Preventive Health Research Articles

Intention to utilize mental health and suicide prevention resources in a community sample during the first year of the COVID-19 pandemic

ObjectiveGiven the stressors experienced during the COVID-19 pandemic, it is critical to identify populations with elevated mental health needs during this crisis. This study investigated demographic correlates of reported intention to utilize mental health (MH) and suicide prevention (SP) resources in a community sample during the COVID-19 pandemic.MethodsA sample of 1,978 adults in the United States completed an anonymous online survey between June 2020 and February 2021.ResultsIntent to utilize MH resources was associated with younger age, single marital status, female gender, and Hispanic vs. White race/ethnicity. Intent to utilize SP resources was associated with younger age, single marital status, and was greater among Black and Hispanic vs. White race/ethnicity. Lower education was associated with MH and SP utilizers in bivariate analysis. Indirect effects of Suicide Crisis Syndrome (SCS) symptoms were found on the association of age, gender, and marital status with MH utilization and of age, marital status, and education with SP Utilization.ConclusionsSpecific demographic populations demonstrate greater interest in mental health care during the COVID-19 pandemic. These help-seeking patterns can be explained in part by an elevated level of SCS symptoms, suggesting greater levels of distress were driving expressed intention to utilize service referrals.

Mamá Empoderada: study protocol for a pilot trial of a novel parenting and mental health prevention intervention for migrant mothers with young children at the Mexico-US border

IntroductionMigrant women in transit face high risk of developing mental health problems such as depression and anxiety, driven by gendered social-structural factors including violence, social isolation, migration uncertainty, limited access...

Using Social Media to Promote Life Skills Among Adolescents: A Debate on Opportunities, Challenges, and Implications for Health and Education.

The digitalization of society increasingly blurs boundaries between analog and digital worlds, offering opportunities such as telemedicine and global connectivity through digital platforms. However, it also presents risks, including cyberbullying, addiction potential, harmful content, misinformation, and privacy concerns from data breaches and surveillance technologies. Social media, with its global reach, amplifies both opportunities for positive engagement and the responsibility to navigate largely unregulated content. Adolescents, due to their developing critical evaluation skills and high prevalence of mental health challenges, are particularly vulnerable in this space and must navigate the risks associated with social media while simultaneously leveraging it for essential developmental tasks, such as identity formation and building social connections. To support them in this challenge, we propose adapting the traditional life skills approach to address the challenges of social media use, empowering adolescents to navigate both digital and analog environments effectively. These life skills include critical thinking, communication, and managing emotions and stress - all of which are essential for navigating social media. Despite its complexities, social media offers a unique platform for health promotion and prevention interventions due to its wide accessibility and reach. It holds significant promise for adolescent health by providing information, motivation, and social support. However, evidence-based, youth-centered prevention strategies on these platforms are still in early development and require further research to ensure effectiveness. Prevention programs integrating proven behavior change techniques, aligning with the preferences and needs of adolescents, and teaching essential life skills can empower them to navigate digital and analog challenges effectively.

Increased TSPO alleviates neuropathic pain by preventing pyroptosis via the AMPK-PGC-1α pathway

Neuropathic pain poses a significant clinical challenge, largely due to the incomplete understanding of its molecular mechanisms, particularly the role of mitochondrial dysfunction. Bioinformatics analysis revealed that pyroptosis and inflammatory responses induced by spared nerve injury (SNI) in the spinal dorsal horn play a critical role in the initiation and persistence of neuropathic pain. Among the factors involved, TSPO (translocator protein) emerged as a key regulator. Our experimental findings showed that TSPO expression was upregulated during neuropathic pain, accompanied by mitochondrial dysfunction, specifically manifested as impaired mitochondrial biogenesis, disrupted mitochondrial dynamics (including insufficient expression of mitochondrial biogenesis and fusion-related proteins, as well as significantly increased expression of fission-related proteins), and activation of pyroptosis. Pharmacological upregulation of TSPO, but not its downregulation, effectively alleviated SNI-induced pain hypersensitivity, improving mitochondrial function and reducing pyroptosis. Immunofluorescence staining confirmed that TSPO was primarily localized in astrocytes, and its expression mirrored the protective effects on mitochondrial health and pyroptosis prevention. PCR array analysis suggested a strong association between TSPO and the mitochondrial regulation pathway AMPK-PGC-1α. Notably, inhibition of AMPK-PGC-1α abolished TSPO effects on mitochondrial balance and pyroptosis suppression. Furthermore, Mendelian randomization analysis of GWAS data indicated that increased TSPO expression was linked to pain relief. Through drug screening, molecular docking, and behavioral assays, we identified zopiclone as a promising TSPO-targeting drug for pain treatment. In summary, this study enhances our understanding of the molecular interplay between TSPO, mitochondrial health, and neuropathic pain, highlighting TSPO as a potential therapeutic target for pain management.Graphical

Reproductive Health Problems Among Women in Selected Terai Districts of Nepal: A Critical Medico-Legal Assessment

Reproductive health challenges persist among women in Nepal's Terai districts, posing a considerable public health burden. The aim is to investigate the prevalence and determinants of reproductive health issues, including Pelvic Inflammatory Disease (PID), Pelvic Organ Prolapse (POP), cervical lesions, cervical cancer, and their associated risk factors. This research utilizes a mixed-methods strategy to thoroughly investigate reproductive health issues among women of reproductive age in specific Terai districts of Nepal. The quantitative aspect of the study encompasses a cross-sectional survey administered to 570 women, employing Slovin's formula for sample size determination and pretested semi-structured questionnaires. Through the saturation theory, along with in-depth exploration and targeted analysis, 40 participants were interviewed, enabling a comprehensive understanding of the investigated phenomenon. The obtained data was analyzed in SPSS with the level of significance <0.005 level. The results indicate a high prevalence of uterine prolapse (42.5%) and cervical cancer (57.5%) within the surveyed population. Pelvic Inflammatory Disease POP, cervical lesions, and cervical cancer are notably linked to various factors including age, ethnicity, economic status, health-seeking behavior, age at first childbirth, nutritional status, and workload (p<0.005). Qualitative analysis identified underlying factors contributing to these reproductive health challenges and insights into health-seeking behavior and treatment practices. These findings highlight the critical need for tailored interventions and healthcare initiatives to tackle the prevalent reproductive health issues. Enhanced awareness of available reproductive health services is crucial for women's well-being. This study offers valuable insights into the complex landscape of reproductive health problems in Nepal's Terai region, laying the groundwork for evidence-based interventions and policy development aimed at enhancing the reproductive health outcomes for women in this demographic.

Exploring the Unidimensionality of the GAD-7 for South African First Responders: Evidence from Multiple Psychometric Approaches

Generalized Anxiety Disorder (GAD) is a prevalent mental health condition and the GAD-7 is widely used as a screening tool and measure of GAD severity. However, research has yielded conflicting findings regarding the factor structure of the instrument, with some studies supporting a unidimensional interpretation while others suggest a two-factor solution. These inconsistencies highlight the importance of validating the GAD-7 across diverse populations. This study aimed to assess the psychometric properties and factor structure of the GAD-7 among South African first responders (n = 429). Participants completed a demographic questionnaire along with the GAD-7, the Patient Health Questionnaire, the Post-Traumatic Stress Disorder Checklist, and subscales from the Maslach Burnout Inventory, namely Emotional Exhaustion and Depersonalization. The dimensionality of the GAD-7 was examined using Mokken Scale Analysis (MSA), parallel analysis, and Confirmatory Factor Analysis (CFA) with a Schmid-Leiman transformation. Results supported the unidimensionality of the GAD-7. MSA indicated that all items were loaded onto a single scale, with strong inter-item correlations and a high H-coefficient. The parallel analysis confirmed that only one factor was necessary, and the Schmid-Leiman transformation extracted a general factor accounting for 84% of the item variance. Furthermore, the reliability of the GAD-7 was excellent, with alpha and omega coefficients exceeding 0.90, indicating high internal consistency. The strong reliability and validity of the GAD-7 in this study reinforce its utility as a reliable tool for assessing generalized anxiety in a non-clinical setting.

Knowledge, Attitudes, and Practices Toward Preventive Health Screenings: Insights from a Rural Health Intervention Program

Knowledge, Attitudes, and Practices Toward Preventive Health Screenings: Insights from a Rural Health Intervention Program

Age-threshold for increased risk of developing back disorders: prospective cohort with 74 000 individuals from the UK Biobank.

To investigate the prospective associations between age and the risk of low back disorders (LBD), dorsal disorders (DD), and cervical disorders (CD), and to identify a potential age-threshold for increased risk of back disorders. Prospective cohort from the UK Biobank comprising adults with no history of back disorders. We examined different ages and their association with the risk of back disorders derived from diagnoses of hospital registers. Associations were investigated using restricted cubic splines adjusted for sex, racial and ethnic background, tobacco use, Townsend Deprivation Index, alcohol consumption, educational attainment, employment status, self-reported health, diet quality, body mass index, medication use, physical activity, and handgrip strength. The analytic sample comprised 74,191 participants (mean [SD] age, 55.2 [7.8] years; 57%women) who were followed-up for 7.9 years (IQR = 7.3-8.4). Overall, 3297 (4.3%) cases of incident LBD, 1224 (1.6%) cases of DD, and 792 (1.0%) of CD were documented. The association between age and LBD showed a curvilinear shape with significant higher risk within the range of 61 (hazard ratio [HR] = 1.39 [95%CI,1.02-1.49]) and 70 (HR = 1.71 [95%CI,1.38-2.12]) years (reference:40 years). Similarly, the association of age with DD exhibited a significant curvilinear association within the range of 60 (HR = 1.31 [95%CI,1.01-1.92]) and 70 (HR = 2.74 [95%CI,1.94-3.86]) years. The association between age and CD was not significant. The risk of LBD and DD, but not CD, increases beyond 60 years of age. Targeting people at this critical age-threshold to prevent risk for LBD and DD may be warranted for future interventions and preventive health programmes.

Mortality and Years of Life Lost From Cardiometabolic Diseases in Mexico: National and State-Level Trends, 1998-2022.

Cardiometabolic diseases (CMDs) are highly prevalent in Mexico. We analyzed the evolution of mortality from CMDs in Mexico at the national and state level, as well as their contribution to years of life lost (YLL), from 1998 through 2022. We conducted an observational study based on a public database. We calculated age-standardized mortality rates, conducted joinpoint regression analyses to determine changes in the trend and magnitude of mortality over time, and calculated YLL from CMDs among people in Mexico nationally and by state. From 1998 through 2022, the age-standardized mortality rate from CMDs increased by 14.9% in Mexico. These rates reached their highest levels in 2020 and 2021 during the COVID-19 pandemic. In 2022, people aged 0 through 84 years had 3.9 YLL from CMDs, which represented an increase of 0.4 years compared with 1998. From 1998 through 2022, age-standardized mortality rates increased for heart disease, diabetes mellitus, and hypertension but decreased for stroke. Mortality and YLL from CMDs have steadily increased among people in Mexico, driven mainly by heart disease and diabetes mellitus. YLL attributable to CMDs could be prevented by early care and health prevention policies. Decision makers should work to implement robust and enduring health policies focused on shared risk factors underlying these diseases.

The Effectiveness of Kindness Intervention for Promoting Positive Emotions and Reducing Depressive Symptoms in Mexican Adults

Background: In recent years, research has noted that depression is a prevalent mental health problem worldwide, including in Mexico among adults. Psychological interventions, such as those based on kindness, have shown promise in reducing depressive symptoms. However, there is little research in cultural contexts such as Mexico. In this context, the objective of the present research was to evaluate the preliminary efficacy of a brief intervention of performing kind acts (amabilidad) to increase happiness level as well as positive affect and reduce negative affect and depression symptoms among Mexican adults. Methods: A feasibility study was carried out with a pre-post intervention design with a control group of Mexican adults. The study used validated scales to measure happiness, positive and negative affect, and depression symptoms before and after the intervention. Participants received a brief intervention that included exercises to write expressions of kindness and practice acts of kindness towards themselves and others. Results: Preliminary results suggest that the kindness-based intervention produced improvements in their happiness, decreases in negative affect, and a significant reduction in depression symptoms compared to baseline levels and the control group. Conclusions: The findings of this study support the feasibility and potential effectiveness of kindness-based interventions to reduce depressive symptoms in Mexican adults.

Corrected Myopia and Its Association with Mental Health Problems Among Rural Primary School Students in Northwest China

ABSTRACT Purpose The aim of this study was to evaluate the myopia correction and its association with mental health problems among rural primary school students in China. Methods Using survey data from 17,950 students in 251 rural primary schools, this study examines the association between corrected myopia and mental health problems, as well as academic performance among rural students in China. Vision exams were offered to sample students, and student mental health status was measured using the Mental Health Test (MHT). Results The results show that 21.98% of sample students failed the vision screening for myopia. Over 65% of sample students showed some form of anxiety, with 56.86% experiencing learning anxiety and 18.71% experiencing body anxiety. The MHT score of myopic students was higher than that of students with normal vision, indicating that myopic students had worse mental health overall. Correcting myopia with eyeglasses was associated with better mental health, indicated by a lower MHT score (by 0.62 points) when controlling for covariates. Myopic students with high baseline academic performance who wore eyeglasses benefited especially from myopia correction, as they had a lower total MHT score (by 1.77 points) and lower body anxiety score (by 0.49 points, p < 0.05) than their high-performing peers with uncorrected myopia. Conclusions These findings suggest that future mental health prevention programs in rural China should focus on reducing the prevalence of myopia and providing eyeglasses to myopic students as potential interventions.

Cutaneous reactions to vaccination.

Vaccination is a fundamental principle of preventive health care. Administration of the vaccine, which contains the antigen(s) of a pathogen, activates the immune system and provides protection against infection. The immunogenicity and allergenicity of a vaccine may lead to various adverse reactions, depending on the responsiveness and susceptibility of the vaccinated individual. Cutaneous adverse events are among the most common and can manifest as various local or generalized vaccination reactions. Understanding their pathogenesis and clinical manifestations is essential for therapy, for further diagnostic clarification if necessary, and for managing any booster vaccination that may be required. Appropriate dermatological expertise therefore plays a crucial role in managing patients with a history of vaccination reactions.

Randomized controlled trial on the efficacy of forest walking compared to urban walking in enhancing mucosal immunity

Scientific research on forest therapy’s preventive medical and mental health effects has advanced, but the need for clear evidence for practical applications remains. We conducted an unblinded randomized controlled trial involving healthy men aged 40–70 to compare the physiological and psychological effects of forest and urban walking. Eighty-four participants were randomly assigned to either the forest or urban group, with 78 completing 90-min walks and analysis. The primary outcome measured was the change in saliva-secreted immunoglobulin A (sIgA) levels. Evaluating researchers were blinded to the groups, but participants and on-site staff were not. Here, we demonstrate a significant increase in saliva-secreted immunoglobulin A (sIgA) levels in the forest group. Furthermore, forest walking resulted in improved mood, including a reduction in stress hormone levels. In conclusion, mindful forest walking has the potential to enhance immunity and promote health.Clinical trial registration: University Hospital Medical Information Network. Trail registration number: UMIN000045851. Approval date: 25/10/2021.

Lutein and inflammation: a comprehensive review of its mechanisms of action

Lutein, a natural dihydroxy carotenoid and a member of the non-vitamin A carotenoids family, is abundant in yellow-colored fruits and green leafy vegetables such as spinach and lettuce. As the second most common type of carotenoid found in human serum, lutein offers a plethora of medicinal benefits, including anti-cancer, anti-inflammatory, and anti-oxidative properties. It is well-absorbed and systemically localized to the liver, lung, and retina, where it can cross the blood-retina barrier and accumulate in the macular pigment. Due to its anti-oxidative and singlet oxygen quenching properties, lutein is reported to reduce the risk of age-related macular degeneration (AMD). Higher concentrations of fasting plasma carotenoids and enhanced skin yellowing after lutein consumption indicate its presence in various regions of the human body, including the skin, breast, brain, and cervix. Lutein has remarkable benefits for neurodegenerative diseases, cardiovascular health, liver protection, and bone disease prevention. In the central nervous system (CNS), lutein supports brain homeostasis through its antioxidant and anti-inflammatory properties, increasing interleukin-10 (IL-10) and reducing tumor necrosis factor-α (TNF-α). It reduces the risk of coronary artery disease and exerts anti-inflammatory effects on peripheral blood mononuclear cells (PBMCs). Lutein protects against alcohol-induced liver damage by modulating the nuclear factor erythroid 2-related factor 2 (Nrf2)/heme oxygenase-1 (HO-1) signaling pathway. Additionally, lutein promotes bone health by enhancing mineralized bone nodule development and inhibiting osteoclast production, reducing bone resorption, and suppressing soluble receptor activator of nuclear factor kappa B ligand (RANKL). These multifaceted benefits make lutein a valuable agent in disease prevention and health promotion. This review discusses the comprehensive profile of lutein as a phytochemical activity, including anti-inflammatory, antioxidant, anti-cancer, hepatoprotective, neurological, and cardioprotective effects. Additionally, it discusses lutein’s beneficial impact on macular degeneration and eye diseases, showcasing its potential as a natural, plant-based therapeutic agent.

Predicting bullying victimization among adolescents using the risk and protective factor framework: a large-scale machine learning approach

BackgroundBullying, encompassing physical, psychological, social, or educational harm, affects approximately 1 in 20 United States teens aged 12-18. The prevalence and impact of bullying, including online bullying, necessitate a deeper understanding of risk and protective factors to enhance prevention efforts. This study investigated the key risk and protective factors most highly associated with adolescent bullying victimization.MethodsData from the Student Health and Risk Prevention (SHARP) survey, collected from 345,506 student respondents in Utah from 2009 to 2021, were analyzed using a machine learning approach. The survey included 135 questions assessing demographics, health outcomes, and adolescent risk and protective factors. LightGBM was used to create the model, achieving 70% accuracy, and SHapley Additive exPlanations (SHAP) values were utilized to interpret model predictions and to identify risk and protective predictors most highly associated with bullying victimization.ResultsYounger grade levels, feeling left out, and family issues (severity and frequent arguments, family member insulting each other, and family drug use) are strongly associated with increased bullying victimization - whether in person or online. Gender analysis showed that for male and females, family issues and hating school were most highly predictive. Online bullying victimization was most highly associated with early onset of drinking.ConclusionsThis study provides a risk and protective factor profile for adolescent bullying victimization. Key risk and protective factors were identified across demographics with findings underscoring the important role of family relationships, social inclusion, and demographic variables in bullying victimization. These resulting risk and protective factor profiles emphasize the need for prevention programming that addresses family dynamics and social support. Future research should expand to diverse geographical areas and include longitudinal data to better understand causal relationships.

Patterns among factors associated with myocardial infarction: chi-squared automatic interaction detection tree and binary logit model

BackgroundAlthough mortality from myocardial infarction (MI) has declined worldwide due to advancements in emergency medical care and evidence-based pharmacological treatments, MI remains a significant contributor to global cardiovascular morbidity. This study aims to examine the risk factors associated with individuals who have experienced an MI in Türkiye.MethodsMicrodata obtained from the Türkiye Health Survey conducted by Turkish Statistical Institute in 2019 were used in this study. Binary logistic regression, Chi-Square, and CHAID analyses were conducted to identify the risk factors affecting MI.ResultsThe analysis identified several factors associated with an increased likelihood of MI, including hyperlipidemia, hypertension, diabetes, chronic disease status, male gender, older age, single marital status, lower education level, and unemployment. Marginal effects revealed that elevated hyperlipidemia levels increased the probability of MI by 4.6%, while the presence of hypertension, diabetes, or depression further heightened this risk. Additionally, individuals with chronic diseases lasting longer than six months were found to have a higher risk of MI. In contrast, factors such as being female, having higher education, being married, being employed, engaging in moderate physical activity, and moderate alcohol consumption were associated with a reduced risk of MI.ConclusionTo prevent MI, emphasis should be placed on enhancing general education and health literacy. There should be a focus on increasing preventive public health education and practices to improve variables related to healthy lifestyle behaviours, such as diabetes, hypertension, and hyperlipidemia.

Prevalence of chronic kidney disease in Saudi Arabia: an epidemiological population-based study

BackgroundChronic kidney disease (CKD) is a prevalent global health issue affecting millions of patients worldwide, impacting quality of life, impeding physical and psychological well-being, causing financial stress, and increasing mortality rates. This study aimed to highlight the prevalence of CKD and its associated risk factors across Saudi Arabia. Method: This is a cross-sectional study conducted from 2015 to 2022, using data from 42 branches of a major network of diagnostic laboratories in Saudi Arabia, covering the country's 13 administrative areas.ResultsThe mean age was 40.35 ± 14.5 years. The highest proportion of participants resided in the Makkah region at 35.77%, followed by the Riyadh region at 25.75%. The overall prevalence of CKD was 4.76%, with most having CKD in stage 3 (3.5%). The prevalence of CKD was higher among males compared to females (5.83% vs. 3.88%) and increased significantly with age, being 0.45% among participants aged 18–29 years and reaching 50.94% among participants aged 90 years or older. Predictors of CKD included increasing age, male sex, administrative area (Makkah 1.40 [95% CI:1.26–1.55], Jazan 1.34 [95% CI:1.18–1.52], Najran 0.47 [95% CI, 0.39–0.57], Alqasim 0.73 [95% CI, 0.64–0.82]), and a high hemoglobin A1C. CKD in Saudi Arabia is influenced by various demographic and geographic determinants contributing to its prevalence and associated burden on the population.ConclusionThese findings emphasize the need for targeted screening and prevention strategies, especially for at-risk populations. Continued surveillance, early detection, and effective management are crucial to reducing CKD's burden and improving kidney health outcomes in Saudi Arabia. Further research is essential to better understand the disease's regional and demographic drivers.

Debate: Where to next for universal school-based mental health interventions? Can research led by young people shape universal solutions for mental health and suicide prevention in school settings?

We have engaged in work that aligns with the call from Birrell etal. (Child and Adolescent Mental Health, 2024), particularly in terms of thinking about co-design with young people to develop new outcomes and targets of universal school-based interventions. We engaged young people in a Cochrane systematic review and co-designed the outcomes for this review. What emerged was the need for research led by young people to develop and evaluate innovative universal school-based interventions that focus on creating environments that build and support young people's ability to cope by expressing and managing emotions. Whole-of-school approaches that ensure compassionate and caring responses can support the development of coping skills to manage distress, mental illness, self-harm and suicidal ideation.

Improving the Quality of Mountain Facilities: A Novel Project in the Dolomites Area

In its broadest sense, the mountain environment represents a setting useful for promoting health. This Italian project, conceived and applied in the Dolomites, aims to encourage multi-sector preventive public health policies; improve refuge hygiene; strengthen safety requirements; and implement projects aimed at promoting health. With the support of healthcare workers (HCWs) of the Prevention Department and other professionals in this field, 27 establishments in the Alpine territory have joined the project, benefiting from being recognized as a “Healthy and Safe Refuge” at the end of the quality improvement process. This process consisted of a documentary assessment, an on-site evaluation, and an assessment of analytical evidence relating to parameters investigated by both HCWs and refuge managers according to specific protocols. Data were collected from a specific database via an application to join the project and from sampling reports of parameters investigated for evaluating the quality of water intended for human consumption. The outdoor Alpine environment has recently witnessed extraordinary development and must continue to meet all health and safety requirements, especially in view of a global event—the Olympic Games—that will be hosted in the Dolomites area in 2026.

Depression, anxiety and its predictor among internally displaced person in metekel Ethiopia, 2023: using a structural equation model

IntroductionThese individuals face psychological and physical trauma, loss of jobs, and emotional isolation, which may lead to the development of depression and anxiety. In 2022, 120 countries had over 71 million IDPs, a 20% increase from the previous year. In sub-Saharan Africa, natural disasters accounted for 40% of all new IDPs worldwide.MethodAn institutional-based cross-sectional study was conducted in Ethiopia. A systematic random sampling method was used to select 997 respondents. Data were collected using a structured interview questionnaire. STATA Version 17 and Amos Version 21 were used for the analysis. Descriptive statistics were summarized using frequency, percentage, table, graph, chart, figure, and summary statistics. Structural equation modeling was employed to assess the relationship.ResultThe overall prevalence of depression and anxiety was 79.64% (95% CI: 77.02 82.03) and 74.62% (95% CI =71.83%, 77.23%) respectively. age (adjusted β = 0.0034, 95% CI: 0.0012, 0.0056), history of the death of a loved one (adjusted β = 0.132, 95% CI: 0.0803, 0.185), had formal education (β = -0.164, 95% CI: -0.229, -0.098) occupation other (adjusted β = -0.183, 95% CI: -0.261, -0.105), Not having medically confirmed mental illness (adjusted β = -0.185, 95% CI: (-0.325, -0.045), PTSD score (adjusted β = 0.0082, 95% CI: 0.0048, 0.012) associated with anxiety.ConclusionDisplacement medically confirmed mental illness, death of a loved one, and post-traumatic stress disorder (PTSD) significantly impact anxiety. Policymakers should provide greater access to mental health management and prevention services, and medical practitioners should understand the connection between depression and anxiety.