Mild Anxiety Symptoms Research Articles

Testing the mood brightening hypothesis: Hedonic benefits of physical, outdoor, and social activities in people with anxiety, depression or both

BackgroundThe mood brightening hypothesis postulates that people with depressive symptoms report more positive affect (PA) and less negative affect (NA) than healthy controls after rewarding daily life activities. Whether mood brightening also occurs in people with anxiety symptoms remains unclear. This study examined effects of physical activity, being outdoors, and social activity on PA and NA across different levels of depression and anxiety symptoms in the general Dutch population. MethodsParticipants completed an electronic diary on their smartphone, thrice daily over 30 days, to assess activities and affect (n = 430; 22,086 assessments). We compared five groups based on their scores on the Depression, Anxiety and Stress Scales: asymptomatic participants, participants with mild symptoms of depression and/or anxiety, depression symptoms, anxiety symptoms, and comorbid depression and anxiety symptoms. Multilevel linear regression models with interaction terms were used to compare the association between activities and affect in these five groups. ResultsAll activities were associated with increased PA and reduced NA in all groups. We found a mood brightening effect in participants with depression, as physical activity and being outdoors were associated with reduced NA. Participants with depression had increased PA and reduced NA when in social company compared to asymptomatic participants. No mood brightening effects were observed in participants with anxiety or comorbid depression and anxiety. LimitationsOur sample included mainly women and highly educated subjects, which may limit the generalizability of our findings. ConclusionMood brightening is specific to depression, and typically stronger when in social company.

The relationship between positive psychological qualities and prenatal negative emotion in pregnant women: A path analysis.

The objective of this study was to investigate the relationship between positive psychological qualities and negative emotions of pregnant women. We surveyed 774 pregnant women in a tertiary hospital in Urumqi using the following measures: a self-report general demographic data questionnaire, Generalized Anxiety Disorder scale (GAD-7), Patients Health Questionnaire depression scale (PHQ-9), Pregnancy Pressure Scale (stocktickerPPS), Perceived Social Support Scale (PSSS), General Self-Efficacy Scale (GSES), and Connor-Davidson Resilience scale (CD-RISC). We used the Amos2.03 system to build a structural equation model. A total of 774 subjects had an average age of 30 years and an average gestational age of 23 weeks. Among the 774 respondents, 122 (15.8%) had moderate or above pregnancy stress (stocktickerPPS > 1), 376 (48.6%) had mild or above anxiety symptoms (GAD-7 ≥ 5), 456 (58.9%) had mild or above depression symptoms (PHQ-9 ≥ 5), 740 (95.6%) had moderate or above social support scores (PSSS ≥ 37), and 124 (16.0%) had good or above psychological resilience scores (CD-RISC ≥ 60). Notably, 372 (48.1%) people had a self-efficacy score above the overall average (GSES ≥ 2.6). Pregnancy stress had positive correlations with anxiety and depression (β = 0.57, 0.30, P < 0.01) and negative correlations with self-efficacy (β = -0.19, P < 0.01). Anxiety had positive correlations with depression (β = 0.54, P < 0.01) and negative correlations with social support (β = -0.45, P < 0.01). Social support had positive correlations with self-efficacy and resilience (β = 0.37, 0.47, P < 0.01). Resilience had negative correlations with anxiety (β = -0.09, P < 0.01), and self-efficacy had positive correlations with resilience (β = 0.41, P < 0.01). Identification of pregnancy stress should be emphasized in pregnant women with negative emotions. Efforts to strengthen the positive psychological qualities of pregnant women should focus on cultivating psychological resilience to reduce the occurrence of anxiety, and improving social support should be a priority because it can enhance psychological resilience and self-efficacy. We provide a reason to intervene in the negative emotions of pregnant women from the perspective of the positive psychology of pregnant women.

Psychology University Students’ Mental Health Status during COVID-19 Pandemic in Karachi, Pakistan

Purpose: The COVID-19 pandemic has brought challenges in various domains of life but for low and middle-income country university students very demanding situations have emerged. University students’ psychological well-being has always been an area of concern worldwide and higher rates of anxiety and depression have been extensively reported among this cohort. Objective: To determine the frequency of depressive symptoms, anxiety symptoms, and quality of sleep and the association of sleep quality and personality traits with anxiety and depressive symptoms among university students in Karachi, Pakistan in the context of the pandemic COVID-19. Method: This web-based cross-sectional study was conducted among the students of a renowned, private, and HEC-recognized university during March 2020 to April 2020. Google forms were used to disseminate the online questionnaire to screen for depression-Patient Health Questionnaire—PHQ-9, anxiety-Generalized Anxiety Disorder—GAD-7, sleep-quality-Pittsburgh Sleep Quality Index Scale— PSQI and personality traits-Short Term Big Five Inventory—BFI-S. Results: Among the total sample size of 227 students, a considerable proportion of student participants had symptoms of mild anxiety [34.8%], moderate anxiety [15.9%], severe anxiety [18%], mild depression [19.8%], moderate depression [21.5%], moderately severe depression [13.3%] and severe depression [12%]. The majority of them were poor sleepers [77.5%]. Poor sleep quality was also associated with the level of depression and anxiety with a p-value of tiousness, Extroversion & Neuroticism were comparatively more vulnerable to anxiety and depression than people with other traits. Conclusion: This study gives strong evidence that a large percentage of university students have been suffering from depressive and anxiety symptoms during the COVID-19 pandemic accompanied by poor sleep quality. Protecting students’ mental health is an inevitable target during health crises by developing preventive strategies and interventions to address the psychological well-being of university students. The findings also highlight the significance of personality traits as a relevant component of individual differences to respond to various health-related emergencies.

Assessment of Anxiety and Associated Risk Factors among General Public During COVID-19 Pandemic: A Community Based Study

Background: Lockdown represents a remarkably effective strategy of social distancing to break the chain oftransmission of COVID-19. This state of lockdown led to a significant influence on physical and mental wellbeingof people. The present study was conducted to assess the impact of COVID-19 pandemic on anxiety level ofgeneral public and find out the associated factors.Methods: The present web based cross-sectional study was carried out among 450 participants in India in themonth of May 2020. Data collection was done using online Google form. A semi-structured questionnaire wasused. Generalized Anxiety Disorder Scale-7 (GAD-7) Scale was used to assess anxiety symptoms among theparticipants. Descriptive Statistics and Chi-square test were done using SPSS version 21.Results: Age of the participants ranged between 18 to 71 years. Nearly one-third of the participants were health careprofessionals. Symptoms of mild anxiety was reported by 17.1% of participants, while 20.2% reported moderateanxiety. Anxiety was found to be significantly more among female gender, health care professional and among thestudy participants who were going to work daily.Conclusion: Covid-19 pandemic has increased the anxiety level among general public.

Prevalence of post-traumatic stress and tests of metacognition as a PTSD risk marker in patients with coronary heart disease and elevated HADS scores: analysis of data from the PATHWAY RCT's in UK cardiac rehabilitation.

Anxiety and depression in coronary heart disease (CHD) are associated with poorer health outcomes, greater healthcare use and reduced quality of life. Post-traumatic stress symptoms may be a particular concern as they are associated with increased mortality at follow-up. We examined prevalence of PTSD in patients with elevated anxiety/depression scores referred for cardiac rehabilitation (CR) across seven NHS sites in North-West England. We tested a possible mechanism (metacognition) linking CHD to PTSD symptom severity as implicated in the metacognitive model. Data was collected at baseline as part of the NIHR funded PATHWAY trial of metacognitive therapy for anxiety and depression in CHD. Patients (n = 572) with at least mild symptoms of anxiety and depression under routine screening (assessed with the Hospital Anxiety and Depression Scale) and attending CR were eligible for the study. A battery of questionnaires, including assessment of demographic variables, PTSD symptoms (using the IES-R) and metacognitive beliefs was administered prior to random allocation and intervention delivery. Rates of PTSD were high, with 48% of patients meeting threshold for PTSD and a further 15% partial PTSD. All five metacognition subscales were positively associated with PTSD vs. no PTSD, with beliefs about the uncontrollability and danger of worry and beliefs about need to control thoughts being most strongly related. For every unit increase in uncontrollability and danger metacognitions the odds of being in the PTSD group increased 30%, whilst the odds of partial PTSD increased 16%. Stepwise regression analysis using the metacognitive subscales along with demographic and health-related covariates found that uncontrollability/danger and need for control metacognitions explained unique variation in PTSD symptom severity, with unique contributions also for age, sex, and number of comorbidities. PTSD symptoms appeared highly prevalent in the current CR sample. Metacognitive beliefs were individually associated with symptom severity with the strongest positive relationship observed for beliefs about uncontrollability and dangerousness of worry, followed by need to control thoughts. The results highlight the importance in assessing PTSD in CR patients and add support to implementing metacognitive therapy in CHD to target particular metacognition risk factors in anxiety, depression and PTSD.

Challenges in Mental Health: Anxiety, Depression and Burnout Syndrome during the COVID-19 Pandemic in Mexico

Results of an observational, cross-sectional and prospective study of students from two medical schools, (ESM and ESMH) from Instituto Politecnico Nacional (IPN) Mexico, are presented, 653 respondents to assess depression, anxiety, alcohol and substance use. Physicians who recently graduated doctors and medical students close to graduating were specifically evaluated. Variables (anxiety, depression, suicidal ideation and substance use) were evaluated. Results: 301 students of the total population attended with symptoms of mild level anxiety while 131 presented severe anxiety; Regarding levels of depression in general, 65.8% coursed with some depression, the ESM reported 27.8% with moderate depression and the ESMH with 24.2 in the same type of depression. The incidence of substance use in both schools was 15.2%. The male sex registered a consumption of 7.4% and the female sex 9.7%. Regarding the results of risk of suicidal ideation, the ESM registered 27% and the ENMH registered a risk of 35.5%. The pressures received due to work overload, the COVID-19 pandemic, the lack of supplies and medical equipment.

Нейропатичний біль при анкілозивному спондиліті та особливості психопатологічного реагування

The purpose of the work was to study the features of psychopathological symptoms in ankylosing spondylitis with and without neuropathic pain. Materials and methods. We clinically examined 142 patients treated between 2019 and 2022 who were diagnosed with ankylosing spondylitis according to the modified New York criteria. These patients were divided into two groups: the first group had the signs of neuropathic pain; the second group had no signs. The study of the psycho-emotional sphere was carried out using the The Zung Self-Rating Depression Scale, scales for assessing the level of personal and reactive anxiety by S. Spilberger, and the Mini Mental State Examination questionnaire was used to determine cognitive function. Results and discussion. It was found that the basis of psychopathological reactions in ankylosing spondylitis are mild and moderate depressive and anxiety symptoms: the average score on The Zung Self-Rating Depression Scale in patients without neuropathic pain was 48.1 ± 13.1 points, and in patients with neuropathic pain – 58.1 ± 4.6 points (p&lt;0.01). 28.9% had no signs of depression, 45.1% showed signs of mild depression, and 26.0% – moderate depression. In 41.5% of patients without neuropathic pain, no signs of depression were found, in 40.4% – mild depression, in 18.1% – moderate, in patients with neuropathic pain – 4.2%, 54.2%, and 41.6%, respectively. The average value of the reactive anxiety index in the examined was 47.2 ± 12.2 points, in patients without neuropathic pain – 45.5 ± 12.7 points, in patients with neuropathic pain – 50.4 ± 10.5 points (p&lt;0.05); personal anxiety indicator was 45.5 ± 10.1, 43.7 ± 10.6 and 49.0 ± 8.2 points, respectively (p&lt;0.05). A low level of reactive anxiety in patients with neuropathic pain was found in 2.1%, without neuropathic pain – in 13.8% (p&lt;0.05); medium – respectively in 31.3% versus 36.2% (p&gt;0.05), high – respectively in 66.6% versus 50.0% (p&lt;0.05). There were significantly more patients with low levels of personal anxiety among those who did not have neuropathic pain – 20.2% versus 6.3% (p&lt;0.05), and with high levels – among patients with neuropathic pain: 56.2% versus 38.3% (p&lt;0.05). The average value of the Mini Mental State Examination index in all patients was 27.46 ± 1.77 points; in patients with neuropathic pain – 26.29 ± 1.39 points, without neuropathic pain – 28.06 ± 1.64 points (p&lt;0.01). Conclusion. Correlation analysis made it possible to establish the presence of significant correlations between expressiveness of neuropathic pain and depression and anxiety. Depressive and anxious manifestations in ankylosing spondylitis reflect psychopathological reactions to severe disease, pain and somatic discomfort, and personal anxiety as a stable personality characteristic, in ankylosing spondylitis patients primarily reflects the formation of patho-characteristic features as a result of long-term somatogenic influence. Cognitive impairment is probably mediated by depressive and anxiety symptoms and the influence of pain syndrome. The presence of a neuropathic component of the pain syndrome is a factor that aggravates the state of the psycho-emotional sphere, which justifies the feasibility of prescribing psychopharmacological therapy for ankylosing spondylitis

Pre-Existing Anxiety and Depression in Injured Older Adults: An Under-Recognized Comorbidity With Major Health Implications.

Little is known about the prevalence and impact of psychiatric comorbidities on early postinjury depression and anxiety in nonneurologically injured older adults. This was a retrospective post-hoc analysis of data from the Trauma Medical Home, a multicenter randomized controlled trial (R01AG052493-01A1) that explored the effect of a collaborative care model on postinjury recovery for older adults compared to usual care. Nearly half of the patients screened positive for at least mild depressive symptoms as measured by the Patient Health Questionnaire-9. Forty-one percent of the patients screened positive for at least mild anxiety symptoms as measured by the Generalized Anxiety Disorder Scale. Female patients with a history of concurrent anxiety and depression, greater injury severity scores, and higher Charlson scores were more likely to have mild anxiety at baseline assessment. Patients with a history of depression only, a prior history of depression and concurrent anxiety, and higher Charlson scores (greater medical comorbidity) had greater odds of at least mild depression at the time of hospital discharge after traumatic injury. Anxiety and depression are prevalent in the older adult trauma population, and affect women disproportionately. A dual diagnosis of depression and anxiety is particularly morbid. Mental illness must be considered and addressed with the same importance as other medical diagnoses in patients with injuries.

Cognitive-behavioral therapy on psychological stress and quality of life in subjects with pulmonary tuberculosis: a community-based cluster randomized controlled trial

BackgroundAnxiety and depression are two common psychological disorders in patients with pulmonary tuberculosis. We aimed to explore the effects of cognitive-behavioral therapy (CBT) on psychological stress and quality of life in patients with pulmonary tuberculosis.MethodsFrom September 2018 to November 2018, 20 communities (461 participants in total) were randomly assigned in an intervention or control group following a two-level cluster random design. The intervention group underwent CBT for 2 months, whereas the control group received routine follow-up. Anxiety, depression, and quality of life were assessed using the Patient Health Questionnaire-9 (PHQ-9), General Anxiety Disorder questionnaire (GAD-7), and 36-Item Short-Form Health Survey (SF-36) scales, respectively. Comparisons between the two groups were conducted using independent samples t-tests, and differences between the two groups before and after treatment were analyzed using paired samples t-tests.ResultsThere were a total of 454 participants in the final analysis. After 2 months of CBT intervention, the CBT group had a GAD-7 score that was 1.72 lower than the control group (1.47–1.99, p < 0.001), a PHQ-9 score of the CBT group that was 2.05 lower than that of the control group (1.74–2.37, p < 0.001). The CBT group had a total SF-36 score that was 10.7 lower than that of the control group (95% CI: 7.9–13.5, p < 0.001). In patients with different degrees of anxiety and depression, only those in the intervention group who had mild and moderate anxiety and depression symptoms showed a significant reduction in anxiety and depression scores following the intervention.ConclusionsCBT can relieve anxiety, and depression symptoms and increase the quality of life in subjects with pulmonary tuberculosis.Trials registrationChiCTR-TRC-12001958 Date of Registration: 22/02/2012.

Psychological Impact of Cancellation of Elective Surgeries for Ophthalmic Patients during COVID-19 Pandemic.

The COVID-19 pandemic has disrupted routine hospital services globally. The cancellation of elective surgeries placed a psychological burden on patients. A questionnaire study was conducted to identify the psychological impact of canceling cataract operations on patients at Kowloon East Cataract Center, Tseung Kwan O Hospital, Hong Kong, from April to June 2020. In total, 99 participants aged 59 years old and above, who had their cataract surgeries postponed or as scheduled, were studied using the standardized patient health questionnaire (PHQ-9) and generalized anxiety disorder questionnaire (GAD-7). None of the patients who had their cataract surgeries rescheduled reached the cutoff score for major depression in PHQ-9, whereas, according to GAD-7, five patients had mild symptoms of anxiety, and one had severe symptoms. There was no significant psychosocial impact of the cancellation of cataract surgeries on patients.

A cross-sectional study on the impact of the COVID-19 pandemic on psychological outcomes: Multiple indicators and multiple causes modeling.

Although the psychological impact of coronavirus disease 2019 (COVID-19) has been evaluated in the literature, further research is needed, particularly on post-traumatic stress disorder (PTSD) and psychological outcomes, is needed. This study aims to investigate the effect of the COVID-19 pandemic on psychological outcomes (depression, anxiety, and insomnia). A cross-sectional study using an online survey was conducted using the following instruments: Impact of Event Scale-Revised (IES-R), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder (GAD-7), and Insomnia Severity Index (ISI). Confirmatory factor analysis (CFA), structural equation model (SEM), multiple indicators and multiple causes (MIMIC) modeling, and differential item functioning (DIF) were performed to analyze the collected data. According to the results, participants with PTSD (n = 360) showed a higher level of depression, anxiety, and insomnia than those without PTSD (n = 639). Among the participants, 36.5% experienced moderate to severe symptoms of depression, and 32.6% had mild depressive symptoms. Moreover, 23.7% of participants experienced moderate to severe anxiety symptoms, and 33.1% had mild anxiety symptoms. In addition, 51.5% of participants experienced symptoms of insomnia. In conclusion, the PTSD caused by COVID-19 is significantly associated with depression, anxiety, and insomnia at the level of latent constructs and observed variables.

The mediating effect of resilience on pregnancy stress and prenatal anxiety in pregnant women.

ObjectiveTo investigate the relationship between pregnancy stress and prenatal anxiety in pregnant women in Urumqi, Xinjiang, and the mediating effect of mental resilience level on the relationship between pregnancy stress and prenatal anxiety.MethodThe investigation involved 750 pregnant women at a tertiary hospital in Urumqi, and included a questionnaire eliciting general demographic information, a pregnancy stress scale (Pregnancy Pressure Scale, PPS), generalized anxiety disorder scale (Generalized Anxiety Disorder-7, GAD-7), and a mental resilience scale (Connor—Davidson resilience scale, CD-RISC). The Bootstrap mediation effect test was used to test the effect relationship between variables, and Amos was used to establish the structural equation model.ResultsAmong the 750 participants, 122 (16.2%) had moderate or greater pregnancy stress (PPS > 1), 372 (49.6%) had mild or greater anxiety symptoms (GAD-7 > 5), and 241 (32.1%) had good or higher mental resilience score. Pregnancy stress negatively affected resilience (β = −0.37, p < 0.01), and resilience also negatively affected prenatal anxiety (β = −0.12, p < 0.01). The mediating effect value of resilience was 8.3%.ConclusionPregnancy stress, mental resilience, and prenatal anxiety were significantly correlated, and mental resilience played a partial mediating role in the influence of pregnancy stress on prenatal anxiety. It is recommended that pregnant women exercise their mental resilience to reduce the incidence of prenatal anxiety and promote physical and mental health.

Self-compassion as a moderator between clinical perfectionism and psychological distress

ABSTRACT Objective Clinical perfectionism is associated with psychological distress, however, few studies have examined factors that moderate the relationship. Self-compassion is a useful construct to examine as it is a component of cognitive-behavioural treatment (CBT) for clinical perfectionism, and lower self-compassion is related to higher perfectionism and distress. Method The aim was to determine if self-compassion is a moderator between clinical perfectionism and distress. Adults who had mild symptoms of anxiety and depression (N = 344, 82% female, M age= 28.14 years, SD = 12.79) completed online measures. Results In considering the total self-compassion score, when self-compassion was higher the association between clinical perfectionism and psychological distress was lower, relative to when self-compassion was lower, hence self-compassion was a moderator between clinical perfectionism and distress. When the Self-Compassion Scale was considered on the basis of the positive and negative subscales, these were not significant moderators between clinical perfectionism and distress. Conclusion Self-compassion may be one explanation of how clinical perfectionism is associated with distress, when considered as a total score. The results support the need for future research examining the moderating role of self-compassion between perfectionism and distress, given the contrast in findings when considered at a subscale level. KEY POINTS What is already known about this topic: Perfectionism is associated with psychological distress. Few studies have examined factors that explain the relationship. Self-compassion is one factor that could explain this link. What this topic adds: Self-compassion may explain how perfectionism is associated with distress. Future research is needed on the moderating role of self-compassion. Treatments for perfectionism should target self-compassion.

Associations between COVID-19 vaccine hesitancy and the experience of violence among women and girls living with and at risk of HIV in Nigeria

Aim : Women and girls living with and at high risk of HIV (WGL&RHIV) had an increased risk for gender-based violence (GBV) during COVID-19. The study aimed to assess the associations between vaccine hesitancy and GBV, HIV status and psychological distress among these vulnerable women and girls in Nigeria. Methods: This cross-sectional study collected data from WGL&RHIV in 10 states in Nigeria between June and October 2021. The dependent variable was vaccine hesitancy. The independent variables were the experience of physical, sexual, economic and emotional GBV, HIV status and psychological distress during the COVID-19 pandemic. We conducted a multivariable logistics regression analysis to test the associations between vaccine hesitancy and the independent variables and covariates. Results: Among the 3 431 participants, 1 015 (22.8%) were not willing to be vaccinated against COVID-19. Not knowing or willing to disclose HIV status (aOR 1.40) and having mild (aOR 1.36) and moderate (aOR 1.38) symptoms of anxiety and depression were significantly associated with higher odds of vaccine hesitancy. Being a survivor of intimate partner physical violence (aOR 5.76), non-intimate partner sexual violence (aOR 3.41), as well as emotional abuse (aOR 1.55) were significantly associated with respectively more than five, three and one and half times higher odds of vaccine hesitancy. One positive outcome is that HIV-positive women and girls appeared to be more likely to get the COVID-19 vaccine when available. Conclusions: Sexual and gender-based violence, low socio-economic status, psychological distress and an unknown HIV status are essential determinants of COVID-19 vaccine hesitancy among vulnerable women and girls in Nigeria. National authorities and civil society organisations need to better integrate COVID-19 mitigation activities with HIV and gender-based violence interventions through a more feminist approach that promotes gender equality and the empowerment of women and girls in all their diversity for better access to health services.

Evaluation and analysis of anxiety and depression symptoms for college students during COVID-19 pandemic

BackgroundThe mental health of students is affected by COVID-19. We aim to evaluate the anxiety and depression symptoms among college students during COVID-19 pandemic, analyze the influence factors that contribute to college students’ anxiety and depression symptoms, and provide some suggestions for improving the mental health of college students.MethodsWith 179 college students participating, an online questionnaire consisting of a general questionnaire, Generalized Anxiety Disorder (GAD-7), and Patient Health Questionnaire (PHQ-9) was conducted in universities in Shanghai. The anxiety and depression symptoms among college students were evaluated using GAD-7 and PHQ-9 scales, and influence factors were analyzed using an unordered multi-class Logistic regression model.ResultsThe reliability and validity of the GAD-7 and PHQ-9 scales were good (reliability ≥ 0.9, validity = 100%). The incidence of anxiety was 32.4%, of which were 23.5%, 8.4%, and 0.6% in mild, moderate, and severe, respectively; and the incidence of depression was 46.40%, of which in mild, moderate, moderate to severe, and severe were 28.5%, 10.1%, 7.3%, and 0.6%, respectively. Multivariate analysis revealed that male students with strong psychological quality, who were not easily affected by the COVID-19 pandemic, who received less negative or false information, and who had a strong grasp of psychology and related knowledge were less likely to suffer from mild or moderate anxiety symptoms [OR (95% CI) 0.18 (0.04, 0.81), 0.12 (0.05, 0.33), 0.23 (0.06, 0.89) and 0.07 (0.01, 0.74)]. Furthermore, college students who were not affected by the COVID-19 pandemic were less likely to suffer from mild, moderate, and moderate to severe depression symptoms [OR (95% CI) 0.23 (0.08, 0.65), 0.22 (0.05, 0.93), 0.10 (0.02, 0.54)].ConclusionThe GAD-7 and PHQ-9 scales are suitable for evaluating anxiety and depression symptoms in college students. The COVID-19 pandemic was associated with a high incidence of anxiety and depression symptoms among college students, although gender and mental state fluctuations during the pandemic, negative and false information, and exposure to psychology and related courses were the main influencing factors.

Interactions between multiple environmental factors and associations with generalized anxiety disorder in Nurses’ Health Study II

Background and Aim: Built and natural environments are linked to lower anxiety. Results are mixed due to heterogeneous study populations and definitions of anxiety. We longitudinally examined associations between generalized anxiety disorder (GAD) symptoms and exposure to residential greenness, walkability, and neighborhood socioeconomic status (nSES) and their interactions in the Nurses’ Health Study II. Methods: 79,838 participants completed the 7-item GAD Assessment (GAD-7) in 2013 and/or 2017. GAD-7 scores for both time points were dichotomized at a clinically-relevant cutoff (GAD-7 &amp;#x2265; 5), indicating at least mild anxiety symptoms. Annual average and peak (July) greenness were assigned to residential addresses using Landsat-based Normalized Difference Vegetation Index (NDVI) at 270m and 1230m buffers. Walkability was calculated from summed z-scores of 2010 Census population density, Tiger/Line shapefile road intersection density, and Infogroup business density. nSES z-scores were linked using 2010 Census data. We employed generalized estimating equations (GEE) for individual and joint exposure models to estimate odds ratios (OR) and 95% confidence intervals (95% CI) adjusted for sociodemographic and lifestyle risk factors for anxiety. Results: Interquartile range increases in peak 270m NDVI (OR: 0.98, 95% CI: 0.96, 1.00), peak 1230m NDVI (OR: 0.97, 95% CI: 0.95, 1.00), and nSES z-score (OR: 0.97 95% CI: 0.95, 0.99) were protective. Higher walkability (OR: 1.02, 95% CI: 1.01, 1.03) was associated with elevated odds of anxiety symptoms. Interaction models showed substantial heterogeneity. For example, peak 270m NDVI was more protective in lower nSES areas (lowest quintile OR: 0.94, 95% CI: 0.90, 0.98, highest quintile OR: 1.01, 95% CI: 0.96, 1.06). The adverse association observed with walkability was stronger in higher NDVI areas. Conclusion: Higher residential NDVI and nSES and lower walkability were associated with decreased odds of anxiety symptoms. Interactions between these contextual factors identified subpopulations that could benefit from improved residential built and natural environments.

The impact of the COVID-19 pandemic on the mental health and academic performance of medical postgraduates.

BackgroundThe Coronavirus disease 2019 (COVID-19) has presented a major challenge to the health, economic, and social sectors of the entire world. This study aimed to investigate the mental health and academic performance of medical postgraduates during the COVID-19 pandemic in China.MethodsA cross-sectional online survey was conducted from March 20 to April 20, 2022 at the Zhejiang University School of Medicine in China. The questionnaire consisted of three parts: general information, mental health and academic performance. Mental health outcomes were assessed according to the Generalized Anxiety Scale (GAD-7) and the Patient Health Questionnaire-9 Scale (PHQ-9).ResultsA total of 153 valid questionnaires were obtained. Of the medical postgraduates in this study, (1) 41.8% had no anxiety symptoms. In addition, 51.0% had mild anxiety symptoms during the COVID-19 pandemic. None of the participants had a severe anxiety or depression disorder; (2) Females experienced significantly more symptoms in mental health measure scores than the males (P < 0.01); (3) 78.4% believed that the COVID-19 pandemic had varying degrees of impact on their academics. Doctoral postgraduates showed greater academic stress, and they were more worried about not meeting graduation standards than the master's postgraduates (P < 0.05). There were no significant differences between the surgical postgraduates and internal postgraduates in either mental health or academic performance.ConclusionsOur study found that the COVID-19 pandemic has had a mild impact on the mental health and academic performance of medical postgraduates in China. Females experienced significantly more symptoms on mental health measure scores than the males. Doctoral postgraduates showed greater academic stress than the master's postgraduates. There is uncertainty regarding how long this COVID-19 situation will persist and increasing recognition that there may be periods of recurrence in the future. We need more active curricular innovation and transformation to maintain and improve medical postgraduates' mental health and academic performance.

Prevalence and factors associated with mild depressive and anxiety symptoms in older adults living with HIV from the Kenyan coast.

IntroductionEmpirical research on the burden and determinants of common mental disorders (CMDs), especially depression and anxiety, among older adults living with HIV (OALWH) in sub‐Saharan Africa is inadequate. To bridge the gap in Kenya we: (1) determined the prevalence of CMDs among OALWH on routine HIV care compared to HIV‐negative peers; (2) investigated HIV status as an independent predictor of CMDs in older adults; and (3) investigated CMD determinants.MethodsIn a cross‐sectional study conducted between 2020 and 2021, the prevalence of CMDs and associated determinants were investigated at the Kenyan coast among 440 adults aged ≥50 years (257 OALWH). The Patient Health Questionnaire and Generalized Anxiety Disorder scale were administered alongside measures capturing biopsychosocial information. Logistic regression was used to examine the correlates of CMDs.ResultsNo significant differences were found in the prevalence of mild depressive symptoms, 23.8% versus 18.2% (p = 0.16) and mild anxiety symptoms, 11.7% versus 7.2% (p = 0.12) among OALWH compared to HIV‐negative peers, respectively. HIV status was not independently predictive of CMDs. Among OALWH, higher perceived HIV‐related stigma, ageism, increasing household HIV burden, loneliness, increasing functional disability, sleeping difficulties, chronic fatigue and advanced age (>70 years) were associated with elevated CMDs. Among HIV‐negative older adults, loneliness, increased medication burden and sleeping difficulties were associated with elevated depressive symptoms. Easier access to HIV care was the only factor associated with lower CMDs among OALWH.ConclusionsOn the Kenyan coast, the burden of moderate and severe CMDs among older adults is low; however, both OALWH and their HIV‐negative peers have a similar relatively high burden of mild depressive and anxiety symptoms. Our results also suggest that determinants of CMDs among OALWH in this setting are predominantly psychosocial factors. These results highlight the need for psychosocial interventions (at the family, community and clinical levels) to mitigate the risks of mild CMDs as they are known to be potentially debilitating.

Psychological responses, mental health, and sense of agency for the dual challenges of climate change and the COVID-19 pandemic in young people in the UK: an online survey study

BackgroundThe COVID-19 pandemic and climate change are both significant and pressing global challenges, posing threats to public health and wellbeing. Young people are particularly vulnerable to the distress both crises can cause, but understanding of the varied psychological responses to both issues is poor. We aimed to investigate these responses and their links with mental health conditions and feelings of agency.MethodsWe conducted an online survey between Aug 5 and Oct 26, 2020, targeting a diverse sample of young people (aged 16–24 years, n=530) in the UK. The survey was distributed using a combination of a survey panel (panel sample) and direct approaches to youth groups and schools who shared the survey with young people in their networks (community sample). We collected data on respondents’ psychological responses to both climate change and the COVID-19 pandemic, their sense of agency to respond to each crisis, and the range of impacts on their lives. We also collected demographics data and screened for mental health and wellbeing indicators. We used non-parametric tests for most statistical comparisons. For paired samples, we used Wilcoxon's signed-rank test, and used Mann-Whitney U-tests or Kruskal-Wallis tests for two or more independent samples. Summed scale scores were considered as interval-level data and analysed with Student's t tests and ANOVAs. Effect sizes are reported as Cohen's d and partial eta-squared (η·2p), respectively.FindingsAfter excluding 18 suspected bots and 94 incomplete responses, 530 responses were retained for analysis. Of the 518 respondents who provided demographic data, 63% were female, 71·4% were White, and the mean family affluence score was 8·22 (SD 2·29). Most participants (n=343; 70%) did not report a history of diagnosis or treatment for a mental health disorder, but mental health scores indicated a common experience of (relatively mild) symptoms of anxiety, depression, and stress. Although UK youth reported more life disruption and concern for their future due to the COVID-19 pandemic, climate change was associated with significantly greater distress overall, particularly for individuals with low levels of generalised anxiety. The COVID-19 pandemic was more associated with feelings of anxiety, isolation, disconnection, and frustration; distress around loss and grief; and effects on quality of life. Climate change was more likely to evoke emotions such as interest and engagement, guilt, shame, anger, and disgust. The greater distress attributed to climate change overall was due, in particular, to higher levels of guilt, sense of personal responsibility, and greater distress triggered by upsetting media coverage. Agency to address climate change was associated with greater climate distress, but pandemic-related distress and agency were unrelated.InterpretationThe COVID-19 pandemic and climate change are affecting the wellbeing of UK young people in distinct ways, with implications for health service, policy, and research responses. There is a need for mental health practitioners, policy makers, and other societal actors to account for the complex relationship between climate agency, distress, and mental wellbeing in young people.FundingImperial College London.

Anxiety Screening among the General Population of Latvia and Associated Factors.

Background and Objectives: The aim of this study was to determine the point prevalence of at least mild anxiety symptoms and symptoms of generalized anxiety disorder in the Latvian general population, and to analyze the associated factors. Materials and Methods: A computer-assisted face-to-face survey was conducted in 2019–2020 with a multistage stratified probability sample of the Latvian general adult population (n = 2687). Anxiety was assessed using the 7-item Generalized Anxiety Disorder (GAD-7) scale; a score of ≥5 was defined as indicating the presence of mild symptoms of anxiety, and a score of ≥10 as the cutoff for identifying cases of generalized anxiety disorder. The Patient Health Questionnaire 9 (PHQ-9) and MINI International Neuropsychiatric Interview (M.I.N.I.) modules were used for assessing comorbid conditions. Multinomial logistic regression was conducted. Results: The point prevalence of mild anxiety symptoms was 10.9%. The point prevalence of generalized anxiety disorder symptoms was 3.9%. Higher odds of mild anxiety symptoms were detected in respondents of a young age (vs. 65 y.o. and older, aOR 3.1, p < 0.001), unmarried respondents (vs. married/cohabiting, aOR 1.5, p = 0.02), those living in the capital city (aOR 1.6, p = 0.008) or rural areas (aOR 1.5, p = 0.03) (vs. other towns), respondents with poor self-rated health (vs. good, aOR 2.6, p < 0.001), and diagnosed alcohol use disorder (aOR 1.9, p < 0.001), suicidal behavior (aOR 2.4, p < 0.001), and symptoms of depression (aOR 6.4, p < 0.001) (vs. no such conditions). As for symptoms of generalized anxiety disorder, female sex (vs. males, aOR 2.5, p = 0.003), age below 44 years (vs. 65+, aOR 6.2, p = 0.002), average self-rated health (vs. good, aOR 2.6, p = 0.005), and poor self-rated health (vs. good, aOR 5.3, p < 0.001), together with comorbid suicidal behavior (aOR 6.1, p < 0.001) and symptoms of depression (aOR 43.4, p < 0.001) (vs. no such conditions), increased the odds. Conclusions: Young age, poor self-rated health, and comorbid symptoms of depression and suicidal behavior were significant factors associated with symptoms of both mild anxiety and generalized anxiety disorder. Being unmarried, living in the capital city or rural areas, and alcohol use disorder were associated with mild anxiety symptoms alone. Female sex was associated with generalized anxiety disorder symptoms alone.