and anxiety are associated with food consumption, especially foods rich in sugars, fast and fried, which help to increase positive feelings. Future studies should focus on understanding the relationship between food consumption and following a healthy diet and improving and reducing symptoms of anxiety and anhedonia in those who suffer from a stressful or task-filled lifestyle, such as students, especially postgraduate students. In addition, it focuses on the importance of awareness of the symptoms of anhedonia, which is classified as a depressive disease, and how to control anxiety to maintain better mental health.

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

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

Single Question for Screening Suicide Risk in Patients With Cancer in Nursing Routine Work: A Retrospective Cross-Sectional Study.

To examine the efficacy of the Single Suicide Question, a tactful single-item tool, in assessing suicide risk among cancer patients. Suicide risk screening in cancer patients faces challenges such as cultural, the degree of attention given and the complexity and diversity of assessment methods. An efficient and simple suicide screening tool is needed within the nursing and treatment process. A retrospective cross-sectional study. All data utilised in this study were obtained from assessments conducted by researchers at our institution between March 2018 and August 2023. Retrospectively analysed Single Suicide Question scores from 9703 patients (March 2018-August 2023), with 229 undergoing additional using other established tools (the Patient Health Questionnaire-9, Generalised Anxiety Disorder-7, Distress Thermometer) alongside the Mini International Neuropsychiatric Interview Suicidal Subscale (MINI Suicidal Subscale). These 229 patients were divided into the cut-off determination dataset (174/229) and the validation dataset (55/229) to analyse, validate and compare the screening efficacy, consistency and optimal cut-off points of the tools relative to the MINI Suicidal subscale (golden standard). K-fold cross-validation was employed to assess the stability of the Single Suicide Question and to revalidate its screening efficacy. In cut-off determination dataset, the Single Suicide Question exhibited good screening efficacy and substantial agreement relative to the MINI Suicidal subscale, as validated in the validation dataset, outperforming other tools. The optimal cut-off points of Single Suicide Question for screening moderate or higher and high suicide risk as 2 and 3 respectively. Its stability in K-fold cross-validation further supported its screening efficacy. The Single Suicide Question shows potential as a preliminary screening tool for suicide risk. Furthermore, it has also demonstrated the potential of a simple, tactful, culturally fitting question in assessing suicide risk, providing insight for the development of relevant tools in different cultural and linguistic backgrounds. Our study demonstrates the potential of the Single Suicide Question as a screening tool for identifying suicide risk among cancer patients, which may facilitate efficient suicide screening. Furthermore, it reveals that tactful, culturally fitting, yet simple tools can achieve good screening efficacy, providing insights for the development of similar tools in different cultural and linguistic contexts. This study investigated the effectiveness of using a culturally contextualised, specific single question to screen for suicide risk in Chinese cancer patients, demonstrating high screening efficacy and stability. With further research, this method may provide a tactful, culturally informed and efficient suicide screening approach to address the critical issue of suicide risk in cancer care, and it also serves as a reference for developing similar tools in diverse cultural and linguistic contexts. The study followed the STROBE checklist guidelines for cross-sectional studies. The data provided by patients were the foundation of this study. Nurses played a central role in conducting the majority of assessments and contributing to the research design in this study.

Prevalence and Correlates of Poor Sleep Quality Among Psychiatry Physicians in Saudi Arabia: A Cross-Sectional Study.

Sleep issues pose a significant burden to public health and well-being in Saudi Arabia. However, research evidence on sleep health among psychiatry physicians in this territory is limited. Therefore, to bridge the research gap, this study was designed to assess the prevalence and predictors of poor sleep quality among psychiatry physicians in the country. This cross-sectional study included 554 psychiatry physicians in Saudi Arabia from March to August 2023. Data were collected via online through a structured questionnaire (Google survey form). Sleep quality, the outcome variable of our study, was evaluated with the Pittsburgh Sleep Quality Index (PSQI; 19 items). Independent variables included sociodemographic and behavioral characteristics, sleep habits, major depression (assessed with Patient Health Questionnaire-9), and anxiety (measured with Generalized Anxiety Disorder-7) symptoms. Binary logistic regression analysis was performed to identify the correlates of poor sleep quality. Based on the PSQI, 61.3% of the study participants had poor-quality sleep (age range: 24-56 years, male: 48.0%). The adjusted model revealed that male participants (AOR = 2.80, 95% CI = 1.70-4.61) and those who had on-call duties ≥ 2 times per week (for three/four per week: AOR = 3.41, 95% CI = 1.89-6.14) were at higher risk of developing poor sleep quality compared to their respective counterparts. Participants with depressive symptoms (AOR = 3.46, 95% CI = 1.60-7.48) and smoking habits (AOR = 3.47, 95% CI = 1.32-9.08) had higher odds of developing poor sleep quality than their counterparts. Moreover, participants who always used their smartphone/laptop before going to bed were more likely to have poor sleep quality than those who never used such (AOR = 3.15, 95% CI = 1.31-7.60). Poor sleep quality is extremely prominent among psychiatry physicians in Saudi Arabia. Male sex, higher on-call duty, smoking habits, depression, and smartphone/laptop use before bedtime were significantly associated with poor sleep quality. These findings emphasize the need for sleep-health promotion interventions for Saudi psychiatry physicians.

Anxiety and Depression Among Patients with Diabetes in Saudi Arabia and Egypt.

Mental stress plagued type II diabetes (T2DM) patients. The psychological and emotional issues related to diabetes and its effects include depression, anxiety, poor diet, and hypoglycemia fear. Compare the impact of diabetes on depression and anxiety in Egyptian and Saudi diabetics. The diabetes, gastroenterology, and hepatology sections of University of Ha'il Clinic, KSA, and the Theodor Bilharz Research Institute, Egypt, conducted this retrospective study. Everyone gave informed consent before participating. Interviews with male and female outpatients and inpatients were conducted from June 2021 to December 2022. The self-administered validated Generalized Anxiety Disorder-7 (GAD-7) and the Patient Health Questionnaire-9 (PHQ-9) scale measured sociodemographic characteristics and symptoms of depression and anxiety. In patients with diabetes, the prevalence of depression was higher in KSA [34.8%] than in Egypt [18%], while anxiety was higher in Egypt [40%] than in KSA [29.1%]. Most depressed patients were 31-55 years old (61.2%) from KSA and 97.8% (41-55 years old) from Egypt. Female anxiety was 70.7% in KSA and 51.0% in Egypt, with no significant difference. The duration of diabetes in depressed patients was 5-10 years ([46.9%, Saudis] vs. [57.8%, Egyptians]), while anxious patients (5-10 years [39.0%, Saudis] vs. >20 years [65.0%, Egyptians]) were mainly type-2. Most depressive patients had an HbA1c (59.2%) from 7-10% (Saudis) and 77.8% [>10% Egyptians] compared to anxiety patients (46.3%) and 48.0% [>10% Egyptians]. Depressed and anxious patients from both nations had higher glucose, triglycerides, and cholesterol levels. Saudis and Egyptians with obesity had higher rates of sadness (75.5% vs. 68.9%) and anxiety (82.9% vs. 69.0%). Treatment adherence and serum glucose monitoring were not significantly different from depression in diabetes individuals in both ethnicities. Anxiety was more common among Egyptian patients because of overcrowding, working whole days to fulfill life requirements, and the unavailability of health insurance to all citizens. Meanwhile, in KSA, obesity, unhealthy food, and less exercise reflect the high percentage of depression among patients with diabetes. The detection of depression and anxiety in the context of DM should be critical for the physical health and quality of life of Saudi and Egyptian diabetics. Further investigation is warranted to encompass anxiety and depression within the scope of future research.

Multidimensional Individualized Stuttering Therapy Outcomes At 24 Months Post Clinic: An Embodiment and Awareness Perspective.

Multidimensional Individualized Stuttering Therapy (MIST) is based on proactive collaborative work and shared decision making between client and clinician with the goal of identifying individual case-appropriate procedures and therapy elements in a manner that is meaningful and context-sensitive for each person. MIST combines value- and awareness-based elements from acceptance and commitment therapy (ACT) with stuttering and speech modification interventions. In keeping with the principles of ACT, we locate mindfulness as part of an embodied practice facilitated through a collaboration between the person who stutters and the speech-language therapist. The aim of this study was to see whether the positive results of MIST recorded at 12 months post-therapy remained stable at 24 months post-therapy and to consider the role of embodiment and awareness within MIST. Fifteen of 18 adults already enrolled in a treatment study (2015/FO12451) took part in a single-group repeated-measures design. They completed measures of stuttering severity, impact of stuttering, unhelpful thoughts and beliefs about stuttering, general anxiety symptoms, and fear of negative evaluation. There was a significant reduction of stuttering severity and negative impact of stuttering from pre-therapy to 24 months post-therapy. Unhelpful thoughts and beliefs about stuttering, symptoms of general anxiety, and fear of negative evaluation were reduced at 12 months post-therapy, and these values remained stable at 24 months post-therapy. MIST was associated with positive outcomes at 24 months post-therapy, suggesting a possible connection between the person-centered approach and longer-term benefit. Findings are discussed within the context of mindfulness and embodied adjustment, and shared client-clinician decision making. The absence of a control group is a limiting factor regarding certainty of interpretation. Future research is therefore needed on collaborative and individualized approaches to stuttering therapy that include embodiment and awareness perspectives.

Efficacy comparison of five antidepressants in treating anxiety and depression in cancer and non-cancer patients.

Cancer patients have a heightened susceptibility to anxiety and depressive disorders, which significantly impact the effectiveness of cancer treatments and long-term quality of life. This study aimed to compare the efficacy of different antidepressants in cancer and non-cancer patients. A total of 610 patients diagnosed with depressive episodes and/or anxiety disorders were retrospectively included and divided into a cancer group and a non-cancer control group. Antidepressants used included escitalopram, duloxetine, sertraline, venlafaxine, and vortioxetine, combined with trazodone or not. The Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder Questionnaire-7 (GAD-7) scores were used to evaluate the efficacy after 4 weeks and 8 weeks of systematic antidepressants treatment. Compared to the non-cancer group, the cancer group had higher proportions of females, older individuals, and patients with poor sleep quality, while reporting fewer somatic symptoms at baseline (all p < 0.05). PHQ-9 and GAD-7 scores in cancer patients treated with antidepressants were significantly lower than baseline at week 4 and week 8 (all p < 0.05). The sertraline group demonstrated significantly less improvement in GAD-7 scores at week 4 and in both GAD-7 and PHQ-9 scores at week 8 compared to the escitalopram group, while duloxetine, venlafaxine, and vortioxetine showed comparable efficacy to escitalopram. Antidepressants combined with trazodone showed significant improvement in PHQ-9 scores at week 4 compared to those without trazodone. The gynecological cancer group showed significantly more improvement in GAD-7 and PHQ-9 scores at week 4 and 8 compared to breast cancer patients. Antidepressant treatment in cancer patients with anxiety and depression is as effective as in non-cancer patients. The efficacy of escitalopram is comparable to duloxetine, venlafaxine, and vortioxetine, all of which outperformed sertraline in cancer patients.

CHARACTERIZATION OF BASELINE SYMPTOMS AND FUNCTIONAL IMPAIRMENTS IN A LARGE COHORT OF OUTPATIENTS ATTENDING A LONG COVID REHABILITATION CLINIC IN THE UNITED KINGDOM.

In response to the high prevalence and morbidity associated with long COVID (LC), outpatient rehabilitation programmes were created across jurisdictions. We aimed to characterize baseline symptoms and impairments of patients attending outpatient LC rehabilitation. This study was a retrospective quality-improvement analysis. Patients attending outpatient LC rehabilitation at the Oxfordshire Post-Covid Service. Data included age/sex and 6 questionnaires performed at baseline: Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F), Dyspnoea-12 (D12), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder Assessment-7 (GAD-7), Visual Analogue Scale (VAS) of self-rated health, and the Work And Social Adjustment Scale (WSAS). All scores were dichotomized (indicating presence/absence of clinically significant pathology). Potential differences between age (</≥ 50 years) and sex were assessed using χ2 tests. A total of 422 patients were included (mean/standard deviation [SD] age = 47.1/13.2;132/31.3% male). A total of 76% had significant fatigue (FACIT-F), 69% had breathlessness (D12), 55% had depression (PHQ-9), 34% had anxiety (GAD-7), 41% self-reported poor health (VAS), and 57% had work/social life dysfunction (WSAS). D12 scores differed between age groups (older > younger, χ2 = 3.19/p = 0.048), with no differences observed on other scales. In this preliminary study, a high proportion of LC outpatients had significant impairments across domains. The findings of this study reaffirm the need for high-quality, multidisciplinary LC rehabilitation, and may be used to help build a standardized set of outcome measures moving forward.