The short-form version of the Depression Anxiety Stress Scales (DASS-21): construct validity and normative data in a large non-clinical sample

Who Engages in Simultaneous Gambling and Alcohol Use, and Why? A Mixed-Method Study

Although previous studies have established the robust concurrent use of alcohol and gambling (i.e., using alcohol and gambling within a similar time period, but not together), there is a scarcity of empirical research focusing on the simultaneous use of alcohol while gambling (i.e., using alcohol while gambling). The wider substance use literature posits that the simultaneous use of substances is associated with increased severity of harm over concurrent use as well as greater social and behavioural consequences (Cummings et al., Journal of Psychoactive Drugs 51:351-359, 2019). The present study examined the psychological impact, mental health variables, and motives of simultaneously using alcohol on gambling behaviours in a sample of Canadian adults (N = 390). Participants who used alcohol while gambling were significantly more likely to endorse various facets of impulsivity, but specifically lack of premeditation. They were also more likely to gamble for enhancement and social reasons, and more likely to endorse greater alcohol use severity compared to those who did not. Interestingly, financial motives were a negative predictor, suggesting that people who gamble for financial reasons are less likely to engage in simultaneous alcohol use. The top reported reasons for using alcohol while gambling were to elicit positive emotions, to relax, and due to social circumstances. These findings corroborate previous work investigating simultaneous substance use and have potential implications for both policy and harm minimization by providing insight into the motivations for simultaneous gambling and alcohol use, and the greater harms resulting from simultaneous use.

Risk of suicide among oncologists in Serbia

OBJECTIVE

There is only limited research on suicidal thoughts and behaviors of oncologists. This study examined the prevalence and correlates of suicidal thoughts among oncologists in Serbia.

METHOD

A cross-sectional study was conducted in January 2024 involving 159 oncologists from Serbia and the Republic of Srpska. Respondents completed an online questionnaire which assessed socio-demographic and work characteristics and included the Risk Assessment Suicidality Scale, Depression Anxiety Stress Scale-21, Maslach Burnout Inventory, and Brief Resilience Scale.

RESULTS

Results indicated that 21.4% of oncologists reported elevated suicidality scores. Medical oncologists had the highest average suicidality scores compared to surgical and radiation oncologists, although these differences were not statistically significant. Key associated factors with suicidality included seeing a psychiatrist, undergoing psychiatric therapy, having family history of depression, and family history of suicide attempts and/or suicide. Resilience and sense of personal accomplishment were inversely associated with suicidality.

CONCLUSIONS

The finding that 1 out of 5 oncologists had elevated suicidality scores underscores the urgent need for mental health support for members of this profession, particularly those showing signs of distress. Interventions should promote resilience, enhance personal accomplishment, and ensure easy access to psychiatric care. While these results contribute to the limited data on suicidality among oncologists, they also identify gaps that future studies should address, such as the need for larger sample sizes and the exploration of other potential risk factors. Addressing oncologists' mental health challenges is critical to reducing suicide risk and fostering well-being in this high-risk profession.

Stress, Anxiety and Depressive Symptoms, Burnout and Insomnia Among Greek Nurses One Year After the End of the Pandemic: A Moderated Chain Mediation Model

Background/Objectives: Several studies have reported alarming rates of mental health issues and sleep problems among nurses even in the post-pandemic era. The objective was to investigate the prevalence of stress, anxiety and depressive symptoms, burnout and insomnia among nurses in Greece one year after the end of the pandemic and to construct a mediation model evaluating the impact of stress on insomnia, the chain mediating roles of depressive symptoms and burnout, as well as the moderating role of anxiety symptoms in the model. Methods: This cross-sectional study was conducted online in July 2024 and included 380 hospital nurses who completed the Depression Anxiety Stress Scale (DASS-21), the Copenhagen Burnout Inventory (CBI) and the Athens Insomnia Scale (AIS). Results: The prevalence rates of stress, anxiety and depressive symptoms, burnout and insomnia were 33.9% with 95% confidence interval (CI): [0.292, 0.390], 33.3% (95% CI: [0.284, 0.381]), 35% (95% CI: [0.302, 0.400]), 46.8% (95% CI: [0.399, 0.502]) and 56.1% (95% CI: [0.509, 0.611]), respectively. Multiple regression analysis indicated that the Depression subscale of the DASS-21 explained 40.6% of the variance in the AIS, while an additional 7.6% was explained by the CBI and another 1.3% rate by the Stress subscale of the DASS-21. Mediation analysis revealed that stress affected insomnia both directly and indirectly through the chain mediating roles of depressive symptoms and burnout. Anxiety symptoms moderated the chain mediation path by enhancing the negative impact of stress on depressive symptoms. Conclusions: The proposed moderated chain mediation model introduces certain factors influencing insomnia and explains how changes in any one of these factors effectuate changes in the other factors, offering insights for individualized interventions.

Evolution of burnout syndrome in Spanish healthcare professionals during and after the COVID-19 pandemic: psychosocial variables involved

Introduction

Evidence shows that throughout the COVID-19 pandemic, healthcare workers have experienced high levels of burnout. The preceding literature also points to the need to consider the three elements of burnout independently, as they appear to have different evolutionary trends and possibly different buffering and amplifying variables, although these aspects have hardly been explored.

Methods

The aim of the present investigation is precisely to shed light on these latter issues. It is a prospective study, carried out in 256 healthcare workers in Spain during three time points in relation to the COVID-19 pandemic: (1) (T1) between 5 May and 21 June 2020 (final phase of the state of alarm declared in Spain on 14 March), (2) (T2) 6 months after the end of the state of alarm (January-April 2021), and (3) (T3) 1 year after this second evaluation (April-July 2022). The different components of burnout syndrome (emotional exhaustion, depersonalization and self-fulfillment) were assessed at the second and third time points. Together with sociodemographic and occupational data (age, gender, professional category, years of experience, hours of work), anxiety, depression, stress, family support, friends' support, and self-efficacy were assessed at the first time point. At the second time point, cognitive fusion and resilience were assessed. At the third time point, optimism and hopelessness were assessed.

Results

The results show significant decreases in burnout syndrome (p < 0.001). However, when observing the evolution of each of the dimensions, it can be seen that emotional exhaustion has significantly decreased (p < 0.001), while an increase in depersonalization (p < 0.001) and a decrease in self-fulfillment (all p < 0.001) are observed. The results of the repeated measures General Linear Models, after controlling for the effect of the covariates show that the evolution of emotional exhaustion is associated with the levels of depression at T1 (p = 0.031), of cognitive fusion at T2 (p < 0.001) and of resilience at T2 (p = 0.039). The evolution of depersonalization is associated with levels of hopelessness at T2 (p = 0.042). Finally, the evolution of self- fulfillment is associated with levels of optimism at T3 (p = 0.043) and hopelessness at T3 (p = 0.019).

Discussion

The results highlight the need to attend to the three components of burnout in a differentiated manner. Our results indicate that, during the COVID-19 pandemic, although overall burnout levels tend to decrease, it is actually emotional exhaustion that decreases, but levels of depersonalization increase and self- fulfillment decreases. In addition, the data point to the different personality factors involved in each of the dimensions. While the evolution of emotional exhaustion seems to be more affected by the levels of symptomatology (i.e., depression) at the onset of the pandemic, and of the inability to handle intrusive thoughts (i.e., cognitive fusion), the evolution of depersonalization and self- fulfillment are more related to long-term cognitive-emotional personality variables such as optimism and hopelessness.

Practical implications

The results found have important practical implications for the prevention of each of the implicated components of the syndrome. Although further research is needed, emotional exhaustion is shown to be one of the dimensions affected in the short term and intervention programs aimed at reducing anxiety and depression at times of acute stress (onset of the COVID-19 pandemic), including thought management, seem fundamental. Depersonalization and decreased self-fulfillment do not seem to respond to the same pattern. They are shown as results of a chronification of a poor management of emotional exhaustion, and in the case of their appearance, given the variables associated with their evolution (i.e., optimism and hopelessness), therapies more focused on the meaning of existence, such as Acceptance and Commitment Therapy, could be useful.

Using the alternative model of personality disorders for DSM-5 traits to identify personality types, and the relationship with disordered eating, depression, anxiety and stress

BACKGROUND

There is a substantial and growing evidence base that has identified three distinct personality types (Overcontrol, Undercontrol and Resilient) among samples of individuals with eating disorders, as well as non-clinical samples. Even in studies where up to six personality types have been identified, the three core types representing Overcontrol, Undercontrol and Resilient consistently emerge. The aim of the research was to explore whether latent Overcontrol and Undercontrol personality types could be identified using pathological personality types as part of the Alternative Model for Personality Disorders published in DSM-5. We further aimed to understand how these personality types were associated with eating pathology, depressed mood and anxiety.

METHODS

A total of 391 women, 167 men and 10 gender-diverse individuals aged 16 to 31 years completed measures of the alternative model of personality disorder traits, disordered eating behaviours, eating pathology, depression, anxiety and stress. A systematic four-step process using hierarchical, k-means, and random forest cluster analyses were used to identify the best fitting cluster solution in the data.

RESULTS

The results revealed a four-cluster solution that represented overcontrol, undercontrol, resilient and an antisocial/psychoticism cluster. The overcontrol, undercontrol, and antisocial/psychoticism types were all associated with increased disordered eating, eating pathology, depression, anxiety and stress compared to the resilient types, with the undercontrol cluster scoring significantly higher than the other three clusters on all measures of clinical pathology.

CONCLUSIONS

Pathological personality traits, as conceptualised within the DSM-5 alternative model of personality disorders may have merit for identifying overcontrol and undercontrol personality types. Our findings provide additional evidence that both overcontrol and undercontrol personality types are associated with increased eating pathology, depression, anxiety and stress.

Prevalence, influencing factors, and prediction model construction of anemia in ankylosing spondylitis based on real-world data: An exploratory study

OBJECTIVE

This study aimed to explore the prevalence and influencing factors of anemia in patients with ankylosing spondylitis (AS) using real-world data and to construct a predictive model for anemia in AS.

METHODS

In November 2023, we accessed the database from China Rheumatoid Arthritis Registry of Patients with Chinese Medicine (CERTAIN). Clinical data of AS collected from the CERTAIN between March 2022 and September 2023 were analyzed. Demographic information, clinical assessment scales, and laboratory test results of the patients were collected. According to the anemia diagnostic criteria established by the World Health Organization (WHO) in 2018, patients were divided into anemia group and non-anemia group. Statistical analyses were performed using SPSS 25.0 software, including χ2 tests, independent sample t-tests to compare differences between the two groups, and multivariate stepwise logistic regression analysis to explore the influencing factors of anemia in AS. The predictive efficacy of the model was evaluated by plotting receiver operating characteristic (ROC) curves. Calibration was assessed through the Hosmer-Lemeshow goodness-of-fit test, and a calibration curve was plotted to comprehensively evaluate the predictive capability of the model.

RESULTS

A total of 251 patients were included in this study, among which 58 cases had anemia (23.1%). There were significant differences in gender, ossification, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) indicators, and clinical assessment scale results between the two groups (P < 0.05). The results of multivariate stepwise logistic regression analysis showed that female gender, underweight, ossification, abnormal CRP and ESR were independent risk factors for anemia in AS (P < 0.05). Based on the results of multivariate stepwise logistic regression analysis, a predictive model for anemia in AS was established as Logit(P) = -5.02 + 2.041 × gender -1.11 × BMI(body mass index) category + 1.103 × ossification category + 0.942 × CRP category + 1.476 × ESR category. The ROC curve analysis showed that the area under the curve of the model for predicting anemia in AS was 0.857 (95% CI: 0.808 ~ 0.906). The Omnibus test of model coefficients yielded χ2 = 85.265, P < 0.001. The Hosmer-Lemeshow test showed χ2 = 7.005, P = 0.536 (P > 0.05).

CONCLUSION

Analysis of real-world AS diagnosis and treatment data showed that the prevalence of anemia in Chinese AS was 23.1%. The occurrence of anemia was closely related to female gender, underweight, ossification, and abnormal CRP and ESR. The logistic model constructed based on these indicators for predicting the risk of anemia in AS demonstrated good efficacy.

App-Based Ecological Momentary Assessment of Problematic Smartphone Use During Examination Weeks in University Students: 6-Week Observational Study

BACKGROUND

The increasing prevalence of problematic smartphone use (PSU) among university students is raising concerns, particularly as excessive smartphone engagement is linked to negative outcomes such as mental health issues, academic underperformance, and sleep disruption. Despite the severity of PSU, its association with behaviors such as physical activity, mobility, and sociability has received limited research attention. Ecological momentary assessment (EMA), including passive data collection through digital phenotyping indicators, offers an objective approach to explore these behavioral patterns.

OBJECTIVE

This study aimed to examine associations between self-reported psychosocial measures; app-based EMA data, including daily behavioral indicators from GPS location tracking; and PSU in university students during the examination period.

METHODS

A 6-week observational study involving 243 university students was conducted using app-based EMA on personal smartphones to collect data on daily behaviors and psychosocial factors related to smartphone overuse. PSU was assessed using the Korean Smartphone Addiction Proneness Scale. Data collected from the Big4+ app, including self-reports on mood, sleep, and appetite, as well as passive sensor data (GPS location, acceleration, and steps) were used to evaluate overall health. Logistic regression analysis was conducted to identify factors that significantly influenced smartphone overuse, providing insights into daily behavior and mental health patterns.

RESULTS

In total, 23% (56/243) of the students exhibited PSU. The regression analysis revealed significant positive associations between PSU and several factors, including depression (Patient Health Questionnaire-9; odds ratio [OR] 8.48, 95% CI 1.95-36.87; P=.004), social interaction anxiety (Social Interaction Anxiety Scale; OR 4.40, 95% CI 1.59-12.15; P=.004), sleep disturbances (General Sleep Disturbance Scale; OR 3.44, 95% CI 1.15-10.30; P=.03), and longer sleep duration (OR 3.11, 95% CI 1.14-8.48; P=.03). Conversely, a significant negative association was found between PSU and time spent at home (OR 0.35, 95% CI 0.13-0.94; P=.04).

CONCLUSIONS

This study suggests that negative self-perceptions of mood and sleep, along with patterns of increased mobility identified through GPS data, increase the risk of PSU, particularly during periods of academic stress. Combining psychosocial assessments with EMA data offers valuable insights for managing PSU during high-stress periods, such as examinations, and provides new directions for future research.

Association of Psychosocial Work Factors and Psychological Distress With Voice Disorders Among Secondary School Teachers

OBJECTIVES

To assess the prevalence, lifetime prevalence of voice disorders, and its association with psychosocial work factors and psychological distress among secondary school teachers.

STUDY DESIGN

Cross-sectional study.

METHODS

Secondary data from the CLUSTer study were analyzed, which included sociodemographics, psychosocial work factors (Job Content Questionnaire-22), psychological distress (Depression Anxiety and Stress Scale-21), and outcome measure of voice (Voice Handicap Index-10).

RESULTS

A total of 1216 teachers were included in this study. Majority of them were females (81.0%), of Malays ethnicity (63.9%), and were married (83.3%). Almost one-third of the participants experienced high occupational stress. Less than one-third of them were having depression (27.9%) and stress (21.8%). More than half had anxiety (53.9%). The prevalence of voice disorders was 11.2% [95% confidence interval (CI): 8.9, 14.1], and the lifetime prevalence of voice disorders was 52.4% (95% CI: 48.8, 56.0). Participants with depression (aOR = 2.50, 95% CI: 1.48, 4.22), anxiety (aOR = 2.08, 95% CI: 1.05, 4.13), and stress (aOR = 1.94, 95% CI: 1.11, 3.40) were associated with voice disorders. Psychosocial work factors such as occupational stress, supervisor support, and coworker support were not associated with voice disorders.

CONCLUSION

Psychological distress is associated with the prevalence of voice disorders among secondary school teachers. These findings can be utilized in developing, designing, and implementing interventions or programs to reduce voice disorders for school teachers.

An Adapted Friendship Bench Counseling Intervention (FB) to Improve Mental Health and HIV Care Engagement Outcomes Among People Living with HIV (PWH) Who Inject Drugs in Hanoi, Vietnam: Results from the VITAL Pilot Randomized Controlled Trial

Common mental disorders (CMDs) are prevalent among people living with HIV (PWH) and cause morbidity, jeopardize HIV care engagement, and worsen HIV outcomes. In Vietnam, PWH who inject drugs are at high risk for poor HIV and CMD outcomes. However, few evidence-based interventions are available to address this population. We conducted a three-arm individually randomized pilot trial assigning 75 PWH with opiate use disorder and a CMD from methadone maintenance treatment clinics to either FB by a professional counselor, FB by a peer counselor, or enhanced usual care. Primary outcomes were feasibility, acceptability, and fidelity of FB; we also assessed preliminary indicators of CMD improvement and HIV care engagement. Feasibility was high, with 99% retention at 6 weeks and 96% retention at 6 months. 100% of patients receiving FB attended all 6 weekly sessions. Acceptability of FB was high for participants in both the professional and peer counselor groups. Providers were highly satisfied with the FB experience. Fidelity was adequate: 72% of professional counselors met or exceeded fidelity expectations, while 44% of peer counselors did. Preliminary indicators of effectiveness for CMDs were promising. Participants in the professional counselor arm had the greatest improvement as measured by CMD symptom improvement and CMD response rates at most follow-up visits. The adapted FB intervention should be scaled up and evaluated in a larger, fully powered randomized controlled trial to evaluate its efficacy in improving CMDs and HIV engagement for PWH and CMDs at greatest risk of poor HIV and CMD outcomes.Clinical Trial Number: NCT04790201 registered 3/10/2021.

Cut-off point development for the Everyday Memory Questionnaire - Revised in perimenopausal women

OBJECTIVE

Subjective cognitive complaints have been reported in women during perimenopause and the Everyday Memory Questionnaire - Revised (EMQ-R) has been recently evaluated as a standardized instrument to measure subjective cognitive changes. The purpose of this study was to identify potential cut-off points for the EMQ-R retrieval subscale and attentional subscale, and to assess the validity of these cut-off points in detecting objective cognitive changes associated with reported subjective cognitive complaints.

METHOD

After screening, 232 perimenopausal women were included in the analyses. The supervised classification and regression tree was applied to identify optimal cut-off points. Its performance was evaluated by the value of the receiver operating characteristics curve, sensitivity and specificity.

RESULTS

Findings revealed that the optimal cut-off point for the attentional subscale was 7, and for the retrieval subscale was 13. Both cut-off points presented acceptable discrimination performance. An independent t-test indicated that both cut-off points were associated with significant differences in scores on neuropsychological measures of retrieval (episodic memory and verbal fluency) as well as neuropsychological measures of higher-level attention (working memory).

CONCLUSION

The identified cut-off points may be helpful for women to track or quantify their subjective experiences of brain fog or cognitive symptoms during the menopause transition.

Extended postpartum intimate partner violence and its associated factors among Iranian women: Community-based cross-sectional study design

OBJECTIVE

The purpose of this study was to determine the prevalence of different types of intimate partner violence (IPV) and factors associated with it during the postpartum period.

METHODS

In this cross-sectional study, 428 women were enrolled from 10 health centers in the south of Tehran, Iran, between April 2023 and October 2023. We used a sociodemographic questionnaire, Conflict Tactics Scale (CTS2), the short form of the Connor-Davidson Resilience Scale (CD-RISC), and the Depression, Anxiety and Stress Scale (DASS-21) for data collection. Multivariate binary logistic regression was used to determine demographic and psychological predictors of IPV after childbirth.

RESULTS

Approximately two-thirds of women (n=285, 66.6%) experienced IPV within 1 year of childbirth. Psychological aggression (n= 276, 64.5%) was the most common type of IPV, whereas injury (n=96, 22.4%) was the least common. Additionally, one in three women experienced physical assault (n= 134, 31.3%), and over one-third experienced sexual coercion (n= 152, 35.5%). Predictor factors of IPV during the postpartum period were: insufficient family income (adjusted odds ratio [aOR] 4.52, 95% confidence interval [CI] 1.24-15.28), husband's smoking (aOR 3.17, 95% CI 1.70-5.92), history of IPV in pregnancy (aOR 2.44, 95% CI 1.33-4.50), number of children (aOR 3.02, 95% CI 1.79-5.10), and depression (aOR 1.2, 95% CI 1.08-1.14). On the other hand, protective factors of IPV during the postpartum period were: longer marriage duration (aOR 0.85, 95% CI 0.77-0.93) and greater resilience (aOR 0.95, 95% CI 0.90-0.99).

CONCLUSION

IPV is prevalent 1 year after childbirth. Healthcare providers should implement a thorough screening program to identify risk and protective factors related to postpartum IPV.

Body Regard as a Volitional Factor for Suicide Attempts: Implications for Ideation to Action Frameworks

INTRODUCTION

One's relationship with, attitudes toward, and subjective experiences of the body have been theorized to contribute to self-preservation and self-destruction. These components of body regard have demonstrated associations with suicidal thoughts and behaviors but remain understudied. This study examined whether body regard acts as a moderator of the relationship between suicide ideation and attempts as well as its effect on the relationships of other established suicide risk factors.

METHODS

A random sample survey of 2021 young adults was conducted assessing body regard, fearlessness about death, depression, anxiety, stress, lifetime NSSI, and past year suicide ideation and attempts.

RESULTS

A logistic regression analyses revealed that body regard was a significant predictor of past year suicide attempt, alongside NSSI, and suicide ideation. Follow-up moderation analyses found that body regard significantly moderated the effect of suicide ideation such that ideation was only significantly associated with suicide attempts when body regard was low. High body regard also weakened the effect of ideation on attempts across levels of NSSI.

CONCLUSIONS

Body regard may operate as a volitional factor for suicide attempts while also buffering the moderating relationships of other risk factors. Etiological models, assessment, and treatments aimed at addressing suicide risk should include attention to one's body regard.

The interaction between the Circadian Locomotor Output Cycles Kaput and Melanocortin-4-receptor gene variants on obesity and parameters related to obesity

INTRODUCTION

Obesity is a multifactorial disease caused by an interaction between genetic, environmental and behavioral factors. Polymorphisms of the two genes Circadian Locomotor Output Cycles Kaput (CLOCK) rs1801260 and Melanocortin-4-receptor (MC4R) rs17782313, are associated with obesity. Knowledge is limited on the interaction between CLOCK, MC4R and obesity. The aim was to explore the interactions between the CLOCK and MC4R gene variants on markers related to obesity.

METHODS

There were 423 subjects with information on two genetic variants of two genes (CLOCK and MC4R). Their interaction was evaluated with: chronotype, sleeping duration, emotional eating, food timing, stress, dietary intake, appetite, physical activity (assessed by questionnaires), anthropometric measures of obesity (assessed by physical measurements), and also hormonal factors (assessed by ELISA). Generalized Linear Models were applied.

RESULTS

Our results revealed that significant differences were observed between the genotypes of CLOCK rs1801260 for weight, Body Mass Index (BMI), Glucagon-like peptide-1 (GLP-1), cortisol, energy, fat, sleep duration, chronotype, appetite, depression, stress, emotional eating, physical activity, breakfast, lunch, and dinner time (p˂0.05). Also, significant differences were observed between the genotypes of MC4R rs17782313 for weight, BMI, Waist Circumference (WC), Waist to Hip Ratio (WHR), ghrelin, energy, carbohydrate, fat, appetite, depression, stress, breakfast time, and emotional eating (p˂0.05). Our findings also showed significant interactions between the CLOCK (CC)∗MC4R (CT) genotypes for higher appetite, stress and CLOCK (CT)∗ MC4R (CC) genotypes for higher fat and energy intake and CLOCK (CC)∗MC4R (CC) genotypes for higher weight, BMI, energy and fat intake, appetite, emotional eating, stress, ghrelin, cortisol and lower sleep duration and GLP-1 (p˂ 0.05).

CONCLUSION

Due to the non-significance of the interaction in CLOCK (CT)∗ MC4R (CT) genotypes, it seems that the presence of a healthy arm in the CLOCK and MC4R polymorphism is necessary for the proper function of the genes. Thus, these results highlight that gene variants and their interaction should be considered in obesity assessment.

Low and high glycemic index drinks differentially affect sleep polysomnography and memory consolidation: A randomized controlled trial

Limited research has examined the effect of meal composition on sleep. Based on previous research, we hypothesized that a low glycemic index (LGI) drink containing 50 g isomaltulose (Palatinose, GI = 32) would result in more N3 sleep, less rapid eye movement (REM) sleep, and better memory consolidation than a high glycemic index (HGI) drink containing 50 g glucose (GI = 100). Healthy males (n = 20) attended the laboratory on three occasions at least a week apart (one acclimatization night and two test nights). Using a repeated measures, randomized, double-blind design, participants consumed a standardized evening meal followed four hours later by a HGI or LGI drink. Sleep architecture and continuity were assessed using polysomnography. Procedural and episodic memory were assessed pre- and post-sleep using a finger tapping task and story recall task, respectively. There was no main effect of drink. However, there was an interaction between drink and drink order. N3 sleep percentage was significantly longer (28.71% vs 23.99%, respectively, p = .032) and overnight retention of neutral story content was significantly better (0.63 words vs -10.13 words, respectively, p = .002) after the LGI drink than HGI drink, but only when the LGI drink was consumed on the second test night and HGI drink on the first test night. No changes in REM sleep were observed. Findings suggest that the nature of carbohydrate consumed before bed may influence sleep quality and quantity and neutral episodic memory consolidation. Pre-registered with ClinicalTrials.gov (NCT05591573).

Development of a short and an ultra-brief version of the Saving Inventory-revised (SI-R) for assessing hoarding severity: The SI-R9 and the SI-R3

Hoarding Disorder (HD) is marked by the inability to discard possessions, and often excessive acquiring, which results in cluttered living spaces that substantially disrupt daily life. While the Saving Inventory-Revised (SI-R) serves as a reliable and valid tool for assessing hoarding severity, its length may preclude routine use. We aimed to develop a valid shorter version of the scale using Item Response Theory and Confirmatory Factor Analysis in a non-selected sample of 2890 individuals and a clinical HD sample of 200 participants, which were divided into test and confirmatory samples in a 2:1 ratio. This led to a 9-item SI-R9, containing the original three subscales of discarding, clutter and acquiring; and an ultra-brief 3-item scale, the SI-R3. The original and revised versions demonstrated construct, convergent, and divergent validity. Significant gender differential was noted on some items, particularly those from the full SI-R, but was small in nature. Clinical cut-offs for all three scales showed good sensitivity and specificity. In conclusion, the SI-R3 and SI-R9 were successfully developed from the original scale, we hope that clinicians and researchers will benefit from reduced administration time, improved compliance, and more cost-effectiveness, and this will lead to greater use in clinical and research settings.

Enrollment and completion rates of a nationwide guided digital parenting program for children with disruptive behavior before and during COVID-19

Our aim was to study enrollment and completion levels for the internet-based and telephone-assisted Finnish Strongest Families Smart Website (SFSW) parent training intervention, for parents of young children with disruptive behavior before and after the COVID-19 lockdown period. Population-based screening was carried out on 39,251 children during routine check- ups at 4 years of age. The parents of children scoring at least 5 on the Strengths and Difficulties Questionnaire were assessed against inclusion and exclusion criteria. Associations with enrollment or completion were analyzed using logistic regression models. The effects of COVID-19 restrictions on these were estimated using interrupted timeseries analysis. Of 39,251 families, 4894 screened positive and met the eligibility criteria. Of those, 3068 (62.6%) decided to enroll in the SFSW program and 2672 (87.1%) of those families completed it. The highest level of disruptive behavior (OR 1.33, 95% CI 1.12-1.57, p < 0.001) and overall severity of difficulties (OR 2.22, 95% CI 1.91-2.57, p < 0.001) were independently associated with enrollment. Higher parental education was associated with enrollment and completion. Higher paternal age was associated with enrollment, and parent depressive symptoms with non-completion. The SFSW enrollment did not significantly change following the COVID-19 restrictions, while the completion rate increased (COVID-19 completion OR 1.75, 95% CI 1.22-2.50, p = 0.002). Guided digital parenting interventions increase the sustainability of services, by addressing the child mental health treatment gap and ensuring service consistency during crisis situations.

War Anxiety: A Review

PURPOSE OF REVIEW

This review critically evaluates literature on war-induced anxiety, highlighting findings from 2021 to 2024, especially during the Russia-Ukraine war.

RECENT FINDINGS

Measures and prevalence estimates of anxiety and fear are updated. Populations affected by armed conflicts include residents of conflict zones and neighboring countries, internally displaced persons, refugees, combatants, and healthcare and humanitarian aid workers. Socioeconomic factors predict anxiety incidence and individuals differ in coping strategies. Anxiety could have long-term adverse effects over the life-course and across generations. Community and online interventions may reduce anxiety. The review underscores research directions in war-related anxiety's definition and assessment, risk and protective factors, health and societal consequences, and prevention and treatment approaches. The review provides an update for mental health researchers and practitioners working with the victims of war and other crises, often compounded by additional layers of stress of social inequalities, political divisions, and ethnic and racial tensions.

Prospective crossover trial of positional and CPAP therapy for the treatment of mild-to-moderate positional obstructive sleep apnea

STUDY OBJECTIVES

We evaluated the efficacy of vibrotactile positional therapy (PT) compared to standard continuous positive airway pressure (CPAP) therapy in mild-to-moderate positional obstructive sleep apnea.

METHODS

We conducted a prospective crossover randomized controlled trial of adult patients with treatment-naïve, symptomatic, mild-to-moderate positional obstructive sleep apnea, defined as ≥ 5 total apnea-hypopnea index < 30 with supine-to-nonsupine apnea-hypopnea index ratio ≥ 2. Participants were randomized to in-laboratory treatment initiation polysomnography with either PT or CPAP on sequential nights before an 8-week trial of each therapy. The primary end point was symptomatic improvement (Epworth Sleepiness Scale; ΔESS). Secondary end points included patient preference, usage, sleep architecture, and quality of life measures.

RESULTS

A total of 52 participants were enrolled and completed both arms of the study. Participants were symptomatic with a median ESS score of 12 (interquartile range, 10-14). Treatment resulted in a significant (P < .001) symptomatic improvement with both PT and CPAP (ΔESS 4; interquartile range, 6-11) without a significant difference between treatment arms (P = .782). PT was effective at restricting supine sleep and demonstrated improved sleep efficiency compared with CPAP, although no better than baseline. Both therapies were effective at reducing apnea-hypopnea index, although CPAP demonstrated superior apnea-hypopnea index reduction. There were otherwise no clinically significant differences in sleep architecture, usage, or secondary outcomes including overall patient preference.

CONCLUSIONS

In this cohort, treatment with PT or CPAP resulted in clinically significant symptomatic improvement (ΔESS) that was not significantly different between treatment arms. No real difference was seen in other secondary outcome measures. This study provides further evidence to support the use of PT as an alternative first-line therapy with CPAP in appropriately selected patients with positional obstructive sleep apnea.

CLINICAL TRIAL REGISTRATION

Registry: Australian New Zealand Clinical Trials Registry; Name: Prospective crossover trial of Positional and Continuous positive airway pressure Therapy for the treatment of mild-to-moderate positional obstructive sleep apnea; URL: https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377221&isReview=true; Identifier: ACTRN12619000475145.

CITATION

Wilson MR, Carroll R, Kinder S, et al. Prospective crossover trial of positional and CPAP therapy for the treatment of mild-to-moderate positional obstructive sleep apnea. J Clin Sleep Med. 2025;21(2):305-313.

Positive psychology psychoeducation makes a small impact on undergraduate student mental health: Further curriculum innovation and better well-being research needed

OBJECTIVES

Courses on well-being are increasingly evaluated to see how they may promote mental health in college. We examined the impact of a course on students' well-being, anxiety, and depression.

METHODS

Subjects were undergraduates enrolled in the "Science of Happiness," (SOH) (n = 105), and "Child and Adolescent Psychopathology," (CAP) (n = 114). Well-being measures included the PERMA Profiler and Satisfaction with Life Scale (SWLS) at the beginning and conclusion of the semester. The Depression Anxiety and Stress Scale - 21 items (DASS-21) measured psychopathology.

RESULTS

There were significant improvements on the SWLS 1.28 (p = .038; d = .264) in SOH. There was no improvement for the PERMA Profiler in either group, and no differences between groups. There was no significant change on the DASS-21 for SOH subjects.

CONCLUSIONS

Undergraduate courses that deliver positive psychology psychoeducation have a small effect size even in non-randomized studies. Future curriculum innovation is needed and better research to validate positive psychology psychoeducation.

Restorative Neurostimulation Therapy Compared to Optimal Medical Management: A Randomized Evaluation (RESTORE) for the Treatment of Chronic Mechanical Low Back Pain due to Multifidus Dysfunction

INTRODUCTION

Many interventional strategies are commonly used to treat chronic low back pain (CLBP), though few are specifically intended to target the distinct underlying pathomechanisms causing low back pain. Restorative neurostimulation has been suggested as a specific treatment for mechanical CLBP resulting from multifidus dysfunction. In this randomized controlled trial, we report outcomes from a cohort of patients with CLBP associated with multifidus dysfunction treated with restorative neurostimulation compared to those randomized to a control group receiving optimal medical management (OMM) over 1 year.

METHODS

RESTORE is a multicenter, open-label randomized controlled trial. Candidates were assessed for CLBP associated with multifidus dysfunction, with no indication for or history of lumbar spine surgery. Participants were randomized to either restorative neurostimulation with the ReActiv8 system or OMM. The primary endpoint was a comparison of the mean change in the Oswestry Disability Index (ODI) between the treatment and control arms at 1 year, and secondary endpoints included pain (numeric rating scale [NRS]) and health-related quality of life (EuroQol Five-Dimension [EQ-5D-5L]).

RESULTS

A total of 203 patients, average age 47 years, and with an average 11-year history of low back pain, were included in the analysis. The primary endpoint was a statistically significant demonstration of a clinically relevant mean improvement in the Oswestry Disability Index (ODI) between restorative neurostimulation and OMM arms: ODI (-19.7 ± 1.4 vs. -2.9 ± 1.4; p < 0.001). Additionally, improvements in both the numeric rating scale (NRS) (-3.6 ± 0.2 vs. -0.6 ± 0.2; p < 0.001) and EuroQol Five-Dimension (EQ-5D-5L) (0.155 ± 0.012 vs. 0.008 ± 0.012; p < 0.001) were statistically and clinically significant in the restorative neurostimulation arm compared to the OMM arm.

CONCLUSION

The RESTORE trial demonstrates that restorative neurostimulation is a safe, reversible, clinically effective, and highly durable option for patients suffering with nonoperative CLBP associated with multifidus dysfunction. This demonstration of treatment superiority over OMM through 1 year is a significant milestone in addressing a major health burden and unmet clinical need.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT04803214.

Effects of a 6-month dual-task, power-based exercise program on cognitive function, neurological and inflammatory markers in older adults: secondary analysis of a cluster randomised controlled trial

Functional power-based exercise training can improve physical performance in older adults and cognitive training can improve measures of cognition, but their combined effects on cognition and related risk factors (neurological and inflammatory markers) remains uncertain. This 6-month cluster randomised controlled trial evaluated the effectiveness of dual-task functional power training (DT-FPT) on cognition and circulating neurological and inflammatory markers in older adults at increased falls risk, and whether intervention responses varied by apolipoprotein-E (ApoE) and brain derived neurotrophic factor (BDNF) polymorphisms. Three hundred residents aged ≥ 65 years at increased falls risk residing in 22 independent-living retirement communities, were randomised by village, to DT-FPT (n = 156, 11 villages) involving a multi-component power-based training program performed simultaneously with cognitive and/or motor tasks (45-60 min, 2/week), or a usual care control (CON) group (n = 144, 11 villages). Cognition (computerized CogState battery), inflammatory cytokines, BDNF, insulin-like growth factor-1, vascular endothelial growth factor, amyloid β (1-40) and (1-42) were assessed at baseline and 6-months. Overall, 233 (78%) participants completed the intervention and adherence averaged 50.1%. DT-FPT led to a net 0.18-0.20 SD benefit versus CON in psychomotor ability/attention and reaction time/attention (both P < 0.05). There were no significant intervention effects on circulating markers, except for a net 10.5% benefit in amyloid β (1-40) in DT-FPT versus CON (P < 0.05). Responses were not influenced by APOE or BDNF genotype. In conclusion, DT-FPT in older adults at increased falls risk can provide some cognitive benefits, but these were not related to corresponding changes in inflammatory or neurological markers or influenced by genotype. Australian New Zealand Clinical Trials Registry (ACTRN12613001161718). http://www.anzctr.org.au/ This project was funded by a grant from the National Health and Medical Research Council (NHMRC) Project (APP1046267).

Perceived changes in mental health and social engagement attributed to a single psychedelic experience in autistic adults: results from an online survey

RATIONALE

Anecdotal reports suggest that psychedelic drugs can improve psychological wellbeing and social engagement in autistic people. However, there are few contemporary studies on this topic.

OBJECTIVES

To examine autistic participants' experiences with psychedelic drugs and the extent to which they attributed changes in mental health and social engagement to their most 'impactful' psychedelic experience. We also explored associations between these changes and mechanistically important variables (e.g., aspects of the acute psychedelic experience and changes in 'psychological flexibility').

METHODS

Self-selecting autistic participants (n = 233) with high autism quotient scores completed an online survey relating to their most impactful psychedelic experience. Questionnaires assessed the acute psychedelic experience and perceived psychedelic-induced changes in distress, social engagement and psychological flexibility, among other relevant variables.

RESULTS

The majority of participants attributed reductions in psychological distress (82%) and social anxiety (78%) and increases in social engagement (70%) to their most 'impactful' psychedelic experience. A substantial minority (20%) also reported undesirable effects such as increases in anxiety with some describing their psychedelic experience as among the most negatively impactful experiences of their lives. The only substantial predictor of reductions in psychological distress was increased psychological flexibility.

CONCLUSION

Autistic people attributed changes in mental health and social engagement to a single highly impactful psychedelic experience. The results and their implications are discussed with caution considering the use of a non-experimental design and biased sampling.

The role of acculturative stress and self-construal in maladaptive eating behaviors among female young adults in diverse college settings

The increasing cultural diversity in the United States means more college students identify with racial and ethnic minority backgrounds and may experience acculturative stress. Emerging research has found an association between acculturative stress and maladaptive eating. However, these studies rarely consider other theoretical factors or confounders, and individual differences. Thus, the unique contribution of acculturative stress and the generalizability of previous findings remain unclear.

OBJECTIVE

This cross-sectional study investigated the role of acculturative stress and self-construal (i.e., how individuals define themselves in relation to others in social environments) in maladaptive eating among female college students.

METHOD

Participants were 446 female young adults (Mage = 20.38, SD = 1.75; MBMI = 23.42, SD = 4.62) who completed online questionnaires.

RESULTS

Structural equation modeling results showed that acculturative stress was related to higher disinhibited eating even when accounting for traditional theoretical risk factors (i.e., body dissatisfaction, perceived sociocultural pressures on body image, and general stress) and potential confounders (i.e., age, BMI, SES, ethnic backgrounds, and birthplace). Furthermore, independent self-construal (i.e., when individuals see themselves as autonomous, prioritizing personal goals and uniqueness over social relationships) moderated this association. When independent self-construal was higher, the magnitude of the regression coefficient between acculturative stress and disinhibited eating was smaller.

DISCUSSION

Given the increasing diversity within U.S. higher education, eating behavior theories should consider integrating acculturative stress to improve inclusiveness. College psychological services should tailor prevention and treatment strategies for maladaptive eating to address acculturative stress, while also promoting an environment that supports healthy, independent self-construal.

Changes in Leisure-Time Physical Activity and Sedentary Time and Their Associations With Psychological Distress: An Occupational Cohort Study

BACKGROUND

Physical inactivity and sedentary behavior are associated with mental ill-health. We examined changes in leisure-time physical activity (LTPA) and sedentary time, and their associations with psychological distress in an occupational cohort.

METHODS

We used phase 1 survey data, collected among the employees of the City of Helsinki, Finland, aged 19-39 years in 2017, and phase 2 follow-up survey from 2022 (n = 1914 participants, 75% women). A 4-category variable (High→High, Low→High, High→Low, and Low→Low) was constructed for both LTPA and sedentary time to reflect the change over time. The 21-item Depression, Anxiety and Stress Scale was used to measure psychological distress. Logistic regression analysis estimated odds ratios (ORs) and their 95% CIs, adjusting for sociodemographic factors, working conditions, health-related factors, and physician-diagnosed mental disorders at phase 1.

RESULTS

Repeated low LTPA was associated with anxiety (OR = 2.03; 95% CI, 1.44-2.85), depressive (OR = 1.69; 95% CI, 1.22-2.36), and stress (OR = 2.22; 95% CI, 1.58-3.12) symptoms after adjusting for gender and age, compared with repeated high LTPA. The associations remained after full adjustments in anxiety (OR = 1.57; 95% CI, 1.08-2.30) and stress (OR = 1.92; 95% CI, 1.32-2.78) symptoms. Additionally, a change from high to low LTPA was associated with anxiety (OR = 1.47; 95% CI, 1.05-2.04) symptoms after full adjustments.

CONCLUSION

Repeated low levels of LTPA are associated with anxiety and stress symptoms. No consistent associations between sitting time and psychological distress could be confirmed. Considering the increasing levels of psychological distress in recent years, particularly among younger adults, it is essential to explore effective countermeasures through large interventions or prospective study designs.

Plant-based eating pattern and psychological symptoms: a cross-sectional survey among patients with migraine

OBJECTIVES

The present study evaluated the association between plant-based diet index (PDI) and psychological symptoms, including depressive symptoms, stress, and anxiety among Iranian women diagnosed with migraine headaches.

METHODS

A cross-sectional study was conducted on 262 patients with migraine (aged 20-50 years; body mass index, 18.5-30 kg/m²). Three versions of the PDI were calculated: overall PDI, healthy PDI (hPDI), and unhealthy PDI (uPDI) based on dietary data collected via a 168-item food frequency questionnaire (FFQ). Psychological symptoms, including depressive symptoms, anxiety, and stress, were assessed using the Depression, Anxiety, Stress Scale-21 (DASS-21) questionnaire.

RESULTS

After adjustment for potential confounders, patients in the highest tertile of the PDI showed a lower risk of depressive symptoms [odds ratio (OR) = 0.41, 95% confidence interval (CI): 0.22, 0.77]. Furthermore, inverse associations were evident between the PDI score and the risk of stress (OR = 0.46, 95% CI: 0.24, 0.85).

DISCUSSION

Higher adherence to a plant-based eating pattern is associated with a reduced risk of psychological symptoms. However, future longitudinal studies and clinical trials should replicate our observations and delineate the underlying mechanisms driving these associations.

Effectiveness of Video Teletherapy in Treating Obsessive-Compulsive Disorder in Children and Adolescents With Exposure and Response Prevention: Retrospective Longitudinal Observational Study

BACKGROUND

An effective primary treatment for obsessive-compulsive disorder (OCD) in children and adolescents as well as adults is exposure and response prevention (ERP), a form of intervention in the context of cognitive-behavioral therapy. Despite strong evidence supporting the efficacy and effectiveness of ERP from studies in research and real-world settings, its clinical use remains limited. This underuse is often attributed to access barriers such as the scarcity of properly trained therapists, geographical constraints, and costs. Some of these barriers may be addressed with virtual behavioral health, providing ERP for OCD through video teletherapy and supplemented by app-based therapeutic tools and messaging support between sessions. Studies of teletherapy ERP in adults with OCD have shown benefits in research and real-world settings in both small and large samples. However, studies of teletherapy ERP in children and adolescents thus far have been in small samples and limited to research rather than real-world settings.

OBJECTIVE

This study reports on the real-world effectiveness of teletherapy ERP for OCD in the largest sample (N=2173) of child and adolescent patients to date.

METHODS

Children and adolescents with OCD were treated with live, face-to-face video teletherapy sessions, with parent or caregiver involvement, using ERP. Assessments were conducted at baseline, after 7-11 weeks, and after 13-17 weeks. Additionally, longitudinal assessments of OCD symptoms were performed at weeks 18-30, 31-42, and 43-54. We analyzed longitudinal outcomes of OCD symptoms, depression, anxiety, and stress using linear mixed models.

RESULTS

Treatment resulted in a median 38.46% (IQR 12.50%-64.00%) decrease in OCD symptoms at 13-17 weeks, and 53.4% of youth met full response criteria at this point. Improvements were observed in all categories of starting symptom severity: mild (median 40.3%, IQR 8.5%-79.8%), moderate (median 38.4%, IQR 13.3%-63.6%), and severe (median 34.1%, IQR 6.6%-58.5%). In addition, there were significant reductions in the severity of depression, anxiety, and stress symptoms. The median amount of therapist involvement was 13 (IQR 10.0-16.0) appointments and 11.5 (IQR 9.0-15.0) hours. Further, symptom improvements were maintained or improved upon in the longitudinal assessment periods of weeks 18-30, 31-42, and 43-54.

CONCLUSIONS

These results show that remote ERP treatment, assisted by technology, can effectively improve both core OCD and related depression, anxiety, and stress symptoms in children and adolescents with OCD in a real-world setting. Notable outcomes were achieved in a relatively small amount of therapist time, demonstrating its efficiency. Demonstrating the usefulness of a delivery format that overcomes several traditional barriers to treatment, these findings have implications for widespread dissemination of accessible, evidence-based care for children and adolescents with OCD.

The MASCC COG-IMPACT: An unmet needs assessment for cancer-related cognitive impairment impact developed by the Multinational Association of Supportive Care in Cancer

PURPOSE

Cancer-related cognitive impairment (CRCI) can have a profound impact on the lives of cancer survivors. A multitude of subjective and objective assessment tools exist to assess the presence and severity of CRCI. However, no purpose-built tool exists to assess the unmet needs of cancer survivors directly relating to CRCI. This paper details the development and initial validation of the Multinational Association of Supportive Care in Cancer - Unmet Needs Assessment of Cancer-Related Cognitive Impairment Impact (the MASCC COG-IMPACT).

METHODS

A multistep mixed-methods measurement development and validation approach was taken with a strong emphasis on co-design. Qualitative interviews were conducted with cancer survivors (n = 32) and oncology health professionals (n = 19), followed by a modified Delphi survey with oncology health professionals (n = 29). Cognitive interviews with cancer survivors (n = 22) over two rounds were then conducted to finalise the penultimate version of the unmet needs assessment tool for CRCI. Four-hundred and ninety-one (n = 491) cancer survivors then completed the MASCC COG-IMPACT and other established measures to inform structural, reliability, validity, acceptability, appropriateness, and feasibility analyses.

RESULTS

The final MASCC COG-IMPACT is a 55-item and eight subscale tool including two indices: "difficulties" and "unmet needs". The MASCC COG-IMPACT was found to have strong structural validity, convergent validity, discriminant validity, internal consistency, and test-retest reliability. The MASCC COG-IMPACT was also found to be highly acceptable, appropriate, and feasible.

CONCLUSION

The MASCC COG-IMPACT may facilitate optimal care and referral in line with a cancer survivor's CRCI-related difficulties and unmet needs. The MASCC COG-IMPACT may also be used to explore factors and contributors to CRCI-related difficulties and unmet needs. Overall, the MASCC COG-IMPACT is a highly reliable and valid tool for the assessment of CRCI-related difficulties and unmet needs in both clinical and research settings. The MASCC COG-IMPACT and supporting materials can be accessed on the MASCC webpage or via the MASCC COG-IMPACT Open Science Framework webpage ( https://osf.io/5zc3a/ ).

The effects of the SARS-CoV-2 pandemic on self-reported interoception and mental health

BACKGROUND

Atypical interoception has been observed across multiple mental health conditions, including anxiety disorders and depression. Evidence suggests that not only pathological anxiety, but also heightened levels of state anxiety and stress are associated with interoceptive functioning. This study aimed to investigate the effects of the recent Coronavirus SARS-CoV-2 pandemic on self-reported interoception and mental health, and their relationship.

METHODS

Self-report measures of interoceptive attention and accuracy, anxiety, stress and depression taken during the pandemic (at three time points) were compared to the same measures taken from comparable samples prior to the pandemic. In the sample collected during the pandemic, the relationship between interoceptive and mental health measures and focus on COVID-19-related news and information, propensity to take objective measures of COVID-19 symptoms, and subjective beliefs concerning COVID-19 symptoms was assessed. Finally, a cross-lagged panel model (CLPM) was used to test directional relationships between self-reported interoceptive and mental health measures across three time points.

RESULTS

Higher self-reported anxiety was associated with a) increased self-reported attention to bodily signals, b) increased focus on COVID-19-related news and information, c) propensity to take objective measures of COVID-19 symptoms, and d) reduced self-reported interoceptive accuracy for bodily signals participants believed were associated with COVID-19. The CLPM revealed a mutual and comparable directional effect from T1 to T2 between interoceptive attention and measures of mental health.

CONCLUSIONS

Implications of these findings are discussed in the light of existing models and newly proposed accounts of the relationship between interoception and mental health.

COVID-19 on patients with immune-mediated rheumatic disease: a comparative study of disease activity, fatigue, and psychological distress over six months

OBJECTIVES

To compare the impact of COVID-19 on the clinical status and psychological distress of patients with immune-mediated rheumatic disease (IMRD) caused by SARS-CoV-2 infection with that of noninfected IMRD controls during a 6-month follow-up period.

METHODS

The ReumaCoV Brazil is a longitudinal study designed to follow IMRD patients for 6 months after COVID-19 (patients) compared with IMRD patients without COVID-19 (controls). Clinical data, disease activity measurements and current treatments regarding IMRD and COVID-19 outcomes were evaluated in all patients. Disease activity was assessed through validated tools at inclusion and at 3 and 6 months post-COVID-19. Fatigue, using FACIT-F (Functional Assessment of Chronic Illness Therapy) and psychological distress, using DASS 21 (Depression, Anxiety and Stress Scale - 21 Items), used to evaluated psychological distress, were evaluated at 6 months after COVID-19 in both groups. The significance level was set as p < 0.05, with a 95% confidence interval.

RESULTS

A total of 601 patients were evaluated-321 patients (IMRD COVID-19 + patients) and 280 controls (IMRD COVID-19- patients)-who were predominantly female with similar median ages. Disease activity assessment over a 6-month follow-up showed no significant difference between cases and controls. Although the mean activity scores did not differ significantly, some patients reported worsened disease activity post-COVID-19, particularly in rheumatoid arthritis (RA) (32.2%) and systemic lupus erythematosus (SLE) patients (23.3%). Post-COVID-19 worsening in RA patients correlated with medical global assessment (MGA) and CDAI scores, with a moderate to large effect size. Diabetes mellitus showed a positive association (OR = 7.15), while TNF inhibitors had a protective effect (OR = 0.51). Fatigue, depression, anxiety, and stress were significantly greater in patients than in controls. Worse disease activity post-COVID-19 correlated with worse FACIT-F and DASS-21 scores in RA patients. No significant associations were found between COVID-19 outcomes and post-COVID-19 disease activity, FACIT-F or DASS-21.

CONCLUSIONS

Post-COVID-19 IMRD patients exhibited significant fatigue, depression, anxiety, and stress, which can be mistaken for disease activity, despite having similar disease activity scores. The variability in reports on IMRD flares and the potential triggering of SARS-CoV-2 for autoimmune manifestations underscore the need for detailed clinical assessment and a comprehensive approach to managing them.

A Clinical Care Pathway for Patients With Chronic Mechanical Low Back Pain Having Restorative Neurostimulation for Multifidus Muscle: Description, Patient Compliance, Clinical Outcomes, and Satisfaction in the First Two Years

OBJECTIVES

Restorative neurostimulation for multifidus muscle is a novel therapy for chronic low back pain (CLBP). Optimal outcomes require interdisciplinary follow-up. We describe a clinical care pathway (CPW) for this therapy and report patient compliance, clinical outcomes, and patient satisfaction with the CPW.

MATERIALS AND METHODS

This study aimed to develop, at a single center, a CPW with derivation, practical basis, description, and evolution. Included in the study were audits of 1) patient compliance with attendance over 24 months, 2) medical and paramedical attendance at the clinic, 3) clinical outcomes in terms of reductions in both patient and cohort disability (Oswestry Disability Index, ODI) and CLBP numeric rating score (NRS), and 4) adverse events; and a prospective cross-sectional survey of patient satisfaction with the CPW.

RESULTS

A CPW that involved both preoperative and postoperative education and integrated interdisciplinary care was developed and incorporated into the clinical service with a dedicated clinic. In the two years under study, 172 patients attended the education session, and 92 proceeded to restorative neurostimulation for multifidus muscle therapy; 15 patients who had this therapy before the CPW also were incorporated into the CPW. Patient compliance with the pathway was 88% (95% CI 79%-94%) at 12 months. Attendance at the dedicated CPW clinic by the various subspeciality clinicians ranged between 74% and 100%. There were serial reductions in both ODI (38.9 [95% CI 35.9-41.9] to 24.7 (95% CI 21.1-28.3) and CLBP NRS (6.3 [95% CI 6.0-6.7] to 3.3 (95% 2.7-3.9) after 12 months; 76 of the 99 patients assessable (77%: 95% CI 67%-85%) had a minimally important clinical difference reduction in either ODI or pain NRS, whereas eight were unassessable. Patient satisfaction with the CPW was very high (mean 26.9; median 27, maximum 28).

CONCLUSIONS

The CPW facilitated clinical management and optimized outcomes in patients having restorative neurostimulation. Its design and delivery were very well accepted by patients.

Psychological symptoms, quality of life and dyadic relations in family members of intensive care survivors: a multicentre, prospective longitudinal cohort study

BACKGROUND

There is scarce literature evaluating long term psychological or Quality of Life (QoL) outcomes in family members of ICU survivors, who have not experienced invasive ventilation. The objective was to compare long-term psychological symptoms and QoL outcomes in family members of intubated versus non-intubated ICU survivors and to evaluate dyadic relationships between paired family members and survivors.

METHODS

Prospective, multicentre cohort study among four medical-surgical ICUs in Australia. Adult family members of ICU survivors and family-survivor dyads had follow-up assessments (3 and 12 months after ICU discharge), using Impact of Event Scale-Revised; Depression, Anxiety Stress Scales-21; EQ-5D-5L. Dyadic relationships examined associations of psychological symptoms or QoL impairments.

RESULTS

Of 144 family members (75% female, 54% partners/spouses) recruited, 59% cared for previously intubated survivors. Overall, 83% (110/132) of eligible family members completed ≥ 1 follow-up. In family members of intubated vs non-intubated survivors, clinically significant psychological symptoms (PTSD/depression/anxiety) were reported by 48% vs 33% at 3-months (p = 0.15); and 39% vs 25% at 12-months (p = 0.23). Family self-rated their QoL with a mean score of 83 (SD 13) on a visual analogue scale (range 0-100), and > 30% reported problems in pain/discomfort or anxiety/depression domains at 12-months. Family members were more likely to have persistent psychological symptoms of PTSD [OR 4.9, 95% CI (1.47-16.1), p = 0.01] or depression [OR 14.6, 95% CI (2.9-72.6), p = 0.001]; or QoL domain problems with pain/discomfort [OR 6.5, 95% CI (1.14-36.8), p = 0.03] or anxiety/depression [OR 3.5, 95% CI (1.02-12.1), p = 0.04], when the paired survivor also reported the same symptoms.

CONCLUSIONS

Almost one-third of the family members of ICU survivors reported persistent psychological symptoms and QoL problems at 12-months. There was a noticeable dyad effect with family members more likely to have persistent symptoms of PTSD, depression, and problems in QoL domains when the paired ICU survivors experienced similar symptoms. The family members of non-intubated ICU survivors had an equal propensity to develop long-term psychological distress and should be included in long-term outcome studies. Future recovery intervention trials should be aimed at ICU family-survivor dyads. Trial registration ACTRN12615000880549.

Effectiveness of social and therapeutic horticulture for reducing symptoms of depression and anxiety: a systematic review and meta-analysis

Background

Depression and anxiety are the two most common mental health conditions, that often co-exist and relapse over time. There is a need for sustainable treatment options to address increasing rates of depression and anxiety and reduce the strain on health systems. Social and Therapeutic Horticulture (STH) is a nature-based health intervention that can reduce symptoms of depression and anxiety, however synthesised evidence of its effectiveness is required to inform commissioning and availability of interventions.

Aim

The aim of this systematic review and meta-analysis was to examine the effectiveness of STH for reducing symptoms of depression and anxiety.

Method

Following PRISMA guidelines and the protocol registered on Prospero (CRD42024542671) a systematic search of scientific databases and grey literature was conducted to identify quantitative studies examining the impact of STH interventions on depression and anxiety outcomes. Studies were eligible for inclusion if they reported on an STH intervention that was led by a trained practitioner, administered to adult populations who were identified as either at risk, with symptoms or diagnosis of depression and/or anxiety and reported on depression or anxiety outcomes measured using validated scales. Data from eligible studies were extracted and analysed using a random effects meta-analysis.

Results

Seventeen studies were identified for inclusion including four RCTs, ten quasi-experimental studies with comparators and three single group studies. Nine studies reported outcomes for depression only, two for anxiety only and six for both depression and anxiety. Across studies with comparators, meta-analyses revealed large and significant effects in favour of the STH group for depression (SMD= -1.01; p=<.001) and moderate and significant effects in favour of the STH group for anxiety (SMD=-.62; p<.001). There was significant heterogeneity across studies, with high risk of bias, particularly for statistical validity and outcome measure reliability.

Conclusions

STH interventions have the potential to support existing treatment approaches for depression and anxiety. However, to inform commissioning and upscaling of services, rigorous randomised studies comparing STH to treatment as usual for depression and anxiety are required.

A Mobile App-Based Gratitude Intervention's Effect on Mental Well-Being in University Students: Randomized Controlled Trial

Background

Gratitude interventions are used to cultivate a sense of gratitude for life and others. There have been mixed results of the efficacy of gratitude interventions' effect on psychological well-being with a variety of populations and methodologies.

objectives

The objective of our study was to test the effectiveness of a gratitude intervention smartphone app on university students' psychological well-being.

Methods

We used a randomized experimental design to test our objective. Participants were recruited undergraduate students from a web-based university study recruitment system. Participants completed 90 web-based survey questions on their emotional well-being and personality traits at the beginning and end of the 3-week research period. Their depression, anxiety, and stress levels were measured with the Depression, Anxiety, and Stress Scale (DASS-21). After the baseline survey, participants were randomly assigned to either the control or the intervention. Participants in the intervention group used both a fully automated mobile sensing app and a gratitude intervention mobile iOS smartphone app designed for youth users and based on previous gratitude interventions and exercises. The gratitude intervention app prompted users to complete daily gratitude exercises on the app including a gratitude journal, a gratitude photo book, an imagine exercise, a speech exercise, and meditation. Participants in the control group used only the mobile sensing app, which passively collected smartphone sensory data on mobility, screen time, sleep, and social interactions.

Results

A total of 120 participants met the inclusion criteria, and 27 were lost to follow-up for a total of 41 participants in the intervention group and 52 in the control group providing complete data. Based on clinical cutoffs from the baseline assessment, 56 out of 120 participants were identified as being in a subsample with at least moderate baseline symptomatology. Participants in the subsample with at least moderate baseline symptomatology reported significantly lower symptoms of depression, anxiety, and stress postintervention (Cohen d=-0.68; P=.04) but not in the full sample with low baseline symptomatology (Cohen d=0.16; P=.46). The number of times the app was accessed was not correlated with changes in either the subsample (r=0.01; P=.98) or the full sample (r=-0.04; P=.79).

Conclusions

University students experiencing moderate to severe distress can benefit from a gratitude intervention smartphone app to improve symptoms of depression, anxiety, and stress. The number of times the gratitude intervention app was used is not related to well-being outcomes. Clinicians could look at incorporating gratitude apps with other mental health treatments or for those waitlisted as a cost-effective and minimally guided option for university students experiencing psychological distress.

Stress-induced increase in heart-rate during sleep as an indicator of PTSD risk among combat soldiers

STUDY OBJECTIVES

Discerning the differential contribution of sleep behavior and sleep physiology to the subsequent development of posttraumatic-stress-disorder (PTSD) symptoms following military operational service among combat soldiers.

METHODS

Longitudinal design with three measurement time points: during basic training week (T1), during intensive stressed training week (T2), and following military operational service (T3). Participating soldiers were all from the same unit, ensuring equivalent training schedules and stress exposures. During measurement weeks soldiers completed the Depression Anxiety and Stress Scale (DASS) and the PTSD Checklist for DSM-5 (PCL-5). Sleep physiology (sleep heart-rate) and sleep behavior (duration, efficiency) were monitored continuously in natural settings during T1 and T2 weeks using wearable sensors.

RESULTS

Repeated measures ANOVA revealed a progressive increase in PCL-5 scores from T1 and T2 to T3, suggesting an escalation in PTSD symptom severity following operational service. Hierarchical linear regression analysis uncovered a significant relation between the change in DASS stress scores from T1 to T2 and subsequent PCL-5 scores at T3. Incorporating participants' sleep heart-rate markedly enhanced the predictive accuracy of the model, with increased sleep heart-rate from T1 to T2 emerging as a significant predictor of elevated PTSD symptoms at T3, above and beyond the contribution of DASS stress scores. Sleep behavior did not add to the accuracy of the model.

CONCLUSION

Findings underscore the critical role of sleep physiology, specifically elevated sleep heart-rate following stressful military training, in indicating subsequent PTSD risk following operational service among combat soldiers. These findings may contribute to PTSD prediction and prevention efforts.

A new protocolized treatment strategy optimizing medical and surgical care leads to improved healing of Crohn's perianal fistulas

BACKGROUND AND AIMS

Crohn's perianal fistula healing rates remain low. We evaluated the efficacy of a protocolized multidisciplinary treatment strategy optimizing care in adults with Crohn's perianal fistulas.

METHODS

A new treatment strategy was established at a single tertiary center. The strategy comprised 3 dynamic stages of care directed toward achieving and maintaining fistula healing. Stage A, active disease, focused on early commencement and proactive escalation of biologic therapies and structured surgical reviews ensuring adequate fistula drainage and conditioning. Stage B, optimized disease with a seton in situ, focused on consideration for seton removal and appropriateness of definitive surgical closure and/or ablative techniques. Stage C, healed disease, focused on proactive care maintenance. Sixty patients were sequentially enrolled and prospectively followed for ≥12 months. Endpoints included clinical healing and radiologic remission in those with clinically active fistulas, and relapse in those with healed fistulas.

RESULTS

At baseline, 52% (n = 31) and 48% (n = 29) had clinically active and healed fistulas, respectively. For patients with clinically active fistulas, 71% achieved clinical healing after 22 months, with estimated healing rates of 39% and 84% at 1 and 2 years, respectively. Radiologic remission was achieved in 25%, significantly higher than baseline inclusion rates of 6%. For patients with healed fistulas, 7% experienced clinical relapse after 23 months, with no significant change in radiologic remission, 80% versus 86% at baseline.

CONCLUSIONS

A protocolized treatment strategy proactively optimizing care resulted in high rates of clinical healing and improved radiologic remission of Crohn's perianal fistulas. Controlled-matched studies are needed.

Examining the Dimensionality, Internal Consistency, and Invariance of the Depression, Anxiety, and Stress Scale-21 (DASS-21) Across Age, Race, Ethnicity, and Caretaking Status

This study investigates the performance of the Depression, Anxiety, and Stress Scale-21 (DASS-21) across diverse demographic groups during the COVID-19 pandemic. Utilizing a large, generalizable U.S. sample (N = 676), we applied multiple-group confirmatory factor analysis to examine the scale's internal consistency and measurement invariance in relation to age, race, ethnicity, and caretaking status. Our findings offer mixed evidence on the performance of the original three-factor structure of the DASS-21, which appears to function more consistently across groups defined by caretaking status and ethnicity, but less well across groups defined by age and racial identity. This research contributes substantially to the field by enhancing the understanding of DASS-21's applicability in diverse populations, particularly in the context of a global health crisis. It underscores the need for nuanced interpretation of DASS-21 scores considering significant demographic variability in its interpretation by participant racial identity and age, thereby guiding more accurate mental health assessments and interventions.

Alcohol use profile, motivation to quit, and attitude toward drinking in participants of a community alcohol de-addiction camp and a clinical setting: A comparative study

BACKGROUND

Due to a lack of awareness and inadequate health infrastructure, the treatment gap for any mental illness is increasing in lower- and middle-income countries, including India. As an alternative to institutional treatment, community de-addiction camps play an important role.

METHOD

This comparative study examined alcohol use profiles, motivation to quit, and attitudes toward drinking in 84 participants, equally divided between a community alcohol de-addiction camp (n = 42) and a clinical setting (n = 42). Data were collected using a socio-demographic data sheet; alcohol use profile questionnaire; AUDIT, DASS21, and SOCRATES scales, and attitude toward drinking scale.

RESULTS

The study found that community-based alcohol de-addiction camp participants were significantly older than the clinical population (p = 0.009). The mean age of alcohol onset was significantly lower in the camp group (p = 0.005), but the onset of regular use and duration of use were similar. Most participants in both groups drank daily. More clinical participants had previously attempted to quit (p = 0.025). There were no significant differences in stress, anxiety, or depression between groups. Camp participants showed higher motivation to quit (recognition: p = 0.15, ambivalence: p = 0.002, taking steps: p = 0.001), while clinical participants had a higher attitude toward drinking (social ease: p = 0.003, pleasure: p = 0.17, economic aspects: p = 0.2).

CONCLUSION AND CLINICAL IMPLICATIONS

Both groups showed high daily alcohol use and readiness to quit, but alcohol de-addiction camp participants (ADCP) participants had higher eagerness for treatment and lower attitudes toward drinking. The study highlights the benefits of tailored, community-based interventions.

Multimorbidity latent classes in relation to 11-year mortality, risk factors and health-related quality of life in Malaysia: a prospective health and demographic surveillance system study

BACKGROUND

We aimed to identify specific multimorbidity latent classes among multi-ethnic community-dwelling adults aged ≥ 18 years in Malaysia. We further explored the risk factors associated with these patterns and examined the relationships between the multimorbidity patterns and 11-year all-cause mortality risk, as well as health-related quality of life (HRQoL).

METHODS

Using data from 18,101 individuals (aged 18-97 years) from the baseline Census 2012, Health Round 2013, and Verbal Autopsies 2012-2023 of the South East Asia Community Observatory (SEACO) health and demographic surveillance system, latent class analysis was performed on 13 chronic health conditions to identify statistically and clinically meaningful groups. Multinomial logistic regression and Cox proportional hazards regression models were conducted to investigate the adjusted association of multimorbidity patterns with the risk factors and mortality, respectively. HRQoL was analyzed by linear contrasts in conjunction with ANCOVA adjusted for baseline confounders.

RESULTS

Four distinct multimorbidity latent classes were identified: (1) relatively healthy (n = 10,640); (2) cardiometabolic diseases (n = 2428); (3) musculoskeletal, mobility and sensory disorders (n = 2391); and (4) complex multimorbidity (a group with more severe multimorbidity with combined profiles of classes 2 and 3) (n = 699). Significant variations in associations between socio-demographic characteristics and multimorbidity patterns were discovered, including age, sex, ethnicity, education level, marital status, household monthly income and employment status. The complex multimorbidity group had the lowest HRQoL across all domains compared to other groups (p < 0.001), including physical health, psychological, social relationships and environment. This group also exhibited the highest mortality risk over 11 years even after adjustment of confounders (age, sex, ethnicity, education and employment status), with a hazard of death of 1.83 (95% CI 1.44-2.33), followed by the cardiometabolic group (HR 1.42, 95% CI 1.18-1.70) and the musculoskeletal, mobility and sensory disorders group (HR 1.29, 95% CI 1.04-1.59).

CONCLUSIONS

Our study advances the understanding of the complexity of multimorbidity and its implications for health outcomes and healthcare delivery. The findings suggest the need for integrated healthcare approaches that account for the clusters of multiple conditions and prioritize the complex multimorbidity cohort. Further longitudinal studies are warranted to explore the underlying mechanisms and evolution of multimorbidity patterns.

Psychological well-being and academic performance of Ukrainian medical students under the burden of war: a cross-sectional study

Introduction

The mental health of medical students is a key factor for academic performance and the delivery of high-quality medical care in the future. Globally, medical students face numerous challenges that can affect their education. Living and studying facing the war has a crucial influence on medical students' education and daily life. The study aimed to determine the psychological well-being and academic achievements of Ukrainian medical students who lived in the rear areas after the 18 months of the Russian-Ukrainian war.

Methods

The cross-sectional study was conducted at I.Ya. Horbachevsky Ternopil National Medical University. We analyzed the psychological well-being and educational achievements of medical students from the second to fifth year of Medical Faculty using the self-report scales DASS-21 and IES-R. A total of 776 students filled out the DASS-21 scale and 491 IES-R scale, respectively.

Results

Following the first 18 months of the war, 62.5, 59.6, and 58.8% of Ukrainian medical students self-reported signs of stress, anxiety, and depression, respectively. Severe and extremely severe depressive symptoms were observed in 25.6% of students, anxiety in 31.9%, and stress in 29.7%, with a higher prevalence among female students. Additionally, 44.2% of responders had significant symptoms of post-traumatic stress disorder, with the highest scores on the hyperarousal subscale (>37). Academic performance in 2023 was significantly lower compared to the pre-war period in 2019 (p < 0.001) (p = 0.000). The multiple linear regression analysis showed that academic performance was positively associated with depression (p = 0.003), hyperarousal (p < 0.001), anxiety (p = 0.03), and negatively associated with stress (p = 0.002).

Conclusion

Ukrainian medical students in rear areas are facing various challenges, with war-related stressors having a profound impact on their mental health. Our findings have shown an increasing prevalence of anxiety, stress, depression, and symptoms of post-traumatic stress disorder, all of which may negatively affect academic performance. The educational process during wartime is important for facilitating qualified medical personnel and quality healthcare. Understanding the burden of war allows for the development of wellness programs that support student mental health in conflict zones.

Psychometric evaluation of the chinese version of transgender congruence scale

BACKGROUND

In China, research on the mental health of transgender populations is increasingly prevalent; however, there is a lack of localized psychological measurement tools that align with the characteristics of this population. The Transgender Congruence Scale (TCS) is widely used internationally. This study aims to assess the reliability, validity, and psychometric characteristics of the Chinese version of the TCS among the Chinese transgender sample.

METHODS

A total of 264 participants with a mean age of 24.88 (SD = 5.91) were recruited from October 2023 to January 2024. They completed the Chinese version of the TCS, the Satisfaction with Life Scale (SWLS), and the Depression, Anxiety, and Stress Scale-21 (DASS-21). Confirmatory factor analysis of the TCS was performed using IBM SPSS Amos 28 software to assess the construct validity. Reliability, convergent validity, and measurement invariance analysis were also evaluated.

RESULTS

The reliability coefficients of the revised 9-item TCS were satisfactory (Cronbach's α = 0.85, McDonald's ω = 0.87). The two-factor model of the instrument was supported (χ2 (26) = 52.525, p = 0.002, CFI = 0.979, TLI = 0.971, SRMR = 0.052, RMSEA = 0.062 [90% CI = 0.037, 0.086]). The TCS scores significantly correlated with life satisfaction (r = 0.486, p < 0.001), stress (r = -0.182, p < 0.01), depression (r = -0.176, p < 0.01), and anxiety (r = -0.176, p < 0.01). The measurement validity of the TCS is good across different gender identity groups.

CONCLUSIONS

These findings suggested that the TCS can serve as a short yet effective tool for assessing the congruence between external appearance and internal self among TGD individuals in clinical or research settings.

The Effects of Lucid Dreaming and Nightmares on Sleep Quality and Mental Health Outcomes

OBJECTIVES

This study aimed to investigate relationships between lucid dreaming and sleep and mental health outcomes within a representative sample of the general population. We also sought to examine how nightmares interact with the relationship between lucid dreaming, sleep, and mental health outcomes.

METHODS

Participants (N = 1332) completed measures of lucid dream frequency, nightmare frequency, anxiety and depressive symptoms, stress, and sleep quality. Hierarchical regression models were conducted, where step-1 examined the direct effect of lucid dreaming on all outcome variables, and step-2 added nightmares into the equation (to examine direct effects of lucid dreaming frequency and nightmares, and the indirect effect of nightmares).

RESULTS

Step-1 results demonstrated that lucid dreaming positively predicted poor sleep quality, stress, anxiety, and depressive symptoms. Step-2 results revealed that nightmares were the only significant predictor of poor sleep quality, stress, and anxiety symptoms, accounting for all of the variance of lucid dreaming. Nightmares and the interaction of nightmares and lucid dreaming positively predicted depressive symptoms.

CONCLUSIONS

Our results suggest that nightmares alone explain associations between lucid dreaming and poor sleep quality, anxiety symptoms, and stress. However, both nightmares and the combination of nightmares and lucid dreaming are associated with increased depressive symptoms.

Sensitized-points acupuncture versus routine integrative acupuncture for chronic low back pain: A randomized-controlled feasibility study

BACKGROUND

Chronic low back pain (cLBP) is a global health complaint. Acupuncture is an effective therapy for cLBP; however, evidence for an optimal acupuncture practice scheme is limited.

OBJECTIVE

This study aimed to determine the feasibility of conducting a randomized controlled trial (RCT) to assess the effectiveness of two acupuncture regimes (sensitized-points acupuncture and routine integrative acupuncture package) for cLBP.

METHODS

This was a two-arm, assessor-blind, randomized-controlled feasibility study. Thirty adult participants with cLBP were randomly assigned into two groups. Each group received 8 sessions of either sensitized-points acupuncture or routine integrative acupuncture package, respectively. Treatments were conducted twice per week. Outcomes were assessed at baseline (week 0), on a weekly basis for four weeks (week 1, 2, 3, 4), and follow-up (week 12). Student's t-tests, Mann-Whitney U tests, Fisher's exact tests, descriptive analyses, and power analyses were used for statistics.

RESULTS

Participants were recruited over 10 weeks with a recruitment rate of 12 participants per month. The treatment plan in both groups was well accepted and tolerated. Besides, the study was characterized by low adverse event rates (8.0% in Group A, 11.7% in Group B), high completion of the outcome measures (97.8% in Group A, 94.3% in Group B), and high participant retention rate (100% in Group A, 93.8% in Group B). Furthermore, preliminary analyses showed that both regimes of acupuncture were potentially efficacious and safe.

CONCLUSIONS

Conducting a fully powered RCT to evaluate efficacy and safety of two acupuncture regimes in the management of cLBP is feasible.

Hovering or invalidating? Examining nuances in the associations between controlling parents and problematic outcomes for college students

Objective: The purpose of these studies was to examine whether college students' beliefs about themselves (i.e., self-compassion and beliefs about emotions) could be mechanisms explaining the relationship between problematic parenting behaviors (helicopter parenting and parental invalidation) and outcomes including perfectionism, affective distress, locus of control, and distress tolerance. Participants: Respondents included 255 (Study 1) and 277 (Study 2) college undergraduates. Methods: Simultaneous regressions and separate path analyses with helicopter parenting and parental invalidation as predictors, with self-compassion and emotion beliefs as mediators. Results: Across both studies, parental invalidation predicted perfectionism, affective distress, distress tolerance, and locus of control, and these links were often mediated by self-compassion. Self-compassion emerged as the most consistent and strongest link between parental invalidation and negative outcomes. Conclusion: People who internalize their parents' criticism and invalidation such that they hold negative beliefs about themselves (i.e., low self-compassion) may be vulnerable to negative psychosocial outcomes.

Food Quality Is Associated With Depression, Anxiety, and Stress Among Recovered COVID-19 Patients: Finding From a Case-Control Study

Following up with recovered coronavirus disease 2019 (COVID-19) patients is necessary. Given the importance of psychological function accompanied by significant effects of food quality, we want to examine the association between food quality score (FQS) and mental disorders among recovered COVID-19 patients. This case-control study was performed on 246 eligible adults. A validated food frequency questionnaire (FFQ) was used to evaluate dietary intake. We using Depression Anxiety Stress Scales, Insomnia Severity Index, Pittsburgh Sleep Quality Index, and 36-Item Short Form Health Survey questionnaires to evaluate the psychological function. Logistic regression analysis was conducted to estimate the odds ratio (OR) and 95% confidence intervals (CIs) for score categories of the FQS index and psychological function in multivariate-adjusted models. Only in case subjects, we found significant associations between adherence to the FQS diet and depression, anxiety, and stress in the crude model (OR, 0.796, 95% CI, 0.661-0.958, p = 0.016; OR, 0.824, 95% CI, 0.707-0.960, p = 0.013; OR, 0.824, 95% CI, 0.709-0.956, p = 0.011, respectively). These associations remained significant in all two adjusted models. However, no significant associations were found between FQS and psychological functions in the control group. Our data suggests that overall food quality intake is associated with depression, anxiety, and stress symptoms during the post-infection period. Also, adequate daily intakes of fruits, legumes, nuts, and whole grains are associated with reduced risks of psychological impairment and sleep disorders which are common among recovered patients.

The Relationship Between Nutrition Habits, BMI, Anxiety, and Seborrheic Dermatitis

BACKGROUND

Seborrheic dermatitis (SD) is a chronic, inflammatory disease characterized by unknown etiopathogenesis. It affects skin areas rich in sebaceous glands. There are strong data on the relationship between nutrition habits, body mass index (BMI), psychoemotional status, and sebaceous gland diseases such as acne, rosacea, and androgenetic alopecia. However, there are very little data on SD, nutrition habits, BMI, and psychoemotional status.

AIMS

We aimed to evaluate the nutrition habits, BMI, and psychoemotional status in patients with SD.

METHODS

One hundred patients with SD and 110 healthy controls aged 18-65 years were included. Adolescents Food Habits Checklist (AFHC), a questionnaire form consisting information about nutrition habits and Depression Anxiety Stress Scale-21 (DASS-21) were completed by the participants, and BMI was calculated.

RESULTS

Severity of SD was positively correlated with BMI (p = 0.018). Patients with SD consumed more bread and less fruits-vegetables (p = 0.001, p = 0.006). Margarine, animal fat, and sugar consumption was higher in patients with moderate to severe SD (p = 0.008, p = 0.050). AFHC score was lower in patients with SD (p = 0.009). DASS-21 anxiety subscale and DASS-21 total scores were higher in the moderate to severe SD group (p = 0.035, p = 0.049).

CONCLUSIONS

Nutrition habits, higher BMI, and psychoemotional status may play a critical role in the etiopathogenesis of SD. Healthy nutrition habits and psychoemotional status may prevent the occurrence and exacerbation of SD.

Cognitive flexibility and resilience measured through a residual approach

Background and Objectives: Resilience refers to the process through which individuals show better outcomes than what would be expected based on the adversity they experienced. Several theories have proposed that variation in resilience is underpinned by cognitive flexibility, however, no study has investigated this using an outcome-based measure of resilience.Design: We used a residual-based approach to index resilience, which regresses a measure of mental health difficulties onto a measure of adversity experienced. The residuals obtained from this regression constitute how much better or worse someone is functioning relative to what is predicted by the adversity they have experienced.Methods: A total of 463 undergraduate participants completed questionnaires of mental health difficulties and adversity, as well as a number-letter task-switching task to assess cognitive flexibility.Results: Multiple regression analyses showed that better cognitive flexibility was not associated with greater resilience.Conclusions: Our findings do not support theoretical models that propose the existence of a relationship between cognitive flexibility and resilience. Future research may serve to refine the residual-based approach to measure resilience, as well as investigate the contribution of "hot" rather than "cold" cognitive flexibility to individual differences in resilience.

Resting fMRI-guided TMS evokes subgenual anterior cingulate response in depression

BACKGROUND

Depression alleviation following treatment with repetitive transcranial magnetic stimulation (rTMS) tends to be more effective when TMS is targeted to cortical areas with high (negative) resting state functional connectivity (rsFC) with the subgenual anterior cingulate cortex (sgACC). However, the relationship between sgACC-cortex rsFC and the TMS-evoked response in the sgACC is still being explored and has not yet been established in depressed patients.

OBJECTIVES

In this study, we investigated the relationship between sgACC-cortical (site of stimulation) rsFC and induced evoked responses in the sgACC in healthy controls and depressed patients.

METHODS

For each participant (N = 115, 34 depressed patients), a peak rsFC cortical 'hotspot' for the sgACC and control targets were identified at baseline. Single pulses of TMS interleaved with fMRI readouts were administered to these targets to evoke downstream fMRI blood-oxygen-level-dependent (BOLD) responses in the sgACC. Generalized estimating equations were used to investigate the association between TMS-evoked BOLD responses in the sgACC and rsFC between the stimulation site and the sgACC.

RESULTS

Stimulations over cortical sites with high rsFC to the sgACC were effective in modulating activity in the sgACC in both healthy controls and depressed patients. Moreover, we found that in depressed patients, sgACC rsFC at the site of stimulation was associated with the induced evoked response amplitude in the sgACC: stronger positive rsFC values leading to stronger evoked responses in the sgACC.

CONCLUSIONS

rsFC-based targeting is a viable strategy to causally modulate the sgACC. Assuming an anti-depressive mechanism working through modulation of the sgACC, the field's exclusive focus on sites anticorrelated with the sgACC for treating depression should be broadened to explore positively-connected sites.

Sleep quality and mental health among medical students in Imphal, Manipur: A cross-sectional study

Background

Sleep and mental health are deeply interlinked, with poor sleep quality, a common issue among medical students, having a profound impact on their mental well-being.

Methods

A cross-sectional study was conducted among medical students in a tertiary care hospital in Imphal, Manipur. Data were collected using a self-administered questionnaire consisting of the Pittsburgh Sleep Quality Index (PSQI) and Depression Anxiety Stress Scale (DASS-21). Descriptive statistics, Chi-square test, and Pearson correlation test were applied, and P < 0.05 was considered statistically significant.

Results

A total of 425 respondents took part in the study, including 268 undergraduate and 157 postgraduate students. Most participants, 236 (55.5%) had poor sleep quality. Among the participants, 168 (39.5%) had depression, 167 (39.3%) had anxiety, and 95 (22.4%) had stress. Poor sleep quality was significantly associated with academic year among undergraduate students (P = 0.005), increased total screentime per day (P = 0.024), and increased screentime before sleep (P = 0.007). Depression, anxiety, and stress were significantly associated with younger age (P = 0.001), the undergraduate course being pursued (P = 0.001, 0.003, and 0.001), and increased screen time before sleep (P = 0.021, 0.046, and 0.039). Depression, anxiety and stress scores had a significant positive correlation with the global PSQI score.

Conclusion

More than half of the participants experienced poor sleep quality, with four out of ten experiencing depression or anxiety, and two out of ten experiencing stress. Hence, medical institutes must implement sleep hygiene education and screen time reduction initiatives to enhance students' sleep quality and overall well-being.

Occupational Balance and Meaning Mediate Higher Education Students' Mental Health During War: A Structural Equation Modeling Analysis

IMPORTANCE

Exposure to trauma and extensive changes in daily life circumstances and occupations as a result of an ongoing armed conflict can significantly affect mental health.

OBJECTIVE

To examine factors related to the mental health status of Israeli students during the Swords of Iron war.

DESIGN

A cross-sectional study.

SETTING

Online survey.

PARTICIPANTS

Students in higher education institutions across Israel (N = 863).

OUTCOMES AND MEASURES

Self-report validated questionnaires were used to assess students' mental health status, resilience, satisfaction with life, executive functions, environmental factors, and occupations.

RESULTS

Moderate levels of depression (Mdn = 18, interquartile range [IQR] = 10-28), anxiety (Mdn = 10, IQR = 4-20), and stress (Mdn = 24, IQR = 14-34) were found for 50% of participants, along with extensive changes in daily life occupations, occupational balance, and meaning. Using structured equation modeling, χ2(15) = 15.969, p = .384, the authors found that satisfaction with life, psychological resilience, religious status, executive functions, occupational balance, and variability in occupational change were directly associated with mental health status, whereas occupational balance and occupational change mediated these connections.

CONCLUSIONS AND RELEVANCE

The modifiable factors related to reduced mental health after exposure to traumatic threat included change in occupational patterns, occupational balance, and sense of belonging, which may all serve as goals for occupation-based interventions and contribute to better coping mechanisms with traumatic events. This study used a cross-sectional design and an online survey with self-reported data, which may limit the generalizability of the findings. Plain-Language Summary: Higher education students in Israel were exposed to traumatic events and changes in daily life because of war. This study aimed to understand their mental health, resilience, executive functions, environments, and changes in their occupational patterns and the complex interplay between these factors. An online survey showed a notable decline in the students' mental health status, with around 50% experiencing at least moderate levels of depression, anxiety, and stress. Changes in occupations, occupational meaning, and balance were also common. The study found that satisfaction with life, mental resilience, occupational balance, religious status, executive functions, and variability in occupational change all contributed directly to the students' mental health status. The findings suggest that modifiable factors such as occupational balance and belongingness could be addressed through interventions to enhance mental health and coping mechanisms of students facing trauma and stressful life events.

Dyadic examination of parents' general psychological distress and coparenting in families with young children: The mediating role of couple satisfaction

The current research explored the dyadic relationships between general psychological distress (GPD) and coparenting dimensions (cooperation, conflict, triangulation) through the mediation of couple satisfaction among parents with young children. The sample comprised 184 heterosexual couples (184 mothers, 184 fathers, age range from 25 to 57 years) married for 10 years on average. The actor-partner interdependence model (APIM) and APIM Mediation Model analyses demonstrated significant relationships between mothers' and fathers' GPD and all three of their own coparenting dimensions (direct actor effects), also through their own couple satisfaction (indirect actor-actor effects). Additionally, mothers' GPD had direct effects on fathers' coparenting cooperation (partner effect). Fathers' GPD had significant indirect effects on all dimensions of mothers' coparenting through mothers' couple satisfaction (partner-actor effects), plus on mothers' coparenting triangulation through fathers' couple satisfaction (actor-partner effect). Findings were in line with Family System Theory and consistent with prior research. Clinical implications were discussed.