State-Trait Anxiety Inventory Trait Research Articles

Anxiety levels and influencing factors among the relatives of patients presenting to the emergency department

Background and objective: In recent years, the majority of incidents of increasing violence against healthcare workers, especially emergency department (ED) staff, have been perpetrated by family members of patients. Anxiety is one of the predictors of this violence in ED. The aims of this study were to measure anxiety levels among the relatives of ED patients at the time of presentation and to identify the factors that affect them. Materials and methods: In this prospective, cross-sectional study, 687 relatives of patients were included. The State-Trait Anxiety Inventory- State (STAI-S) and State-Trait Anxiety Inventory- Trait (STAI-T) scales were administered to assess state and trait anxiety levels. The data for the study were recorded using the SPSS 16.0 statistics program. Results: STAI-S averages were found to be statistically significantly higher than their STAI-T averages in parents (p = 0.036). A statistically significant difference was found between the state and trait anxieties of the group whose patients had a history of previous hospitalization (p = 0.013), previous surgeries (p = 0.009), presented with trauma (p=0.007), and received intervention in ED (p = 0.003). The state anxiety of the patient relatives who brought their patients to the ED by their own means was found to be statistically significantly higher than the trait anxiety (p=0.028). Conclusion: Our study showed that patient relatives whose patients presented to the ED due to trauma or had a history of surgery/hospitalization, or arrived at the hospital under their own means, experienced elevated anxiety levels. More multi-center studies are needed. July 2024; Vol. 18(2):008. DOI: https://doi.org/10.55010/imcjms.18.020 *Correspondence: Seçkin Bahar Sezgin, Emergency Department,Gaziantep City Hospital, Gaziantep, Turkey. Email: seckinbahar34@gmail.com

Trait-anxiety and glial-related neuroinflammation of the amygdala and its associated regions in Alzheimer's disease: A significant correlation

BackgroundPositron emission tomography, which assesses the binding of translocator protein radiotracers, 11C-DPA-713, may be a sensitive method for determining glial-mediated neuroinflammation levels. This study investigated the relationship between regional 11C-DPA713 binding potential (BPND) and anxiety in patients with Alzheimer's disease (AD) continuum. MethodsNineteen patients with AD continuum determined to be amyloid-/p-tau 181-positive via cerebrospinal fluid analysis were included in this cross-sectional study (mild cognitive impairment [MCI, n = 5] and AD [n = 14]). Anxiety was evaluated using the State-Trait Anxiety Inventory (STAI). A whole-brain voxel-based analysis was performed to examine the relationship between 11C-DPA-713-BPND values at each voxel and the STAI score. Stepwise multiple regression analysis was performed to determine the predictors of STAI scores using independent variables, including 11C-DPA-713-BPND values within significant clusters. 11C-DPA-713-BPND values were compared between patients with AD continuum with low-to-moderate and high STAI scores. ResultsVoxel-based analysis revealed a positive correlation between trait anxiety severity and 11C-DPA713-BPND values in the centromedial amygdala and the left inferior occipital area [P < 0.001 (uncorrected) at the voxel-level]. 11C-DPA713-BPND values in these regions were a strong predictor of the STAI trait anxiety score. Specifically, patients with AD continuum and high trait anxiety had increased 11C-DPA713-BPND values in these regions. ConclusionsThe amygdala–occipital lobe circuit influences the control of emotional generation, and disruption of this network by AD pathology-induced inflammation may contribute to the expression of anxiety. Our findings suggest that suppression of inflammation can help effectively treat anxiety by attenuating damage to the amygdala and its associated areas.

Association Between Pandemic-Related Maternal Perinatal Anxiety and Early Postpartum Breastfeeding Success.

Prior studies have shown conflicting results on the impact of maternal anxiety on breastfeeding initiation and success. Furthermore, a substantial increase in maternal anxiety levels was shown in response to the COVID-19 pandemic. In this study, we aimed to investigate the relationship between maternal perinatal anxiety induced by the COVID-19 pandemic and early breastfeeding outcomes. This cross-sectional study was conducted in two regional maternity hospitals, involving 220 first-time pregnant patients with a gestational age of ≥37 weeks. All patients had no current diagnosis of COVID-19 and no cases of COVID-19 in their close environment at the time of admission. At 24-48 hours postpartum or at the time of discharge, threefollowing scoring systems were employed: the Coronavirus Anxiety Scale (CAS), the State-Trait Anxiety Inventory (STAI), and the LATCH (short for latch, audible swallowing, type of nipple, comfort, and hold) score. A LATCH score of ≥8 was chosen as the cutoff point for defining successful breastfeeding performance. Spearman's rank correlation was used to evaluate relationships between the CAS, STAI scores, maternal and infant factors, and LATCH scores. There were no differences in baseline characteristics between groups categorized as successful and unsuccessful in breastfeeding initiation. The mean total STAI score was 86.3±13.2, the CAS score was 1.07±1.91, and the LATCH score was 8.42±1.7. Although there was an increase in State-Trait Anxiety Inventory-State Anxiety (STAI-S) scores compared to State-Trait Anxiety Inventory-Trait Anxiety (STAI-T) scores, and the STAI-S score and CAS score were higher in the unsuccessful group, these differences did not reach statistical significance (p = 0.22 and 0.16, respectively). When we evaluated the correlation of the LATCH score with STAI total, STAI-S and STAI-T scores, CAS score, and maternal and infant factors, only the type of delivery showed a significant correlation with the LATCH score (p = 0.008). Early postpartum breastfeeding efficiency, as measured by the LATCH score, was only correlated with the type of delivery. No significant correlation was found between pandemic-related maternal perinatal anxiety and early postpartum breastfeeding success.

Feasibility of Guided Internet-Based Cognitive Behavioral Therapy for Panic Disorder and Social Anxiety Disorder in Japan: Pilot Single-Arm Trial.

Cognitive behavioral therapy (CBT) is effective in treating anxiety disorders. Accessibility to CBT has been limited in Japan due to the shortage of therapists. While an open-source e-learning system can be used to create a simple internet-based cognitive behavioral therapy (ICBT) program, the safety and outpatient acceptance of this treatment approach have not been explored in Japan. The aim of this study was to investigate whether outpatients with anxiety disorders could accept and successfully complete the ICBT program with guidance by CBT therapists when implementing therapeutic modules and CBT tasks. Due to being in the initial phase of a novel treatment in Japan, this study was intended for verification with a small sample size. In total, 6 adults, including 4 male participants and 2 female participants, were enrolled in a single-arm trial. The intervention involved guided ICBT comprising 12 sessions, including CBT text, comprehension confirmation tests, and explanatory videos about cognitive behavioral models, accessible through a website. The therapist guided the participants in accessing the ICBT program and answering their questions using a chat tool. The primary outcome was anxiety severity assessed using the State-Trait Anxiety Inventory-Trait. Secondary outcomes included the Panic Disorder Severity Scale, Liebowitz Social Anxiety Scale (LSAS), Beck Anxiety Inventory (BAI), Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, and Working Alliance Inventory-Short Form (WAI-SF). Statistical analyses were performed using paired 2-tailed t tests to assess the changes in clinical symptoms. The total WAI-SF score at the final session was used to evaluate the therapeutic alliance. For statistical analyses, mean changes for total State-Trait Anxiety Inventory-Trait, BAI, Panic Disorder Severity Scale, LSAS, Patient Health Questionnaire-9, and Generalized Anxiety Disorder-7 scores were analyzed using the paired 2-tailed t test. The 2-sided significance level for hypothesis testing was set at 5%, and 2-sided 95% CIs were calculated. Most participants diligently engaged with the ICBT program. No adverse events were reported. The mean total scores for the primary outcome decreased by 11.0 (SD 9.6) points (95% CI -22.2 to 0.20; Hedges g=0.95), but it was not statistically significant. The mean total scores for the secondary outcomes that assess clinical symptoms decreased, with a significant reduction observed in the BAI of 15.7 (SD 12.1) points (95% CI -28.4 to -3.0; P=.03; Hedges g=1.24). The mean total scores for PDSS and LSAS decreased significantly, by 12.0 (SD 4.24) points (95% CI -50.1 to 26.1; P=.16; Hedges g=1.79) and 32.4 (SD 11.1) points (95% CI -59.7 to -4.3; P=.04; Hedges g=1.38), respectively. Of the participants, 67% (n=4) showed treatment response, and 50% (n=3) achieved remission after the intervention. The therapeutic alliance, measured using the WAI-SF, was moderate. Guided ICBT may be feasible for the treatment of outpatients with panic disorder and social anxiety disorder in Japan. University Hospital Medical Information Network Clinical Trials Registry UMIN0000038118; https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000043439.

The Psychometric Properties of the Turkish Version of the Belief About Losing Control Inventory (BALCI): Testing the Measurement Invariance Across Gender

Recent studies suggest that beliefs about losing control may have a pivotal role in the formulation of anxiety-related problems. The Beliefs About Losing Control Inventory (BALCI) is a self-report measure to assess control-failure thoughts. The BALCI consists of 21 items and three subscales. This study aimed to investigate the psychometric properties and measurement invariance across gender groups of the Turkish version of the BALCI. The BALCI, Obsessive Belief Questionnaire-44 (OBQ-44), Vancouver Obsessive Compulsive Index (VOCI), Anxiety Sensitivity Index-3 (ASI-3) and State-Trait Anxiety Inventory-Trait Version (STAI-T) were administered to 531 volunteer undergraduates. Confirmatory factor analysis replicated the original 21-items three-factor structure of the BALCI. Internal consistency of the BALCI total and subscales were adequate. Retest reliability for the total scores of the BALCI was .76, for the subscales varied from .72 to. 78. The BALCI scores significantly correlated with OBQ-44, ASI-3, and STAI-T. The BALCI and subscales also explained a significant amount of variance in OCD symptoms above and beyond obsessive beliefs. This study also provided evidence of the measurement invariance of the BALCI across gender groups. It is concluded that the Turkish version of the BALCI is a valid and reliable instrument to assess negative beliefs about losing control.

Association between periodontal health and trait anxiety in Egyptian women: A cross-sectional study.

This study explored the relationship between periodontal problems and trait anxiety in a sample of Egyptian women. The Egyptian validated Arabic version of the State-Trait Anxiety Inventory-Trait subscale was used to measure levels of trait anxiety, and the periodontal health status of 451 Egyptian women was assessed using the Community Periodontal Index. Data were also collected on potential covariates such as age, educational level, marital status, parity, smoking, and oral healthcare-seeking behavior. Multivariate logistic regression analysis was done to evaluate the association between periodontal diseases and trait anxiety. Among study participants, and after adjusting for some of the potential confounders, trait anxiety exhibited weak association with periodontal diseases (OR: 1.11; 95% CI= 1.07, 1.14; p <0.001). Also, old age (OR: 1.12; 95% CI = 1.07, 1.17; p < 0.001) as well as parity (OR: 7.26; 95% CI = 2.89, 18.27; p <0.001) were significantly associated with periodontal problems in the adjusted model. While the study findings may implicate that personality traits, such as trait anxiety, could be linked to periodontal diseases more research is warranted to confirm or reject this association.

Is Alexithymia Associated With Sleep Disturbances, Independent of Depression and Anxiety?

Objectives: We aimed to examine the relationship between alexithymia and sleep, independent of depression and anxiety.Methods: This cross-sectional study included participants who visited our sleep clinic between 2016 and 2022. In total, 142 participants (98 males and 44 females) were included, and they completed the Toronto Alexithymia Scale-20 (TAS-20). Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), and Insomnia Severity Index (ISI) scores were also recorded. The relationship between alexithymia and sleep (PSQI, ISI, and ESS scores) was determined after controlling for demographic and psychological (Beck Depression Inventory and State Trait Anxiety Inventory-Trait) variables.Results: Individuals with alexithymia had significantly higher PSQI, ESS, and ISI scores than those without alexithymia. Correlation analysis showed significant correlations between the total TAS-20 score and ISI (r=0.321) and ESS (r=0.253) scores. In multivariate linear regression analysis, the total TAS-20 score (β=0.201; &lt;i&gt;p&lt;/i&gt;=0.022) was significantly associated with the ESS score.Conclusions: Alexithymia was associated with the severity of insomnia and daytime sleepiness in adults. However, when considering depression and anxiety in multivariate analysis, alexithymia was significantly associated with daytime sleepiness; however, its relationship with the severity of insomnia was not significant.

Relationships Between Parental Anxiety and Child Quality of Life in Advanced Childhood Cancer.

Background: Family factors, such as household income and parental psychosocial distress, have been associated with quality of life in children with cancer. However, relationships between parent anxiety and child health-related quality of life (HRQoL) have not been evaluated in children with advanced cancer. Objective: To examine relationships between parent anxiety and both parent-reported and child self-reported HRQoL for children with advanced cancer. Method: Children (aged 5-17 years) with relapsed or refractory cancer and their parents participated in this single-institution cross-sectional study. Parents completed measures of their own baseline anxiety (State-Trait Anxiety Inventory-Trait [STAI-T] form) and their ill child's HRQoL (PedsQL Generic and PedsQL Cancer, parent report). Children completed age-specific PedsQL Generic and PedsQL Cancer, child report. Spearman's rho coefficients assessed correlations between total parent STAI-T score and both parent-reported and child-reported HRQoL scales. Results: Twenty children (Mage = 9.5 years, 50% female) and their 20 parents (90% mothers) participated. The strongest and statistically significant (p < .05) correlations were inverse associations between parental trait anxiety and parent-reported child psychosocial HRQoL (rs = -.54), emotional functioning (rs = -.49), school functioning (rs = -.45), and child pain and hurt (rs = -.45). Correlations of parental anxiety with all dimensions of child-reported HRQoL were generally smaller (rs < .40), positive, and not statistically significant (p > .05). Discussion: Given the inverse correlations between parental anxiety and child psychosocial HRQoL, assessment of parent mental health needs and access to interventions should be provided routinely for parents of children with advanced cancer.

Efficacy of the myofascial approach as a manual therapy technique in patients with clinical anxiety: A randomized controlled clinical trial

BackgroundTo analyze the efficacy of the myofascial approach in patients with clinical anxiety and to study its relationship with associated symptoms. MethodsRandomized placebo-controlled clinical trial. Thirty-six adult patients with clinical anxiety were randomized to receive the myofascial treatment (n = 18) or placebo (n = 18). The patients and the evaluators were blinded to this assignation. The treatment consisted of four myofascial sessions of 40 min each for four weeks. The placebo intervention consisted of four sessions of simulated myofascial intervention of the same duration and frequency as the treatment. Follow-up was at one, three and six months. The primary outcome was clinical anxiety measured using the STAI (State-Trait Anxiety Inventory). Secondary outcomes were central sensitization, general health, somatization, depression, and pain. ResultsThere were significant differences in the behavior of the groups over time for clinical anxiety (STAI Trait-Anxiety) (p < 0.001), central sensitization (p = 0.005) and somatization (p = 0.008) in favor of the myofascial group, with a large effect size for anxiety and a medium effect size for central sensitization and somatization. Regarding clinical anxiety, after the intervention a mean difference was observed with respect to the baseline of 19.98 points in the myofascial group (p < 0.001) and 5.95 in the placebo group (p = 0.22). The intention-to-treat principle was used. There were no adverse events or side effects in either group. ConclusionsThe myofascial approach is effective in improving anxiety levels and associated central sensitization processes in patients with clinical anxiety and this improvement is maintained over time. Clinical Trial RegistrationNCT04826302.

The Impact of Psychedelic Drugs on Anxiety and Depression in Advanced Cancer or other Life-threatening Disease: A Systematic Review With Meta-analysis.

Life-threatening cancer or other diseases can induce anxiety and depressive symptoms. We performed a systematic review with meta-analyses of randomized controlled trials assessing patients with cancer or other life-threatening diseases using validated anxiety and depression scales. PubMed was searched up to November 15, 2022 and citations were applied to prespecified inclusion criteria. Disease rating scales for anxiety or depression included the State-Trait Anxiety Inventory (STAI) (STAI Trait [STAI-T], STAI-State [STAI-S]), Beck Depression Inventory (BDI), Hospital Anxiety and Depression Scale (HADS) (HADS-Anxiety [HADS-A]; HADS-Depression [HADS-D]), Profile of Mood States (POMS), and the Hamilton Rating Scale for Depression (HAM-D or GRID-HAM-D-17). Safety outcomes included assessments of blood pressure and heart rate. Five trials, predominantly in cancer patients, had data assessing anxiety and depressive symptoms. These trials found promising results for psychedelics versus placebo in several anxiety and depression scales but increases in blood pressure and heart rate also occurred. There were some concerns of risk of bias because it is difficult to truly randomize a psychedelic trial and there was a high percentage of patients in the trials who had used psychedelics in the past. There was high heterogeneity for all analyses that we could not explain. Although the results are promising, future trials are needed to assess the optimal psychedelic, dose, number of sessions required, and how psychedelic naïve patients would respond both psychologically and hemodynamically before this therapy can be considered for widescale clinical use.

Depression, anxiety, and sleep quality of caregivers of children with spinal muscular atrophy.

The aim of this study was to evaluate the prevalence of anxiety, depression, sleep, and associated factors in caregivers of children with spinal muscular atrophy (SMA). Beck Depression Inventory (BDI), the State-Trait Anxiety Inventory-State (STAI-S), the State-Trait Anxiety Inventory-Trait (STAI-T), and Pittsburgh Sleep Quality Index (PSQI) were used to assess the anxiety, depression, and sleep quality of the caregivers of children with SMA. Higher scores indicated worse outcomefor all three questionnaires. Fifty-six caregivers of children with SMA were included in the study. Median age of children was 6 (3.2-10) years and mean age of the caregivers was 37.0 ± 6.5 years. Median scores of the BDI, STAI-S, STAI-T, and PSQI were 12 (7.2-17), 35.5 (31-44), 40.5 (35-48), and 7.0 (5.0-10.0), respectively. There was a positive correlation between BDI and PSQI scores (p < 0.05). There was a negative correlation between the age of the caregivers and PSQI, BDI, STAI-T scores (p = 0.01,r = -0.341; p = 0.006,r = -0.364; p = 0.003,r = -0.395, respectively). There was a negative correlation between the age of the patients and the PSQI scores of the caregivers (p = 0.01, r = -0.33). There was a negative correlation between BDI scores and household income (p = 0.01, r = -0.34). Caregivers of children with SMA had elevated depression and anxiety levels and they also had decreased sleep quality. Economic and social support resources are needed to help caregivers of those children.

The role of resilience in the relationship between role stress and psychological well-being during the COVID-19 pandemic: a cross-sectional study

BackgroundStress resistance resources, such as social support and resilience, have been found to be important in promoting psychological well-being during the COVID-19 pandemic. However, most prior research studies have conceptualized stress resistance resource variables as having a mediating or moderating role. Cooper (2018) proposed a model of the relationship between stress and health which posits that coping resources are always present and not only invoked in the face of adversity. Thus, we hypothesize that coping resources are causally antecedent to stressors and influence well-being indirectly via the stressor. We focused specifically on school teachers due to them being at the frontlines of service provision during the pandemic. Teaching was already identified as a highly stressful profession prior to COVID-19 and disease containment measures placed additional strain on teachers who had to adapt to emergency remote teaching.AimThe current study tests this hypothesis by examining the indirect effects of resilience on indices of psychological health via role stress.MethodsParticipants (N = 355) were teachers who completed the Connor-Davidson Resilience Scale-10, the Role Stress Scale, the Satisfaction with Life Scale, the State-Trait Anxiety Inventory-Trait Scale, and the Center for Epidemiological Studies Depression Scale. An electronic version of the questionnaires was distributed to teachers via Facebook and to officials from the Department of Education, who assisted with distribution of the electronic link to the survey. Participants were mostly women (76.6%) and mean number of years in the teaching profession was 15.7.ResultsStructural equation modelling results demonstrated significant direct effects of resilience on life satisfaction, anxiety, and depression, which indicates that resilience is beneficial for psychological health even in the absence of stress. Resilience also had a significant indirect effect on indices of psychological well-being via role ambiguity but not role conflict.ConclusionThese findings have theoretical implications for the understanding of the role of resilience in promoting psychological health among educators. Practical implications include an empirical contribution to education policy and information that can inform interventions aimed to promote resilience among educators.

Low oxytocin levels are broadly associated with more pronounced psychopathology in anorexia nervosa with primarily restricting but not binge/purge eating behavior.

Anorexia nervosa (AN) is commonly associated with depression, anxiety, and deficits in socioemotional functioning. Basal levels of oxytocin, a neurohormone with antidepressant, anxiolytic, and prosocial properties, are low in women with AN. However, the relationship between oxytocin and psychopathology of AN/atypical AN has not been examined in individuals with primarily food restriction (AN/AtypAN-R) or those with restriction plus binge/purge behaviors (AN/AtypAN-BP) alone, which is important to further elucidate the neurobiology of different AN presentations. We investigated whether oxytocin levels are related to eating, affective, and socioemotional psychopathology in women with AN/AtypAN-R and separately AN/AtypAN-BP. In a cross-sectional study of 53 women with low-weight AN or atypical AN based on DSM-5 (AN/AtypAN-R: n=21, AN/AtypAN-BP: n=32), we obtained fasting serum oxytocin levels and self-report measures of psychopathology, including the Eating Disorder Examination-Questionnaire (EDE-Q), Beck Depression Inventory-IA (BDI), State-Trait Anxiety Inventory (STAI), and Toronto Alexithymia Scale (TAS-20). In individuals with AN/AtypAN-R, oxytocin levels were negatively associated with eating psychopathology (EDE-Q Global Score: r=-0.49, p=0.024), depressive and anxiety symptoms (BDI Total Score: r=-0.55, p=0.009; STAI Trait Score: r=-0.63, p=0.002), and socioemotional symptoms (TAS-20 Difficulty Identifying Feelings Score: r=-0.49, p=0.023). In contrast, in those with AN/AtypAN-BP oxytocin levels were negatively associated with depressive symptoms only (BDI Total Score: r=-0.52, p=0.049). These findings support the notion that AN/AtypAN-R and AN/AtypAN-BP might have divergent underlying neurobiology. Understanding these differences is crucial to develop targeted treatments for a population with high levels of chronicity, for which no specific pharmacological treatments are currently available. https://clinicaltrials.gov, identifier: NCT01121211.

Psychedelics for Patients With Cancer: A Comprehensive Literature Review.

To assess the role of psychedelics in the treatment of anxiety or depression among patients with cancer. PubMed search from inception to March 11, 2022, using the terms anxiety, depression, psychedelics, psilocybin, lysergic acid, methylenedioxymethamphetamine, or ayahuasca. Studies assessing patients with cancer receiving psychedelics for the treatment of anxiety or depression. Five unique randomized, double-blind, placebo-controlled trials were conducted. Significant reductions were found in 2 trials with 2 anxiety scales (State-Trait Anxiety Inventory-State, State-Trait Anxiety Inventory-Trait) and in 1 trial with 2 additional anxiety scales (Hamilton Rating Scale-Anxiety, Hospital Anxiety and Depression Scale-Anxiety). Significant reductions were found in 2 trials in 2 depression scales (Hospital Anxiety and Depression Scale-Depression, Beck Depression Inventory) and in 1 trial with an additional depression scale (Hamilton Rating Scale-Depression). Two studies assessed for clinically relevant reductions in anxiety and depression scores, and they occurred much more commonly in psychedelic-treated patients than those given placebo. There is a new potential option for treating patients with anxiety and depression along with cancer, which is important given the generally lackluster benefits with traditional antidepressants. Only a few sessions may also provide benefits extending out for 6 to 12 months and possibly beyond that. However, the studies were small, had many methodological limitations, and there were increases in blood pressure and heart rate. Psychedelics have a unique mechanism of action that might be well suited for treating anxiety and depression associated with cancer. This offers new promise for patients who are not being sufficiently treated with current antianxiety or antidepressant medications.

The effect of psychological inflexibility on health-related quality of life, depression, and anxiety in patients with chronic tinnitus without hearing loss

The purpose of this study was to investigate the relationship between psychological inflexibility, depression, anxiety, and quality of life in patients with chronic tinnitus without hearing loss. The study was carried out involving 85 patients with chronic tinnitus without hearing loss and a control group of 80 individuals. All participants completed the Acceptance and Action Questionnaire-II, the State-Trait Anxiety Inventory-Trait, the Beck Depression Inventory, and Short Form-36. The patient group exhibited higher Acceptance and Action Questionnaire-II (t=5.418, p<0.001), State-Trait Anxiety Inventory-Trait (t=6.592, p<0.001), and Beck Depression Inventory (t=4.193, p<0.001) scores and lower physical component summary (t=4.648, p<0.001) and mental component summary (t=-5.492, p<0.001) scores than the control group. Psychological inflexibility predicted depression, anxiety, and impairment of quality of life. The effect of psychological inflexibility on physical component summary was mediated by depression (β=-0.15, [95%CI -0.299 to -0.017]), while its effect on mental component summary was mediated by anxiety and serial anxiety and depression (β=-0.17 [95%CI -0.344 to -0.055] and β=-0.06 [95%CI -0.116 to -0.100], respectively). Psychological inflexibility plays an important role in patients with chronic tinnitus without hearing loss. It is associated with increased levels of anxiety and depression and decreased quality of life.

Evaluation of the relationship between anxiety levels and dental appearance.

The aim of this study was to evaluate the relationship between personal traits, dental anxiety level and dental appearance of the individuals. The study included 431 individuals who completed State Trait Anxiety Inventory-Trait Form (STAI-T) and Corah's Dental Anxiety Scale (CDAS) questionnaires during their first appointment at the orthodontic clinic. The Index of Complexity, Outcome and Need (ICON) index scoring was performed using intraoral frontal photographs by an orthodontist. According to the STAI-T scores, three anxiety groups were formed: mild, moderate, and severe. The Kruskal-Wallis H test was used for intergroup comparisons. Spearman's correlation analysis was performed to evaluate the relationship between STAI-T, CDAS, and ICON scores. It was found that 38.28% of the participants had mild, 34.1% had severe, and 27.62% had moderate anxiety levels. CDAS score was significantly lower in the mild anxiety group (p ≤ 0.0001) compared to the groups showing moderate and severe anxiety. There was no significant difference between the moderate and severe anxiety groups. ICON score was significantly higher in the severe anxiety group (p ≤ 0.0001) than the other groups. It was also significantly higher in the moderate anxiety group (p ≤ 0.0001) than in the mild anxiety group. There was a significant positive correlation between STAI-T and both CDAS and ICON scores. There was no significant correlation between CDAS and ICON scores. Dental appearance had a significant effect on the general anxiety of individuals. Improving the dental appearance with orthodontic treatments can have positive effects on reducing anxiety. The low level of dental anxiety in individuals with a high need for treatment will facilitate the work of the orthodontist in the procedures to be applied.

Prenatal maternal anxiety promotes atopic dermatitis in offspring via placental DNA methylation changes.

Maternal anxiety during pregnancy has been previously reported to be associated with atopic dermatitis (AD) in offspring. The potential mechanism is not yet proven but epigenetic change may be suggested. We examined whether maternal anxiety during pregnancy may alter placental DNA methylation, then develop AD in the offspring. We evaluated maternal anxiety at 36 weeks of gestation by self-reported questionnaires, the State-Trait Anxiety Inventory-Trait subscale (STAI-T), in the Cohort for Childhood Origin of Asthma and Allergic Diseases (COCOA) study. AD was diagnosed at 6 months of age by pediatric allergists. We stratified the subjects into four groups according to the STAI score of mothers and diagnosis of AD in children. Placental genome-wide methylation microarray was analyzed using Infinium 450K BeadChip and selected genes were validated by pyrosequencing. From microarray, several differential methylation sites were identified in AD and healthy subjects and in total subjects, regarding to the STAI scores. Among differential methylation sites in microarray, six sites were selected for pyrosequencing. And site of matrix metalloproteinases 27 (MMP27) among 6 sites showed decreased methylation in AD infants with high STAI mothers compared to healthy infants with low STAI mothers. Epigenetic change in placenta can be a suggesting mechanism for the development of AD in offspring at 6 months of age associated with maternal anxiety during pregnancy and MMP27 may be a candidate gene.

Central Autonomic Network Alterations in Anorexia Nervosa Following Peripheral Adrenergic Stimulation

BackgroundAnorexia nervosa (AN) is characterized by low body weight, disturbed eating, body image disturbance, anxiety, and interoceptive dysfunction. However, the neural processes underlying these dysfunctions in AN are unclear. This investigation combined an interoceptive pharmacological probe, the peripheral β-adrenergic agonist isoproterenol, with resting-state functional magnetic resonance imaging to examine whether individuals with AN relative to healthy comparison participants show dysregulated neural coupling in central autonomic network brain regions. MethodsResting-state functional magnetic resonance imaging was performed in 23 weight-restored female participants with AN and 23 age- and body mass index–matched healthy comparison participants before and after receiving isoproterenol infusions. Whole-brain functional connectivity (FC) changes were examined using central autonomic network seeds in the amygdala, anterior insular cortex, posterior cingulate cortex, and ventromedial prefrontal cortex after performing physiological noise correction procedures. ResultsRelative to healthy comparison participants, adrenergic stimulation caused widespread FC reductions in the AN group between central autonomic network regions and motor, premotor, frontal, parietal, and visual brain regions. Across both groups, these FC changes were inversely associated with trait anxiety (State-Trait Anxiety Inventory-Trait), trait depression (9-item Patient Health Questionnaire), and negative body image perception (Body Shape Questionnaire) measures, but not with changes in resting heart rate. These results were not accounted for by baseline group FC differences. ConclusionsWeight-restored females with AN show a widespread state-dependent disruption of signaling between central autonomic, frontoparietal, and sensorimotor brain networks that facilitate interoceptive representation and visceromotor regulation. Additionally, trait associations between central autonomic network regions and these other brain networks suggest that dysfunctional processing of interoceptive signaling may contribute to affective and body image disturbance in AN.

Mental Health Symptoms Mediate the Association of Subjective Cognitive Function with Participation after Stroke

<h3>Research Objectives</h3> To investigate if mental health (MH) symptoms - depression, apathy, and anxiety - mediate the association of subjective (SCF) and objective (OCF) measures of cognitive function with participation after stroke. <h3>Design</h3> A prospective cross-sectional study. We performed a regression-based mediation analysis using Hayes's PROCESS macro. 12 Models were built for three MH mediators in the association of SCF and OCF measures with two participation measures, respectively. <h3>Setting</h3> Community. <h3>Participants</h3> 74 persons with stroke. <h3>Interventions</h3> Not applicable. <h3>Main Outcome Measures</h3> We used Patient Health Questionnaire-9 for depression, Apathy Evaluation Scale, and State-Trait Anxiety Inventory-Trait Anxiety Scale as MH mediators. The dependent variables were participation measured using Reintegration to Normal Living (RNL) and Activity Card Sort (ACS). Independent variables were SCF, measured using Stroke Impact Scale Memory and Thinking, and OCF, measured using Delis-Kaplan Executive Function System Trail-Making Test (Number-letter switching). <h3>Results</h3> In the model of RNL, depression (b=0.093, 95% CI=0.038∼0.157), apathy (b=0.134, 95% CI=0.071∼0.202), and anxiety (b=0.116, 95% CI=0.049∼0.194), were full mediators of the association between the SCF measure and RNL total score. For the ACS, apathy was the only mediator between the SCF measure and ACS total activity retention (b=0.144, 95% CI=0.032∼0.293). In both models, none of the MH measures were significant mediators of the association between the OCF measure and RNL or ACS after stroke (p>0.05). <h3>Conclusions</h3> These findings indicate that depression, apathy, and anxiety may be stronger mediators of the association between SCF with participation than for OCF with participation after stroke. Rehabilitation professionals should pay attention to measures of both SCF and OCF as they have different dynamics with MH symptoms and participation after stroke. <h3>Author(s) Disclosures</h3> None.

The multidimensional assessment of interoceptive awareness, version 2: Translation and psychometric properties of the Chinese version.

The Multidimensional Assessment of Interoceptive Awareness (MAIA) is a self-report questionnaire developed by Dr. Mehling that has been widely used to assess multiple dimensions of interoceptive awareness. To further improve the MAIA, Mehling developed the Multidimensional Assessment of Interoceptive Awareness, Version 2 (MAIA-2). The goal of this study is to systematically translate the MAIA-2 into Chinese and to investigate the psychometric properties of the Chinese version (MAIA-2C). The translation and adaptation of the questionnaire was conducted according to Beaton's method. A total number of 627 participants were enrolled and completed the survey. The entire sample was randomly divided into a training sample (n = 300, 47.8%) and a validation sample (n = 327, 52.2%) for a cross-validation. Exploratory factor analysis (EFA) was used to identify the factor structure of the MAIA-2C in the training sample while confirmatory factor analysis (CFA) was used to test the factor structure obtained by EFA. The reliability of the MAIA-2C was indicated by Cronbach's alpha. The convergent and discriminant validity were assessed by Pearson intercorrelations between the MAIA-2C and the Five-Facet Mindfulness Questionnaire (FFMQ) and State-Trait Anxiety Inventory-Trait anxiety (STAI-T). The EFA results showed an initial 10-factor model, but some items (1, 2, 3, 4, 15, and 16) were deleted because they did not yield the original subscale construct, eventually resulting in a 7-factor model. The CFA results represented a good model fit (χ2/df = 2.170, RMSEA = 0.060, SRMR = 0.0810, CFI = 0.890). The Cronbach's alpha was 0.822 for the total scale and ranged from 0.656 to 0.838 for the subscales. The results of convergent and discriminant validity showed that most MAIA-2C subscales were correlated with the average score and subscales of FFMQ (r = -0.342∼0.535, p < 0.05), and all of the subscales of the MAIA-2C showed negative correlations with the STAI-T total score (r = -0.352∼-0.080, p < 0.05). The MAIA-2C is a valid and reliable instrument for evaluating multiple dimensions of interoceptive awareness in a Chinese population.