Generalized Anxiety Disorder-7 Scores Research Articles

Predicting Concussion Recovery with PHQ-9 and GAD-7.

To determine whether scores obtained from Patient Health Questionnaire-9 (PHQ-9) or the General Anxiety Disorder-7 (GAD-7) instruments administered following a concussion can be used to predict recovery time. Retrospective cohort study in a university-based specialty concussion center of 502 concussed participants. Participants completed a PHQ-9 and GAD-7 during their initial visit and subsequent visits during the recovery period (ie, at 14, 28, 56, and 84 days). The median recovery time from a concussion was 21 days from the initial clinical evaluation; however, individuals with a PHQ-9 score ≤ 6 (n = 262) had a median recovery time of 17 (95% confidence interval [CI] 15-19) days, whereas those with PHQ-9 scores >6 (n = 240) had a median recovery time of 33 (95% CI 28-37) days and a hazard ratio of 0.525 (95% CI 0.438-0.629, P < 0.0001). For individuals with a GAD-7 score ≤ 4 (n = 259), the median recovery was 19 (95% CI 17-21), days whereas for those with a GAD-7 score > 4 (n = 243), the median recovery was 32 (95% CI 28-36) days with a hazard ratio of 0.554 (95% CI 0.462-0.664, P < 0.00). Scores obtained from PHQ-9 and GAD-7 screening tools appear to be predictive of an individual's recovery and may help identify those subjects who may benefit from early psychological interventions.

COVID-19 Pandemisi ve Koruyucu Tedbirlerin Çocukların Ruh Sağlığı Üzerindeki Etkisi

Objective: World Health Organization declared the novel Coronavirus disease 2019 (COVID-19) as a pandemic in March 2020. The aim of this study is to evaluate the effects of COVID-19 pandemic on children’s mental health.Materials and Methods: Revised Childhood Anxiety and Depression Scale - The Parent Form was applied to the participants to determine the compliance of parents and children with protection rules. In addition, the methods of getting news and protection methods about the pandemic were evaluated. Participants were divided into two groups as those with and without suspicious symptoms of COVID-19.Results: Personal hygiene levels were found to be negatively correlated with social phobia score and total anxiety score (p&amp;lt;0.05). A negative correlation was observed between generalized anxiety disorder scores and the variety of use of protective equipments (p&amp;lt;0.05). Panic disorder and obsessive compulsive disorder scores were negatively associated with the isolation status of participants (p&amp;lt;0.05).Conclusion: The use of personal protective equipment, following the personal hygiene rules and compliance to the isolation measures of the parents have a positive effect on their children's mental health.

Do baseline anxiety symptoms impact response to IV Ketamine in treatment resistant depression?

• We examined if anxious depression impacts Ketamine outcomes. • Forty-three patients received six IV Ketamine infusions over a three-week period. • Patients with anxious depression at baseline had comparable levels of improvement. • Improvement in anxiety was about half the magnitude of improvement in depression. • Depressed patients who present with anxiety may be appropriate for IV Ketamine. In a retrospective study, we analyzed if anxious depression impacts outcomes in patients with treatment resistant depression (TRD) receiving IV Ketamine infusions at an academic center Ketamine clinic. Forty-three patients with TRD received six IV Ketamine infusions over a three-week period. Anxious depression (ANX-TRD) was defined as a Hamilton Depression Rating Scale Anxiety/Somatization factor score of ≥ 7 at the baseline evaluation. Beck Depression Inventory (BDI-II) and Generalized Anxiety Disorder-7 (GAD-7) scales were used through the infusion course to assess symptom change. Twenty-three patients were categorized as ANX-TRD and 20 as non-anxious TRD. Generalized estimating equation (GEE) models revealed BDI-II and GAD-7 scores for ANX-TRD and NANX-TRD groups did not differ significantly during any time point. Symptoms of anxiety and depression improved after treatment in both groups, though the degree of change was significant and greater for depression. This was a naturalistic, retrospective study, without a control group. Symptoms of depression show greater improvement than symptoms of anxiety. IV Ketamine is effective in the treatment of depression, regardless of the baseline anxiety level.

Impulsivity in persons with epilepsy: Association with seizure severity and suicide risk

PurposeClinical research regarding impulsivity in patients with epilepsy is limited. The present study investigated the associations between impulsivity and seizure-related factors or suicidality in patients with epilepsy, independent of depression and anxiety. MethodsThe multicenter study included 146 subjects (63% men). We utilized the Barratt Impulsiveness Scale-11 (BIS-11), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and suicidality module of the Mini International Neuropsychiatric Interview (MINI). Stepwise regression analyses and an analysis of covariance with interaction terms were performed. ResultsThe mean BIS-11 score was 59.3 (SD = 10.7). Psychiatric pathologies, including suicidality, were reported in relatively large proportions of patients, including PHQ-9 score ≥ 10 in 29 (19.9%) patients, GAD-7 score ≥ 7 in 35 (24.0%) patients, and MINI suicidality score ≥ 6 in 15 (10.3%) patients. Stepwise linear regression revealed that BIS-11 score was positively associated with the PHQ-9 scores (p < 0.001), antiseizure medication polytherapy (p < 0.001), use of lamotrigine (p = 0.009), and recurrence of generalized or focal to bilateral tonic clonic seizures (p = 0.010). The coefficient of determination for the model was 0.397. Generalized or focal to bilateral tonic clonic seizure recurrence tended to be positively associated with total BIS-11 scores in men but not in women. In subscale analyses, somewhat different variables were associated with different BIS-11subscales. A trend for a positive association between BIS-11 score and suicidality was found (p = 0.066). ConclusionsThis study identified a positive association between clinical seizure severity and impulsivity, and found that this association tended to be sex-specific, occurring only in males. Impulsivity could potentially be weakly associated with suicidality in patients with epilepsy.

Differential contributions between objective and subjective psychosis-like experiences to suicidal ideation in college students.

The present study aimed to investigate the prevalence rate of objective and subjective psychosis-like experiences (PLEs) in non-help-seeking college students and to explore their differential contributions to suicidal ideation. First-year college students were recruited and surveyed with the Chinese version of the 16-item Prodromal Questionnaire (CPQ-16), Childhood Trauma Questionnaire (CTQ-SF), Patient Health Questionnaire-9 (PHQ-9), General Anxiety Disorder-7 (GAD-7) and Beck Scale for Suicide Ideation (BSI). The Structured Interview of Psychosis-Risk Syndromes (SIPS) was conducted in individuals with a CPQ-16 score of 9 or higher. Data were available for 8367 students. Three hundred and seventy of them scored 9 or higher on the CPQ-16, suggesting potential PLEs (4.42%). Among them, 194 agreed to the SIPS screening. The PLEs were confirmed in 103 individuals who scored 1-5 on any positive symptom scales of the SIPS (objective PLEs, oPLEs). For the remaining 91 individuals, their PLEs were not confirmed by the SIPS and thus were categorized as individuals with subjective PLEs (sPLEs). In univariate logistic regression, oPLEs was associated with a two times risk of suicidal ideation compared to sPLEs (OR=1.971, p= .029). In multivariate logistic regression when non-PLE status was set as a reference, oPLEs significantly predicted suicidal ideation (OR=3.441, p= .011), while the sPLEs (OR=2.277, p= .091) was no longer a significant predictor after controlling for PHQ-9, GAD-7 and CPQ-SF scores. OPLEs and sPLEs have differential contributions to suicidal ideation. OPLEs seems to be associated with a higher risk of suicidal ideation and is independent of other psychopathology.

Sleep Quality and Mental Health of Medical Students in Greece During the COVID-19 Pandemic.

Background-Aim: Medical students have been greatly affected by the COVID-19 pandemic due to their educational program, which comprises theoretical knowledge and also clinical duties, making them vulnerable to viral exposures and possibly affecting their everyday life. The aim of this study was to explore changes in sleep and mental health parameters among medical students in Greece during the second year of the pandemic.Methods: This cross-sectional study comprised students of all medical schools in Greece (n = 7), using an anonymous online survey. Participants completed the following questionnaires: Pittsburgh Sleep Quality Index (PSQI), Athens Insomnia Scale (AIS), Fatigue Severity Scale (FSS), General Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9). Statistical analysis was conducted with the use of SPSS v.26 (IBM SPSS, Armonk NY, USA).Results: Out of the 562 received responses, 559 met the inclusion criteria. The largest proportion of the respondents came from 4th-year (27.8%) and the majority of the sample were females (69.8%). Only 5.9% of the participants reported having been infected by SARS-COV-2. Most of the respondents experienced insomnia (65.9%, mean AIS score: 7.59 ± 4.24), poor sleep quality (52.4%, mean PSQI score: 6.6 ± 3.25) and increased fatigue (48.5%, mean 35.82 ± 11.74). Moderate to severe symptoms of anxiety (mean 9.04 ± 5.66) and depression (mean 9.36 ± 6.15) were noted. Suicidal ideation was found in 16.7% of the sample, while use of sleeping pills in the previous month was reported by 8.8% (n = 47). Further analysis revealed independent associations between sleep and mental health parameters. Higher AIS score was associated with greater FSS score; higher PSQI scores with higher GAD-7 and PHQ-9 scores. Additionally, female students were found to be significantly more affected than males by the COVID-19 pandemic, displaying higher levels of insomnia, sleep disturbances, anxiety and depression. In addition, those with a history of COVID-19 infection or in close proximity with a positive case reported significantly more significant post-traumatic symptoms in IES-COVID-19 questionnaire.Conclusions: In the aftermath of the COVID-19 pandemic, prevalence of sleep and mental health disorders among Greek medical students is significant, highlighting the need for better surveillance of students' wellbeing and subsequent counseling, with special focus on female students and other affected groups.

Abstract 11670: Psychological Distress and Health Status Perception in Patients With a Previous Myocardial Infarction or Stroke

Introduction: While understanding the impact of mental health on health status perception improves patient-centered care, this relationship is not well-established in cardiac patients. We examined the association between psychological distress and health status perception in patients with a previous myocardial infarction (MI) and/or stroke. Methods: We extracted data for patients with a previous MI and/or stroke from the 2019 National Health Interview Survey (NHIS). Health perception was self-reported and grouped as poor/fair (0) or good/very good/excellent (1). Anxiety and depression were estimated using the Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-8 (PHQ-8) and grouped based on severity. Multivariable logistic regressions controlling for sex, age, education level, smoking status, race, and BMI were performed to assess our hypothesis that higher GAD-7 and PHQ-8 scores are associated with worse health perception in patients with a previous MI/stroke. Results: Of 31,948 individuals for whom data on MI/stroke was available, 6.8% (n=2,181) reported a previous MI and/or stroke. Of these patients, 36.6% (n=799) had scores consistent with anxiety and/or depression on the GAD-7 or PHQ-8. The odds of reporting good/very good/excellent health status were lower for individuals with anxiety (OR 0.245, 95% CI = 0.192-0.314, P &lt;0.001) or depression (OR 0.243, 95% CI = 0.197-0.298, P &lt;0.001) compared to those without anxiety/depression. Increasing severity of anxiety/depression was also associated with worse perception of health status ( Table 1 ). Respondents identifying as “Black” or “Other” race and those with lower education levels also demonstrated significantly worse perceived health status. Conclusion: Patients with previous MI/stroke and concomitant psychological distress have worse perception of health status. Understanding the range of patient health perceptions can help physicians provide more patient-centered care.

Tadalafil improves erectile dysfunction and quality of life in men with cirrhosis: a randomized double blind placebo controlled trial.

Patients with cirrhosis have high prevalence of erectile dysfunction (ED). The aim of this study was to study the efficacy and safety of tadalafil for ED in patients with cirrhosis. 140 cirrhotic males with ED were randomized into tadalafil 10mg daily (n = 70) or placebo (n = 70) for 12weeks. ED was diagnosed if erectile function (EF) domain score was < 25 in International Index of Erectile Function (IIEF) questionnaire. The erectile function domain consists of six questions concerning erection frequency, erection firmness, frequency of partner penetration, frequency of maintaining erection after penetration, ability to maintain erection to completion of intercourse and confidence in achieving and maintaining erection. Primary outcome was proportion of patients having an increase in > 5 points in EF domain of the IIEF. Generalized Anxiety Disorder 7(GAD-7) questionnaire was used for screening and severity measuring of GAD. The presence of depression was screened using the Patient Health Questionnaire (PHQ-9) and the assessment of health related quality of life was done using the Short Form (36) Health Survey. At the end of 12weeks, more patients in tadalafil group achieved > 5 points increase in the EF domain of the IIEF when compared with the placebo group [44(62.9%) vs. 21(30%), p < 0.001]. At the end of 12weeks, patients receiving tadalafil had significantly more change in scores on the erectile function domain, orgasmic function domain, intercourse satisfaction domain, overall satisfaction domain, erection vaginal penetration rates and successful intercourse; significantly more decline in the GAD-7 and PHQ-9 scores; significantly more improvement in scores of five of the eight domains of SF-36 (general health perception, vitality score, social functioning, role emotional and mental health) and the mental component summary rates when compared with placebo. The development of side effects and the changes in HVPG were not significantly different between the two groups. Tadalafil therapy may enhance erectile function, improve anxiety, depression and quality of life; and is well tolerated by men with cirrhosis (CTP score < 10) and ED. However, further larger and long-term studies are needed to confirm these results and look for rarer side effects of using tadalafil in patients with cirrhosis. ClinicalTrials.gov identifier number NCT03566914; first posted date: June 25, 2018.

The Effect of Preoperative Behavioral Intervention on Pain, Anxiety, Opioid Use, and Function in Patients Undergoing Total Knee Arthroplasty: A Randomized Controlled Study.

To evaluate the efficacy of preoperative cognitive-behavioral psychoeducation (CBE) for improved pain, anxiety, opioid use, and postoperative function in total knee arthroplasty (TKA) patients. A randomized controlled trial was conducted among 36 military health system beneficiaries attending preoperative education for TKA. The standard of care (SOC) group (n = 18) received information on home safety, rehabilitation, postoperative precautions, and pain management. In addition, the occupational therapy led CBE group (n = 16) received information on principles of holistic wellness (healing process, effects of stress on healing, heart-rate control through diaphragmatic breathing, anti-inflammatory nutrition, goal setting, and mental imagery). Outcomes of interest: knee active range of motion, pain (Defense and Veterans Pain Rating Scale), opioid medication use, heart-rate coherence (emwave2), anxiety (Generalized Anxiety Disorder Scale), and function (Knee Outcome Survey Activities of Daily Living [KOS-ADL], modified Functional Independence Measure, and Global Rate of Change). The CBE group demonstrated significantly greater decline in pain overall, with activity, and during sleep in relation to the SOC group when comparing visit 1 to visit 5. Opioid medication use was significantly lower for CBE versus SOC. Postoperative General Anxiety Disorder-7 scores decreased significantly among CBE participants with similar increase in high heart rate coherence. Function significantly improved postoperatively based on KOS-ADL and Global Rate of Change scores. Twice as many CBE participants had same-day discharge compared to SOC participants and most CBE participants continued with healthy lifestyle recommendations at the 3-month follow-up. A cognitive-behavioral approach to preoperative education may improve postoperative pain, anxiety, and function while decreasing opioid use among TKA patients. Findings from this pilot study support further research to examine similar interventions among distinct surgical populations and encourage further evaluation on the effects of CBE to enhance health and healthcare delivery.

The impact of patient delirium in the intensive care unit: patterns of anxiety symptoms in family caregivers

BackgroundThe purpose of this study was to examine the association of patient delirium in the intensive care unit (ICU) with patterns of anxiety symptoms in family caregivers when delirium was determined by clinical assessment and family-administered delirium detection.MethodsIn this cross-sectional study, consecutive adult patients anticipated to remain in the ICU for longer than 24 h were eligible for participation given at least one present family caregiver (e.g., spouse, friend) provided informed consent (to be enrolled as a dyad) and were eligible for delirium detection (i.e., Richmond Agitation-Sedation Scale score ≥ − 3). Generalized Anxiety Disorder-7 (GAD-7) was used to assess self-reported symptoms of anxiety. Clinical assessment (Confusion Assessment Method for ICU, CAM-ICU) and family-administered delirium detection (Sour Seven) were completed once daily for up to five days.ResultsWe included 147 family caregivers; the mean age was 54.3 years (standard deviation [SD] 14.3 years) and 74% (n = 129) were female. Fifty (34% [95% confidence interval [CI] 26.4–42.2]) caregivers experienced clinically significant symptoms of anxiety (median GAD-7 score 16.0 [interquartile range 6]). The most prevalent symptoms of anxiety were “Feeling nervous, anxious or on edge” (96.0% [95%CI 85.2–99.0]); “Not being able to stop or control worrying” (88.0% [95%CI 75.6–94.5]; “Worrying too much about different things” and “Feeling afraid as if something awful might happen” (84.0% [95%CI 71.0–91.8], for both). Family caregivers of critically ill adults with delirium were significantly more likely to report “Worrying too much about different things” more than half of the time (CAM-ICU, Odds Ratio [OR] 2.27 [95%CI 1.04–4.91]; Sour Seven, OR 2.28 [95%CI 1.00–5.23]).ConclusionsFamily caregivers of critically ill adults with delirium frequently experience clinically significant anxiety and are significantly more likely to report frequently worrying too much about different things. Future work is needed to develop mental health interventions for the diversity of anxiety symptoms experienced by family members of critically ill patients.Trial registrationThis study is registered on ClinicalTrials.gov (https://clinicaltrials.gov/ct2/show/NCT03379129).

Associations Between Substance Use Problems and Stress During COVID-19

The COVID-19 pandemic has produced major life disruptions and increased stress. We explored associations between pandemic-related stress and substance use problems. Adults (N = 180; 65% female) with problematic substance use (CAGE-AID > 1) were recruited online June-August 2020. Measures included the 15-item Short Inventory of Problems-Alcohol and Drugs (SIP-AD), Generalized Anxiety Disorder-7 (GAD-7) seven-item anxiety measure, Patient Health Questionnaire-8 (PHQ-8) eight-item depression measure, a three-item measure of pandemic life disruptions, a six-item measure of pandemic-related mental health effects, and a five-item measure of pandemic-related personal growth. Participants reported whether they frequented bars and attended large gatherings. Participants with children (<18 years of age) in the home completed a four-item measure of pandemic-related worry about children's well-being. Pandemic-related measures with significant bivariate associations with SIP-AD, GAD, and PHQ scores were tested in multivariable linear regression, adjusting for sex, age, and race/ethnicity. Participants who struggled with responsibilities at home, had greater mental health impacts, had greater personal growth, and frequented bars or large gatherings had higher SIPAD scores (all ps < .05). Participants who struggled with responsibilities at home, had difficulty getting necessities, had greater mental health impacts, and worried more about their children had higher GAD-7 and PHQ-8 scores (all ps < .05). Participants who lost a job or income during the pandemic had higher PHQ-8 scores (p = .015). In multivariable analyses, greater mental health impacts were associated with higher SIP-AD, PHQ-8, and GAD-7 scores (all ps < .05). Experiencing worsened mental health symptoms during COVID-19 was associated with more substance use problems and symptoms of depression and anxiety. Pandemic disruptions may exacerbate preexisting substance use problems.

Repetitive transcranial magnetic stimulation therapy markedly reduces anxiety in adults with major depressive disorder: A retrospective analysis of 664 patients

Abstract Background: Patients with MDD commonly have comorbid anxiety that can severely affect quality of life and, in some cases, predicts inferior response to antidepressant treatment. Nonetheless, for some antidepressant treatments, it is also established that clinical improvement in depressive symptoms is accompanied by improvement in comorbid anxiety symptoms. However, there is limited information on the impact of treatment with TMS on the severity of comorbid anxiety symptoms in MDD patients. Methods: Patient data was extracted from a clinical registry of patients treated with left-sided high frequency TMS. Six hundred and sixty-four (664) patients were identified who demonstrated at least moderate depression and anxiety symptom severity prior to commencing treatment for MDD. These patients had total scores greater than 10 on both the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) scales. Patients were aged 22 to 70 years and had received a minimum course of 20 left-sided treatments. Results: GAD-7 response was defined as a postTMS decrease from baseline in GAD-7 scores ≥ 6 (minimally clinically important difference) and remission was defined as a final GAD-7 score < 5; 65.5% of patients (95% CI: 61.9%. 69.1%) were GAD-7 responders and 34% met the remission criterion. Mean change in the GAD-7 score was -8.0 ± 5.7 (p<0.0001). Mean change in total score on the PHQ-9 was -10.5±6.7 (p<0.0001), and 58.9% of patients demonstrated a 50% or greater improvement in PHQ-9 score. The correlation between change scores on the GAD-7 and PHQ-9 was 0.75 (p<00001), indicating substantial covariation. Conclusions: High frequency TMS may reduce symptoms of both anxiety and depression in adults with MDD. We will also contrast this group with significant co-morbid anxiety to MDD patients with low baseline levels of anxiety in likelihood of antidepressant response to TMS. Keywords: TMS, anxiety, depression, high frequency

A FOCUSED EDUCATIONAL PROGRAM FOR FRONT-LINE HEALTH CARE WORKERS DURING COVID -19 OUTBREAK IMPROVES MENTAL HEALTH

Objective: To determine whether an educational program on personal protective measures can reduce anxiety and depression in Hospital workers exposed to COVID-19.&#x0D; Study Design: Quasi-experimental study.&#x0D; Place and Duration of Study: COVID Units &amp; Emergency Room, from May to Jul 2020.&#x0D; Methodology: Educational tool based on World Health Organization and Pan American Health Organization guidelines including videos on Personal Protective Equipment usage was delivered to hospital staff assigned to areas with COVID-19 patients. Likert scale, Generalised Anxiety Disorder-7 score and Major Depression Inventory were used.&#x0D; Results: 100 hospital staff were included. About 40% doctors, 41% Nurses. None had preexisting anxiety or depression. 11% reported COVID-19, 46% reported quarantine, and 91% reported contact. About 93% stated insufficient knowledge of usage of personal protective equipment and 35% reported inadequate provision of personal protective equipment. Median score on the likert scale was 5 (IQR 4-7). Mean generalized anxiety disorder score was 6.48 ± 3.4, which improved to 4.65 ± 2.7 post session, p-value &lt;0.001. 41% reported minimal, 34% mild, 24% moderate and 1% severe anxiety. Post session, 62% reported minimal Anxiety, 33% mild, 5% moderate and 0% severe anxiety. Mean major depression inventory score was 16.10 ± 7.05 which reduced to 13.58 ± 5.84, p-value &lt;0.001. Pre-session 59% reported „no/doubtful depression‟, 40% mild, 1% moderate depresssion, while post-session 85% reported „no/doubtful‟, 15% mild and none had moderate/severe depression.&#x0D; Conclusion: We found an educational program that provided information on personal protective measures significantly reduced anxiety and depression in front-line workers during COVID-19 pandemic.

The association of gratitude with perceived stress among nurses in Korea during COVID-19 outbreak

BackgroundDuring the COVID-19 pandemic, nurses might experience added emotional stress. This study examined the relationship between gratitude and psychological stress to explore effective psychological support among nurses. MethodsA cross-sectional survey assessed the level of psychological distress in 646 nurses in Gwangju, South Korea, using the Perceived Stress Scale-10 (PSS-10), Gratitude Questionnaire-6 (K-GQ-6), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and Maslach Burnout Inventory-General Survey (MBI-GS). Sociodemographic factors and COVID-19-related experiences were also examined. A linear regression model was used to determine the factors influencing perceived stress. ResultsThe mean PSS-10 score was 19.0 ± 4.4. Linear regression analyses revealed that the MBI-GS-Exhaustion, PHQ-9, and GAD-7 scores were positively associated with perceived stress, while the MBI-GS-Professional efficacy score was inversely associated with perceived stress. Gratitude disposition using the K-GQ-6 score negatively predicted PSS-10 (β = 0.829, p < 0.001). ConclusionsPsychological interventions that help cultivate gratitude and professional efficacy among nurses can help promote stress resilience throughout the course of the COVID-19 pandemic.

High Work-Related Stress and Anxiety as a Response to COVID-19 Among Health Care Workers in South Korea: Cross-sectional Online Survey Study.

BackgroundThe COVID-19 outbreak had a severe impact on health care workers' psychological health. It is important to establish a process for psychological assessment and intervention for health care workers during epidemics.ObjectiveWe investigated risk factors associated with psychological impacts for each health care worker group, to help optimize psychological interventions for health care workers in countries affected by the COVID-19 pandemic.MethodsRespondents (n=1787) from 2 hospitals in Korea completed a web-based survey during the period from April 14 to 30, 2020. The web-based survey collected demographic information, psychiatric history, and responses to the 9-item Stress and Anxiety to Viral Epidemics (SAVE-9), 9-item Patient Health Questionnaire (PHQ-9), and 7-item Generalized Anxiety Disorder-7 (GAD-7) scales. We performed logistic regression to assess contributing factors as predictor variables, using health care workers’ depression as outcome variables.ResultsAmong 1783 health care workers, nursing professionals had significantly higher levels of depression (PHQ-9 score: meannurse 5.5, SD 4.6; meanother 3.8, SD 4.2; P<.001), general anxiety (GAD-7 score: meannurse 4.0, SD 4.1; meanother 2.7, SD 3.6; P<.001), and virus-related anxiety symptoms (SAVE-9 score: meannurse 21.6, SD 5.9; meanother 18.6, SD 6.3; P<.001). Among nursing professionals, single workers reported more severe depressive symptoms than married workers (PHQ-9 score ≥10; meannurse 20.3%; meanother 14.1%; P=.02), and junior (<40 years) workers reported more anxiety about the viral epidemic (SAVE-9 anxiety score; meannurse 15.6, SD 4.1; meanother 14.7, SD 4.4; P=.002). Logistic regression revealed that hospital (adjusted odds ratio [OR] 1.45, 95% CI 1.06-1.99), nursing professionals (adjusted OR 1.37, 95% CI 1.02-1.98), single workers (adjusted OR 1.51, 95% CI 1.05-2.16), higher stress and anxiety to the viral infection (high SAVE-9 score, adjusted OR 1.20, 95% CI 1.17-1.24), and past psychiatric history (adjusted OR 3.26, 95% CI 2.15-4.96) were positively associated with depression.ConclusionsPsychological support and interventions should be considered for health care workers, especially nursing professionals, those who are single, and those with high SAVE-9 scores.

Individual Differences in the Affective Response to Pandemic-Related Stressors in COVID-19 Health Care Workers

BackgroundWe investigated the evolving prevalence of mood and anxiety symptoms among health care workers from May 2020 to January 2021, risk factors for adverse outcomes, and characteristic modes of affective responses to pandemic-related stressors. MethodsA total of 2307 health care workers (78.9% female, modal age 25–34 years) participated in an online survey assessing depression (Patient Health Questionnaire-9) and anxiety (Generalized Anxiety Disorder-7 scale) symptoms, demographic variables, and self-reported impact of pandemic-related stressors. A total of 334 subjects were reassessed ∼6 months later. ResultsThe prevalence of clinically significant depression and anxiety was 45.3% and 43.3%, respectively, and a majority (59.9%–62.9%) of those individuals had persistent significant symptoms at 6-month follow-up. Younger age, female gender, and specific occupations (support staff > nurses > physicians) were associated with increased depressive and anxiety symptoms. The most important risk factors were social isolation and fear of contracting COVID-19. The prevalence of clinically significant mood and anxiety symptoms increased by 39.8% from May 2020 to January 2021. Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7 scores were highly correlated and associated with nearly identical risk factors, suggesting that they are not capturing independent constructs in this sample. Principal component analysis identified seven orthogonal symptom domains with unique risk factors. ConclusionsClinically significant mood and anxiety symptoms are highly prevalent and persistent among health care workers, and are associated with numerous risk factors, the strongest of which are related to pandemic stressors and potentially modifiable. Interventions aimed at reducing social isolation and mitigating the impact of fear of infection warrant further study.

Income Differences and COVID-19: Impact on Daily Life and Mental Health.

The COVID-19 pandemic has caused disproportionate suffering among vulnerable and socioeconomically disadvantaged portions of the population. Low-income and minority populations are likely to experience disparate disease and mental health burdens. Currently, there is little evidence regarding how the experience of the early months of the US COVID-19 outbreak differed by income level, and how that related to mental health symptoms. The present study used data from a national sample of US adults (n = 5023) who completed measures related to the COVID experience, the COVID-19 Fear Scale, the Generalized Anxiety Disorder-7 (GAD-7), and the Patient Health Questionnaire-8 (PHQ-8). Multivariable regression was performed to determine whether income level (low: <$45,000 vs high: ≥$75,000) was significantly associated with COVID experience measures, PHQ-8, GAD-7, and COVID fear scores. Among the low-income group, COVID-19 had a significantly greater negative impact on: family income/employment, access to food, access to mental health treatment, and stress and discord in the family. Participants in the low-income group also had greater odds of a PHQ-8 score ≥10 (odds ratio [OR] = 1.38, 95% confidence interval [CI] 1.08, 1.77) and a GAD-7 score ≥10 (OR = 1.65, 95% CI 1.27, 2.14) compared to those in the high-income group. Study findings suggest substantial differences in how COVID-19 impacted daily life and mental health between adults living in low-income households compared to high-earning households during the early months of the pandemic.

Application of Stress and Anxiety to Viral Epidemics-6 Items (SAVE-6) to Public Workers for Measuring Their Anxiety Response During the COVID-19 Pandemic.

Objective: This study aimed to compare the adaptability of the adapted version of Stress and Anxiety to Viral Epidemics-9 (SAVE-9) for public workers and the SAVE-6 scale and to validate them among public workers who are on the frontline of the coronavirus disease 2019 pandemic.Methods: A total of 300 public workers responded to the anonymous online survey during April 1–12, 2021. Principal component analysis was conducted with varimax rotation to explore the factor structure of this scale. Confirmatory factor analysis was also used to explore construct validity. Spearman correlation analysis of the scale with the Generalized Anxiety Disorder-7 (GAD-7) and the Patient Health Questionnaire-9 (PHQ-9) was performed to explore the convergent validity. The cut-off score in accordance with the mild degree of generalized anxiety symptoms (GAD-7 score of 5) was defined using the receiver operating characteristic (ROC) analysis.Findings: The single-structure model of each scale (the adapted version of SAVE-9 and SAVE-6) was adopted based on the results of the parallel analysis. Because SAVE-6 showed good construct validity, but the adapted version of SAVE-9 did not, we adopted to apply the SAVE-6 scale to assess the anxiety response of public workers in response to the viral epidemic. SAVE-6 showed good internal consistency (Cronbach's alpha = 0.817; McDonald's Omega = 0.818) and good convergent validity with GAD-7 (rho = 0.417, p < 0.001) and PHQ-9 (rho = 0.317, p < 0.001) scale scores. The appropriate cut-off score for SAVE-6 was determined to be ≥ 16.Conclusion: The SAVE-6 scale, as compared to the public workers' version of SAVE-9, is a reliable and valid rating scale to assess the work-related stress and anxiety of public workers due to the viral epidemic.

Trajectories and Predictors of Anxiety Over a Ten-year Duration after Traumatic Brain Injury: A TBIMS Study

<h3>Research Objectives</h3> To determine anxiety trajectories across the first 10 years after traumatic brain injury (TBI), and to identify predictors of the longitudinal course of anxiety. <h3>Design</h3> Longitudinal cohort study. <h3>Setting</h3> Community. <h3>Participants</h3> 2836 participants with moderate to severe TBI enrolled in the Traumatic Brain Injury Model Systems (TBIMS) National Database who had anxiety outcomes for ≥2 data collection points over a 10-year follow-up period. <h3>Interventions</h3> N/A. <h3>Main Outcome Measures</h3> Generalized Anxiety Disorder-7 (GAD-7) at 1, 2, 5, and 10-year follow-ups. Relationships were examined with demographic variables, indicators of TBI severity, number of TBIs in addition to the index TBI, pre-morbid mental health, and substance abuse history. <h3>Results</h3> A latent class mixed model identified three anxiety trajectories: low-stable (n=2195), increasing (n=289), and decreasing (n=352). Higher GAD-7 scores were significantly associated with Black race, having public insurance, premorbid mental health problems, experiencing ≥2 additional TBIs with loss of consciousness (LOC), and increased years post-TBI. An interaction between follow-up year and age was also related to GAD-7 scores (p=.001). <h3>Conclusions</h3> Most individuals in the sample had low anxiety that was stable over time (77%). Smaller percentages of individuals had higher levels of anxiety, that either increased (10%) or decreased (13%) as time progressed. Multiple TBI's with LOC were related to greater anxiety up to 10 years after injury. Systemic economic and racial inequities likely contribute to long-term anxiety, as evidenced by greater anxiety in those who had public insurance and/or identified as Black. Younger individuals were more likely to experience an increase in their anxiety over time, suggesting a need for long-term anxiety surveillance, particularly for patients whose TBI occurred at an earlier stage in life. <h3>Author(s) Disclosures</h3> None.

Difference in health‐related quality of life between anxiety and depressive symptoms in Japanese patients with plaque psoriasis: the ProLOGUE study

Anxiety symptoms and depressive symptoms are observed in approximately 20%-50% and 30% of patients with psoriasis, respectively.1,2 To date, however, evidence for the association of these symptoms with patients' direct perception of their disease (called patient-reported outcomes [PROs]) remains limited. We assessed the association of anxiety symptoms and depressive symptoms with the severity of psoriasis, psoriatic symptoms, health-related quality of life (HRQoL), and satisfaction levels in Japanese patients with psoriasis using baseline data of participants from a single-arm, open-label, multicenter, prospective cohort study-ProLOGUE (Japan Registry of Clinical Trials identifier: jRCTs031180037).3 Patients (aged ≥18 years) who had plaque psoriasis without peripheral arthritis symptoms and were eligible for self-administration of brodalumab were enrolled at 15 facilities across Japan (study period, October 2017-March 2020).3.