Spielberger State-Trait Anxiety Inventory Scores Research Articles

Benefit of Watching a Live Visual Inspection of the Cervix With Acetic Acid and Lugol Iodine on Women's Anxiety: Randomized Controlled Trial of an Educational Intervention Conducted in a Low-Resource Setting.

BackgroundWomen undergoing pelvic examination for cervical cancer screening can experience periprocedural anxiety.ObjectiveThe aim of this study was to assess the anxiety level experienced by women undergoing a visual inspection with acetic acid and Lugol iodine (VIA and VILI) examination, with or without watching the procedure on a digital screen.MethodsThis prospective randomized study took place in the district of Dschang, Cameroon. A previous cervical cancer screening campaign tested women aged between 30 and 49 years for human papillomavirus (HPV). HPV-positive women were invited for the 12-month follow-up control visit, including a VIA/VILI examination. During that visit, we recruited women to participate in this study. Before the examination, participants were randomized in a 1:1 ratio to a control group (CG) and an intervention group (IG). Women in both groups underwent a pelvic examination and were verbally informed about the steps undertaken during the gynecological examination. The IG could also watch it live on a tablet screen. Women’s anxiety was assessed before and immediately after the examination, using the Spielberger State-Trait Anxiety Inventory (STAI). A paired t test was used to compare the mean STAI score for each question before and after VIA/VILI while a nonpaired, 2-sided t test was used to compare the mean differences of the STAI score between the 2 study groups.ResultsA total of 122 women were randomized in the study; 4 of them were excluded as they did not undergo the pelvic examination, did not answer to the second STAI questionnaire because of personal reasons, or the cervix could not be properly visualized. Thus, the final sample size consisted of 118 patients of whom 58 women were assigned to the CG and 60 to the IG. The mean age was 39.1 (SD 5.2) years. Before the examination, the mean (SD) STAI score was 33.6 (SD 10.9) in the CG and 36.4 (SD 11.8) in the IG (P=.17). The STAI score after pelvic examination was significantly reduced for both groups (CG: 29.3 [SD 11.2]; IG: 28.5 [SD 12.0]). Overall, the difference of the STAI scores before and after the pelvic examination was lower in the CG (4.2 [SD 9.0]) than in the IG (7.9 [SD 14.3]), although the difference was not significant (P=.10). However, the women’s emotional state, such as I feel secure and I feel strained, was improved in the IG as compared with the CG (CG: P=.01; IG: P=.007).ConclusionsWatching the VIA/VILI procedure in real time improved the women’s emotional state but did not reduce the periprocedural anxiety measured by the STAI score. Furthermore, larger studies should assess women’s satisfaction with watching their pelvic examination in real time to determine whether this tool could be included in VIA/VILI routine practice.Trial RegistrationClinicalTrials.gov NCT02945111; http://clinicaltrials.gov/ct2/show/NCT02945111

Anxiety and depression symptoms in infertile men during their first infertility evaluation visit

Objective: To assess the psychological condition of men at the start of the infertility work-up.Methods: Men seeking an infertility evaluation for the first time were recruited. Depression and anxiety symptoms and subjective psychological burden were assessed with the Beck Depression Inventory (BDI), the Spielberger State-Trait Anxiety Inventory (STAI), and a visual analog scale (VAS).Results: Data from 113 patients were analyzed. The mean age of the patients was 33.3 (range: 23–54) years, whereas the mean duration of infertility was 16.3 (range: 0–96) months. Results from the BDI and STAI were 2.24 (SD: ±3.18) and 33.74 (SD: ±8.04). Mild depressive symptoms were found in 4.5% of patients, whereas anxiety reached an abnormal level in 4.9%. There were significant correlations between the results from the BDI score and the duration of infertility (p = .024), whereas the STAI and VAS scores showed no similar connection (p = .142 and p = .261, respectively). Among patients with infertility longer than 2 years, mild depressive symptoms occurred in 23.1%.Conclusion: Among men, the levels of depressive and anxiety symptoms were low at the start of the infertility work-up. Depressive symptom levels increased significantly with the duration of infertility, whereas anxiety levels and VAS scores did not demonstrate a similar correlation.

Gender Differences in Patients with Anxiety after Coronary Artery Bypass Surgery.

The present study was designed to evaluate the relationship between gender and coexisting anxiety in patients undergoing coronary artery surgery.Materials and Methods: A total of 137 patients (41 women and 96 men with a mean age 66.1 ± 6.0 years) patients underwent state and trait anxiety evaluation at baseline (preoperatively) and at six months after (postoperatively) coronary artery bypass graft (CABG). Anxiety symptoms were assessed at enrollment using the Spielberger State-Trait Anxiety Inventory (STAI). Psychological, social, clinical, and surgical data were assessed statistically.Results: There were statistically significant differences between female and male patient characteristics for the mean age, mean education year, and mean body mass index. The women were found to be statistically younger and less educated, and more likely to be overweight, diabetic, and hyperlipidemic. The mean hospitalization time, wound infection, and extreme postoperative pain complaints were found to be higher in the female group. 61 patients (33 female and 28 male) (44.5%) were classified as presenting clinically significant anxiety symptoms (STAI score of ≥ 40). The female patients' STAI scores were significantly higher than men in state and trait anxiety, both preoperatively and six months postoperatively. Postoperatively, there was not any significant decrease in the level of trait anxiety when comparing the level of state anxiety in female patients. Conclusion: Even after adjusting for known risk factors for compromised STAI, women do not show the same long-term quality benefits of CABG surgery that men do. The results indicate that the STAI is a valuable instrument for identifying and supporting patients with higher levels of anxiety, which can aid in determining patients that may have poor adjustment after CABG surgery.

Anxiety and 10-Year Risk of Incident Dementia-An Association Shaped by Depressive Symptoms: Results of the Prospective Three-City Study.

Background: Anxiety is common in patients with cognitive impairment and dementia. However, whether anxiety is a risk factor for dementia is still not known. We aimed to examine the association between trait anxiety at baseline and the 10-year risk of incident dementia to determine to which extent depressive symptoms influence this relationship in the general population.Methods: Data came from 5,234 community-dwelling participants from the Three-City prospective cohort study, aged 65 years at baseline and followed over 10 years. At baseline, anxiety trait was assessed using the Spielberger State-Trait Anxiety Inventory (STAI), and depressive symptoms using Center for Epidemiologic Studies-Depression Scale (CESD). Use of anxiolytic drugs was also considered. Diagnoses of dementia were made at baseline and every 2 years. To examine the relationship between anxiety exposures and risk of incident dementia, Cox proportional hazard regression models were performed.Results: Taking anxiolytic drugs or having high trait anxiety (STAI score ≥ 44) increased the risk of dementia assessed over 10 years of follow-up [Hazard Ratio (HR) = 1.39, 95%CI: 1.08–1.80, p = 0.01 and HR = 1.26, 95%CI: 1.01–1.57, p = 0.04, respectively], independently of a large panel of socio-demographic variables, health behaviors, cardio-metabolic disorders, and additional age-related disorders such as cardiovascular diseases, activity limitations, and cognitive deficit. However, the associations were substantially attenuated after further adjustment for depressive symptoms.Conclusion: Our findings suggest that depressive symptoms shape the association between anxiety trait and dementia. Further research is needed to replicate our findings and extrapolate our results to anxiety disorders.

Successful lumbar surgery results in improved psychological well-being: a longitudinal assessment of depressive and anxiety symptoms

Background ContextPreoperative psychological symptoms predict surgical outcomes. The impact of surgical outcomes on psychological well-being, however, has not been delineated. PurposeThis study aimed to compare pre- with postoperative depressive and anxiety symptoms based on success of surgery, defined as fulfilled expectations and improvement in disability and pain. Study Design/SettingA prospective 2-year longitudinal study in a tertiary care center was carried out. Patient SampleThe sample consisted of 276 patients who underwent lumbar surgery. Outcome MeasuresThe Geriatric Depression Scale (GDS) and the Spielberger State-Trait Anxiety Inventory (STAI) were the outcome measures. MethodsPatients completed the following validated surveys several days before and again 2 years after surgery: the GDS with a set threshold for a positive screen for depression; the STAI with population norms used as threshold values; the Oswestry Disability Index (ODI); a numerical pain rating; and the Expectations Survey measuring amount of improvement expected. Dependent variables were pre- to postoperative within-patient change in GDS and STAI scores. Independent variables were three outcomes of surgery: proportion of expectations fulfilled, and changes in ODI scores and pain ratings. Analyses were conducted with GDS and STAI scores as continuous variables and according to threshold values, and for expectations, ODI and pain according to minimum clinically important differences (MCIDs). ResultsMean age was 55, 56% were men, and 78% had degenerative diagnoses. For depressive symptoms, 41% screened positive preoperatively and 16% screened positive postoperatively; 72% had some improvement. In multivariable analysis adjusted for age, gender, comorbidity, diagnosis, and surgical invasiveness, depressive symptoms improved more for more expectations fulfilled (p<.0001), more ODI improvement (p<.0001), and more pain improvement (p=.001). For anxiety symptoms: 59% were worse than population norms preoperatively and 26% were worse postoperatively; 73% had some improvement. In adjusted multivariable analyses, anxiety symptoms improved more for more expectations fulfilled (p=.0002), more ODI improvement (p<.0001), and more pain improvement (p=.03). Similar results were obtained according to threshold values and MCIDs. ConclusionSubstantial improvements in psychological well-being resulted after surgery among patients with favorable spine-specific outcomes.

The effects of ultrasound-guided corticosteroid injection for the treatment of hemiplegic shoulder pain on depression and anxiety in patients with chronic stroke

ABSTRACTPurpose: We attempted to investigate whether ultrasound (US)-guided intra-articular or subacromial bursa corticosteroid injections can potentially influence the severity of depression and anxiety in patients with chronic stroke with hemiplegic shoulder pain (HSP). Methods: Thirty patients with chronic stroke with HSP received US-guided corticosteroid injections. Numeric rating scale (NRS) scores, passive shoulder range of motion (ROM), Beck Depression Inventory (BDI) scores and Spielberger State-Trait Anxiety Inventory (STAI) scores were evaluated before the injection, and one and two months after the injection. Results: NRS, passive shoulder ROM, BDI and STAI scores were significantly lower one and two months following the injection. Changes in NRS scores were significantly correlated with changes in psychological outcomes (BDI and STAI). Conclusion: US-guided intra-articular or subacromial bursa corticosteroid injections might be a beneficial treatment option for relieving depression and anxiety symptoms in patients with chronic stroke with HSP. Also, US-guided injections appear to be helpful for reducing shoulder pain and increasing shoulder ROM.

Children's postoperative symptoms at home through nurse-led telephone counseling and its effects on parents' anxiety: A randomized controlled trial.

The objective of this study was to evaluate children's postoperative symptoms at home after outpatient surgery through nurse-led telephone counseling and the effects of the nurse-led telephone counseling on parents' state-trait anxiety scores. In this prospective randomized controlled study, nurse-led telephone counseling was provided every day to parents in the intervention group until they came for the follow-up visit. Parents of children (n = 54) ages 3-17 years who had undergone outpatient surgery for appendicitis, cholecystectomy, or ovarian cysts were eligible to participate in the study. On the first postoperative day and at the follow-up visit, the Spielberger State-Trait-Anxiety Inventory (STAI) was administered to parents who were randomly allocated to the intervention (n = 24) and control groups (n = 30). The parents reported on postoperative symptoms such as pain, activity levels, excretion, sleep, nutrition, and wound infection. While there was no difference in STAI scores for parents between the groups at the first postoperative day, there was a significant decrease in STAI scores in the intervention group versus the control group, with parents in the intervention group reporting lower anxiety scores. Our results suggest that nurse-led telephone counseling is effective at reducing anxiety in parents of children after outpatient surgery.

The effects of forest therapy on depression and anxiety in patients with chronic stroke

Objective: To assess whether forest therapy is effective for treating depression and anxiety in patients with chronic stroke by using several psychological tests. We measured reactive oxygen metabolite (d-ROM) levels and biological antioxidant potentials (BAPs) associated with psychological stress. Methods: Fifty-nine patients with chronic stroke were randomly assigned to either a forest group (staying at a recreational forest site) or to an urban group (staying in an urban hotel); the duration and activities performed by both groups were the same. Scores on the Beck Depression Inventory (BDI), Hamilton Depression Rating Scale (HAM-D17), Spielberger State-Trait Anxiety Inventory (STAI), d-ROMs and BAPs were evaluated both before and after the treatment programs. Results: In the forest group, BDI, HAM-D17 and STAI scores were significantly lower following treatment, and BAPs were significantly higher than baseline. In the urban group, STAI scores were significantly higher following treatment. Moreover, BDI, HAM-D17 and STAI scores of the forest group were significantly lower, and BAPs were significantly higher following treatment (ANCOVA, p <0.05). Conclusion: Forest therapy is beneficial for treating depression and anxiety symptoms in patients with chronic stroke, and may be particularly useful in patients who cannot be treated with standard pharmacological or electroconvulsive therapies.

Women show a higher level of anxiety during IVF treatment than men and hold different concerns: a cohort study.

The aim of the present study was to determine levels of anxiety during the course of IVF treatment and gender differences in treatment anxiety. This was a prospective cohort study set in a university affiliated, tertiary care IVF program. 119 women and 82 men entering the clinic to undergo IVF treatment filled out questionnaires containing the Spielberger state-trait-anxiety-inventory (STAI) as well as further items on specific stress triggers. Women and men undergoing IVF have higher levels of anxiety than the average population in Germany. Overall, female patients show significantly higher values (mean ± SD) for state and trait anxiety (47.4 ± 11.0 and 40.1 ± 9.85) than their male partners (41.4 ± 9.66 and 35.3 ± 8.57, p < 0.01). Over the course of several IVF cycles, average STAI scores increased for both genders. When asked about specific stress factors on a 4-point scale from 'not at all' to 'very much so', women report as their main anxiety the failure to achieve a successful pregnancy, scoring significantly higher on questions like 'obtaining a negative pregnancy test' (3.24 ± 0.82, p < 0.01) and 'disclosure of infertility' (3.02 ± 1.10, p < 0.001). Their male partners are more concerned about the health risks the women have to take such as 'side effects of ovarian stimulation' (2.55 ± 0.77, p = 0.002) and 'bleeding or infection after the oocyte aspiration' (2.58 ± 0.84, p = 0.007). Both genders indicated to be very little worried about multiple pregnancies after IVF. Women show a higher level of anxiety during IVF treatment and hold different concerns. Neither of the sexes appears to be familiar with the risks associated with multiple pregnancies, a matter that should better be addressed.

Effect of stress and anxiety on 1st year medical students

Context: Medical students are exposed to various stresses such as demanding medical education and different teaching protocols.[4],[5] Heart rate variability (HRV) is a simple and noninvasive indicator for the detection of cardiac autonomic dysfunction. This study was done to assess the effect of stress and anxiety on HRV. Aims: This study aims to assess the perceived stress, anxiety, and HRV in 1st year medical students and to correlate stress and anxiety to HRV. Subjects and Methods: The study included 110, 1st year MBBS students, excluding students with any infections, metabolic diseases, cardiorespiratory diseases, and medications which alter the autonomic functions. Anxiety and stress were measured using Spielberger State-Trait Anxiety Inventory (STAI) and Perceived Stress Scale (PSS) questionnaires, respectively. Based on the scores, students were assigned to stress and nonstress group and anxious and nonanxious group. The electrocardiogram (ECG) was recorded using a house built analog ECG amplifier, which was further analyzed using HRV analysis software. Results: STAI and PSS were analyzed; those who have STAI score of above 40 come under anxious group and those with PSS score of 13 and above comes under stress group. Sixty-two percent students are both anxious as well as stressed. The parameters, namely, mean heart rate, standard deviation of normal to normal, root mean square successive difference (RMSSD), low-frequency (LF) normalized unit, and high-frequency (HF) normalized unit were correlated with stress and anxiety scores. During state-anxiety, there is a significant increase in heart rate, RMSDD, LF domain, and LF/HF and during trait-anxiety, there is significant increase in RMSDD and LF/HF ratio. In this study, perceived stress is not significant with HRV. Conclusions: This study shows that during anxiety there is increased activity toward sympathetic, but no difference in parasympathetic activity and during perceived stress, there is no significance with HRV.

Depressed mood, anxiety, and the use of labor analgesia.

Relatively little is known about mental health and labor pain. The aim of this study was to assess if self-rated antenatal depressed mood and anxiety are associated with pain-related behaviors and self-reported labor pain. We also wanted to replicate our previous finding of altered labor pain behavior in carriers of a specific guanosine triphosphate cyclohydrolase 1 gene (GCH1) haplotype. Ninety-nine women in gestational weeks 37 to 40 filled out questionnaires on depression and anxiety symptoms and later rated their labor pain by use of visual analog scales. Each subject was also genotyped for GCH1. Following adjustment for relevant confounders, women who arrived early to the delivery unit (cervical dilation <5 cm) had a significantly higher antenatal Montgomery-Åsberg Depression Rating Scale (MADRS-S) score, p < 0.05, than late arrivers (cervical dilation >5 cm). Women with increased Spielberger State-Trait Anxiety Inventory (STAI-T) scores reported higher self-rated pain prior to labor analgesia, p < 0.05, than women with low STAI-T scores. No association between the GCH1 pain-protective haplotype and cervical dilation was found, but a previously demonstrated association with increased use of second-line analgesia was confirmed. Depressed mood during pregnancy is associated with early arrival to the delivery department, whereas antenatal anxiety is associated with increased self-rated pain prior to labor analgesia.

Breastfeeding and maternal sensitivity predict early infant temperament.

Research findings are inconclusive when it comes to whether breastfeeding is associated with the mother-infant relationship or infant temperament. We examined the association between breastfeeding at three months postpartum and infant temperament at 18 months postpartum and whether this link was affected by the mothers' anxiety and mediated by her sensitivity. We assessed 170 mothers for breastfeeding and anxiety using the Spielberger State-Trait Anxiety Inventory (STAI) at three months postpartum, maternal sensitivity using the Ainsworth Sensitivity Scale at six months postpartum and infant temperament using the Early Childhood Behaviour Questionnaire at 18 months postpartum. Mothers who breastfed at three months postpartum were more sensitive in their interactions with their infants at six months postpartum, and elevated sensitivity, in turn, predicted reduced levels of negative affectivity in infant temperament at 18 months postpartum. This indirect mediation persisted after controlling for confounders (effect ab = -0.0312 [0.0208], 95% CI = -0.0884 to -0.0031). A subsequent analysis showed that the mediation through sensitivity only occurred in women experiencing higher anxiety, with a STAI score ≥33.56 at three months (ab = -0.0250 [0.0179], 95% CI = -0.0759 to -0.0013). Our results suggest that breastfeeding and maternal sensitivity may have a positive impact on the early development of infant temperament.

(458) Evaluation of anxiety in procedure naïve patients during cervical and lumbar epidural steroid injection procedures

In order to minimize patient anxiety and maximize patient comfort, pain practitioners frequently administer sedatives when performing spine injections. The lack of studies that identify patient and procedural risk factors for increased levels of anxiety during spine injections and the potential risk of neurologic injury in patients undergoing injection treatments while sedated represent major barriers to the development of safe, tailored sedation practices. This prospective observational cohort study was conducted with injection-naïve patients presenting for a routine cervical or lumbar epidural steroid injection for a pain related indication at a tertiary urban academic medical center to measure and compare anxiety levels in order to identify predictors of patient movement and vasovagal responses. Anxiety was measured using validated outcomes. The primary outcome measure was the Spielberger State Trait Anxiety Inventory (STAI) score. Numeric rating scale (NRS) for anxiety was also used. A two-sample Wilcoxon rank-sum test was used to compare STAI scores. NRS was analyzed with ANOVA and categorical variables were evaluated by using an c2 statistic. We found no group differences in age, gender, marital status, VAS pain score, duration of pain symptoms, or utilization of healthcare resources for pain symptom management. The mean STAI score was 43 ± 8 in the cervical group (n =139) and 44 ± 9 in the lumbar group (n = 140) (p = 0.35), a low level of anxiety (the lowest possible score is 20, and the highest score, representing the highest possible level of anxiety is 80). We found no between-group differences in anxiety at any point during the peri-procedure period. A vasovagal response was identified in 10% of the cervical group and in 3% of the lumbar group (p=0.04). Our results suggest that the practice of routine prevention or treatment of injection-related anxiety in the procedure-naïve general population should be re-evaluated. In order to minimize patient anxiety and maximize patient comfort, pain practitioners frequently administer sedatives when performing spine injections. The lack of studies that identify patient and procedural risk factors for increased levels of anxiety during spine injections and the potential risk of neurologic injury in patients undergoing injection treatments while sedated represent major barriers to the development of safe, tailored sedation practices. This prospective observational cohort study was conducted with injection-naïve patients presenting for a routine cervical or lumbar epidural steroid injection for a pain related indication at a tertiary urban academic medical center to measure and compare anxiety levels in order to identify predictors of patient movement and vasovagal responses. Anxiety was measured using validated outcomes. The primary outcome measure was the Spielberger State Trait Anxiety Inventory (STAI) score. Numeric rating scale (NRS) for anxiety was also used. A two-sample Wilcoxon rank-sum test was used to compare STAI scores. NRS was analyzed with ANOVA and categorical variables were evaluated by using an c2 statistic. We found no group differences in age, gender, marital status, VAS pain score, duration of pain symptoms, or utilization of healthcare resources for pain symptom management. The mean STAI score was 43 ± 8 in the cervical group (n =139) and 44 ± 9 in the lumbar group (n = 140) (p = 0.35), a low level of anxiety (the lowest possible score is 20, and the highest score, representing the highest possible level of anxiety is 80). We found no between-group differences in anxiety at any point during the peri-procedure period. A vasovagal response was identified in 10% of the cervical group and in 3% of the lumbar group (p=0.04). Our results suggest that the practice of routine prevention or treatment of injection-related anxiety in the procedure-naïve general population should be re-evaluated.

Is there relationship between social support, psychological distress, mood disorders and emesis gravidarum?

Objective: Emesis Gravidarum (EG) is common medical condition in pregnancy with significant negatively effects on daily social life, physical and psychological health. In this study, relationship of social support, psychological distress and mood disorders on EG were investigated. Methods: The pregnant women with mild EG were accepted as control group and moderate and severe EG were accepted as patient group. All patients completed sociodemographic data collection form, Pregnancy-Unique Quantification of Emesis and Nausea scale (PUQE-24), Symptom Check List questionnaire (SCL-90 R), Spielberger state-trait anxiety inventory (STAI), Beck depression inventory (BDI) and Multidimensional Scale of Perceived Social Support (MSPSS). STAI, BDI, MSPSS and GSI (global symptom index) scores of the patients and control groups were compared. Results: Statistically significant differences were found between the patients and control group on STAI score, BDI score and GSI scores. No statistically significant were found between the patients and control group on MSPSS score. Conclusion: Social support does not prevent patients from EG. But, there is a clear relationship between EG and psychological distress. Thus, psychiatric evaluation should be done in patients with EG. Obstetricians should encourage their patients to have psychiatric support. Further studies on relationship of psychosocial factors and EG are needed.

Prevalence and associated factors for temporomandibular disorders in Chinese civilian pilots.

Piloting is a special profession with prolonged stress, which could induce the occurrence of TMD. This sample is useful to reduce the effect of confounders in the analyses. Based on this, the present study aims to determine the prevalence and associated factors for TMD in civilian pilots of China. A cross-sectional epidemiological survey was carried out in 616 male subjects (aged 23-52 years). The questionnaire included general information, chewing preference (bilateral or unilateral), and Trait Anxiety section of Spielberger State-Trait Anxiety Inventory (STAI-T). The clinical examination contained TMD screening per research diagnostic criteria for TMD and diagnosis of sleep bruxism per American Academy of Sleep Medicine standards. The level of statistical significance was set at P ≤ 0.05. The program was conducted from June 2012 to April 2013, in which period, and the percentage of TMD in the samples we examined was 33.3 % (=205/616). Only high anxiety (OR 2.48; 95 % CI 1.25-4.90) and unilateral chewing preference (OR 12.67; 95 % CI 7.77-20.65) were the most significant associated factors with TMD. Also, salivary cortisol and the STAI-T score had a significant correlation (r = 0.47, P < 0.001). It was more reliable to study the associated factors on TMD with the exclusion of the possible confounding factors, and only unilateral chewing preference and psychological stress had a significant association with TMD. In addition, the salivary cortisol levels might assist to assess psychological stress in epidemiological research.

Evaluation of Anxiety in Procedure-Naive Patients During Cervical and Lumbar Epidural Steroid Injection Procedures

The lack of studies that identify patient and procedural risk factors for increased levels of anxiety during spine injections represents a major barrier to the development of safe tailored sedation practices. We measured and compared anxiety in procedure-naive patients undergoing a cervical or lumbar interlaminar epidural steroid injection to identify predictors of patient movement and vasovagal responses in the periprocedural period. This prospective observational cohort study was conducted with injection-naive patients presenting for a routine cervical or lumbar epidural steroid injection. The primary outcome measure was the Spielberger State Trait Anxiety Inventory (STAI) score. Participants also reported anxiety using the Numeric Rating Scale in the periprocedural period. The Wilcoxon rank sum test was used to compare STAI scores; Numeric Rating Scale values were compared using Friedman test. Post hoc tests were corrected for 12 comparisons using the Bonferroni method. We found no group differences in age, gender, marital status, Visual Analog Scale pain score, duration of pain symptoms, or utilization of health care resources for pain symptom management. The mean STAI score was 43 ± 8 in the cervical group (n = 140) and 44 ± 9 in the lumbar group (n = 140) (P = 0.35), a low level of anxiety. There were no between-group differences in anxiety at any point during the periprocedural period. A vasovagal response was identified in 10% of the cervical group and in 3% of the lumbar group (P = 0.04). No group differences in anxiety were seen between cervical and lumbar groups. Anxiety levels were not associated with patient movement or vasovagal symptoms. Our results suggest that the practice of routine prevention or treatment of injection-related anxiety in the procedure-naive general population with a duration of pain less than 6 months and without a history of an anxiety disorder should be reevaluated.

Does watching a video on third molar surgery increase patients' anxiety level?

To identify the effects of watching live taping of third molar removal on patients' anxiety levels before and after extraction. This study was based on a prospective, cross-sectional, observational investigation of the different patient education techniques about the effect of third molar removal on patients' anxiety level. A total of 333 patients were randomized into three groups: two study groups (for group 1, basic information was given verbally; for group 2, which was the study group, basic information was given verbally and through a movie on third molar extraction); and a control group (basic information was given verbally; it did not include information on operative procedures and recovery). Anxiety levels were assessed by using the Dental Anxiety Scale (DAS) and the Spielberger State-Trait Anxiety Inventory (STAI). Pain was assessed with a visual analog scale. Statistical analysis was performed with SPSS 16.0. Group 2 patients were significantly more anxious before the surgical procedure, and the most significant decreases in DAS and STAI scores were observed in that group. The age, surgery time, and education level were not correlated with anxiety or pain levels; however, female patients had high levels of anxiety (P < .05). Preoperative multimedia information increases the anxiety of patients undergoing third molar surgery.

Analysis of Dizzy Patients with High Depression and Anxiety Index

Objectives: Some patients with dizziness often show psychological distress. However, the association of vestibular deficit with psychological symptoms remains controversial. Thus, we investigated the incidence of high depression and anxiety index in patients who complained of dizziness, their dizziness severity, and the distribution of disease to induce dizziness. Methods: In 562 patients with dizziness, dizziness and the psychological distress of all patients were measured using the Korean versions of the Dizziness Handicap Inventory (DHI), the Beck Depression Inventory (BDI), and the Spielberger State-Trait Anxiety Inventory (STAI). We examined the incidence of patients having high depression and anxiety using a cutoff value (BDI ≥21, STAI ≥57). We divided patients into a high psychological distress index group and a moderate to low index group on the basis of cut-off value and compared the type of disease and DHI score between the 2 groups. Results: The incidence of high BDI and STAI scores were 11% and 13.5%, respectively. The high BDI and STAI group showed the higher DHI scores, including functional, emotional and physical subscales, and the higher STAI and BDI scores, respectively. The mean age, sex and the distribution of the type of disease between high psychological distress index group and moderate to low index group showed no difference. Conclusions: Of patients with dizziness, about one-tenth have serious psychological distress, various vestibular diseases, and more dizzy symptoms. Thus, we should keep in mind the psychological factor in dizzy patients and the necessity of psychological support in the patients.

Assessment of Anxiety and Depression in Adolescents with Primary Dysmenorrhea: A Case-Control Study

Study ObjectiveTo examine the relationship between primary dysmenorrhea and symptoms of depression and anxiety among adolescent female students in Tbilisi, Georgia. DesignA case-control study. SettingTbilisi, Georgia. ParticipantsFour hundred twenty-four postmenarcheal girls aged 14-20 years (a subset of a larger study involving 2561 girls). MethodsThe data was gathered in 2011 by the use of a questionnaire prepared for the purpose of this study, completed anonymously. Menstrual pattern, depression and anxiety level were evaluated in both groups; continuous and categorical variables were compared by Pearson chi-square test. Depressive symptoms were determined by a self-reporting scale (Beck Depression Inventory); anxiety was determined using Taylor Manifest Anxiety Scale (TMAS) and Spielberger State-Trait Anxiety Inventory (STAI). Main Outcome MeasuresDifferences in mental health between two groups. ResultsPatients with primary dysmenorrhea (PD) had significantly higher scores of depression than the control subjects: moderate depression, 15.9% in PD patients vs 6.2% in control subjects and severe depression, 1.8% vs 0% (P < .003, LR 0.001). High anxiety (TMAS) was also more prevalent in adolescents with primary dysmenorrhea (44% vs 9.9%; P < .001, LR < 0.001). STAI scores were also significantly higher in these patients than in healthy women (68.9% vs 25.0%; P < .001, LR < 0.001). ConclusionPrimary dysmenorrhea is strongly linked with positive scores for depression and anxiety. Because of this association, attention should be given to effective mental health screening in these patients; psychological support may be necessary during their treatment and follow-up.

Low Degree of Formal Education and Musical Experience Predict Degree of Music-Induced Stress Reduction in Relatives and Friends of Patients

To determine the factors that may predict music-induced relaxation in friends and family of patients in the emergency department. It remains unclear to date which demographic and experiential factors predict the effectiveness of music-induced relaxation. Furthermore, in-hospital stressors for friends and family of patients rather than patients themselves are underresearched and deserve in-depth investigation to improve this group's experience in health care environments. A total of 169 relatives and friends of patients in the emergency department-waiting area completed a series of questionnaires, including the Spielberger State-Trait Anxiety Inventory (STAI), the Music Experience Questionnaire (MEQ), and a demographic survey. They were then randomly assigned to either Case Group (1 hour in the waiting area with classical music in the background) or Control Group (1 hour with no music) before completing a second, identical copy of the STAI to measure change from baseline. Data were analyzed for associations between music intervention, change in STAI scores, MEQ scores, and demographic characteristics. Participants who underwent the music intervention experienced a 9.8% decrease in overall mean State Anxiety, whereas those in the Control Group experienced no change over time (P = 0.001). Higher education significantly inversely correlated with the effectiveness of music intervention: participants with no formal education beyond high school showed a greater overall mean decrease in State Anxiety than those with a college education or beyond in response to classical music (P = 0.006). Furthermore, MEQ scores indicated that the Social Uplift scale (a measure of one's tendency to be uplifted in a group-oriented manner by music) was highly predictive of the effectiveness of music intervention. Music is an effective and inexpensive means of reducing anxiety in friends and family of patients, who are underresearched in medicine. Moreover, low educational attainment and tendency to respond positively to music in a group setting can predict the effectiveness of music-induced relaxation.