State-Trait Anxiety Inventory Research Articles

Examination of emotional distress, depression, and anxiety in neurodiverse students: A cross-sectional study

BACKGROUND Neurodiverse students frequently encounter distinct challenges that can adversely affect their mental well-being. This research aimed to investigate emotional distress, depression, and anxiety among neurodiverse students, examine the interrelationships among these factors, and assess the impact of participant characteristics. AIM To address the problem of lack of data pointed out in the neurodiversity research in Nigeria, this study aims to examine the emotional distress, depression, and anxiety in neurodiverse students. METHODS A cross-sectional study was carried out involving 200 neurodiverse students in Nigeria. Participants filled out self-report questionnaires that measured emotional distress (Brief Emotional Distress Scale for Youth), depression (Center for Epidemiologic Studies Depression Scale Revised), and anxiety (State-Trait Anxiety Inventory). The data were analyzed using descriptive statistics, correlation analyses, Bayesian Mann-Whitney U tests, two-way ANOVAs, and Kruskal-Wallis tests. RESULTS Anxiety was found to have the highest prevalence (mean = 68.8), followed by depression (mean = 34.2) and emotional distress (mean = 26.3). Significant positive correlations were identified among all three mental health factors, with the strongest correlation observed between depression and anxiety (rho = 0.492, P < 0.001). Moderate evidence indicated gender differences in emotional distress (BF10 = 2.448). The interaction between educational environment and diagnosis had a significant effect on emotional distress (F = 3.106, P = 0.017). Kruskal-Wallis tests indicated significant variations in anxiety levels across different educational settings (P = 0.002), although post-hoc comparisons did not reveal significant differences among specific settings. CONCLUSION This research emphasizes the prevalence of mental health challenges among neurodiverse students, particularly concerning anxiety. The intricate relationships among emotional distress, depression, and anxiety highlight the necessity for thorough mental health support. The impact of educational settings and diagnoses on mental health outcomes stresses the importance of customized interventions. These findings are significant for educators, mental health professionals, and policymakers in formulating targeted support strategies for neurodiverse students.

The effects of controlled acute psychological stress on serum cortisol and plasma metanephrine concentrations in healthy subjects

Background As cortisol and metanephrine are involved in the stress response, it is often recommended that individuals are relaxed at the time of venepuncture, however, evidence behind these recommendations is lacking. We investigated the effects of acute psychological stress on serum cortisol and plasma metanephrine concentrations in healthy individuals exposed to varying levels of psychological stress and compared these results to self-reported measures of stress. Methods Ten medical students completed two medical in-person simulations (one low-complexity, one high-complexity) in a random order. At four times, participants completed the State-Trait Anxiety Inventory (STAI) and serum cortisol and plasma metanephrine/normetanephrine were tested. Results Median (interquartile range) STAI prior to the low-complexity simulation was 44 (18) versus 33 (13) afterwards ( P = 0.050). STAI prior to the high-complexity simulation was 33 (10) versus 48 (17) afterwards ( P = 0.007). Cortisol prior to the low-complexity simulation was 272 nmol/L (115) versus 247 (115) afterwards ( P = 0.333). Prior to the high-complexity simulation, cortisol was 246 (70) versus 261 (137) afterwards ( P = 0.859). Metanephrine prior to the low-complexity simulation was 242 pmol/L (79) versus 247 (93) afterwards ( P = 0.515). Metanephrine prior to the high-complexity simulation was 220 (81) versus 251 pmol/L (120) afterwards ( P = 0.074). Normetanephrine prior to the low-complexity simulation was 593 pmol/L (247) versus 682 (281) afterwards ( P = 0.047 for the difference). Normetanephrine prior to the high-complexity simulation was 696 (123) versus 705 pmol/L (224) afterwards ( P = 0.169). Conclusions The trend in cortisol levels largely reflected changes in STAI. We outline some implications of these findings for current practice and future research.

Effect of hyperhidrosis on quality of life and its correlation with anxiety

Hyperhidrosis, characterized by excessive sweating beyond thermoregulatory needs, affects about 3% of the global population. This condition, often underreported and underdiagnosed, significantly impairs quality of life (QoL) and may correlate with increased anxiety.This study explores the impact of hyperhidrosis on QoL and examines its correlation with anxiety levels among affected individuals.A qualitative and correlational study was conducted over two months, involving 70 participants who met inclusion criteria from an initial screening of 366 individuals. Data were collected using a QoL questionnaire and the State-Trait Anxiety Inventory (STAI). Participants were recruited through snowball sampling from a dermatology department and social networks.Of the 70 participants, 91.4% reported that excessive sweating adversely affected their daily lives. Key areas impacted included physical activities (37.1%), hobbies and chores (50%), work and career (24.3%), use of technology (37.5%), physical discomfort (62.8%), and clothing choices (50%). Psychosocial effects were substantial, with 88.6% of participants experiencing negative emotions, 78.5% reporting nervousness and lack of self-confidence, and 82.8% avoiding social interactions. STAI results indicated that 11.4% had no or low anxiety, 52.8% had moderate anxiety, and 35.7% had high anxiety. The severity of hyperhidrosis correlated with higher anxiety levels. Hyperhidrosis profoundly impacts QoL and is strongly associated with elevated anxiety levels. Despite its significant effects, there is a lack of awareness and understanding of hyperhidrosis among sufferers and healthcare providers. Enhancing awareness and implementing appropriate interventions are crucial to improve the QoL and mental health of individuals with hyperhidrosis.

Exploring and comparing the relationship between maternal anxiety and children's anxiety during admission, hospitalization, and discharge in pediatric wards of Iranian hospitals.

Parental anxiety levels increase during their child's hospitalization. Consequently, anxiety can disrupt parental functioning as a caregiver and potentially transfer distress to the child. This study seeks to explore how maternal anxiety affects the anxiety levels of hospitalized children across three key stages: admission, in-hospital stay, and discharge. A cross-sectional study was conducted with hospitalized children aged 8 to 15 years their mothers. The sample size was determined based on the formula. Data were collected using demographic questionnaires and validated tools, including the State-Trait Anxiety Inventory (STAI) and the Spence Children's Anxiety Scale (SCAS). The STAI measures state and trait anxiety, while the SCAS assesses various domains of child anxiety. Data analysis involved descriptive statistics, Pearson correlation coefficients, and fractional polynomial modeling to assess anxiety trends. The study involved 179 participants, with mothers averaging 36.95 years old. Most participants were homemakers (82.7%) and had less than a high school education (62.6%). The average number of children per mother was 2.02, and only 2.8% utilized assisted reproductive technologies. Maternal anxiety levels were notably high, with mean state anxiety scores decreasing slightly from 45.74 at admission to 44.53 at discharge. Trait anxiety scores followed a similar trend, averaging 42.79 at admission and dropping to 41.60 at discharge. The Spence Children's Anxiety Scale scores were relatively stable, starting at 50.93 at admission and ending at 50.89 at discharge. Severe state anxiety affected 25.7% of participants, while 11.2% experienced severe trait anxiety. Importantly, significant positive correlations were identified between maternal anxiety and children's anxiety throughout the hospitalization period. This study reveals high levels of both maternal and pediatric anxiety throughout hospitalization. Mean scores for state and trait anxiety remained elevated at all stages, with significant correlations between maternal and child anxiety. These results highlight the need for targeted interventions to address and manage anxiety in both mothers and children during hospital stays. Future research should focus on strategies to mitigate these anxieties and improve support for families.

INTEGRATING A VIRTUAL REALITY MASK IN FUNCTIONAL UROLOGICAL SURGERIES UNDER LOCAL ANESTHESIA: A PROSPECTIVE COHORT STUDY ON UTILITY AND SATISFACTION.

To evaluate the safety and efficacy of a virtual reality (VR) mask as a distraction tool during minimally invasive functional urological interventions as part of the local anesthesia protocol. This is a single-centre prospective observational pilot cohort study which included all consecutive patients undergoing intradetrusor botulinum toxin injection, sacral neuromodulation, and urethral bulking agent injection with combined anesthetic protocol composed by local anesthesia and a VR mask (Hypno VRTM virtual reality mask, Strasbourg, France). Preoperative and postoperative evaluation included the State-Trait Anxiety Inventory (STAI) index. Intraoperatively, a 4-point Likert anxiety rating scale and a visual analog scale (VAS) pain score were assessed. Vital signs were measured preoperative and intraoperatively. Postoperatively, two questionnaires exploring patient satisfaction were administered. The evaluated outcomes were the tolerability of the device and patient's reported intraoperative pain and anxiety. Thirty-nine patients were included. Mean age was 64 years. Eleven patients (28%) were affected by neurological conditions. Two patients experienced subjective discomfort. Preoperative and intraoperative mean arterial pressure was 105 and 111 mmHg (p=0.01), respectively. Preoperative and intraoperative mean heart rate was 72 and 75 bpm (p=0.12), respectively. Preoperative and postoperative STAI index were 34.8+-10 and 32.8+-10.3 (p=0.88). Mean Likert anxiety scale value was 2.2+-1.1, mean intraoperative VAS score was 5.3+-2.5. Thirty-four (87%) patients declared themselves satisfied with the surgical procedure and 36 (92.3%) patients would have recommended the same procedure to a relative. Virtual reality mask may play a role in reducing pain and anxiety in minimally-invasive functional urological interventions.

Optimising Healthcare Education with Design-Based Theory

Introduction In complex, and socially dynamic educational systems, traditional research methodologies often fail to connect with everyday practice, creating a need for “usable knowledge” when solving individual and collective education problems (Design-Based Research Collective, 2003). Traditional methods are effective, but do not necessarily uncover the nature of changes to student thinking during an education experience. With this, Design-Based Research (DBR) is a proposed solution that emerges as a pivotal methodology in educational research, as it aims to integrate theories of learning with practical experiences. Seen as a systematic yet adaptable approach, DBR integrates iterative cycles of analysis, design, and evaluation in collaboration with researchers and practitioners within authentic educational settings, (Harrington, 2012; Wang & Hannafin, 2005). This (poster) presentation will describe how DBR was utilised to create a learning environment to improve learning experiences within healthcare education. An analysis of the problem highlighted that healthcare students experienced high levels of anxiety during high-fidelity simulation when asked to perform and treat simulation manikins (Aiello et al., 2023). In part, the main issues relate to a lack of environmental authenticity, resulting in under-stimulation and performance anxiety resulting in over-stimulation. This relates to the Yerkes Dodson stress performance curve and suggests that too little or too much arousal results in poor performance (Yerkes, 1908). The hypothesis therefore was to design a solution for peak performance by increasing environmental authenticity and managing anxiety. Method The hypothesis is conceptualised as a ‘design solution’ rather than an intervention. To provide an authentic learning experience virtual reality environments were developed, and to aid performance anxiety, the centering technique was used. Centering is a visualisation technique that teaches participants to focus on the here and now, reduce negative thoughts, and lower anxiety. Virtual reality scenarios were provided prior to each simulation and included a ward-based environment (nurse students) and a rescue helicopter (paramedic students). The study involved 35 Master of Nursing Science, Entry to Practice student nurses at the University of Melbourne and 33 Bachelor of Health Science, Paramedicine students at Auckland University of Technology and industry experts within nurse and paramedic education. All data was collected for each cohort iteratively in 2023 and 2024 to evaluate and develop the design. Data collection included using the State-Trait Anxiety Inventory as a pre-test baseline to measure general and long-standing anxiety for each participant. Within-test heart rates was recorded on a Polar H10 chest strap to measure an objective physiological response to stress. Post-test participants completed the Competitive State Anxiety Inventory–2R after each simulation to understand subjective anxiety and several focus groups were completed to gain further insight into experiences and perspectives. Discussion and Conclusion This presentation outlines the design characteristics used to support student learning within healthcare education settings. Design-Based Research offers a robust framework to develop and refine educational practices through iterative design and implementation cycles. Early results suggest that both virtual reality and the centering technique impact healthcare learning and the implementation of this approach could lead to long-term resilience and build confidence that maximises potential.

Factors Predicting Posttraumatic Stress and Anxiety in Parents Who Experienced the Great Eastern Anatolian Fault Line Earthquakes: A Community-Based Cross-Sectional Study.

To identify levels and predictors of posttraumatic stress disorder (PTSD) symptomatology and anxiety in parents who experienced the Great Eastern Anatolian Fault Line earthquakes. A cross-sectional and correlational study was conducted from May to September 2023, with 200 parents who experienced earthquakes along the East Anatolian Fault Line. A descriptive information form, the State-Trait Anxiety Inventory (STAI), and Impact of Event Scale-Revised (IES-R) were used for data collection. Independent samples t test, analysis of variance, and multiple linear regression were used to analyze the data. The earthquakes caused significant distress among parents: 53% experienced unemployment, 85% had damaged homes, 31.1% lost a relative, 82% lacked an emergency kit, and 90% were concerned for their children's safety. Significant predictors of PTSD included loss of a loved one or relative, not having an emergency kit, having a severely damaged or uninhabitable home, having a chronic illness, and being anxious about the earthquake's impact on their child. High anxiety and PTSD levels were prevalent, with a positive correlation between STAI and IES-R scores. Parents were found to have high levels of PTSD symptoms and anxiety. Findings highlight the complex needs of parents in the post-earthquake context, underscoring the critical need for health professionals, including nurses, to provide comprehensive support to individuals who experienced natural disasters. [Journal of Psychosocial Nursing and Mental Health Services, xx(xx), xx-xx.].

Changes in Resting-State Functional Connectivity and Cognitive-Affective Symptoms in Patients With Post-Concussion Syndrome Treated With N-Acetyl Cysteine.

Concussion accounts for more than 80% of people experiencing traumatic brain injury. Acute concussion is associated with characteristic cognitive and functional deficits that may persist for weeks to months. A subgroup of these patients (from 10% to 50%) have persistent symptoms referred to as chronic post-concussion syndrome (PCS). There are limited treatment options for these patients and the pathophysiology is poorly understood, though oxidative stress is thought to be a contributing factor. The purpose of this study was to evaluate whether an antioxidant, N-acetylcysteine (NAC), might be beneficial in patients with PCS. Outpatient medicine center. Fifty patients with chronic PCS for at least 3 months post injury. The patients with PCS were enrolled in this randomized unblinded clinical trial to receive the antioxidant NAC as a combination of daily oral and weekly intravenous infusions, or assigned to a waitlist control group where they would continue to receive standard of care. Resting-state functional connectivity (FC) magnetic resonance imaging (rsFC-MRI) was performed pre and post either NAC or the waitlist period along with cognitive, emotional, and sensory symptom assessments. The results demonstrated significant (P <.05) improvements in symptoms as determined by the Rivermead Post-Concussion Symptoms Questionnaire, Spielberger State-Trait Anxiety Inventory, and Profile of Mood Scale in the PCS group receiving NAC as compared to patients receiving ongoing standard care. Importantly, there were significant (P<.01) changes in FC in the NAC group, particularly in networks such as the default mode network, salience network, and executive control network. These changes in FC also correlated with improvements in symptoms. In patients with chronic PCS, NAC treatment was associated with significant changes in resting state FC and improvement in a variety of symptoms, particularly cognitive and affective symptoms.

The Effect of Virtual Reality on Pain, Anxiety, Physiological Parameters, and Postspinal Headache in Patients Undergoing Spinal Anesthesia: A Randomized Controlled Trial

PurposeThe purpose of this research was to determine the effect of virtual reality (VR) on pain, anxiety, physiological parameters, and postspinal headache in patients undergoing spinal anesthesia. DesignThis was a randomized controlled experimental trial. MethodsThe research was conducted in the operating room unit of the state hospital in Hakkari-Şemdinli District Center between May 2021 and June 2022. Data were collected using the Descriptive Information Form, visual analog scale (VAS), verbal category scale (VCS), State-Trait Anxiety Inventory, and the Application Registration Form to record preoperative and postoperative oxygen saturation and heart rate. FindingsWhen the groups’ VAS and VCS mean scores were compared for head and incision site pain, the mean scores of headache and incision site pain in both groups were found to be significantly lower in the experimental group patients (P < .001). In addition, the difference between the groups in headache VAS and VCS mean scores at all hours was statistically significant; incision site pain VAS and VCS mean scores were significantly lower between the groups at all hours, except the 1st and 2nd hours (P < .001). While there was no significant difference in the State-Trait Anxiety Inventory (SAS) pretest mean scores between the groups (P > .05), the SAS post-test mean scores of the experimental group were significantly lower (P < .05). The mean heart rate in the intraoperative and postoperative periods and the mean saturation in the postoperative period differed significantly between the groups (P < .05). The difference between the blood pressure averages before, during, and after the operation was not statistically significant in both groups (P > .05). While nausea and vomiting was significant in the experimental group only at the 2nd hour (P < .05), it was not statistically significant at the other hours (P > .05). ConclusionsVR was found to effectively reduce pain, anxiety, postspinal headache, and increase the oxygen saturation level in the postoperative period in patients who underwent spinal anesthesia. Hence, VR is an effective treatment for patients who have undergone surgery under spinal anesthesia.

The Psychophysiological Relaxation Effects of Essential Oil Combined with Still-Life Painting Activities on Older Adults in Taiwan During the COVID-19 Pandemic.

Although the COVID-19 pandemic affected all types of people, older adults were disproportionately affected. Therefore, we developed an indoor program inspired by art and natural elements (plant essential oils [EOs]) intended to have a relaxing effect akin to a forest atmosphere to enhance psychophysiological health during this period. Thirty Taiwanese older adults (range, 59-79 years) participated in the study. We combined an art activity (still-life painting of vegetables) with the inhalation of Pseudotsuga menziesii and Lavandula angustifolia EOs during a 100-minute experiment. The study showed that physiological measures (heart rate, normalized low-frequency heart variability, the ratio of low- to high-frequency heart variability, high-beta waves, and gamma waves) decreased during the experiment; correspondingly, increased standard deviation of normal-to-normal intervals, normalized high-frequency heart variability, and high-alpha waves were observed, indicating relaxed physiological state. Subjective psychological assessments using the State-Trait Anxiety Inventory-State showed lower posttest scores, further supporting the relaxation effects. The psychophysiological data from this study provide important scientific evidence for the physical and mental health benefits of indoor nature-based activity programs for older adults, thereby improving their quality of life.

Gender identity and symptoms of anxiety and depression and their relationship with sleep disorders among Polish adolescents during the Covid-19 pandemic and the outbreak of war in the Ukraine.

For most people, gender identity is consistent with biological sex and such people are called cisgender. People in whom such a relationship does not occur or occurs to a lesser extent are referred to as gender non-conforming-and these include transgender, non-binary, agender and gender-fluid people. These individuals are usually affected by minority stress, which, combined with the circumstances of the pandemic and Russian aggression against Ukraine, may have led to mental disorders and sleep disorders in this population. The aim of the study was to analyze the symptoms of anxiety, depression and insomnia in a group of Polish youth during the Covid-19 pandemic and the outbreak of the war in Ukraine, taking into consideration gender differences, including non-binary gender. The study involved 1621 secondary school students aged 14 to 19, the average age was 16.73 ± 1.35, including 857 girls, 690 boys and 74 people who defined their gender as non-binary. A set of questionnaires for the Diagnosis of Depression in Children (CDI 2), the State-Trait Anxiety Inventory (STAI), the X-1 subscale, The Athens Insomnia Scale (AIS) and an original questionnaire of sociodemographic data were used in research. Analyzing the results obtained in the study group, the respondents scored an average of 17.99 ± 9.55 points in the assessment of depressive symptoms. After division into groups taking into account gender, the corresponding score was 19.69 ± 9.40 points for girls, 15.03 ± 8.68 for boys and 25.86 ± 9.91 for non-binary people. The difference was statistically significant (p = 0.000) in all three study groups. In the anxiety symptoms assessment, the respondents scored an average of 46.92 ± 11.67 points. After division into gender groups, the corresponding score was 49.21 ± 11.12 points for girls, 43.39 ± 11.47 for boys and 53.39 ± 10.41 for non-binary people. The difference was statistically significant (p = 0.000) in all three study groups. Analyzing the results obtained in The Athens Insomnia Scale (AIS), the average score was 8.31 ± 4.58 points, which allows to evaluate sleep onset as a norm. After dividing into groups, the results were 8.95 ± 4.55 points, respectively for girls, 7.19 ± 4.21 points for boys and 11.35 ± 5.43 for non-binary people, the difference was significant in terms of comparisons between all statistically tested groups. The analysis of the relationships between the studied variables was presented for each gender separately. Statistically significant positive correlations were found between the results obtained on the scale assessing depressive symptoms (CDI-2) and anxiety symptoms (STAI-X1) and the results obtained on the AIS scale. Among the studied group of teenagers, the highest intensity of depressive symptoms is demonstrated by non-binary people, followed by females, and finally by males. Similar results were obtained in the assessment of anxiety symptoms. The non-binary group achieved results indicating sleep disorders, while the cisgender group's results of sleep onset were borderline normal. Whatsmore, the greater the severity of depressive and anxiety disorders, the greater the sleep disorders in all study groups, regardless of gender.

Effect of Music on Anxiety and Fatigue in Cancer Patients Undergoing Chemotherapy: A Randomized Controlled Trial.

Anxiety and fatigue are symptoms typically experienced by cancer patients undergoing chemotherapy. In dealing with these symptoms, listening to music may help patients. The randomized controlled study was conducted between May 1, 2022 and November 10, 2022 with 60 patients treated in the outpatient chemotherapy unit. The data were gathered using a patient information form, Brief Fatigue Inventory, and the State Trait Anxiety Inventory. In addition to standard treatment and care, 30-minute music was played with a passive listening method in a total of three cycles of chemotherapy in the intervention group patients who completed the first cycle and visited for the second cycle of chemotherapy. According to the analysis of covariance (ANCOVA) findings, the group variable significantly affected the post-test state anxiety scores when an adjustment was made for pre-test state anxiety scores (F=240.398, P<0.001, η²=0.808). In addition, pre-test state anxiety scores affected post-test results (F=7.925, P=0.007, η²=0.122). According to the ANCOVA findings, the group variable significantly affected the post-test trait anxiety scores (F=235.243, P<0.001, η²=0.805). In addition, pre-test trait anxiety scores affected post-test results (F=34.977, P<0.001, η²=0.380). According to ANCOVA results, the group variable significantly affected post-test fatigue scores (F=79.201, P<0.001, η²=0.582). In addition, pre-test scores affected post-test scores (F=11.082, P=0.002, η²=0.163). We observed that music had positive effects on fatigue and anxiety levels in cancer patients undergoing chemotherapy. It may be recommended to include music intervention in nursing practices for cancer patients during chemotherapy. The study results demonstrated that music intervention can be used in nursing practices for cancer patients during chemotherapy. Its low-cost and non-invasive nature also provide ease of application. Therefore, we can recommend the application of music intervention in outpatient chemotherapy units.

The Stress-Induced Hyperprolactinemia Might Not be That Stress-Induced as Argued: Observational Case-Control Study

The mechanism behind prolactin (PRL) elevation in stress-induced hyperprolactinaemia (si-HP) in humans is unclear. This study aimed to investigate the effect of psychological stress and venous puncture (VP) pain on si-HP. The study included 91 individuals (nine males, 82 females) referred for HP. Anxiety levels were assessed using the Anxiety Sensitivity Index-3 (ASI-3) and the State-Trait Anxiety Inventory (STAI-1 and STAI-2), and visual scales were used to evaluate trypanophobia, nosocomephobia, and scanxiety. Serial PRL measurements (SPM) were performed with venous cannula (VC) at 0 minutes (min), 30 min, and 60 min for the first 32 patients and with the VP method at the same intervals for the following 59 patients. si-HP was defined as PRL levels at 60 min (PRL60min) decreasing to normal limits according to gender. There were 23 HP (-), 25 HP (+), and 19 si-HP individuals, as well as 24 with macroprolactinaemia. The frequency of si-HP in the VC group (n = 7/32) was similar to that in the VP group (12/59, p=0.9). The PRL0min and PRL60min levels of the VC group were similar to those of the VP group. Trypanophobia, nosocomephobia, scanxiety, ASI-3, STAI-1, and STAI-2 scale scores were similar between the si-HP group and other groups. Trypanophobia, nosocomephobia, scanxiety, ASI-3, STAI-1 and STAI-2 scales scores were not correlated with PRL0min, or PRL60min levels. Si-HP is independent of states momentary or trait anxiety, and phobias trypanophobia, nosocomephobia and scanxiety. In this context, the relevance of the nomenclature of si-HP is controversial.

Evaluating Virtual Reality Patient Education in Cardiac Surgery: Impact on Preoperative Anxiety and Postoperative Patient Satisfaction.

Background/Objectives: Preoperative anxiety in cardiac surgery patients can adversely affect mental well-being and postoperative outcomes. Virtual reality (VR) patient education has been proposed as a novel method to enhance patient education and potentially reduce preoperative anxiety. The VR Patient Journey Trial aimed to evaluate the impact of VR patient education on preoperative anxiety and patient satisfaction compared to traditional education methods. Methods: This randomized controlled trial included 121 patients undergoing cardiac surgery. Participants were randomized to receive either VR patient education (intervention group) or traditional education (control group). Preoperative anxiety was measured using the State-Trait Anxiety Inventory (STAI) and the Amsterdam Preoperative Anxiety and Information scale (APAIS). Patient satisfaction was assessed postoperatively through a custom questionnaire. Statistical analyses included linear regression and non-parametric testing. Results: Neither STAI nor APAIS scores showed differences in preoperative anxiety between both groups. However, the intervention group reported significantly higher patient satisfaction with the information provided (median score 9 vs. 8; p < 0.001). Furthermore, women reported higher levels of anxiety than men (p = 0.01), and open-ended feedback from participants indicated a need for more detailed information on postoperative rehabilitation and potential risks. Conclusions: The VR Patient Journey Trial revealed that, although VR patient education did not significantly reduce preoperative anxiety levels, it significantly improved patient satisfaction with the information provided. These results suggest that VR patient education can be a valuable addition to preoperative patient programs.

Reduction of Preoperative Anxiety Using Virtual Reality vs Midazolam: A Randomized Controlled Trial

More than 50% of pediatric patients experience significant stress and anxiety prior to surgery.1 High anxiety can result in increased postoperative pain, analgesic consumption, and delayed recovery.2 To reduce this preoperative anxiety, multiple therapeutic modalities have been developed, including the use of distraction, such as playing video games, watching movies, and listening to music. In severe cases of anxiety, anxiolytic and sedative medications like midazolam are used. However, given the acknowledged drawbacks of medications, including the risk of paradoxical reactions to the drug, alternatives to medication for reducing preoperative anxiety in patients may be useful. We aim to compare the use of virtual reality (VR) to midazolam in reducing preoperative anxiety in surgical patients and assess differences in induction compliance, emergence delirium, pain scores, and opioid use in VR vs. midazolam-treated patients. Methods This study was approved by the Phoenix Children’s Hospital Institutional Review Board. First-time surgical patients (N = 36) between the ages of 5 and 11 years undergoing tonsillectomy or tonsillectomy/adenoidectomy procedures were randomly assigned to either receive midazolam (0.5 mg/kg up to 25 mg) or play an interactive underwater-themed game using VR. The Modified Yale Preoperative Anxiety Scale (mYPAS) was administered by a single child life specialist preoperatively, and only patients who reached a threshold of &gt;40 on mYPAS scoring were enrolled (scale range: 23 - 100). Additional anxiety measurement was tested using the adult and child State-Trait Anxiety Inventory (STAI). Midazolam or VR was administered prior to transport to the OR, and mYPAS was scored again at the time of separation from the family. The Induction Compliance Checklist (ICC) was utilized for assessment at the time of anesthesia induction. The VR-treated patients continued use of the VR headset through mask induction. A standardized anesthesia induction protocol was used for all patients. The Pediatric Anesthesia Emergence Delirium (PAED) scale was administered at emergence, postoperatively. Postoperative nurses scored pain and administered IV pain medication as needed. Group means and standard deviations were reported and compared with two-sided t tests. Results Interim results show the mYPAS anxiety scores dropped 20.1 ± 11.7 points following midazolam treatment (p&lt;0.001) and dropped 28.3 ± 7.3 points following VR treatment (p &lt; 0.001). There was a significant difference in mYPAS scores between groups following treatment (midazolam = 32.0 ± 4.9; VR = 25.4 ± 4.7; p = 0.04). There were no significant differences between midazolam- and VR-treated groups in the Induction Compliance Checklist, PAED scale, peak postoperative pain scores, and medication use for pain control postoperatively. This study is currently ongoing. Conclusion VR appears to reduce preoperative anxiety similarly to midazolam in anxious first-time surgical pediatric patients. Limitations include patient population. Further studies should be conducted for greater generalizability.

Quality of life in atrial fibrillation patients and its relationship to family member anxiety and depression

Abstract Background Atrial fibrillation (AF) has been found to decrease quality of life (QOL), and a few studies suggest that family members of AF patients can also experience negative emotions. This study aims to assess the anxiety and depression of the immediate family members of AF patients and to investigate the influence of the QOL of the AF patients on this anxiety and depression. Method This cross-sectional study recruited 121 pairs of AF patients and their immediate relatives along with 121 controls who and whose immediate relatives did not have AF. The patients filled out the Atrial Fibrillation Effect on QualiTy-of-life (AFEQT) questionnaire, and the relatives and the controls were required to complete the State-Trait Anxiety Inventory (ST-AI) and Self-Rating Depression Scale (SDS). Results The score (mean (SD)) of the State Anxiety Inventory (S-AI, a subscale of ST-AI) in the relatives’ group was 44.9 (10.6), which was significantly higher than that of the control group (38.5 (9.5), p &amp;lt; 0.001). Among the different kinship subgroups, the children of the AF patients had the highest state anxiety score (mean value = 47.0, p=0.075). A negative linear relationship between the patients' overall AFEQT score and the relatives' S-AI score was found (standardized regression coefficient = -0.244, p &amp;lt; 0.001). For those patients who had particularly low AFEQT scores of less than 40, their relatives’ S-AI scores were significantly higher than other members of the relatives’ group (52.1 vs. 42.9, p = 0.001). AF patients in the peri-ablation period (81, 66.9%) had no difference in their AFEQT scores compared to other patients (60.8 vs. 64.4, p= 0.316) and there was also no difference in their family members’ ST-AI or SDS scores. Conclusion Study members showed considerable state anxiety if their family members had AF and increases in this anxiety were positively correlated with decreases in the HRQOL of the AF patients.

Metaverse-based cardiac magnetic resonance simulation to overcome claustrophobia (META-MRI): a feasibility trial

Abstract Background Cardiac Magnetic Resonance Imaging (CMR) is crucial for diagnosing and stratifying cardiac disease, but up to 10% of patients face challenges due to claustrophobia. Conventional methods for overcoming claustrophobia have limited success. The metaverse, an immersive 3D environment using virtual and augmented reality, is under investigation for healthcare applications. A metaverse-based VR CMR simulation program was developed to assist patients with claustrophobia, but its clinical effectiveness is unexplored. Methods The META-MRI study involved 450 patients screened, with 32 enrolled. They were randomly assigned to intervention (Metaverse-based simulation + standard care) or control (standard care alone). The Metaverse program used a VR headset within the Aimedis metaverse platform. Training sessions occurred before scheduled CMR exams, with anxiolytic treatment when necessary. Primary endpoints included successful CMR completion, anxiety assessment using the State-Trait Anxiety Inventory (STAI), and usability through a questionnaire. Results Patients in the intervention group (n=16) completed Metaverse training successfully. During simulations, anxiety decreased (STAI scores: 73 ± 8 to 51 ± 11, p=0.02). Intervention group completion rate was significantly higher (81%) than the control group (37%) during real CMR exams (p=0.01). Usability scores indicated moderate satisfaction. Discussion The metaverse-based program significantly improved CMR completion rates and reduced anxiety levels in patients with severe claustrophobia compared to standard care alone. Traditional methods for claustrophobia have limitations, making the metaverse a promising tool. Despite promising results, further research is necessary, considering identified usability issues and economic implications. Conclusion This feasibility trial demonstrates the effectiveness of a metaverse-based simulation program in enhancing compliance with CMR exams for patients with severe claustrophobia. The strategy, combined with standard care, led to reduced anxiety and increased CMR completion. Further investigation with larger cohorts is required to validate these findings, addressing usability concerns and assessing the cost-effectiveness of incorporating the metaverse into routine clinical practice.Clinical and demographic characteristics

Cost-effectiveness analysis of mindfulness-based cognitive therapy in patients with anxiety disorders in secondary mental health care settings alongside a randomized controlled trial.

Anxiety disorder is one of the most prevalent mental disorders. Mindfulness-based cognitive therapy (MBCT) is effective for treating anxiety disorders. However, no studies have investigated the cost-effectiveness of MBCT for anxiety disorders. We aimed to conduct a cost-effectiveness analysis alongside a randomized controlled trial (RCT) to clarify the cost-effectiveness of MBCT for anxiety disorders. A cost-effectiveness analysis alongside an RCT was conducted for 8 weeks in 40 patients with anxiety disorders at a university hospital. Patients (1) aged 20-75 years; (2) who were diagnosed with panic disorder/agoraphobia or social anxiety disorder based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria; and (3) who provided written consent were analyzed. The participants were allocated randomly (1:1 ratio) to the augmented MBCT group (i.e., MBCT plus treatment as usual [TAU]) or TAU (waitlist control) group. The cost-effectiveness was assessed using the incremental cost-effectiveness ratio (ICER), which is the ratio of the incremental costs divided by the incremental state-trait anxiety inventory- state (STAI-S), state-trait anxiety inventory- trait (STAI-T), and quality-adjusted life years (QALYs). The QALYs were estimated using The Japanese version of EuroQoL five-dimensional 3-level questionnaire. The unit cost data were derived from the government-regulated fees. This study was conducted from a public healthcare insurance perspective. No discount rates were considered. A total of 38 participants with complete data were included in the analysis. The MBCT was JPY 13,885 more than the cost of TAU and was associated with a STAI-S, STAI-T, and QALY increase of 10.13, 12.00, 0.009 respectively. The ICER were JPY 1,371 (USD13) per STAI-S, JPY 1,157 (USD 11) per STAI-T, and JPY 1,566,357 (USD 14,940) per QALY respectively. MBCT had an 77.5% probability of being cost-effective at a willingness to pay threshold in Japan (JPY 5,000,000 per QALY). The results of the four one-way sensitivity analyses supported the robustness of the base-case analysis findings. Augmented MBCT for anxiety disorders is cost-effective compared with TAU post-treatment from a public healthcare insurance perspective. Future studies should include long-term observations, and analysis from a societal perspective.

Pain Candidate Genes 5-HTTLPR and COMT Affect Anxiety and Mood in Japanese Ballet Dancers: A Cross-Sectional and Longitudinal Study

The balance of mental, physical, and technical aspects is essential in improving ballet performance. Ballet dancers’ emotional and behavioral characteristics vary, even under identical stress conditions. This study aimed to investigate the association between the pain candidate genes 5-HTTLPR and COMT and anxiety in Japanese ballet dancers. Participants were 18 youth elite ballet students with professional aspirations (Y-Elite) and 16 dancers in a professional ballet company (Pro). We administered psychological questionnaires, the State-Trait Anxiety Inventory (STAI) and Brunel Mood Scale (BRUMS), to participants under the following four different stress conditions: standard practice day, cast decision day, rehearsal day, and one week before competition day. In addition, the genotypes of 5-HTTLPR and COMT Val158Met were examined. The distribution of 5-HTTLPR was not different between Y-Elite and Pro dancers, although one of the COMT genotypes was different. Y-Elite dancers had higher trait anxiety scores than Pro dancers for these genotypes before competition (ps &lt; 0.03), although no significant association was observed between both genotypes and scores on the STAI across conditions. Their moods were significantly different through the four conditions (p &lt; 0.004). Pro dancers’ moods were also more stable than those of the Y-Elite dancers in the presence of pain. The results indicate that 5-HTTLPR and COMT play a crucial role in dancers’ anxiety and mood during pain (ps &lt; 0.05). Pro dancers are probably predicted by their lower neuroticism and mood scores and their better adaptation to stress than Y-Elite dancers. The 5-HTTLPR and COMT genes may be influencing the sensitivity to the environment. Youth elite ballet dancers need to understand the relationship between pain and physical activity from an early stage.

Mindfulness Exercises Reduce Acute Physiologic Stress Among Female Clinicians.

Approximately 50% of clinicians experience excessive emotional, physical, and mental stress, with repercussions across the entire medical system. Mindfulness exercises may mitigate this excessive stress. Heart rate variability (HRV) is an objective stress measure that can quantify which mindfulness exercises provide the greatest stress reduction. To define the impact of specific mindfulness exercises on HRV, a surrogate for physiologic stress, and the relationship between physiologic (HRV) and subjective stress measured by the State-Trait Anxiety Inventory during a one-day mindfulness workshop. This was a prospective observational pilot study performed at a quaternary children's hospital with diverse subspecialists of pediatric nurses, nurse practitioners, and physicians. Our primary outcome measure was change in HRV from baseline during three mindfulness exercises. The grounding, deep breathing, and body scan exercises all produced statistically significant changes in HRV among our 13 female participants. The body scan exercise produced statistically significant changes in all studied HRV parameters compared with baseline. We observed significant increases in Root Mean Square of Successive Differences between normal heartbeats (p = 0.026), high frequency (p ≤ 0.001), and the parasympathetic nervous system index (p ≤ 0.001) reflecting increased parasympathetic tone (e.g., relaxation), whereas sd 2/sd 1 ratio (p ≤ 0.001) and the stress index (p = 0.004) were decreased reflecting sympathetic withdrawal (e.g., decreased stress). Subjective stress decreased after 1-day mindfulness training (44.6 to 27.2) (p < 0.001). Individuals with the largest decrease in subjective stress also had the most improvement in HRV during the body scan exercise. Clinician stress levels (HRV) improved after participating in grounding, deep breathing, and body scan meditations, which may highlight their importance as stress reduction tools for clinicians. Monitoring of HRV during mindfulness exercises may provide deeper understanding of which specific exercises produce the greatest physiologic stress reduction for individual participants and the trend of these changes over time.