T2 Anxiety Research Articles

Acupuncture for cancer symptoms: Clinical application and longitudinal impact.

e23191 Background: Evidence for acupuncture (ACUP) in cancer care is inconsistent. ACUP is variously used for multiple symptoms, e.g. anxiety, chemotherapy-related peripheral neuropathy, dyspnea, hot flashes, insomnia, and pain. Approximately 500 unique patients are treated for ACUP annually in our Section of Integrative Oncology. Our objective was to evaluate ACUP’s clinical application and longitudinal impact on symptoms severity. Methods: This was a retrospective analysis of those treated in a group ACUP session. Symptoms were rated before each session on a severity numeric rating scale (0-10). Clinical improvement was defined as a 2-point decrease from baseline (T1). We report symptoms from baseline to the fourth sessions (T1-T4). Counts are presented as percentages and numbers summarized by mean (standard deviation; SD) or median (interquartile range; IQR). Groups were compared statistically as appropriate. Results: 2239 consecutive patients were treated between 2015-2022. Mean (SD) age was 57 (±12); 83% were female; 57% breast primary site, 9% hematologic, 9% gastrointestinal, 8% gynecologic, 4% lung, 3% prostate, and 9% other malignancies. Symptoms treated were pain (61%), insomnia (48%), fatigue (44%), neuropathy (41%), anxiety (37%), hot flashes (37%), and other symptoms (17%). 68% presented with multiple symptoms. They received a median (IQR) of 4 (2-6) sessions and 7 (7-14) days apart. At T1 symptom severity scores, median (IQR), were anxiety 5(2-7), fatigue 5(3-7), hot flashes 6(4-8), insomnia 6(4-8), neuropathy 5(3-8), and pain 5(3-7); Table1. By T2, improvement was observed in patients, N (%), with hot flashes 476 (66%), anxiety 434 (62%), fatigue 464 (56%), insomnia 407 (55%), neuropathy 441 (55%), and pain 563 (50%). Symptom severity improvement was statistically significant by T2 and by T3 clinically relevant; Table 1. By T4, about 60% were still on ACUP treatment. Multiple ACUP sessions ( > 1) were associated with older age and higher symptom burden, and fewer sessions with more severe T1 anxiety and fatigue. Fewer males were treated, yet symptoms improved like in females. Conclusions: Symptoms were of moderate severity at referral. In this large consecutive sample (N = 2239) of mostly younger breast cancer women, group ACUP was associated with broad based symptom benefit. Repeated ACUP treatments were important for clinical improvement. Males and females benefited equally however fewer males were referred. Several confounders need to be considered interpreting these results. [Table: see text]

Differentiating action from inaction: Longitudinal relations among impulsive personality traits, internalizing symptoms, and drinking behavior

BackgroundImpulsive personality traits are strong, consistent risk factors for heavy drinking, and modern theories suggest that impulsive traits may also confer risk for internalizing symptoms. However, it remains unclear which specific impulsive traits are linked with heavy drinking versus internalizing symptoms, and whether heavy drinking and internalizing symptoms are mechanisms of risk for negative alcohol consequences in impulsive individuals. MethodData are from a longitudinal study of young adults (N = 448, Mage = 22.27, 43.5 % female) assessed at baseline (T1), 6 months (T2), and one year later (T3). Longitudinal path models tested whether T1 impulsive traits (i.e., lack of premeditation, lack of perseverance, sensation seeking, positive urgency, negative urgency) were indirectly associated with T3 negative alcohol consequences through heavy T2 drinking and T2 internalizing symptoms (i.e., depression, anxiety, stress). Separate models were tested for positive and negative urgency given strong correlations between these measures. ResultsAcross models, T1 lack of premeditation indirectly predicted more T3 negative alcohol consequences through heavy T2 drinking. When tested separately, T1 negative urgency indirectly predicted more T3 negative consequences through higher T2 stress and depressive (but not anxiety) symptoms, and T1 positive urgency predicted higher T2 anxiety symptoms, but T2 anxiety was unrelated to T3 negative consequences. Across models, T1 sensation seeking indirectly predicted less T3 negative consequences through decreased T2 depression. ConclusionsDistinct impulsive traits prospectively predicted heavy drinking and internalizing symptoms, both of which conferred risk for negative alcohol consequences. Findings underscore the importance of targeted interventions based on personality and suggest that decreases in drinking may be more effective prevention for those who lack premeditation, whereas decreases in internalizing, particularly depression/stress, may be critical for those high in negative urgency.

The temporal association between religious/spiritual struggles and anxiety symptoms: A longitudinal study of psychiatric outpatients

BackgroundAnxiety disorders like Generalized Anxiety Disorder (GAD) often cooccur with religious/spiritual (R/S) struggles, but the temporal association between anxiety symptoms and R/S struggles has not been studied in many clinical samples. The current longitudinal study examines this association in a sample at high risk for elevated anxiety and R/S struggles—adult psychiatric outpatients. MethodsAfter their initial psychiatrist evaluation at a U.S. group practice, 163 outpatients completed measures of R/S struggles, anxiety symptoms, depressive symptoms, and religiousness. The analytic sample (N = 120; 77.9% T1 retention) completed these measures 6-months and 12-months later (T2 and T3). ResultsPatients exhibited high baseline rates of anxiety symptoms (72.5% met likely criteria for GAD) and R/S struggles (59.2% reported high levels of at least one R/S struggle subtype), yet they demonstrated small-to-moderate decreases in anxiety, depression, and R/S struggles over time. Controlling for sociodemographics and baseline struggles, anxiety, and depression, there was a bidirectional association between T2/T3 overall R/S struggles and T3/T2 anxiety symptoms. T2 moral and ultimate-meaning struggles were related to higher T3 anxiety symptoms, and T2 anxiety symptoms were related to higher T3 demonic struggles. LimitationsResults may have been impacted by attrition, selection bias, maturation, and statistical regression. Findings need replication in larger, more diverse samples and in other countries, treatment settings, and clinical populations. ConclusionsAdult psychiatric outpatients are at high risk for R/S struggles, and these struggles are important to assess and address in their mental health treatment. Moral, ultimate-meaning, and demonic struggles may be most anxiety-relevant.

Relationship between psychiatric symptoms and bidirectional change in subjective cognitive decline

AbstractBackgroundSubjective Cognitive Decline (SCD) is increasingly recognized as a prodromal risk state for Alzheimer’s disease. However, relatively little is known about trajectories of SCD within cognitively normal older adults, or the factors that associate with SCD change in this group. In this study, we examine the extent to which specific psychiatric symptoms including anxiety, depression, and apathy associate with an individual’s change in SCD over time.MethodParticipants were community dwelling cognitively normal older adults. SCD was measured using a 20‐item age‐anchored questionnaire that assessed complaints of cognitive functioning. Anxiety, depression, and apathy were assessed using the Beck Anxiety Inventory(BAI), Geriatric Depression Scale(GDS), and Apathy Evaluation Scale(AES), respectively. Measurements were conducted at two timepoints (T1 and T2). Average duration between visits was 35.62 months(SD = 13.28). High SCD change individuals(HC), as opposed to low SCD change individuals(LC), were defined as those who’s total SCD rating changed more than ±1 SD from the mean change score. Regression models were conducted to examine the association between SCD change group and psychiatric symptoms.ResultParticipants were 82 cognitively normal older adults (6.1% Hispanic, 93.9% Non‐Hispanic; 79.3% White, 15.9% Black; 67% female; mean age = 70.96(SD = 6.98); mean education = 16.38(SD = 2.26)). 22 participants were classified as HC(11 with increasing SCD; 11 with decreasing SCD). Anxiety symptoms were higher in the HC group than the LC group at T1(6.57 vs 3.53, p = 0.013) and T2(6.70 vs 2.91, p = 0.003). After adjusting for demographics(age, gender, and education), only T1 anxiety was associated with the HC group(B = 0.297, p = 0.017).ConclusionIndividuals with greater change in SCD over time had higher levels of anxiety at baseline than individuals with relatively stable SCD. This was true for individuals who had a large increase in SCD as well as a large decrease. Our results inform the factors that may contribute to variability in SCD among cognitively normal older adults and underscore the importance of assessing anxiety along with SCD. Importantly, as psychiatric symptoms may also confer risk for future dementia, current findings do not undercut the potential relevance of SCD for future cognitive decline and dementia. Ongoing longitudinal research is examining the interplay of SCD change, psychiatric symptoms, objective cognition, and diagnostic conversion.

Evolution of psychopathology, purpose in life, and moral courage in healthcare workers during the COVID-19 pandemic: a longitudinal study.

Almost 2 years and five infection waves after the COVID-19 pandemic started, healthcare workers continued dealing with the pandemic situation and facing the health consequences and the mental health disorders it caused. This study aimed to evaluate the onset and progression of psychopathology as well as the role of predictor variables such as purpose in life and moral courage among healthcare workers during this time. This was a longitudinal prospective study carried out with 45 Spanish healthcare workers who answered two questionnaires, the first questionnaire in April-May 2020 (T1) and the second questionnaire in September-October 2021 (T2). Although 29.5% of the sample considered that their mental health had improved over this time, almost half of them (47.7%) said it had not changed, while 22.7% reported a decline in their mental health from the first time they were asked. Specifically, 46.8% presented anxiety, 23.4% depression, and 42.6% acute stress at T1, and 38.3% had anxiety, 17% depression, and 27.7% post-traumatic stress disorder at T2. Despite this, there were no differences between T1 and T2 anxiety scores (p = 0.53), although there was a decrease in depression (p = 0.03) and acute stress (p = 0.02) scores. Predictor variable outcomes such as purpose in life (p = 0.88) and moral courage (p = 0.86; p = 0.38) did not change over time, but when modelling the data, purpose in life predicted psychopathology at T1, which in turn affected the psychopathology results at T2. This study showed that, although psychopathology decreased over the months, its prevalence remained high. Even though the purpose in life predicted psychopathology at T1, it seems that once the psychopathology is established (T2), the factors that would improve it would be different from the protective factors that prevented its establishment, which become secondary.

Interactions between COVID-19 family home disruptions and relationships predicting college students' mental health over time.

The present study tested whether family home disruptions during the COVID-19 pandemic in the Spring 2020 (Time 1; T1) informed mental health (i.e., posttraumatic stress disorder [PTSD], depressive, and anxiety symptoms) 7 months later in Fall 2020 at T2 and whether family relationship quality moderated relations. Multigroup path analysis models were used to test whether there were significant differences in relations by emerging adults' ethnic-racial backgrounds. Participants were 811 Black, Asian American, Latine, and White emerging adult college students (Mage = 19.95, SD = .33), and the majority (79.6%) who reported their gender identified as cisgender women. Results indicated that across all individuals, T1 family relationship quality moderated relations between T1 family home disruptions and T2 anxiety and depressive symptoms. At lower levels of T1 family relationship quality, family home disruptions predicted greater T2 depressive and anxiety symptoms. At higher levels of T1 family relationship quality, these relations were not significant. Findings highlight that family relationship quality is an important protective factor for diverse emerging adult college students. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Adolescent Anxiety, Depression and Flourishing before and During COVID-19 and the Predictive Role of Baseline Psychological Capital (PsyCap) on Student Mental Health and Subjective Wellbeing During the Pandemic.

Studies indicate the COVID-19 pandemic has resulted in rises in adolescent mental health symptoms globally, although the impact of the pandemic on subjective wellbeing is under-researched in this population. Psychological capital (PsyCap), a cluster of four positive psychological constructs comprising hope, efficacy, resilience and optimism (HERO), has demonstrated preventative and promotive qualities on mental health symptoms and subjective wellbeing outcomes with adult populations (employees, university students). However, PsyCap's influence on these outcomes in young people is unclear. The present exploratory study investigated changes in self-reported anxiety and depressive symptoms (measured via the RCADS-SV) and subjective wellbeing (measured by the Flourishing Scale) from pre-pandemic levels to 3 months into the pandemic and explored gender differences at each time point in a sample of Australian Year 10 students (N = 56, Mage = 14.93 years, SD = 0.50, 51.8% male). The longitudinal predictive role of baseline PsyCap on follow-up assessments of anxiety symptoms, depressive symptoms and flourishing were also examined. There were no significant changes in levels of anxiety and depressive symptoms between the timepoints, but flourishing significantly declined from T1 to T2. Baseline PsyCap was not a significant predictor of T2 anxiety and depressive symptoms but was a significant predictor of T2 flourishing. Further, different baseline HERO constructs predicted T2 mental health symptoms and flourishing. Future larger studies building on the current preliminary findings investigating the roles of student PsyCap, mental health and subjective wellbeing are warranted to better understand these constructs in the COVID-19 era and beyond.

Analyzing protective factors for adolescents’ mental health during COVID-19 pandemic in Spain: A longitudinal study

ObjectiveThis study examined the protective role of self-esteem and perceived emotional intelligence on mental health problems in Spanish adolescents during COVID-19 pandemic. MethodParticipants (N=139; Mage=13.83years; SD=0.96; 63.8% female) completed measures before the outbreak of COVID-19 (T1) and during the first wave of the pandemic in Spain (T2). Participants self-reported emotional intelligence, self-esteem, mental health problems and suicidal behavior. ResultsAdolescent mental health problems were equally affected by COVID-19 pandemic according to gender, age and lockdown conditions. Adolescents with low levels of emotional intelligence and self-esteem at T1 showed a significant decrease in self-reported anxiety, depression, stress and suicidal behavior at T2. However, adolescents with average or high levels of emotional intelligence and self-esteem at T1 showed no significant changes in mental health problems at T2. Self-esteem at T1 meditated the relationships between emotional intelligence at T1 (clarity and repair) and emotional symptoms at T2 (depression, anxiety and stress). Furthermore, the relationship between self-esteem and anxiety symptoms was moderated by the number of people living together during COVID-19 lockdown. ConclusionOur findings highlight the protective role of pre-pandemic development of self-esteem and emotional intelligence in mitigating the impact of COVID-19 outbreak on adolescent mental health during the pandemic.

Hair brain-derived neurotrophic factor (BDNF) as predictor of developing psychopathological symptoms in childhood

BackgroundDysregulation in the expression of neurotrophins is implicated in the pathophysiology of several mental disorders. Peripheral brain-derived neurotrophic factor (BDNF) can be measured in hair and might represent a marker of adequate neuroplasticity regulation. In early developmental periods, neuroplasticity regulation might be particularly important, but BDNF markers have not yet been analyzed in this regard. We used the hair-BDNF concentration (HBC) to investigate the prediction of emerging symptoms of anxiety/depressive and attention-deficit hyperactivity disorder (ADHD) in the developmentally crucial period from preschool to school age. Methods117 children (58 girls, 59 boys) participated in a longitudinal study at the ages of 4–5 (T1) and 8 (T2) years. At T1, HBC was measured in a 3 cm hair segment. At T1 and T2, symptom domains were assessed using a multi-method (clinical interview, questionnaire) and multi-informant approach. ResultsT1 HBC was significantly negatively associated with T1 anxiety/depressive symptoms (r = −0.27) and predicted T2 anxiety disorder symptoms (r = −0.34) after controlling for the T1 symptoms. T1 HBC also predicted T2 depressive disorder symptoms (r = −0.18) but was not associated with ADHD symptom development. LimitationsBDNF hair analysis is a new method with a not yet large number of studies on methodological issues. Our study adds evidence to the validity of the method. ConclusionsPrediction of anxiety/depressive symptom development by HBC was shown. As this study was the first to use HBC in this context, cross-validation is necessary and worthwhile. HBC might prove to constitute a useful, non-invasive early marker of risk for anxiety/depressive disorders in childhood.

COVID-19 stressors and symptoms of anxiety and depression in a community sample of children and adolescents.

BackgroundThe COVID‐19 public health crisis has created abrupt and unparalleled disruptions to the daily lives of children and adolescents across the world, placing them at significant risk for developing symptoms of anxiety and depression.MethodThe current study used two data collection periods to determine which types of COVID‐19‐related stressors were associated with the greatest risk of anxiety and depression symptoms in a community sample of children and adolescents in the United States (U.S.) from May–August 2020 (T1) to February–April 2021 (T2). Seventy‐nine youth (ages 10–17; M = 13.41, SD = 2.10; 54.4% female) completed a battery of online standardized questionnaires about COVID‐19 stress and psychiatric symptoms at T1 and 56 of these also participated at T2.ResultsThe majority of children and adolescents reported experiencing the COVID‐19‐related stressors in multiple domains including daily routines, interpersonal relationships, education, finances, and health. A substantial proportion of the sample reported clinical levels of depression and anxiety symptoms at both T1 and T2. Multiple linear regression analyses revealed that, controlling for T1 anxiety and depression symptoms, T2 interpersonal stressors were significantly associated with elevated depression and anxiety scores at T2.ConclusionsThe findings highlight the salience of social connection for children and adolescents, and may also underscore the risk associated with lockdown restrictions, social distancing, and school closures during the pandemic.

Psychological outcomes in advanced cancer patients after receiving genomic tumor profiling results.

Comprehensive tumor genomic profiling (CGP) offers hope for personalized treatment for cancer patients when other treatment options have been exhausted. However, receipt of nonactionable or ambiguous results could be an ongoing source of distress. We investigated patterns of hope, anxiety, depression, and CGP-specific anxiety in advanced cancer patients after receiving CGP results and 2-3 months later. Participants were enrolled in a longitudinal psychosocial substudy, embedded in the Molecular Screening and Therapeutics Program, and had advanced solid cancers of any histological type with sufficient and accessible tissue for CGP. At T0 (before receiving CGP results), 1,431 participants completed sociodemographic, disease and psychosocial measures. At T1 (1-4 weeks after receiving CGP results) and T2 (2-3 months post-T1), 374 participants completed psychological outcome measures. Predictors of outcomes at T2 were identified using multinomial logistic regression. Approximately 75% of participants did not experience significant hopelessness or distress at T1 and T2. Hope decreased by T2, yet general anxiety and CGP-specific anxiety also decreased. Receiving actionable results did not impact psychological outcomes at T2. At T2, lower hope, and higher anxiety, depression and CGP-specific anxiety were associated with lower self-efficacy. Psychological and demographic factors (age, socioeconomic status, language, medical occupation, urban living, family history of cancer) independently predicted one or more psychological trajectories. Worse health status and perceived susceptibility to cancer progression predicted hope and anxiety trajectories. Further research on interventions to best support patients undergoing CGP with high anxiety, hopelessness, fear of cancer progression, and poorer health is urgently needed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

0258 Systemic Determinants and Consequences of Sleep Disturbance in Family Members of the Critically Ill

Abstract Introduction Family members of intensive care unit (ICU) patients are at increased risk of experiencing sleep disturbances, which in turn can exacerbate symptoms of anxiety and depression. However, little is known about how sociocultural determinants influence their predisposition to sleep disturbances, and how such sleep disturbances contribute to symptoms of anxiety and depression across the trajectory of the patient’s ICU stay. Therefore, we sought to: 1) identify individual and interpersonal sociocultural predictors of sleep disturbance symptoms, and 2) describe the influence of select sociocultural determinants and sleep disturbances on subsequent symptoms of anxiety and depression. Methods Using a repeated-measures, correlational design, we recruited family members of incapacitated, mechanically ventilated patients within four adult intensive care units at a tertiary medical center in northeast Ohio. We collected baseline data (T1) after obtaining informed consent and seven (T2) days post-baseline. We measured individual and interpersonal sociocultural determinants, as well as symptoms of sleep disturbance, anxiety, and depression with self-report instruments. To test our aims, we used step-wise linear regression. Results For aim 1 (N = 30), participants who were female, non-white, married, and had prior healthcare decision-making experience reported more severe sleep disturbance symptoms (R2 = .69, F(11,18) = 3.59, p = .008). For aim 2 (n = 20), the aforementioned determinants and T1 sleep disturbance scores significantly predicted T2 anxiety (R2 = .62, F(5,14) = 4.61, p = .01) and depression (R2 = .65, F(5,14) = 5.24, p = .006) severity. None of the predictors were statistically significant for the full anxiety model; notably, the effects of gender and prior healthcare decision-making experience were statistically significant until T1 sleep disturbance was inserted in the model. T1 sleep disturbance scores were the only statistically significant predictor in the full depression model. Conclusion We provide preliminary evidence that sleep disturbances among family members of ICU patient may contribute to the severity of depressive symptoms in family members of ICU patients. We encourage future researchers to replicate and expand upon these findings to understand the development of sleep disparities in this vulnerable population. Support (If Any) Sayre Memorial Fund; Midwest Nursing Research Society; NCATS (1KL2TR002547)

State Anxiety in People Living with Disability and Visual Impairment during the COVID-19 Pandemic

There has been growing recognition of the impact of COVID-19 and the restrictions implemented to contain the virus on mental health. This study provides a preliminary assessment of the longitudinal impact on state anxiety in individuals with disabilities and a subsample of individuals with visual impairment (VI). Two surveys were conducted in April–May 2020 (T1) and March 2021 (T2) to explore state anxiety (State-Trait Anxiety Inventory). Participants who consented to being re-contacted were invited to take part in T2. A total of 160 participants completed T1 and T2. There were no significant group differences in median anxiety at T1; however, at T2 anxiety was significantly higher in those with disabilities and there was a trend towards being higher in participants with VI compared to those with no disabilities. While not statistically significant within any of the three subgroups, state anxiety decreased slightly in those with no disabilities. The absence of a disability affecting mobility, experiencing loneliness, and poorer sleep quality predicted state anxiety at both timepoints. While anxiety appeared to decrease in individuals with no disabilities, it remained comparatively stable, and higher in those with disabilities. Loneliness and poor sleep may need to be addressed to alleviate feelings of anxiety.

Mental Disorders and Emotional Competence Among Chinese Adolescents Before and During COVID-19 Pandemic: A Longitudinal Mediation Model.

Background: The outbreak of the COVID-19 pandemic has had a profound influence on the mental health and well-being of individuals across the globe. Emotional competence, defined as one's ability to recognize, understand, and manage their emotions, has been found linked with mental health problems (e.g., depression and anxiety) in previous studies. However, there is limited knowledge about the direction of the association between these factors among populations exposed to COVID-19. This study examined the possible mediation relationships between depression, anxiety, emotional competence, and COVID-19 exposure among Chinese adolescents.Methods: Responses from 7,958 Chinese adolescents who had previously taken part in a two-wave study before (December 23, 2019–January 13, 2020) and during COVID-19 (June 16, 2020–July 8, 2020) were analyzed (51.67% males, mean age = 11.74, SD = 2.15). Structural equation modeling with three covariates (i.e., age, gender, and ethnicity) was used to test the longitudinal mediation relationships between COVID-19 exposure and depression, anxiety via emotional competence.Results: Results indicated that the prevalence of depression (38.67 to 36.74%) and anxiety (13.02 to 12.77%) decreased from Time 1 to Time 2. The T2 emotional competence significantly mediated the relationship between T2 COVID-19 exposure and T2 anxiety (indirect effect [95% CI] = 0.011 [0.004–0.019], p < 0.05). T2 emotional competence also significantly mediated the relationship between T2 COVID-19 exposure and T2 depression (indirect effect [95% CI] = 0.013 [0.005–0.022], p < 0.05). The results indicated that T2 emotional competence had a significant and negative influence on T2 anxiety (β = −0.266, SE = 0.005, p < 0.001), and T2 depression (β = −0.326, SE = 0.029, p < 0.001).Conclusions: This longitudinal research study demonstrated the crucial role of emotional competence in influencing the severity of long-term mental health problems, and suggested that emotional competence interventions can be conducted to improve mental well-being among Chinese adolescents exposed to COVID-19.

Psychiatric symptoms mediate the effect of resilience on health-related quality of life in patients with breast cancer: Longitudinal examination.

Patients with breast cancer receiving neoadjuvant chemotherapy are at increased risk of poor health-related quality of life (HRQOL). This study examined clinical caseness on depression and anxiety mediate the relationship between resilience and HRQOL in patients with breast cancer. A total of 193 patients with breast cancer undergoing neoadjuvant chemotherapy completed questionnaires including the Connor-Davidson Resilience Scale, Hospital Anxiety and Depression Scale (HADS), and Functional Assessment of Cancer Therapy-Breast before the first session (T0), before the start of the last session (T1), and 6months after the end (T2) of chemotherapy. Mediation analyses using a bootstrapping method was performed. The indirect effect (IE) through T1 depression was significant (IE through depression=0.043, 95% confidence interval [CI] [0.002-0.090]), while IE through T1 anxiety was not significant (IE through anxiety=0.037, 95% CI [-0.010-0.097]) in the association between T0 resilience and T2 HRQOL. Clinical caseness on HADS depression subscale during chemotherapy was a mediating factor of the relationship between resilience before chemotherapy and HRQOL after chemotherapy in patients with breast cancer receiving neoadjuvant chemotherapy. Depression during chemotherapy in patients with breast cancer may be a target symptom of screening and intervention to maintain the HRQOL after chemotherapy. Also, patients with low resilience are more likely to develop depression during chemotherapy, and clinicians should carefully monitor whether depression occurs in these patients with low resilience.

Analysis of Nursing Effect and Impact of Narrative Nursing Model on Anxiety of Tumor Patients with PICC under Chemotherapy.

Objective To explore the nursing effect of the narrative nursing model on tumor patients with PICC under chemotherapy and the impact on patients' anxiety. Methods 200 tumor patients with PICC under chemotherapy treated in our hospital from March 2019 to March 2021 were randomly selected and divided into the control group (routine nursing) and the experimental group (narrative nursing) by the draw method, with 100 cases each. All patients were investigated with the General Anxiety Disorder-7 (GAD-7) scale, and their anxiety scores were over 5 points. The GAD-7 anxiety scores, satisfaction scores, Self-Rating Anxiety Scale (SAS) scores, Self-Rating Depression Scale (SDS) scores, quality of life (QLI) scores, and Mental Status Scale in Non-Psychiatric Settings (MSSNS) scores before intubation (T0), 1 d after intubation (T1), 3 d after intubation (T2), and after extubation (T3) of patients in both groups were compared. The adverse reaction rate (ARR) during placement was assessed in both groups, and the effectiveness of patient care was evaluated after extubation. Results Compared with the control group, the experimental group obtained significantly higher satisfaction scores and QLI scores at T0, T1, T2, and T3 and lower GAD-7 anxiety scores, SAS scores, SDS scores, and MSSNS scores at T0, T1, T2, and T3, which were statistically significant (P < 0.05). The experimental group had a significantly higher efficiency of care than the control group and a significantly lower ARR during treatment (P < 0.05). Conclusion The narrative nursing model can remarkably improve the nursing effect, alleviate the anxiety, and provide a more quality nursing for tumor patients with PICC under chemotherapy.

Temporal associations among loneliness, anxiety, and depression during the COVID‐19 pandemic period

Numerous studies have reported that individuals' loneliness, anxiety, and depression levels increased during the COVID-19 pandemic period. However, reciprocal associations among loneliness, anxiety, and depression, as well as gender differences in these associations, have not been investigated. Therefore, temporal associations among loneliness, anxiety, and depression and gender differences in these associations were examined in a longitudinal study during the COVID-19 pandemic period. The loneliness, anxiety, and depression levels of 458 university students were evaluated at three timepoints (T1, T2, and T3) during the COVID-19 pandemic period in China. The timepoints were separated by 1 month. Cross-lagged panel designs were used to examine reciprocal associations among loneliness, anxiety, and depression as well as the stability and gender differences of these associations. Cross-lagged panel analysis revealed that T1 depression positively predicted T2 anxiety and loneliness, T1 loneliness positively predicted T2 depression, T2 anxiety positively predicted T3 depression, T2 depression positively predicted T3 anxiety and loneliness, T2 loneliness positively predicted T3 depression, and T1 loneliness positively predicted T3 anxiety through the mediating role of T2 depression. No gender differences were observed in the cross-lagged associations. During the COVID-19 pandemic period, loneliness and depression predicted each other across time, and loneliness predicted anxiety across time, mediated by depression. No gender differences were observed in the cross-lagged associations among loneliness, anxiety, and depression.

The ratio of morning cortisol to CRP prospectively predicts first-onset depression in at-risk adolescents

RationaleEarly-onset adolescent depression is related to poor prognosis and a range of psychiatric and medical comorbidities later in life, making the identification of a priori risk factors for depression highly important. Increasingly, dysregulated levels of immune and neuroendocrine markers, such as C-reactive protein (CRP) and cortisol, have been demonstrated as both precursors to and consequences of depression. However, longitudinal research with adolescent populations is limited and demonstrates mixed immuno-endocrine-depression links. ObjectiveThis study explored the putative bidirectional relationship between salivary measures of cortisol (Cort) and CRP, including the novel Cort:CRP ratio and depression. MethodsParticipants from the randomized control trial ‘Sleep and Education: learning New Skills Early’ (SENSE) Study were 122 adolescents at risk for depression (73 females) aged 12–16 years (M = 12.71 years, SD = 1.01 years) assessed at baseline (T1), post-intervention (T2), and a two-year follow-up (T3). ResultsLogistic regression results demonstrated that adolescents with higher T1 Cort:CRPmorn ratio levels were two-fold more likely to develop a first-onset depressive disorder from T2 to T3 as compared to adolescents with lower Cort:CRPmorn ratio levels, β = 0.73, t (36) = 2.15, p = .04, OR = 2.08. This effect was not moderated by treatment condition (β = −1.38, t (13) = -1.33, p = .20) and did not change when controlling for known risk factors for depression, including sex, age, body-mass index, socio-economic status, T1 anxiety disorder, nor T1 sleep disturbance, anxiety, or depressive symptoms (β = 0.91, t (31) = 2.14, p = .04). ConclusionResults highlight potential immuno-endocrine dysregulation as an underlying risk factor for adolescent first-onset depression, and may inform the development of targeted, preventative biobehavioral treatment strategies for youth depression.

Association among income loss, financial strain and depressive symptoms during COVID-19: Evidence from two longitudinal studies

BackgroundCOVID-19 pandemic has major ramifications for global health and economy, with growing concerns about economic recession and implications for mental health. Here we investigated the associations between pandemic-related income loss with financial strain and mental health trajectories over a 1-month course, in two independent cohorts. MethodsTwo independent studies were conducted in the U.S and in Israel at the beginning of the outbreak (March-April 2020, T1; study I: N = 2904, study II: N = 1267) and at a 1-month follow-up (T2; study I: N = 1318, study II: N = 241). Mixed-effects models were applied to assess associations among COVID-19-related income loss, financial strain, and pandemic-related worries about health, with anxiety and depression, controlling for multiple covariates including pre-COVID-19 income. ResultsIn both studies, income loss and financial strain were associated with greater depressive symptoms at T1, above and beyond T1 anxiety, worries about health, and pre-COVID-19 income. Worsening of income loss was associated with exacerbation of depression at T2 in both studies. Worsening of subjective financial strain was associated with exacerbation of depression at T2 in one study (US). ConclusionsIncome loss and financial strain were uniquely associated with depressive symptoms and their exacerbation over time, above and beyond pandemic-related anxiety. In times when a myriad of stressors are affecting mental health worldwide, our findings reveal specific links between the economic impact of COVID-19 and psychiatric outcomes.

Psychological outcomes of low-dose CT lung cancer screening in a multisite demonstration screening pilot: the Lung Screen Uptake Trial (LSUT)

BackgroundPrevious studies of psychological burden in low-dose CT (LDCT) lung cancer screening trials may lack generalisability due to participation bias and control arms having elevated distress.MethodsCurrent and former smokers (n=787,...