Generalized Anxiety Research Articles

Development and validation of the mathematics self-efficacy scale for university students

Background: Academic underperformance in mathematics is widespread across all educational levels. To comprehend its causes, it is crucial to analyze various factors that impact academic advancement in mathematics through their interplay. The present study aimed to develop and validate a mathematics self-efficacy scale for university students. Methods: The research method was correlational and of instrument development type. The statistical population included all undergraduate students of Islamic Azad Universities in Tehran in 2021, of which 300 were selected as a sample using a multi-stage cluster random sampling method. In the process of scale construction, a set of items was initially selected based on a review of the research literature in the field of mathematics self-efficacy and the identification of valid tests in this area. Then, a preliminary version of the questionnaire was administered to a sample of 300 students. Factor analysis, Cronbach’s alpha coefficient, and Pearson correlation coefficient were used to analyze the data. Results: Based on the results of the exploratory factor analysis, the mathematics self-efficacy scale consisted of four components: mathematical achievement and success, general mathematical self-efficacy, mathematical anxiety, and mathematical stress. Cronbach’s alpha for the four components were 0.97, 0.95, 0.95, and 0.93, respectively. The results of the convergent validity evaluation showed that all four components of the mathematics self-efficacy scale were positively correlated with the intrinsic and extrinsic motivation components of the Academic Motivation Scale and negatively correlated with academic motivation. Conclusion: The components of the mathematics self-efficacy scale had acceptable internal consistency and convergent validity. Therefore, it can be concluded that the designed scale can be used as a valid tool to measure the level of mathematics self-efficacy in university students.

Arabic translation and validation of the clinician administered Staden schizophrenia anxiety rating scale (S-SARS)

BackgroundResearch on anxiety in patients with schizophrenia of Arab origin is surprisingly scarce, particularly given that expressions of both psychotic disorders and anxiety disorders can be largely shaped by cultural factors. This study proposes to complement previous research by exploring the psychometric characteristics of an Arabic translation of the Staden Schizophrenia Anxiety Rating Scale (S-SARS) in chronic, remitted patients diagnosed with schizophrenia. As the Arabic version of the Generalized Anxiety Disorder 7-Item Scale (GAD-7) has not been previously validated in Arabic in patients with schizophrenia, this study had as a secondary aim to investigate the psychometric properties of this scale before its use. MethodThis cross-sectional study was performed over a period of three months (August–October 2023). A total of 177 chronic inpatients diagnosed with schizophrenia (63.3 % males) who were remitted and clinically stable participated in the study. ResultsConfirmatory factor analyses showed that all 10 items loaded onto a single factor and had high factor loading values between .53 and .81. The reliability of the S-SARS in its Arabic version was excellent as attested by a McDonald's omega and a Cronbach's alpha coefficients of .90 and .89, respectively. The score of Arabic S-SARS correlated positively with the GAD-7 scores (r = .55; p < .001), thus supporting good convergent validity. As for discriminant validity, findings showed positive correlations between S-SARS and depression scores as assessed using the Calgary Depressive Symptoms Scale. In addition, the Arabic S-SARS correlated negatively with general functioning, further supporting the good validity and clinical relevance of the scale. Finally, measurement invariance was established in the sex subsamples (males vs. females) at the scalar, metric and configural levels, with females showing more anxiety than males. ConclusionFindings suggest that the Arabic S-SARS holds good psychometric properties, and is suitable for use among Arabic-speaking people diagnosed with schizophrenia in both research and clinical practice. The Arabic version of S-SARS will hopefully be widely applied to provide useful and timely clinical information for monitoring and adequately treating patients with schizophrenia, in order to improve the course and prognosis of the disease.

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

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

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

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

Depression, anxiety and cognitive function in persons with inflammatory rheumatic diseases: cross-sectional results from the German National Cohort (NAKO)

ObjectiveTo assess the presence of mental health disorders in persons with rheumatoid arthritis (RA), ankylosing spondylitis (AS), psoriatic arthritis (PsA), systemic lupus erythematosus (SLE) and Sjögren’s disease (SjD) (all: inflammatory...

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

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

The combined effects of depression or anxiety with high-sensitivity C-reactive protein in predicting the prognosis of coronary heart disease patients

BackgroundDepression, anxiety and high-sensitivity C-reactive protein (hs-CRP) are individually associated with poor prognosis in patients with coronary heart disease (CHD). However, the combined effects of depression with inflammation or anxiety with inflammation on the prognosis have been rarely explored.MethodsThis prospective cohort study included 414 patients diagnosed with CHD. The Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) were used to assess depression and anxiety. A score ≥ 5 points was defined as elevated depression or anxiety. High hs-CRP was defined as ≥ 3 mg/L. Follow-up was performed 2 years after the patients were discharged. The clinical results included noncardiac readmission, cardiac readmission, major cardiovascular events (MACEs), and composite events. The composite events included noncardiac readmission and MACEs. The Cox proportional hazard regression model was used to analyze the prognostic risk.ResultsAfter full adjustment, patients with elevated depression and high hs-CRP had a higher risk in predicting noncardiac readmission (hazard ratio (HR) = 3.87, 95% confidence interval (CI) = 1.10–9.02, p = 0.002) and composite events (HR = 1.93, 95% CI = 1.13–3.30, p = 0.016) than those with high hs-CRP alone. For the anxiety and hs-CRP group, high hs-CRP alone predicted a higher risk of noncardiac readmission (HR = 3.32, 95% CI = 1.57–7.03, p = 0.002) and composite events (HR = 1.75, 95% CI = 1.12–2.76, p = 0.015) than references. Elevated anxiety had no significant effects on all the endpoints. Furthermore, we didn’t find interactions between depression and hs-CRP or anxiety and hs-CRP.ConclusionIn patients with CHD, elevated depression with high hs-CRP was found to be significant in predicting the risk of noncardiac readmission and composite events. Early diagnosis and treatment of depression with inflammation are necessary in CHD patients.

Network analysis of resilience, anxiety and depression in clinical nurses

BackgroundResilience is a protective feature against anxiety and depression disorders. However, the precise relationship and structure of resilience and anxiety and depression remain poorly understood. This study sought to investigate the link among resilience’ components and anxiety as well as depression.Methods1,279 clinical nurses were recruited. 10-item Connor-Davidson Resilience Scale, Generalized Anxiety Disorder 7, and Patient Health Questionnaire 9 were employed to evaluate resilience, anxiety, and depression, respectively. The regularized partial-correlation network was generated utilizing data from cross-sectional survey and the bridge expected influence index was utilized to quantify bridge components.ResultsThe rates of anxiety and depression within clinical nurses were 67.3% and 67.2%, accordingly. Four strongest bridge edges appeared in the resilience-anxiety network, like “Adapt to change”- “Fear that something might happen”, and “Stay focused under pressure”- “Uncontrollable worry”. Two strongest bridge edges appeared in the resilience-depression network, like “Adapt to change”- “Concentration difficulties” and “Stay focused under pressure”- “Fatigue”. “Adapt to change” was recognized as bridging nodes in both the resilience-anxiety network and the resilience-depression network.ConclusionsInterventions targeting the bridge component “Adapt to change” within resilience, may mitigate the intensity of anxiety and depression symptoms among clinical nurses.

Improving Workplace Well-being in Modern Organizations: A Review of Large Language Model-based Mental Health Chatbots

The global rise in mental disorders, particularly in workplaces, necessitated innovative and scalable solutions for delivering therapy. Large Language Model (LLM)-based mental health chatbots have rapidly emerged as a promising tool for overcoming the time, cost, and accessibility constraints often associated with traditional mental health therapy. However, LLM-based mental health chatbots are in their nascency, with significant opportunities to enhance their capabilities to operate within organizational contexts. To this end, this research seeks to examine the role and development of LLMs in mental health chatbots over the past half-decade. Through our review, we identified over 50 mental health-related chatbots, including 22 LLM-based models targeting general mental health, depression, anxiety, stress, and suicide ideation. These chatbots are primarily used for emotional support and guidance but often lack capabilities specifically designed for workplace mental health, where such issues are increasingly prevalent. The review covers their development, applications, evaluation, ethical concerns, integration with traditional services, LLM-as-a-service, and various other business implications in organizational settings. We provide a research illustration of how LLM-based approaches could overcome the identified limitations and also offer a system that could help facilitate systematic evaluation of LLM-based mental health chatbots. We offer suggestions for future research tailored to workplace mental health needs.

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

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

Psychological morbidity among coal miners compared to other occupations in Appalachia

ObjectivesDepressive symptoms, anxiety, and post-traumatic stress disorder (PTSD) are common morbidities among coal miners, but the risk of these morbidities has not been analyzed relative to other occupations taking into account relevant covariates.MethodsUsing random digit dialing, we surveyed men aged 50 or over with a history of employment who resided in counties in Appalachia with high coal workers’ pneumoconiosis (CWP) mortality rates. We used the Primary Care Post-Traumatic Stress (PTSD) Screen and the Brief Trauma Questionnaire to query specific traumatic experiences. We used the Patient Health Questionnaire scale to assess depression symptoms and the Generalized Anxiety Disorder questionnaire to measure anxiety. Multivariable logistic regression analyzed associations between coal mining and depression, anxiety, and PTSD, adjusting for trauma, smoking and demographics.ResultsOf 1,428 participants, 233 (16.3%) reported coal mining employment. Coal mining was associated with increased odds of depression (OR 1.6; 95% CI 1.1 to 2.4) and anxiety (OR 1.7; 95% CI 1.1 to 2.7). Among those with any trauma (n = 711), coal mining was not associated with increased risk of PTSD (OR 0.80; 95% CI 0.5 to 1.3]. Non-coal trauma was associated with three-fold increased odds of anxiety (OR 3.2; 95% CI 2.0 to 5.1); for coal trauma, anxiety was associated with six-fold increased odds (OR 6.0; 95% CI 2.9 to 12.4).ConclusionsAppalachian region coal miners carry an increased burden of depression and anxiety. This should be recognized by clinicians and at a population level, as worthy of individual and public health intervention.

The impact of immersive virtual reality meditation for depression and anxiety among inpatients with major depressive and generalized anxiety disorders.

Mindfulness-Based Cognitive Therapy (MBCT) is a non-pharmacological approach to alleviating depression and anxiety. While technology based MBCT is a standardized cost-effective approach, there have been concerns about its feasibility and effectiveness in clinical settings. The purpose of this study was to investigate the longitudinal relationship between improved emotional regulation resulting from participation in Immersive Virtual Reality Meditation (IVRM) and Major Depressive Disorder (MDD) and Generalized Anxiety Disorder (GAD) as monitored by electrocardiogram. This study was a longitudinal single-arm clinical trial in which the intervention was conducted three times a week for 10 weeks at a behavioral health unit in a community hospital (n = 26). We measured Coherence Achievement Score (CAS), depression, and anxiety. The relationships between CAS, anxiety, depression, and covariates were analyzed using a Generalized Estimated Equation (GEE). The findings of our study provide evidence that the CAS scores indicative of emotional regulation function after IVRM participation were associated with a reduction in depression and anxiety. Among the many technology-based complementary health care interventions that are available to reduce depression and anxiety, IVRM program use increases emotional regulatory function and decrease depression and anxiety.

Childhood trauma impacts internalizing problems in early adulthood: the affective implications of olfactory dysfunctions

Early detection and prevention of internalizing problems demand a thorough exploration of latent vulnerabilities before clinical symptoms emerge. Limited research attention has been paid to the influence of olfactory perception, a flexible factor intricately linked to emotional processing and external environmental factors. This study sought to examine the mediating role of olfactory function in the relationship between childhood trauma, encompassing both dimensions of child abuse and neglect, and internalizing problems. A total of 1661 individuals (801 males, Meanage = 21.67 years) participated in wave 1, with 327 participants (152 males, Meanage = 21.8 1 years) included in the follow-up wave 2 three months later. Online questionnaires, including the Childhood Trauma Questionnaire, Self-reported Olfactory Disorder Questionnaire, Beck Depression Inventory, and General Anxiety Disorder-7, were administered. Mediation tests were conducted using Mplus 8. Our findings revealed a significant mediating effect of olfactory dysfunction between childhood trauma and adult internalizing problems in wave 1 (B = 0.224, 95% CI [0.167, 0.294]). Childhood trauma heightened vulnerability to olfactory dysfunction (B = 0.721, 95% CI [0.671, 0.724]), subsequently exacerbating internalizing problems (B = 0.311, 95% CI [0.226, 0.408]). This effect persisted in longitudinal data (abuse: B = 0.686, p < 0.001; neglect: B = 0.200, p < 0.001). Regarding internalizing problems influenced by olfactory function, childhood abuse had a greater impact compared to childhood neglect (wave 1: χ2 = 56.012, p < 0.001; wave 2: χ2 = 5.156, p = 0.023). This study found that olfactory dysfunction mediated the relationship between childhood trauma and internalizing problems, contributing valuable insights into psychopathology and the early identification of symptoms related to internalizing problems.

Psychiatric Health, Life Skills, and Opportunities for Wellness Program: Addressing psychiatric need through integrated consultation, collaboration, and brief episodes of care.

Integrated behavioral health programs bring strong benefits to patients and health organizations including reductions in overall costs. However, obstacles to funding prevent the implementation and maintenance of these programs across the country. The Psychiatric Health, Life Skills and Opportunities for Wellness (PHLOW) Program is based on the collaborative care model and seeks to provide psychiatric care through an integrated model that is financially sustainable for the organization. This pilot observational study included patients who received psychiatric care indirectly via consultations with primary care providers and directly through brief episodes of care. Patient outcomes were demonstrated by score changes on the nine-item Patient Health Questionnaire and Generalized Anxiety Disorder 7 before and after participation in brief episodes of care. Overall cost of care savings was demonstrated through change over time in risk-adjusted per-member-per-month. Patients participating in the PHLOW program showed potential drops in anxiety and depression ratings, coinciding with a reduction in mental health claims. In addition, participation in the program involved a small number of patient visits and prevented referrals to long-term psychiatry, preserving access for higher acuity presentations. This demonstration of the value of the PHLOW program has led to additional financial support of the program through the primary regional Medicaid payor, enhancing sustainability, and potentially modeling a collaboration that may be feasible for other organizations implementing integrated behavioral health programs. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

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

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

The role of anxiety in the association between nutrition literacy and health-related quality of life among college students.

The health-related quality of life (HRQOL) of college students is not promising and needs to be improved through effective interventions. This study aimed to investigate the associations of nutrition literacy (NL) with HRQOL and anxiety among college students, and to identify the role of anxiety in the relationship between NL and HRQOL. The cross-sectional survey was conducted via the "Wenjuanxing" platform from September to November 2023. The Food and Nutrition Literacy Questionnaire (FNLQ), the Generalized Anxiety Disorder (GAD-7) diagnostic tool and the SF-12 scale were used to assess NL, anxiety, and HRQOL, respectively. Logistic regression models, mediation analysis, additive and multiplicative interaction analyses were used. 2066 college students participated in the analysis. After adjusting for potential confounders, we found that college students with higher NL had higher HRQOL (OR = 2.52, 95% CI: 2.09-3.03, p < 0.001) and a lower risk of anxiety (OR = 0.53, 95% CI: 0.39-0.73, p < 0.001). Additionally, anxious college students had lower HRQOL (OR = 0.16, 95% CI: 0.11-0.24, p < 0.001). Furthermore, mediation analysis confirmed that anxiety was a partial mediator of the relationship between NL and HRQOL (β = 0.600, 95% CI: 0.406-0.779/0.430-0.818). Significant additive interactions were found between NL and Anxiety (RERI = 6.96, 95% CI: 2.74-11.17; AP = 0.51, 95% CI: 0.37-0.64; SI = 2.21, 95% CI: 1.58-3.07). Higher levels of NL are associated with better HRQOL and lower anxiety among college students. Additionally, anxiety partially mediated the relationship between NL and HRQOL. Furthermore, there is a synergy between NL and anxiety.

Linking early emotional abuse/neglect with young adolescents’ social (versus general) anxiety symptoms: A developmental cascade through emotion regulation

Despite the widely documented implications of childhood emotional abuse/neglect for subsequent anxiety symptoms, the implicated mechanisms remain under-revealed, especially the various transdiagnostic and specific pathways related to early experiences of emotional abuse versus emotional neglect and different types of subsequent anxiety symptoms (social versus general). Using three-wave data from 844 Chinese adolescents (Meanage = 13.21 at Wave 1, SD = 0.39; 53 % Boys), we tested emotion regulation strategies (cognitive reappraisal and expressive suppression) as explanatory mechanisms underlying the links between childhood emotional abuse/neglect and subsequent social anxiety symptoms (SAS), while simultaneously considering general anxiety symptoms (GAS) for the identification of possible specificity. Results indicated that expressive suppression played a mediating role in the links between emotional neglect and both forms of anxiety symptoms, whereas cognitive reappraisal served as a linking mechanism only for the link between emotional neglect and GAS. No effects were identified for emotional abuse. All associations were identified after controlling for the baseline levels of anxiety symptoms, the baseline uses of emotion regulation strategies, and covariates (age, gender, and family socioeconomic status). Our findings re-confirm that emotion regulation is an important intermediate process accounting for anxiety-related sequelae of early emotional deprivation, suggesting that expressive suppression appears to be a more developmentally transdiagnostic process shaped particularly by early emotional neglect to contribute to different types of subsequent anxiety symptoms. Accordingly, educational and clinical practices on emotion regulation likely benefit the affective well-being of young adolescents whose childhood has been clouded with emotional neglect.

Depression, Anxiety, and Stress Symptoms Among Students in Croatia During the COVID-19 Pandemic: A Systematic Review.

Background: The COVID-19 pandemic has led to an increased fear of infection, social isolation, financial concerns, and feelings of loneliness and uncertainty. Studies reveal that the pandemic has had a significant negative impact on mental health. This systematic review aimed to investigate the prevalence of depression, anxiety, and stress symptoms among students in Croatia during the COVID-19 pandemic. Methods: A systematic review was conducted following PRISMA guidelines. A literature search was performed on August 5, 2024, using the electronic databases Scopus, PubMed, Web of Science, and PsycINFO. The search utilized the Boolean logical operator expression ('depression' AND 'anxiety' AND 'stress' AND 'COVID-19' AND 'Croatia' AND 'student'). Results: Out of one hundred and fifty-four identified studies, five met the inclusion criteria and were included in the review. The studies used the Generalized Anxiety Disorder 7-item scale (GAD-7), the Patient Health Questionnaire-9 (PHQ-9), and the Depression, Anxiety, and Stress Scale-21 (DASS-21) to assess mental health. The results indicate a high prevalence of symptoms of depression, anxiety, and stress among students in Croatia during the pandemic. Conclusion: A high prevalence of negative affective emotions was observed among students in Croatia during the pandemic. This finding underscores the importance of developing effective strategies for the early identification and management of mental disorders among students, irrespective of the pandemic's conclusion.

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.

A Review of Survey Instruments and Pharmacy Student Outcomes for Stress, Burnout, Depression and Anxiety.

While the need to measure burnout, stress and mental health among pharmacy students has been emphasized in the literature, there is limited information on which validated scales should be used. The objective of this scoping review was to identify published studies that used validated scales for burnout, stress and mental health among pharmacy students to provide recommendations for implementation at schools/colleges of pharmacy. Thirty-two out of 153 articles published in the United States from 1 January 2000 to 30 September 2022 were included and categorized into studies measuring stress (20), burnout (4) and depression/anxiety (8). The most common validated scales used to assess stress and burnout among pharmacy students were the Perceived Stress Scale (PSS) and the Maslach Burnout Inventory and the Oldenburg Burnout Inventory, respectively. For mental health, anxiety was most commonly investigated using a variety of scales such as the Generalized Anxiety Disorder-7; the Patient Health Questionnaire, 9-item was used to measure depression in two studies. Validity, ease of use, cost and generalizability are important considerations for selecting a scale. The PSS has been studied extensively in pharmacy students and has been correlated with other well-being domains. Studies that measured burnout and mental health (specifically, depression and anxiety) have less published evidence among pharmacy students.