Spielberger State Anxiety Inventory Research Articles

The Relationship Between Intensive Care Experience and State Anxiety in Patients Treated in Coronary Intensive Care Units

Objective: This study aimed to determine the correlation between the intensive care experience and the state anxiety of patients hospitalized in the coronary intensive care unit.
 Methods: This descriptive cross-sectional study included 192 patients from the coronary intensive care unit of a university hospital. Data were collected using a Patient Information Form, the Intensive Care Experience Scale (ICE), and the Spielberger State Anxiety Inventory (STAI-I). The analysis was conducted using SPSS software version 25.0. Descriptive statistics were reported as counts, percentages, means, and standard deviations. A p-value of less than 0.05 was considered to indicate statistical significance.
 Results: Among the participants, 38% were aged 65 and older, 76.6% were male, 93.2% were married, 63% were admitted to the intensive care unit from the emergency room, and 88.5% had prior experience in an intensive care unit. The total and sub-dimension scores of the ICE and STAI-I were moderate. We found a weak positive correlation between the STAI-I total score and the ICE total score (r= 0.320). There was a very strong positive correlation between pessimistic experiences in the intensive care unit and the STAI-I total score (r=0.907). Additionally, there was a moderate negative correlation between satisfaction with care received in the intensive care unit and the sub-dimensions of memory of experiences (Awareness of Surroundings, Satisfaction with the Care, Recollection of Experiences) (r=0.252, r=-0.489, r=-0.496).
 Conclusion: The study found that pessimistic experiences in the intensive care unit can significantly impact patients' state anxiety.

Comparing the effects of rosemary aromatherapy and music therapy on anxiety levels in patients undergoing general surgery: A randomized controlled clinical trial

BackgroundPreoperative anxiety is a prevalent concern among patients undergoing surgery, potentially elevating the risk of postoperative complications. This study aimed to compare the effectiveness of inhalation aromatherapy using rosemary essential oil and music therapy in reducing anxiety levels among general surgery patients. MethodsThis study employed a randomized controlled clinical trial design involving 236 patients scheduled for general surgery. The participants were randomly assigned to one of four groups: aromatherapy with Rosmarinus officinalis L. essential oil (n = 59), music therapy (n = 59), combined aromatherapy and music therapy (n = 59), and a control group (n = 59). Data collection instruments consisted of the Spielberger State Anxiety Inventory, a personal information form, a music player, and wireless headphones. In the aromatherapy group, patients were instructed to inhale three drops of 25% rosemary essential oil. The music therapy group listened to instrumental music through headphones, while the combined group received both inhalation aromatherapy with rosemary essential oil and music therapy. The control group received three drops of an aromatic placebo. The interventions were administered for a duration of 30 min, starting one hour before surgery. Inferential statistics, including the Kolmogorov-Smirnov test, chi-square test, paired t-test, one-way analysis of variance, and LSD post-hoc test, were employed for data analysis. ResultsThe study findings demonstrated significant effectiveness in reducing anxiety among surgical patients for aromatherapy (P = 0.001), music therapy (P < 0.001), and combined aromatherapy and music therapy (P = 0.001). Aromatherapy showed the highest anxiety-reducing effect, whereas combined therapy exhibited the lowest effect. ConclusionThe results indicate that inhalation aromatherapy, music therapy, and combined aromatherapy and music therapy are all effective approaches for anxiety reduction in surgical patients. Hence, the implementation of these cost-effective and non-invasive interventions is recommended to alleviate anxiety among surgical patients.

Anxiety in oncology outpatients is associated with perturbations in pathways identified in anxiety focused network pharmacology research

PurposeEvaluate for perturbed signaling pathways associated with subgroups of patients with low versus high levels of state anxiety. These pathways were compared to the pathways identified across eight network pharmacology studies of the anxiolytic effect(s) of a variety of compounds.MethodsAdult outpatients had a diagnosis of breast, gastrointestinal, gynecological, or lung cancer; had received chemotherapy within the preceding four weeks; and were scheduled to receive at least two additional cycles of chemotherapy. Latent profile analysis was used to identify subgroups of patients with distinct anxiety profiles based on Spielberger State Anxiety Inventory scores that were obtained six times over two cycles of chemotherapy. Blood samples were processed using RNA sequencing (i.e., RNA-seq sample, n = 244) and microarray (i.e., microarray sample; n = 256) technologies. Pathway perturbations were assessed using pathway impact analysis. Fisher’s combined probability method was used to combine test results using a false discovery rate of 0.01.ResultsIn the RNA-seq sample, 62.3% and 37.7% of the patients were in the low- and high-anxiety classes, respectively. In the microarray sample, 61.3% and 38.7% were in the low and high-anxiety classes, respectively. Forty-one perturbed signaling pathways were identified. Eight of these pathways were common to those identified in the network pharmacology studies.ConclusionsFindings increase our knowledge of the molecular mechanisms that underlie anxiety in patients receiving chemotherapy. This study provides initial insights into how anxiety in patients with cancer may share common mechanisms with anxiety in patients with other clinical conditions.

Cross-sectional study to assess the psychological morbidity of women facing possible miscarriage.

Threatened miscarriage is a common complication of pregnancy. This study aimed to assess psychological morbidity in women with threatened miscarriage, with the goal of identifying early interventions for women at risk of anxiety or depression. Women in their first trimester attending an Early Pregnancy Assessment Clinic were recruited between July 2013 and June 2015. They were asked to complete the 12-item General Health Questionnaire (GHQ-12), the Beck Depression Inventory (BDI), Spielberger's State Anxiety Inventory State form (STAI-S), the Fatigue Scale-14 (FS-14), and the Profile of Mood States (POMS) before consultation. They were also asked to rate anxiety levels before and after consultation using a visual analogue scale (VAS). In total, 1390 women completed the study. The mean ± standard deviation of GHQ-12 (bi-modal) and GHQ-12 (Likert) scores were 4.04 ± 3.17 and 15.19 ± 5.30, respectively. Among these women, 48.4% had a GHQ-12 (bi-modal) score ≥4 and 76.7% had a GHQ-12 (Likert) score >12, indicating distress. The mean ± standard deviation of BDI, STAI-S, and FS-14 scores were 9.35 ± 7.19, 53.81 ± 10.95, and 2.40 ± 0.51, respectively. The VAS score significantly decreased after consultation (P<0.001). Compared with women without a history of miscarriage, women with a previous miscarriage had higher GHQ-12, BDI, and POMS scores (except for fatigue-inertia and vigour-activity subscales). A higher bleeding score was strongly positively correlated with GHQ-12 (Likert) score. There were weak correlations between pain score and the GHQ-12 (bi-modal) ≥4, BDI >12, and POMS scores (except for confusion-bewilderment subscale which showed a strong positive correlation). Women with threatened miscarriage experience a considerable psychological burden, emphasising the importance of early recognition for timely management.

Adverse Childhood Experiences and Higher Levels of Stress Are Associated With the Co-occurrence of Cancer-Related Cognitive Impairment and Anxiety

We sought to identify subgroups of patients with distinct joint cancer-related cognitive impairment (CRCI) AND anxiety profiles and evaluate for differences in demographic and clinical characteristics, as well as levels of global stress, cancer-specific stress, cumulative life stress, and resilience. Patients (n = 1332) completed the Attentional Function Index and the Spielberger State Anxiety Inventory six times over two cycles of chemotherapy. Global, cancer-specific, and cumulative life stress and resilience were evaluated using Perceived Stress Scale, Impact of Event Scale-Revised, Life Stressor Checklist-Revised, and Connor-Davidson Resilience Scale, respectively. Latent profile analysis was used to identify subgroups of patients with distinct joint CRCI AND anxiety profiles. Differences were evaluated using parametric and nonparametric tests. Three classes were identified (ie, No CRCI and Low Anxiety [57.3%], Moderate CRCI and Moderate Anxiety [34.5%], and High CRCI and High Anxiety [8.2%]). All of the stress measures showed a dose-response effect (ie, as the CRCI AND anxiety profile worsened, scores for all three types of stress increased). The two highest symptom classes reported higher occurrence rates for six specific stressors (eg, emotional abuse, physical abuse, sexual harassment). Findings suggest that higher levels of co-occurring CRCI AND anxiety are associated with some common risk factors, as well as higher levels of stress and lower levels of resilience. Increased knowledge of modifiable risk factors and sources of stress associated with the co-occurrence of these two symptoms will assist clinicians to identify high-risk patients and implement individualized interventions.

The effects of acupressure on pain, anxiety and vital signs in patients undergoing coronary angiography: A randomized and sham-controlled trial

AimThis randomised sham-controlled trial aimed to analyse the effects of acupressure on pain, anxiety, and vital signs in patients who underwent coronary angiography. Materials and methodsAfter undergoing coronary angiography, 105 patients were randomised into acupressure (n = 35), sham acupressure (n = 35), and control groups (n = 35). Patients in the acupressure group received acupressure on the heart meridian 7 (HT7), large intestine meridian 4 (LI4), and pericardium meridian (PC6) acupoints 30 min after admission to the clinic, for a period of 16 min, whereas those in the sham group received acupressure on locations 1–1.5 cm away from these points. The control group received standard treatment. The patient information form, Spielberger's state anxiety inventory, visual analogue scale, and vital signs follow-up form were used for data collection. FindingsConsecutive measurements revealed that anxiety levels in the acupressure group were lower than that in the sham and control groups (p < 0.05). In addition, compared to the sham and control groups, the pain scores in the acupressure group decreased significantly after acupressure (p < 0.01). Although there was no significant difference between the pain scores of the sham group before and after acupressure intervention (p > 0.05), the scores of the control group increased significantly over time (p < 0.01). Finally, the vital signs decreased significantly in the acupressure and sham groups after intervention (p < 0.01), but increased significantly in the control group (p < 0.01). ConclusionThe findings of this trial indicated that acupressure is an effective method for reducing anxiety, pain, and vital signs.

0161 Structural Changes in Mood Domains During Sleep Deprivation and Recovery

Abstract Introduction Mood is known to vary as a function of sleep debt. Mood batteries often measure multiple, non-orthogonal domains. In the present study, the latent structure of the Automated Neuropsychological Assessment Metrics Mood (ANAM-mood) battery was assessed during five different states of alertness. We present a novel scheme to evaluate changes in the structure of such batteries across conditions. It was hypothesized that the structure would change, with the greatest changes manifest during sleep deprivation. Methods The present analyses were conducted on data from a prior sleep deprivation study (n = 25 healthy young adults). We used the identity property of MANOVA. Given correlation matrices Σi and Σj, structural invariance was defined as Σi Σj-1 ≈ I (Identity). MANOVA statistic m was the largest eigenvalue of Σi Σj-1. Resampling was used to generate m-distributions within and between the five different alertness conditions - Rested, Sleep Deprived (SD) days 1 and 2, and Recovery days 1 and 2. In addition, the relative number of mood dimensions was estimated by the odds (via resampling) of two dimensions explaining 80% of the variance of Σi compared to Σj. Results The pairwise MANOVA-statistic revealed significant structural variations across conditions (p&amp;lt; 0.001 for all comparisons). Significant differences included Rested vs SD1 and SD2. Recovery 1 showed the most pronounced differences to all conditions. Recovery 2 was like Recovery 1, but more like Rested than the prior day. The odds ratio of two-dimensions for Recovery 1 was much higher compared to all other conditions (OR: 2.4-245, p&amp;lt; 0.001). Conclusion Individuals respond differently to a mood survey across specific alertness conditions resulting in structural changes to the data. Wakefulness during recovery from severe sleep loss differs most significantly from all states, contrary to our hypothesis. This is important to consider when interpreting mood changes as measured by such batteries (including related Spielberger's State Anxiety Inventory and Beck Depression Inventory-II) during sleep studies. Follow up studies are needed to fully assess such effects and devise methods to account for them. Support (if any) This effort was fully supported by the Department of Defense Military Operational Medicine Research Program (MOMRP).

Evaluation of the effectiveness of artificial intelligence assisted interactive screen-based simulation in breast self-examination: An innovative approach in nursing students

BackgroundBreast self-examination is important in the early diagnosis of breast cancer. The use of traditional education methods is insufficient for student nurses to gain breast self-examination skills in nurse education. New and different education methods are needed to gain skills in nurse education. ObjectiveThe aim of this study was to evaluate the effectiveness of artificial intelligence-assisted screen-based simulations practice and standard patient simulation in teaching breast self-examination skills in nursing undergraduate students. DesignThis study was a comparative intervention trial. SettingsThis study was conducted at a university in XX, in XXX in the first semesters of the academic years 2022–2023. MethodsThis study enlisted 103 students enrolled in first year in a nursing department. Students were randomized into artificial intelligence-assisted screen-based simulations practice group (n = 52) and standard patient simulation group (n = 51). Data were collected using student description form, breast self-examination checklist, student satisfaction and self-confidence in learning scale, Spielberger's state and trait anxiety inventory. ResultsThe highest score regarding the total score means of breast self-examination skills belonged to the standard patient simulation group, and the differences between the groups were found to be statistically significant (p < 0.05). Although the mean score of anxiety levels of the students' artificial intelligence-assisted screen-based simulations practice group was higher than the standard patient simulation (p < 0.05). The mean score of the students' satisfaction with the simulation was higher in artificial intelligence-assisted screen-based simulations practice group than the standard patient simulation group (p < 0.05). ConclusionsThe results of the research showed that the use of artificial intelligence-assisted simulation learning increased students' satisfaction, but at the same time students' anxiety increased. In addition, artificial intelligence-assisted simulation learning is not as effective as standard patient simulation learning in gaining breast self-examination skills.

Associations Between Distinct State Anxiety Profiles, Exposure to Stressful Life Events, Resilience, and Coping in Patients with Gynecologic Cancers Receiving Chemotherapy

In a sample of patients with gynecologic cancers who are receiving chemotherapy, subgroups of patients with distinct state anxiety profiles were identified, and differences among the subgroups in demographic and clinical characteristics, stress, exposure to stressful life events, resilience, and coping behaviors were evaluated. Patients (n = 230) completed questionnaires six times over two chemotherapy cycles. State anxiety was measured using the Spielberger State Anxiety Inventory. Subgroups of patients with distinct state anxiety profiles were identified using latent profile analysis. Differences among the classes were assessed using parametric and nonparametric tests. Three distinct state anxiety profiles were identified: low (55.2%), moderate (38.3%), and very high (6.5%). Compared with the low class, persons in the other two classes had lower functional status, more comorbidities, higher perceived stress, and lower resilience and were more likely to report a history of depression and to use disengagement coping strategies. Compared with the low class, the very high class was more likely to report childcare responsibilities; have a history of lung disease, stomach disease, or low back pain; have experienced physical neglect, serious money problems, a serious disaster, or foster care; or were a caregiver for someone with a severe disability. Nearly 45% of patients reported clinically meaningful levels of state anxiety that persisted over two cycles of chemotherapy. Experiences with a variety of stressors may be risk factors for higher levels of anxiety during chemotherapy. Clinicians need to perform comprehensive social histories and assess for anxiety in patients receiving chemotherapy.

Efficacy of a Relaxation Scenario in Virtual Reality for the Comorbid Symptoms of Anxiety and Asthenia in a General Hospital Setting: A Pilot Comparative Randomized Open-Label Study.

Patients in general hospitals often display concomitant signs of mental maladjustment: low mood, anxiety, apathy, asthenia, all of which can have a negative impact on the course of the underlying disease and the recovery process. One of the non-pharmacological approaches that has gained wider acceptance in medical practice in recent years is the use of procedures based on virtual reality. Assess the efficacy of the new domestic, virtual reality application Flow as relates to symptoms of anxiety and asthenia in patients undergoing inpatient treatment. The study was open-label and had a comparison group; the patients were assigned to the experimental or control group using a randomization table. The patients were assessed using the Spielberger State Anxiety Inventory; the Fatigue Symptom Rating Scale; the Well-being, Activity, Mood questionnaire; the Depression Anxiety Stress Scale; and the Clinical Global Impression Scale. Physical parameters were measured before and after each virtual reality session. The obtained data were statistically processed. The study involved 60 patients. In 40 patients, the treatment program included a course of five daily relaxation sessions in virtual reality; the control group consisted of 20 patients, who were treated in accordance with the usual practice of the institution. The addition of virtual reality sessions to the standard treatment course yielded significant advantage in terms of affective symptoms reduction in patients both after a single session and as a result of undergoing the full course, and several days after its completion. The patients in the experimental group also showed a significant decrease in blood pressure after the sessions, and this was most pronounced in individuals who initially had elevated and high blood pressure. The use of relaxation program courses in the virtual reality application Flow is an effective and promising means of non-pharmacological care for non-psychiatric inpatients showing symptoms of anxiety, apathy, depressive mood, as well as hypertension.

Should Preoperative Information Before Impacted Third Molar Extraction Be Visual, Verbal, or Both?

Offering preoperative information is one option to help patients cope with the anxiety associated with oral and maxillofacial surgical procedures. Although this information is commonly delivered verbally, written information, audio recordings, and videos are also recommended. This study aimed to evaluate the effects of different preoperative information techniques on patients' anxiety levels before and after third molar tooth extraction. A single-blind randomized controlled clinical trial with parallel groups was performed. 92 patients who fulfilled the inclusion criteria were randomly assigned to one of four groups. Group 1 was provided information via a silent video with subtitles. Group 2 was informed via a video with background audio. Group 3 was provided a written information brochure. Group 4, designated as the control group, was informed verbally. The Spielberger state anxiety inventory (STAI-S), dental fear scale (DFS), modified dental anxiety scale (MDAS), and visual analog scale (VAS) were used pre- and postoperatively to evaluate the dental anxiety of patients. The primary predictor variable was the preoperative information method. The primary outcome variables were the scores of STAI-S, DFS, MDAS, and VAS. Gender was also set as a covariate variable. Data analysis was performed with the IBM SPSS Statistics 25.0 software program. Unless otherwise stated, P<.05 was considered statistically significant. A total of 86 patients scheduled for impacted third molar extractions under local anesthesia were included in the study. There was no statistically significant difference among the groups in the mean age (P=.275) or distribution of gender (P=.070). Compared to preoperative values, the postoperative scores of MDAS and VAS were decreased significantly in group 1 (P=.002, P=.003, respectively) and group 3 (P=.007; P=.009, respectively). No statistically significant differences were found between the preoperative and postoperative scores of STAI-S, DFS, MDAS, and VAS in group 2 (P=.300, P=.028, P=.063, P=.038, respectively) and group 4 (P=.127, P=.587, P=.072, P=.016, respectively). The findings indicate that visual or written material, without audio or oral delivery, substantially reduced the anxiety associated with oral and maxillofacial surgery. Therefore, clinicians should preferentially provide information via written methods to control patients' anxiety before impacted third molar surgery.

Effects of Patient Education and Distraction Approaches Using Virtual Reality on Pre-operative Anxiety and Post-operative Pain in Patients Undergoing Laparoscopic Cholecystectomy

BackgroundFear of post-operative pain often contributes to pre-operative anxiety; accordingly, pain and anxiety are among the most common complications in patients undergoing laparoscopic cholecystectomy (LC). AimThe present study aimed to determine the effects of patient education and distraction using virtual reality (VR) on pre-operative anxiety and post-operative pain in patients undergoing LC. MethodThis randomized clinical trial included 150 patients in the surgery wards of educational hospitals in Mashhad, Iran, in 2020. The participants were randomly assigned to three groups of education, distraction, and control. The education and distraction groups watched two five-minute animations and three 360-degree images of nature using VR glasses 2 hours before and 4 hours after the surgery, respectively. On the other hand, the control group received routine care. Anxiety was measured using Spielberger's State Anxiety Inventory before and half an hour after the intervention. Moreover, the pain was measured using the visual analog scale and McGill Pain Questionnaire. ResultsThe results demonstrated a significant reduction in the two VR groups regarding the pre-operative anxiety mean scores, compared with the control group (p < .001). Furthermore, a significant reduction was observed in post-operative pain scores of patients in the two intervention groups compared with the control group (p = .001). ConclusionsAs evidenced by the results, both VR approaches of patient education and distraction equally decreased pre-operative anxiety and post-operative pain in patients undergoing LC.

Psychometric Properties of the Slovenian Version of the Cardiac Depression Scale.

The aim of this study was to translate the Cardiac Depression Scale into the Slovenian language and test its validity and reliability on Slovenian patients with heart disease. A total of 272 patients with heart disease who underwent elective coronary angiography at Celje General Hospital participated in this study. We used the Slovenian Cardiac Depression Scale (S-CDS), the Spielberger State Anxiety Inventory (STAI-S), and the Center for Epidemiologic Studies Depression Scale-20 (CES-D) to collect data. An exploratory and confirmatory factor analysis, internal consistency, test-retest reliability, and concurrent validity were performed. Cronbach's alpha for the total scale was 0.92 and the test-retest reliability was 0.71. Exploratory factor analysis confirmed six factors, accounting for 61% of the total variance. The confirmatory factor analysis indicated that a two- and one-factor solution had acceptable goodness-of-fit measures. However, we kept a more parsimonious one-factor method, given a high correlation between the two factors and the theoretical background in previous studies. Concurrent validation against the CES-D and the STAI-S showed moderate to strong correlations. The S-CDS is a reliable and valid instrument for screening for depression in Slovenian patients with heart disease.

Anxiety and Uterine Artery Doppler Flow in A Population of Pregnant Women of High Risk Down Syndrome Fetus: A Prospective Cohort Study.

Fetal exposure to maternal anxiety is associated with low birth weight and maternal stress may be led to constriction of uterine arteries. This study compared the relation of anxiety and uterine artery doppler flow indices in pregnant women with the high and low-risk of Down syndrome. This prospective cohort study was conducted among pregnant women in the second trimester that were classified as having a high or low risk according to their prenatal aneuploidy screening outcome. The high risk group underwent amniocentesis. Anxiety was initially assessed using the Spielberger State-Anxiety Inventory (STAI) and uterine artery blood flow indices were evaluated 2 times for the both groups. For the high-risk group first: immediately before amniocentesis and second: after two weeks follow up, when receiving the karyotype results and for the low-risk group in the first admission and two weeks later. Totally, 375 pregnant women participated in our study that sorted into 2 risk populations based on the aneuploidy screening test, low-risk=176 and high-risk women=199. The high-risk group for Down syndrome amniocentesis showed abnormal results in the 23 cases (23/199). The mean state (P=0.003) and trait (P=0.033) of the Anxiety Inventory scores were significantly different between the groups. Baseline uterine artery indices were no significant difference between the groups. Baseline Uterine artery indices in the high-risk group was significantly different with follow-up (in both positive-amniocentesis and negative amniocentesis sub-groups) indices. Also, there was a weak and significant correlation in the uterine resistance index and STAI scores (P=0.008, r=0.137) during the follow-up period. All pregnant women experienced high level anxiety, especially in the high-risk group that may reduce after confirmation of prenatal aneuploidy screening test and also affects the Doppler indices. For all pregnant women; Stress management and emotional support training is recommended before and during pregnancy.

Resilience Among Gifted Students: Are they Prone to Anxiety During Pandemic?

Resilience is an important protective factor for psychological wellbeing. According to the previous literature, physical activity level and digital game playing are likely to impact anxiety level. The present study aimed to identify the role of resilience, doing physical activity, and playing digital games on gifted children's anxiety levels during the Pandemic period in 2021 in Turkey. The sample consisted of 199 gifted students. Anxiety was measured using the Spielberger's State Anxiety Inventory. Resilience was measured using The Brief Resilience Scale. The physical activity and online/digital game-playing were measured using two open-ended questions. Results provided evidence that resilience had a strong negative association with anxiety among gifted students during the Pandemic period (β = -.59, p<.001). Doing physical activity was associated with anxiety among gifted boys (β = -.16, p<.001) but not girls. Finally, digital game playing was associated with anxiety among neither girls nor boys. These results reflected the importance of resilience for anxiety.

Effect of low-carbohydrate diet on depression and anxiety: A systematic review and meta-analysis of controlled trials

BackgroundDespite considerable advances in pharmacological and non-pharmacological treatments, mental health illnesses carry many economic and social burdens. Depression and anxiety are known as mental disorders which are highly prevalent worldwide. Previous studies have shown different results. This diet has attracted enormous interest. ObjectiveThis is the first meta-analysis conducted to review systematically all trials to evaluating the effect of a low carbohydrate diet (LCD) on depression, and anxiety. MethodsPubMed, Web of Science, and Scopus have been searched until 9 September 2021. In total, 8 RCTs (n = 590) were carried out for evaluation the effects of LCDs on depression and anxiety were included. All the trials included in the analyses evaluated patients without a mood disorder. Random model effects meta-analysis was conducted. To evaluate the heterogeneity among the included studies. The egger test was used. Subgroup analyses performed based on regions, assessment methods, carbohydrate intake and duration of studies. ResultsThis study did not show any significant association between a low carbohydrate diet and the of anxiety (SMD = 0.19, 95 % CI −0.10, 0.47; P = 0.20) and also depression (SMD = 0.06, 95 % CI −0.11, 0.24; P = 0.49). If one of the studies is excluded, this diet significantly increases anxiety (SMD = 0.33, 95 % CI 0.12, 0.54; P ≤ 0.001). This study showed that this diet increases anxiety in studies with <26 % carbohydrate intake (SMD = 0.31; 95%CI 0.10, 0.52; P ≤ 0.001; I2 = 0.00, P = 0.52), in the Australia (SMD = 0.29; 95%CI 0.08, 0.49; P = 0.01; I2 = 0.00, P = 0.42), and in studies that used the Spielberger State Anxiety Inventory (SAI) to assess anxiety (SMD = 0.33; 95%CI 0.11, 0.54; P ≤ 0.001; I2 = 0.00, P = 0.54). LimitationsOne of the limitations of intervention studies examining the effect of diet is that it is difficult to blind people under intervention. ConclusionThe present study did not demonstrate significant association between a low carbohydrate diet and improvement of depression and anxiety. More accurate studies are needed to reach definitive conclusions.

Effectiveness of Gender Matching of the Urological Patients with the Surgical Team: A Quasi-experimental Study

Background and Objective: Urological surgery could be an unpleasant experience for patients due to the need for exposure of the patient's genital area. The present study aimed to determine the effect of gender matching of urological patients and the surgery team on anxiety, shame, and vital signs. Materials and Methods: This quasi-experimental study was conducted in Shahid Beheshti Hospital, Hamadan, Iran, in 2021. A total of 160 patients were selected via convenience sampling and randomly divided into control and intervention groups (n=80 in each group). The patients in the control group were admitted to the operating room as usual, but the gender of the surgical team was matched with the patients of the intervention group. The data were collected using the Vital Signs Flow Sheet, Spielberger's State Anxiety Inventory, and Cook’s Internalized Shame Scale and finally analyzed in SPSS software (version 16). Results: Based on the findings of this study, the two groups were homogeneous in terms of demographic and clinical characteristics (P&gt;0.05). At the beginning of the study, there was no significant difference between the two groups in terms of variables of vital signs, anxiety, and internalized shame (P&gt;0.05). After admission to the operating room, the rate of vital signs, except for temperature, was significantly lower in the intervention group than in the control group (P&lt;0.05). Moreover, the level of anxiety and shame of the intervention group was significantly lower than the control group (P&lt;0.05). Conclusion: If gender of patients is matched with the surgical team, the patients will feel less ashamed and anxious, and the level of vital signs will be closer to normal.

Risk factors for worse anxiety trajectories among patients undergoing cancer chemotherapy

Patients undergoing chemotherapy for cancer often experience heightened anxiety. While receipt of chemotherapy occurs over multiple cycles, limited research has examined anxiety longitudinally. The purposes of this study, in a large sample of patients with breast, gynecological, gastrointestinal, or lung cancer, were to evaluate, over the course of two cycles of chemotherapy, for inter-individual differences in the trajectories of anxiety and identify associations between demographic, clinical, symptom, and psychological adjustment characteristics and initial levels and trajectories of anxiety. Patients with breast, gynecologic, lung, or gastrointestinal cancer (n = 1323) were assessed with the Spielberger State Anxiety Inventory (STAI-S) six times over two cycles of chemotherapy. At enrollment, patients completed self-report instruments assessing demographic, symptom, stress, and coping characteristics. We used hierarchical linear modeling to identify risk factors associated with initial levels and trajectories of state anxiety. Inter-individual differences in initial levels of anxiety were associated with functional status, sleep disturbance, morning fatigue, cognitive function, global and cancer-specific stress, resilience, and several coping characteristics (i.e., sense of coherence, acceptance, using emotional support, self-distraction, denial, venting, and self-blame). Demographic and clinical characteristics associated with interindividual differences in anxiety trajectories were age, employment status, and MAX-2 score. This study provides novel data on the course and predictors of anxiety during two cycles of chemotherapy among a large sample of patients with varied cancer types. Further research focused on risk factors for heightened levels of anxiety during chemotherapy may help point toward more effective interventions for this commonly experienced symptom.

Anxiety and fear about childbirth and postpartum period in last trimester and its relation to childbirth pain

Objective: This study aimed to determine the fear and anxiety related to childbirth and postpartum period in last trimester for pregnant women, and its relation to childbirth pain. Methods: This study was conducted in a training and research hospital’s obstetric clinic in Turkey. Totally, 104 pregnant women admitted to the hospital during the last trimester and they were followed up to delivery, which occurred in the same hospital. Data were gathered with an Information Form, Fear of Childbirth and Postpartum Anxiety Scale (FCPAS), Spielberger State and Trait Anxiety Inventory (STAI) and Visual Analogue Scale (VAS). Results: The mean FCPAS score of the women was 4.87±1.25. The highest scores were for the FCPAS subscales of fears about breastfeeding, behavior of the health staff at childbirth, and the possibility of Cesarean section. Labor pain had a significant positive weak relation with fear about childbirth and the total STAI-State score (r=0.281, p=0.041; r=0.327, p=0.017), respectively. Conclusion: It is important to determine the fear and anxieties about childbirth and postpartum period experienced during last trimester, in terms of planning prenatal education and counseling services, and supporting women to cope effectively.

Anxiety trajectories: An observational study of women undergoing chemotherapy for breast or gynecological cancer

While anxiety is prevalent among women who undergo chemotherapy for breast or gynecologic cancer, research on its predictors has focused primarily on cross-sectional evaluations or on assessments of anxiety prior to and after receipt of chemotherapy. Few studies have evaluated for predictors of inter-individual variability in levels of anxiety during chemotherapy. This study evaluated for inter-individual differences in anxiety across two cycles of chemotherapy and identified demographic, clinical, symptom, and psychological adjustment (e.g., stress, coping) characteristics associated with initial levels and trajectories of anxiety. Patients with breast (n=530) or gynecologic (n=233) cancer completed the Spielberger State Anxiety Inventory six times over two cycles of chemotherapy. At enrollment, self-report measures were used to assess demographic, symptom, stress, and coping characteristics. Hierarchical linear modeling was used to evaluate for risk factors associated with initial levels and trajectories of state anxiety. At enrollment, demographic, clinical, symptom, and psychological adjustment characteristics associated with inter-individual differences of anxiety were: marital status, functional status, sleep disturbance, cognitive function, global stress, cancer-specific stress, resilience, sense of coherence, and the coping strategies of venting and self-blame. Employment status and morning fatigue were the only characteristics associated with inter-individual differences in the trajectories of anxiety. Denial was the only characteristic associated with both initial levels and the trajectories of anxiety. A variety of patient characteristics predicted initial levels of anxiety. Fewer characteristics predicted trajectories of anxiety. Identification of specific risk factors, such as avoidant coping, suggests the need for targeted interventions among higher-risk patients.