Self-report Measures Of Anxiety Research Articles

Effect of Model of Neonatal Care on Neurodevelopment at the 18 Month Follow-Up in Moderate and Late Preterm Infants.

Background: Preterm birth, even for moderate or late preterm infants (MLPIs), is associated with longer-term developmental challenges. Family Integrated Care (FICare) models of care, like Alberta FICare, aim to improve outcomes by integrating parents into neonatal care during hospitalization. This follow-up study examined the association between models of care (Alberta FICare versus standard care) and risk of child developmental delay at 18 months corrected age (CA) and explored the influences of maternal psychosocial distress. Methods: We assessed 257 mothers and 298 infants from a cluster randomized controlled trial (ID: NCT0279799) conducted in ten Level II NICUs in Alberta, Canada. Risk of delay was assessed using developmental screening tests. Maternal psychosocial distress was assessed using self-reported measures of depressive symptoms, anxiety, parenting stress, and self-efficacy. Results: There was no association between model of care and risk of developmental delay. Higher maternal parenting stress was associated with increased risk of developmental delay. Conclusions: Alberta FICare was not associated with decreased risk of developmental delay at 18 months CA. Maternal parenting stress may play an important role in the development of MLPIs and should be addressed post-discharge.

The mediating roles of perceived social support and resilience in the relationship between earthquake anxiety and traumatic experiences among earthquake survivors in Turkey.

The devastating earthquakes that struck Turkey have left profound psychological impacts on those affected, with anxiety and trauma being particularly prevalent. Understanding the factors that can mitigate these effects is important for developing effective interventions. This study seeks to analyse the intermediary functions of perceived social support (PSS) and resilience within the correlations linking earthquake-induced anxiety and the occurrence of traumatic experiences after the seismic event in Turkey. The study involved a sample of 504 young adults (61.31% females) who survived the earthquake in Turkey on February 6, 2023. Participants aged 18 to 30 (M=21.57, SD=2.55) completed an online survey of self-reported measures of earthquake anxiety, traumatic experiences post-earthquake, PSS, and resilience. The results indicated that earthquake anxiety significantly predicted levels of traumatic experiences, PSS, and resilience. Additionally, PSS and resilience emerged as significant predictors of traumatic experiences. Importantly, resilience and PSS served as mediators in the relationship between earthquake anxiety and traumatic experiences. These results highlight the importance of coordinating social and mental assets that focus on strengths in guidelines and interventions designed to enhance positive mental health among earthquake survivors coping with traumatic experiences.

Symptom Attributions in Illness Anxiety Disorder.

A major characteristic of health anxiety is the tendency to attribute benign bodily sensations to serious illnesses. This has been supported by empirical research in non-clinical samples, and samples of individuals diagnosed with Hypochondriasis. However, no study to date has explored symptom attribution styles of individuals with the DSM-5 diagnosis of Illness Anxiety Disorder. Sixty-one participants, including a clinical Illness Anxiety Disorder (n = 35) and healthy control (n = 26) sample, completed self-report measures of health anxiety and an Attribution Task, whereby they were presented with eight common bodily sensations and asked to generate possible explanations for them. Results showed that relative to healthy controls, participants with Illness Anxiety Disorder overall were more likely to make more serious, 'catastrophic' somatic attributions to symptoms, and less likely to generate non-threatening normalising explanations. These results also extended to their initial attributions, conceptualised as the 'jumping to conclusions' bias, and as an exploratory index of flexibility, they were also found to make less attributions overall compared to healthy controls. Findings provide support for the cognitive behavioural theory of health anxiety, and highlight the importance of assessing and addressing symptom attributions with clients with illness anxiety disorder.

Social, Emotional, and Behavioral Functioning in Adolescents with Klinefelter Syndrome.

Klinefelter syndrome (KS) is a common genetic condition in males associated with an extra X chromosome (i.e., 47,XXY). Individuals with KS often experience androgen insufficiency and tall stature and are at increased risk for depression, anxiety, and social challenges. This cross-sectional study investigates social and emotional functions in 52 boys with KS and 62 typically developing (TD) boys, aged 8 to 13 years. Self-report measures of anxiety, depression, and behavior and parent-report measures of social functioning and behavior were completed. In primary analyses, linear regression was used to test the effect of group (KS, TD) on standardized scores derived from widely used rating scales. In secondary analyses, we explored the influence of pubertal status on these scores and concordance between self- and parent ratings. Our results indicate that boys with KS exhibit significantly increased anxiety, depression, and social difficulties relative to TD peers. Among participants with KS, peripubertal boys generally experienced more difficulties in aspects of social and emotional functioning as compared to prepubertal boys. Concordance analyses revealed differences between parent- and child-reports. These findings indicate that alterations in social, emotional, and behavioral functions are present in boys and adolescents with KS and may be influenced by puberty.

Preliminary feasibility and efficacy of a brief behavioural treatment for insomnia after acquired brain injury: A case series.

Insomnia after acquired brain injury (ABI) is common and can negatively impact an individual's rehabilitation, recovery, and quality of life. The present study investigated the feasibility and preliminary efficacy of a Brief Behavioural Treatment for Insomnia (BBTI) in a community sample following ABI. Ten participants were recruited. Seven participants attended four weekly sessions of BBTI and kept a daily sleep diary. Participants completed a semi-structured sleep interview at baseline and self-report measures of sleep, anxiety, and depression pre- and post-treatment as well as a treatment acceptability questionnaire post-treatment. Follow-up data were collected at 1-, 2-, and 3-months post-treatment. Visual analyses of the data were performed on a case-by-case basis. Five of the seven participants (71%) no longer met the criteria for insomnia disorder on the Sleep Condition Indicator (SCI) post-treatment. Treatment effects on sleep outcomes were either maintained or augmented at follow-ups. BBTI was found to be well tolerated, as evidenced by the high overall retention rates (70%) and positive feedback on the treatment acceptability questionnaire. These results provide preliminary evidence of BBTI being both feasible to use and potentially efficacious in individuals with post-brain-injury insomnia. Larger-scale randomised controlled trials are needed to establish the effectiveness of BBTI following ABI.

Observational cohort study of a group-based VR program to improve mental health and wellbeing in people with life-threatening illnesses

IntroductionBeing diagnosed with a life-threatening illness (LTI) is often accompanied by feelings of fear, uncertainty, and loneliness that can severely impact mental health. Relatively few interventions are available to address the existential concerns of individuals facing LTI, while treatment of the underlying physical ailment typically remains the priority of the healthcare system. Research has shown that psychedelic-assisted psychotherapy (PAT) holds promise for supporting mental health in people with LTIs. However, PAT’s potential in this population remains curtailed by several limitations, including regulatory and accessibility issues. Novel approaches that could provide some of the benefits of psychedelic experiences, while avoiding associated challenges, would therefore be highly desirable for supporting the mental wellbeing of people with LTIs. Among such interventions, virtual reality (VR)-based experiences have been suggested as a promising candidate. We here evaluate a program that includes weakly representational, multi-user VR experiences based on a design aesthetic previously described as “numadelic,” which has been demonstrated to elicit self-transcendent experiences comparable to psychedelics.MethodsA prospective cohort study design was used to assess the effects of “Clear Light” (CL), a group-based, 6-session multimedia program that included VR experiences, video calls, and text chats spanning 3 weeks. Participants were individuals suffering from LTIs that self-selected to participate in the CL program. A total of N = 15 participants were evaluated based on assessments 1 week before and after the program, using self-report measures of anxiety, depression, wellbeing, and secondary psychological outcomes.ResultsThe intervention was well-tolerated among participants. Significant improvements with moderate effect sizes were observed on self-reported measures of anxiety, depression, and wellbeing. Secondary measures assessing demoralization, connectedness, and spiritual wellbeing also showed significant improvements.DiscussionThis observational study demonstrated the feasibility and potential benefits of a group-based VR program that can be delivered at-home to people suffering from LTIs. While conclusions are presently limited by the lack of randomization or a comparison group, our findings strongly suggest further research is warranted, including randomized controlled trials.

Disentangling developmental trajectories of childhood anxiety and depression symptoms in the prediction of adolescent substance use.

Adolescent substance use is comorbid with internalizing problems (e.g., anxious and depressive symptoms) and externalizing problems (EPs). Developmental researchers have linked early anxious and depressive symptoms to later substance use behaviours via an "internalizing pathway". Support for this pathway exists among young adults; however, evidence from prospective studies of adolescents has been inconsistent. Given the paucity of prospective studies in this area, the current study used a developmental framework to examine childhood anxiety and depression symptom trajectories as predictors of adolescent substance use and whether these relationships depend on sex and EPs. Children with and without EPs participated annually in an ongoing longitudinal study (N = 744; Time 1 age = 6.3-10.6). Youth completed self-report measures of anxiety and depression symptoms (Times 3-6) and substance use (Times 7-8). Parents and teachers completed measures of children's EPs (Time 0). Parallel process growth models showed that changes over time in childhood depression symptoms were significantly positively associated with adolescent alcohol/cannabis use, substance-related consequences, and total score of problematic substance use. Changes over time in childhood anxiety symptoms were significantly negatively associated with adolescent alcohol/cannabis use. These results were invariant by EPs and sex. Research implications of this study emphasize the importance of isolating the respective pathways of anxious and depressive symptoms to later substance use outcomes, while clinical implications focus on targets for early identification and prevention of problematic substance use in adolescence.

Computational modeling of social evaluative decision-making elucidates individual differences in adolescent anxiety.

Adolescents experience significant developmental changes during a time of heightened sensitivity to social cues, particularly rejection by peers, which can be especially overwhelming for those with elevated levels of social anxiety. Social evaluative decision-making tasks have been useful in uncovering the neural correlates of information processing biases; however, linking youths' task-based performance to individual differences in psychopathology (e.g., anxiety symptoms) has proven more elusive. Here, we address this weakness with drift diffusion modeling to decompose youths' performance on the social judgment paradigm (SJP) to determine if this approach is useful in discovering individual differences in anxiety symptoms, as well as puberty, age, and sex. A sample of 103 adolescents (55 males, Mage = 14.49, SD = 1.69) completed the SJP and self-report measures of anxiety, as well as self- and parent-reported measures of puberty. The decision threshold parameter, reflecting the amount of evidence needed to make a social evaluative decision, predicted youth self-reported anxiety, above and beyond typical metrics of SJP performance. Our results highlight the potential advantage of parsing task performance according to the underlying cognitive processes. Future research would likely benefit from applying computational modeling approaches to social judgment tasks when attempting to uncover performance-based individual differences in psychopathology.

Intervention-Related Changes in Coping Ability Drives Improvements in Mood and Quality of Life for Patients Taking Adjuvant Endocrine Therapy.

A recent randomized trial of a group psychosocial telehealth intervention (STRIDE) improved anxiety, depression, quality of life (QOL), symptom distress, coping, and self-efficacy to manage symptoms related to taking adjuvant endocrine therapy (AET) in women with non-metastatic hormone receptor-positive breast cancer. This study examined whether changes in coping and self-efficacy mediated intervention effects on anxiety, depression, QOL, and symptom distress. Women (N=100) were recruited between 10/2019-06/2021 from Massachusetts General Hospital and were randomized to STRIDE or to the medication monitoring control group. Participants completed self-report measures of anxiety and depression (Hospital Anxiety and Depression Scale), QOL (Functional Assessment of Cancer Therapy-Breast Cancer scale), symptom distress (Breast Cancer Prevention Trial Symptom Scale), coping (Measure of Current Status-Part A), and self-efficacy (Self Efficacy for Managing AET Symptoms) at baseline and 24-week follow-up. Mediated regression models tested whether changes in coping ability and self-efficacy mediated the intervention effects on anxiety, depression, QOL, and symptom distress, controlling for key variables. Improvements in coping across the 24-week study period mediated the effect of STRIDE on anxiety symptoms (indirect effect, B=-0.61, SE=0.28, 95% CI: -1.28, -0.17), depressive symptoms (indirect effect, B=-0.50, SE=0.21, 95% CI: -0.97, -0.15), and QOL (indirect effect, B=3.80, SE=1.25, 95% CI: 1.54, 6.49), but not symptom distress. Changes in self-efficacy did not mediate improvements in any of the proposed outcomes. Coping is an essential component of a brief group psychosocial intervention that drives improvements in mood and QOL for women with non-metastatic hormone receptor-positive breast cancer taking AET. NCT03837496.

A Multisite, Longitudinal Study Assessing Prevalence of Anxiety in Student Pharmacists

ObjectiveConduct a multisite, survey-based study assessing rates of self-reported anxiety symptoms among student pharmacists enrolled in the first 3 professional years (PY1 to PY3) of a 4-year Doctor of Pharmacy (PharmD) curricula. MethodsThis study followed a cross-sectional observational design conducted at Washington State University, College of Pharmacy and Pharmaceutical Sciences (WSU) and the University of Arkansas for Medical Sciences, College of Pharmacy (UAMS). Student pharmacists in PY1 to PY3 of the PharmD curricula were invited to voluntarily complete the Generalized Anxiety Disorder 7-item (GAD-7) scale in order to self-report measures of anxiety. The GAD-7 is a validated 7-item instrument using a 4-point Likert scale. ResultsA total of 2022 surveys were evaluated from PY1-PY3 students at WSU and UAMS over a 5-year period (2019 to 2023). Overall, 882 (43.6%) completed surveys indicated the presence of moderate to severe anxiety according to the GAD-7. When asked about the difficulty of doing work, taking care of things at home, or getting along with other people, 487 (24.1%) respondents indicated “very” or “extremely” difficult using a 4-point Likert scale. ConclusionBehavioral and mental health support appears to be needed to support students living with symptoms of anxiety that are impacting life activities. Pharmacy educators should consider proactive approaches to improve mental well-being and support skill development related to anxiety management for student pharmacists. Future studies may include measuring change in student pharmacist anxiety over time with targeted interventions and studies to determine impact on reported levels of anxiety.

Differential patterns of emotion regulation in sexual minority adolescents in residential treatment

ObjectiveSexual minority adolescents experience disproportionate mental health problems, including increased anxiety, depression, and suicidal thoughts and behaviors. Minority Stress Theory posits that sexual minority people experience significantly more stress (e.g., via discrimination or prejudice) in their everyday lives, which can underlie these mental health disparities. Though group differences in mental health symptoms are well-documented, there has been less focus on symptom trajectories, which is critical for identifying effective mental health interventions. MethodSeventy adolescents ages 13–19 years enrolled in a short-term, acute residential psychiatric treatment program provided self-report measures of depressive symptoms, anxiety, and emotion regulation difficulties at baseline, discharge (∼2 weeks), and one-month post-treatment follow-up. Adolescents self-reported sexual orientation and were stratified into sexual minority (SM, n = 37) or heterosexual (n = 33) groups. ResultsDepressive and anxiety symptoms and emotion dysregulation scores were significantly reduced at follow-up, compared to baseline. While there were no significant group x time interactions for depressive and anxiety symptoms, the SM group entered the program with worse emotion dysregulation scores, which improved more over time compared to the heterosexual group. ConclusionThese findings show that although sexual minority individuals can make substantial gains during residential treatment, emotion regulation difficulties are a particularly relevant treatment target. Emotion regulation, a transdiagnostic construct that typically develops substantially during adolescence, might be of critical importance when identifying effective treatment interventions for sexual minority youth. LimitationsAdolescents in this sample demonstrated limited racial diversity and likely displayed a higher degree of psychopathology than the general population.

Beyond Reading: Psychological and Mental Health Needs in Adolescents with Dyslexia.

Overall, children and adolescents diagnosed with dyslexia or ADHD show an increased risk for psychological and mental health problems, and dyslexia and ADHD tend to coexist frequently. Thus, the main objective of this study was to examine psychological and mental health problems in dyslexia. Participated 95 adolescents with dyslexia (DG), comorbid dyslexia + attention-deficit hyperactivity disorder, combined subtype (D + ADHD-CG), and a comparison group with typical development (TDCG). Self-reported measures of anxiety and depression, and parent and teacher versions of the Strengths and Difficulties Questionnaire (SDQ) were used. Self-reports of internalizing problems showed that adolescents in the GD and D + ADHD-CG groups had more depression and stated anxiety problems with a very high percentage above the clinical cut-off point than the CG. Both the parent and teacher reports showed that the DG and D + ADHD-CG groups obtained higher mean values and a higher number of adolescents above the clinical cut-off of internalizing, externalizing, and total problems than the TDCG. The comorbid D + ADHD-CG group had the highest internalizing and externalizing problems. In conclusion, our findings indicate that the internalizing and externalizing problems experienced by adolescents with dyslexia and comorbid ADHD should be recognized early and treated promptly by education professionals.

Cardiovascular comorbidities, mental health, and physical activity in persons with multiple sclerosis

ABSTRACT This study examined the associations among cardiovascular comorbidities, symptoms of depression and anxiety, and physical activity in persons with multiple sclerosis. Participants with multiple sclerosis (N = 217) completed demographic, cardiovascular comorbidity, depression, and anxiety self-report measures, and wore an accelerometer for 7 days. We examined the bivariate, non-parametric correlations among the variables and conducted parametric, independent samples t-tests when examining the differences in variables based on cardiovascular comorbidity status. Bivariate correlation analysis indicated that there were statistically significant associations between anxiety scores, but not depression scores, and cardiovascular comorbidities. Physical activity, especially moderate-to-vigorous physical activity (MVPA), was correlated with cardiovascular comorbidities. There were small significant differences based on hyperlipidemia status in anxiety scores (p = 0.015, d = -0.42), MVPA (p < 0.001, d = 0.44), and steps/day (p < 0.001, d = 0.50), and based on hypertension status in anxiety scores (p = 0.010, d = -0.35), depression scores (p = 0.046, d = -0.26), MVPA (p = 0.003, d = 0.41), and steps/day (p < 0.001, d = 0.53). The findings indicate that there are significant associations among cardiovascular comorbidities, symptoms of depression and anxiety, and physical activity in persons with multiple sclerosis. Physical activity, specifically MVPA, may be a target for managing those outcomes in persons with multiple sclerosis.

A 'Problematic' Pattern of Power-system Functioning and its Association with psychopathological Symptoms.

Following the well-researched two-dimensional model of attachment-system functioning, based on the concepts of hyperactivation and deactivation, a two-dimensional model of the power behavioral system has recently been proposed. The power system is aimed at activating, organizing, and implementing action patterns that protect or restore a sense of power or dominance. Here, we tested predictions derived from the two-dimensional model of power-system functioning regarding the contribution of a 'problematic' high-high pattern, characterized by the coexistence of both hyperactivating and deactivating strategies, to psychopathological symptoms. A non-clinical sample of Italian adults (N = 385) completed the Power Behavioral System Scale together with self-report measures of anxiety and depression symptoms and difficulties in executive control. Multiple regression analyses showed that higher deactivation and hyperactivation scores, characteristic of the 'problematic' pattern, significantly predicted anxiety and depression symptoms as well as executive function difficulties. These results provide initial support for the pathogenic implications of the 'problematic' high-high pattern of power-system functioning.

Severe Cognitive Impairment in Trauma-Affected Refugees-Exploring the Impact of Traumatic Brain Injury.

Background/Objectives: This study explores the relationship between cognitive performance measured by the Symbol Digit Modality Test (SDMT) and the severity of self-reported head injury, traumatic brain injury (TBI), post-traumatic stress disorder (PTSD), depression, pain, and psychosocial dysfunction in a population of trauma-affected refugees. Refugees, especially those who have been subjected to torture, often face various difficulties, such as PTSD, depression and somatic disturbances (e.g., pain), which can significantly impact their day-to-day functioning. Methods: Participants included 141 adult refugees (38% women) with a mean age of 45.4 years (SD = 9.4) and 9.7 years (SD = 4.9) of education who were referred for treatment of post-traumatic distress to DIGNITY, Danish Institute Against Torture. Participants completed standardized self-report measures of PTSD, anxiety, depression, pain, and health-related disability and measures of trauma history, physical injuries including head injury and loss of consciousness, and the SDMT, a quick standardized performance-based measure of cognitive impairment. Results: Eighty-eight percent of participants evidenced signs of substantial cognitive impairment as indexed by lower SDMT scores. Those with a self-reported history of TBI, marked by loss of consciousness, exhibited lower SDMT scores and higher health-related disabilities. Severity of PTSD, depression, anxiety, and pain were highly correlated with lower SDMT scores. TBI history was not significantly associated with the severity of PTSD, depression, anxiety, or pain, suggesting a complex interplay among these factors. Conclusions: Cognitive impairments are prevalent in trauma-affected refugees, interacting with symptoms of post-traumatic stress and pain, likely explaining the high disability levels in this population. Further research should employ a broader range of cognitive measures and detailed investigations of head injury/TBI experiences to investigate their impact on overall functioning, treatment response, and longer-term outcomes. This study adds to a small but growing body of studies documenting cognitive impairments in trauma-affected refugees, highlighting the importance of addressing cognitive impairments in treatment for trauma-affected refugees, particularly those with histories of torture and TBI. Clinicians working with trauma-affected refugees should consider the assessment of cognitive difficulties as part of comprehensive care planning.

Social anxiety, voice confrontation and voice recognition: A bilingual exploration.

Many people dislike the sound of their voices, especially when listening back to audio recordings (voice confrontation). Previous research reports that disliking the sound of one's voice is associated with elevated levels of social anxiety. The present study investigated the relationship between social anxiety and voice dislike and voice misrecognition among a bilingual population: Arabic (L1) and English (L2). Participants (N = 176) completed self-report measures of social anxiety and own voice liking. Additionally, they performed a novel own voice recognition task, assessing their ability to recognise a recording of their voice, differentiating it from digitally altered versions of the same recording. Social anxiety symptomatology was associated with disliking the sound of one's voice, with a larger effect for L1 than L2. Social anxiety was also associated with own voice misrecognition, but only for L1. Highly negative evaluations about the sound of one's voice may represent a vulnerability for social anxiety disorder.

Assessing relinquishment of positivity as a central symptom bridging anxiety and depression

Anxiety and depression are often comorbid and chronic disorders. Previous research indicates that positivity relinquishment is a moderator of anxiety and depression, such that only anxious individuals who endorsed relinquishing positivity were also depressed. We sought to extend those findings by conducting three network analyses with self-report measures of anxiety, depression, activity avoidance, and perceived positivity of avoided activities (N = 104). We pre-registered our hypothesis for the first two networks that relinquishment of positivity would emerge as a central bridge symptom between anxiety and depressive symptoms. After combining redundant nodes, we estimated three networks and investigated the bridge symptoms in each network. Relinquishment of positivity bridged the symptom clusters in the first network, and avoidance of positivity was found to bridge the two symptom clusters of anxiety and depression in networks two and three. Additionally, an anhedonia circuit was uncovered in all three networks in which loss of interest/worthlessness, loss of energy, and loss of pleasure/pessimism connected to anxiety through relinquishment or avoidance. Our findings suggest that both relinquishment of positivity as well as avoidance of positivity could be potential pathways explaining the development and maintenance of anxiety and depression and should be properly targeted in treatment.

Translation and examination of construct validity of the Danish version of the Tampa Scale for Kinesiophobia.

This study investigates the construct validity of the Danish Tampa Scale for Kinesiophobia (TSK). The English 17-item scale was translated into Danish adhering to WHO's guidelines. The construct validity of the TSK was examined in a random general population sample of 4,884 18- to 72-year olds with pain within the past 4 weeks. Examination of construct validity adhered to the COSMIN checklist. Structural validity was examined by splitting the sample and conducting exploratory factor analysis on one half and confirmatory factor analysis on the other half. Convergent validity was examined through associations with self-report measures and objective physical performance tests. Reference scores for the TSK were calculated. After translation, all respondents felt confident that they understood the meaning of the items. All but one found the questionnaire acceptable. The exploratory factor analysis suggested that a 1-factor 13-item version without 4 reversed items resulted in the most consistent fit across subgroups of gender, age, and severe pain report. Five different models of the TSK were tested in the confirmatory factor analysis. While none were excellent fits, both one- and two-factor models of the TSK-13 and TSK-11 were acceptable. Two-factor models marginally outperformed one-factor models on goodness of fit. There was no association between TSK scores and muscular fitness or self-reported physical activity. Cardiorespiratory fitness, self-perceived physical fitness, and self-efficacy had weak correlations with TSK scores. Scores showed modest associations with self-report measures of anxiety, illness worry, pain interference, and daily limitations. Based on an overall consideration of results, we recommend using the TSK-13 as a one-dimensional construct for both research and clinical purposes pending further examinations of the TSK in clinical samples. TSK scores from the present study can serve as a standard of reference for levels of Kinesiophobia in the general population.

A - 38 Examining Persisting State Anxiety and Concussion Clinical Outcomes across Concussion Recovery

Abstract Purpose Document changes in state anxiety over the course of recovery from concussion and examine the effect of persisting state anxiety on concussion clinical outcomes. Method Patients (ages 15–51 yrs) seeking care for a sport or non-sport-related concussion within 1–7 days post-injury were included in this study. Participants completed a self-report measure of state anxiety (STAI) at each clinical visit. Differences in STAI scores from visit 1 and visit 2 were calculated and used to categorize patients into a PERSIST (scores stayed the same or got worse) and an IMPROVE group (scores improved). Changes in STAI scores across two clinical visits were examined with a paired samples t-test, and a series of independent samples t-tests and chi-square analyses were used to examine between-group differences in clinical outcomes (symptom score, neurocognitive scores, vestibular/ocular motor symptoms and impairment, and recovery time). Results 187 participants (M = 22.37, SD = 10.67 yrs, 65% female) completed study measures at 4.25 (SD = 1.68) (visit 1) and 13.20 (SD = 28.65) (visit 2) post-injury. STAI scores significantly differed between first (M = 20.99, SD = 6.05) and second visit (M = 17.41, SD = 6.21, p &amp;lt; 0.001). The PERSIST group (n = 41, M = 25.90, SD = 20.03) had significantly higher total symptom scores at visit 2 compared to those in the IMPROVE group (n = 122, M = 16.23, SD = 16.17, p = 0.002). There were no significant differences in other clinical outcomes between those with and without persisting state anxiety. Conclusions State anxiety changes throughout concussion recovery and individuals with persisting state anxiety exhibit higher symptom scores at visit 2. Assessment, reassurance and recognition of anxiety is important for overall symptom recovery.

Direct Losses and Media Exposure to Death: The Long-Term Effect of Mourning during the COVID-19 Pandemic.

Background: The social distancing policies adopted during the COVID-19 pandemic forced many individuals to confront their mortality and worry about losing loved ones, making it impossible to say goodbye to them properly. Those not directly experiencing loss were inundated with information about COVID-19-related deaths throughout social media, leading to vicarious grief. This study delved into the long-term effects of direct and vicarious mourning on people's mental health during the COVID-19 pandemic. Method: A sample of 171 adults (65% female) aged 19-66 years (Mage = 25.8, SD = 8.57) voluntarily participated in an online survey assessing self-reported psychological measures of complicated grief, stress, depression, dispositional neuroticism, trait anxiety, and situational anxiety. Results: MANOVAs revealed that direct mourning experiences had an extremely severe impact on anxiety, stress, and fear of COVID-19, and a moderate effect on those without personal losses. Indeed, participants reporting high media exposure showed higher scores of depression and stress. Conclusions: Findings from the current study displayed that during the COVID-19 pandemic, people engaged more in proximal defenses than distal ones, taking health-protective measures, experiencing increased anxiety levels toward virus infection, and feeling distressed. Additionally, vicarious mourning was more strongly associated with depression due to emotional empathy with others.