Spielberger State Anxiety Inventory Research Articles

The Investigation of The Anxıety Level And Lıfe Style Changes Of Healtcare workers ın Hatay durıng covıd-19 pandemıa Process

Background: This study aimed to assess the anxiety levels and lifestyle changes experienced by healthcare professionals in Hatay during the COVID-19 outbreak. Materials and Methods: The study was conducted through a WhatsApp-based survey, involving healthcare workers from primary, secondary, and tertiary care facilities in Hatay province, between February 25, 2021, and March 25, 2021. Participants completed a 25-question survey designed by the researchers, along with the Spielberger Trait and State Anxiety Inventory and the Insomnia Severity Index to assess sleep disturbances. Results: Among the 201 physicians, 137 nurses/midwives, and 64 other healthcare professionals who participated, 60.2% (n=242) reported moderate anxiety according to the state anxiety scale, while 72.9% (n=293) did so on the trait anxiety scale. Additionally, 62.5% (n=251) were found to have sleep disorders. Factors associated with higher anxiety levels included older age (p=0.018), being a physician (p=0.005), working in settings with more frequent exposure to infected patients (p=0.001), having chronic illnesses (p=0.004), changes in dietary habits (p=0.001), smoking (p=0.011), seeking support (p=0.001), and risky contact with infected patients (p=0.001). Variables linked to sleep disturbances included working in high-contact areas (p=0.001), being female (p=0.033), being a doctor or nurse (p=0.013), smoking (p=0.005), dietary habits (p=0.001), physical activity (p=0.001), seeking supportive care (p=0.001), and risky contact with infected patients (p=0.001). Conclusions: The pandemic has had a negative psychological impact on healthcare workers, resulting in elevated anxiety levels and increased sleep disturbances.

Preoperative Anxiety's Impact on the Median Effective Dose of Esketamine for Alleviating Propofol Injection Pain in Patients Undergoing Painless abortion: A Randomized, Double-Blind, Controlled Trial.

Propofol injection pain (PIP) is a frequent adverse effect during anesthesia induction, impacting patient comfort and satisfaction. Esketamine has been shown to alleviate PIP, but the optimal dose, especially in relation to preoperative anxiety levels, remains unclear. Preoperative anxiety may heighten pain perception and influence analgesic requirements. A randomized, double-blind, controlled trial was conducted at The Affiliated Women and Children's Hospital of Ningbo University. A total of 150 eligible patients scheduled for painless abortion were assessed using the Spielberger State Anxiety Inventory - State form (STAI-S) and categorized into non-anxious (STAI-S score <40) and anxious (STAI-S score ≥40) groups. Patients were randomized using a computer-generated random number table to receive one of five escalating doses of esketamine (0.10, 0.12, 0.14, 0.17, or 0.20 mg/kg) prior to propofol administration. The primary outcome was the occurrence of PIP, assessed using Ambesh's four-point pain scale. Secondary outcomes included hemodynamic parameters and adverse events such as hypotension, bradycardia, and hypoxemia. A clear dose-response relationship was observed, with higher doses of esketamine significantly reducing the incidence of PIP in both groups. Anxious patients required higher doses of esketamine to achieve comparable pain relief to non-anxious patients. The effective dose for 50% of patients (ED50) in the non-anxious group was 0.114 mg/kg (95% CI: 0.096-0.129 mg/kg), whereas it was 0.133 mg/kg (95% CI: 0.117-0.146 mg/kg) in the anxious group, with the difference being statistically significant (P < 0.05). No significant differences were observed between groups in terms of adverse events or hemodynamic stability. Preoperative anxiety significantly increases the ED50 of esketamine required to alleviate propofol injection pain in patients undergoing painless abortion. Anxious patients require higher doses of esketamine to achieve effective analgesia. Individualizing esketamine dosing based on preoperative anxiety levels may enhance patient comfort and optimize pain management during anesthesia.

Feasibility and Acceptability of Internet-Based Emotion-Focused Cognitive Behavioral Therapy in Women with Suspected Fetal Anomalies: A Quasi-Experimental Study

Background: There is a notable lack of empirical validation regarding the use of internet-based emotion-focused cognitive behavioral therapy (IECBT) for counseling pregnant women. Objectives: This study examines the feasibility, acceptability, and effectiveness of IECBT in counseling women with suspected fetal anomalies. Methods: In a quasi-experimental study, 130 pregnant women diagnosed with anxiety disorders were randomly assigned to either IECBT with spousal participation (65 participants) or IECBT alone (65 participants). All participants completed three pregnancy-specific stress questionnaires—the NuPDQ, Spielberger State Anxiety Inventory, and Edinburgh Depression Scale—both before and immediately after the intervention. Results: Within-group analyses indicated that both counseling methods, with and without spousal involvement, led to significant reductions in pregnancy-specific stress, depression, and anxiety symptoms by the end of the intervention (P &lt; 0.001). Between-group comparisons revealed that IECBT with spousal participation significantly reduced pregnancy-specific stress (effect size = 0.055, P = 0.007) and depressive symptoms (effect size = 0.480, P &lt; 0.001) compared to IECBT without spousal involvement. However, neither intervention produced a significant reduction in anxiety symptoms (effect size = 0.001, P = 0.787). Conclusions: Both IECBT approaches (with and without spousal participation) are feasible, reliable, and effective methods for alleviating depression and stress symptoms in pregnant women with suspected fetal anomalies.

Efficacy of virtual reality therapy versus pharmacological sedation for reducing pain and anxiety during coronary catheterisation procedures: A prospective randomised controlled trial.

The use of virtual reality (VR) therapy has grown considerably, as it is effective for reducing pain and anxiety in different clinical areas. However, it has not been well evaluated for coronary angiography and angioplasty. This study aimed to compare VR therapy with pharmacological sedation (Sedation) for reducing pain in patients undergoing a planned coronary angiography or coronary/peripheral angioplasty. In this prospective randomized controlled trial, patients were randomly allocated to one of two groups before catheterization: a Sedation group (injection of midazolam and fentanyl) or a VR group (Deepsen VR headset). The primary outcome measure was the maximum pain during the procedure (visual analogue scale: 0-10). The secondary outcome measures were anxiety following the procedure (Spielberger State Anxiety Inventory: 20-80), the occurrence of arterial spasm, the haemodynamic profile and patient satisfaction. The VR group (n = 63) had a mean pain rating of 2.5; for the Sedation group (n = 59) this was 1.0. This did not meet the criterion for non-inferiority. Anxiety was comparable between the two groups (VR: 25.4; Sedation: 24.7), as was the occurrence of arterial spasm (VR: 7.9%; Sedation: 8.5%; p = 0.91), but blood pressure was higher in the VR group (140.2/71.7 mmHgvs. 121.8/64.7 mmHg). There were no VR-related adverse effects, and patient satisfaction was high for both groups. Virtual reality therapy was not non-inferior to pharmacological sedation for reducing pain during coronary angiography or angioplasty. However, it reduced anxiety to a comparable level. Virtual reality therapy represents an alternative to pharmacological sedation, which is well accepted by patients.

Effect of bitter orange blossom distillate on anxiety and sleep disorder in mothers with infants admitted to neonatal intensive care unit: A Randomized controlled clinical trial.

Mothers of neonates admitted to the intensive care unit are prone to sleep disorders due to stress and anxiety. Some herbs have anti-anxiety and sedative properties. This study aimed to investigate the effect of bitter orange blossom distillate on anxiety and sleep disorders in mothers with infants admitted to the neonatal intensive care unit. This randomized controlled clinical trial was conducted from 2021 May 15 to 2022 February 2, on 60 mothers with NICU-admitted infants in one of the medical teaching centers affiliated with Babol University of Medical Sciences, Iran. Permuted block randomization was used to assign the mothers to the experimental (bitter orange blossom distillate syrup) and control groups (syrup prepared from water and sugar). Given the impossibility of blinding the participants, allocation concealment was used to prevent the researcher from predicting the future allocation of the samples to the groups. In addition, the statistical consultant received coded data pertaining to the type of intervention in each group. A demographic questionnaire, the Spielberger State and Trait Anxiety Inventory (STAI), and the General Sleep Disorder Scale were employed to collect data. We assessed the level of anxiety and sleep disorder (in both groups before the intervention and again after the last day of the intervention). Data were analyzed using SPSS V22 software. A P-value less than 0.05 were considered significant. The mean and standard deviation of the sleep disorder score in the intervention group from (50.26±5.81) to (44.70±6.94) and in the control group from (50.46±6.95) to (48.53±8.62) changed. The covariance test showed that bitter orange blossom distillate syrup has a significant effect on the improvement of sleep disorders (P = 0.01, Effect size = 0.09), but there was no significant difference in the State and Trait anxiety level of mothers (P = 0.122, 0.144 and Effect size = 0.04, 0.03) respectively. Due to the positive effect of bitter orange blossom distillate syrup on sleep disorders of mothers with hospitalized babies, this low-cost and low-risk intervention is recommended. This study is registered at clinicaltrials.gov as Trial ID = IRCT20201209049666N1.

Investigating the impact of patient-centered peer counseling on anxiety and pain among burn patients: A randomized controlled trial

ObjectivePain and anxiety are common complications in burn patients, significantly impacting treatment effectiveness and overall patient well-being. Peer counseling, a form of patient education provided by individuals with shared experiences, may hold potential to alleviate this pain and anxiety. This study seeks to investigate the effectiveness of patient-centered education through peer counseling on background pain and state anxiety levels in these patients. MethodsA two-arm, parallel, randomized, controlled trial design was employed. A total of 86 participants were randomly allocated to one of two groups: control and intervention groups. State anxiety and background pain levels were assessed using the Spielberger State Anxiety Inventory (STAI) and Visual Analogue Scale (VAS), respectively, before and after intervention. Statistical analyses, including Chi-square test, Fisher's exact test, independent t-test, and paired t-test, were employed to analyze the data. ResultsThe intervention significantly reduced pain and anxiety in the intervention group compared to baseline (p < .001). There was no significant difference between the control and intervention groups in baseline levels, but there was a significant difference after the intervention (p < .001). ConclusionThis study demonstrates the efficacy of patient-centered education through peer counseling in reducing background pain and state anxiety levels in burn patients. Compared to standard education, peer counseling led to a more pronounced reduction in both pain and anxiety, suggesting its potential as a valuable nonpharmaceutical intervention to improve patient well-being during burn recovery. Practice implicationsBased on our findings, we recommend that healthcare providers consider implementing peer-based education programs in burn care settings.

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.&#x0D; 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.&#x0D; 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).&#x0D; 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.