Brave men and timid women? A review of the gender differences in fear and anxiety

Fear of the COVID-19 vaccine in a public healthcare system and university setting

Despite the known benefits, some individuals remain apprehensive about receiving the COVID-19 vaccine, which hampers vaccination efforts and the achievement of herd immunity. Therefore, this cross-sectional study aimed to assess vaccination rates and identify factors influencing fear of the COVID-19 vaccine among individuals served by the public healthcare system (Family Health Strategy - FHS) and in a university community in Minas Gerais, Brazil. Surveys were conducted face-to-face with FHS participants and online with university members, employing a free sharing approach on social media. A total of 1896 and 312 responses were collected, respectively. The survey covered sociodemographic information, COVID-19 fear levels, and vaccination status for both individuals and their children Vaccination coverage was 83% among FHS participants and 99.1% in the university setting. Female respondents in both groups exhibited higher levels of COVID-19 fear (p<0.05), with FHS-assisted women reporting greater apprehension towards vaccination (p<0.05). Educated parents demonstrated better understanding of the importance of child vaccination, while younger parents expressed heightened concerns about vaccine side effects. Among FHS participants, women exhibited a 1.6 times higher fear of vaccination compared to men. Additionally, fear of vaccination increased by 1.10 times for each additional point on the COVID-19 Fear Scale (physiological domain). Effective communication strategies and dispelling misconceptions surrounding immunization could alleviate fear and promote vaccination acceptance.

[Mental health in the workplace - What role do socioeconomic-, gender-, and migration-related inequalities play?]

BACKGROUND

Risk factors for mental health can be found in socio-economic-, gender- and migration-specific inequalities. These factors and the extent of depression, anxiety, and somatization among employees were examined in the present study.

METHODS

As part of the Early Intervention in the Workplace Study (friaa), mentally burdened employees at five locations in Germany were surveyed on socio-demographic-, work-, migration-, and health-related content. Regression analyses were used to examine the relationship between these factors and depression (Patient-Health-Questionnaire-9, PHQ-9), anxiety (Generalized Anxiety Disorder-2, GAD-2), and somatization (Somatic Symptom Scale-8, SSS-8) in the entire sample and in people with migration background (MB). For the latter, acculturation (Frankfurt Acculturation Scale, FRACC) and the perception of burden in terms of demands of immigration (Demands of Immigration Scale, DIS) were also taken into account.

RESULTS

On average, the 550 employees (12% with MB) showed clinically relevant depression (M = 13.0, SD = 5.1) (PHQ-9 ≥ 10), anxiety (M = 3.5, SD = 1.7) (GAD ≥ 3) and somatization (M = 13.0, SD = 5.8) (SSS-8 ≥ 12). Female gender was associated with higher anxiety and somatization. Older age and night shift work were associated with higher somatization.

DISCUSSION

The results confirm the high level of mental burden among this sample of employees in Germany. In order to maintain their mental health, support measures should be offered, especially for vulnerable groups such as women, older employees, and night shift workers.

A novel approach to anxiety level prediction using small sets of judgment and survey variables

Anxiety, a condition characterized by intense fear and persistent worry, affects millions each year and, when severe, is distressing and functionally impairing. Numerous machine learning frameworks have been developed and tested to predict features of anxiety and anxiety traits. This study extended these approaches by using a small set of interpretable judgment variables (n = 15) and contextual variables (demographics, perceived loneliness, COVID-19 history) to (1) understand the relationships between these variables and (2) develop a framework to predict anxiety levels [derived from the State Trait Anxiety Inventory (STAI)]. This set of 15 judgment variables, including loss aversion and risk aversion, models biases in reward/aversion judgments extracted from an unsupervised, short (2-3 min) picture rating task (using the International Affective Picture System) that can be completed on a smartphone. The study cohort consisted of 3476 de-identified adult participants from across the United States who were recruited using an email survey database. Using a balanced Random Forest approach with these judgment and contextual variables, STAI-derived anxiety levels were predicted with up to 81% accuracy and 0.71 AUC ROC. Normalized Gini scores showed that the most important predictors (age, loneliness, household income, employment status) contributed a total of 29-31% of the cumulative relative importance and up to 61% was contributed by judgment variables. Mediation/moderation statistics revealed that the interactions between judgment and contextual variables appears to be important for accurately predicting anxiety levels. Median shifts in judgment variables described a behavioral profile for individuals with higher anxiety levels that was characterized by less resilience, more avoidance, and more indifference behavior. This study supports the hypothesis that distinct constellations of 15 interpretable judgment variables, along with contextual variables, could yield an efficient and highly scalable system for mental health assessment. These results contribute to our understanding of underlying psychological processes that are necessary to characterize what causes variance in anxiety conditions and its behaviors, which can impact treatment development and efficacy.

"I've accepted it because at the end of the day there is nothing, I can do about it": A qualitative study exploring the experiences of women living with the HIV, intimate partner violence and mental health syndemic in Mpumalanga, South Africa

In South Africa, Mental Health (MH), HIV, and Intimate Partner Violence (IPV) form a syndemic, that disproportionately affects women. These challenges are often co-occurring and create complex adversities for women. Recognising these intersections and the broader socio-cultural dynamics at play is crucial to understanding the layered experiences of these women and developing effective interventions. This research explores the experiences of the women living with at least two of the epidemics (HIV, IPV and or MH) and how they cope. A qualitative study design was used and 20 women (22-60 years) were recruited from Mpumalanga, South Africa. To be eligible for the study the women had to have experienced at least two of the epidemics. Data were collected through home-based interviews, arts-based activities, and analysed thematically using MAXQDA (2022) software. MH challenges were prevalent among all the participants and were linked to both IPV and HIV, resulting in symptoms such as anxiety, depression, and suicidal thoughts. In relation to the HIV-MH link, MH challenges in this combination included feelings of denial, sadness and anxiety related to participant's HIV diagnosis. A bidirectional relationship also existed in the IPV-MH group where pre-existing MH challenges among women increased their vulnerability of having violent partners, whilst IPV also increased MH challenges. In the IPV-MH-HIV group early childhood violence exposure was linked with MH challenges and later victimization and vulnerability to HIV. Participants primarily used religion, acceptance, occasional alcohol, and family support as coping strategies. Particularly in IPV situations, alcohol use/misuse was the most prevalent coping strategies. The study highlights the syndemic relationship between HIV, IPV and MH challenges among South African women living in a peri-urban community, with a central emphasis on MH challenges. Interventions should holistically address these challenges, with particular focus on MH challenges, cultural sensitivity, and promotion of healthy coping strategies.

Impact of Gender on Chronic Complications in Participants With Type 2 Diabetes: Evidence From a Cross-Sectional Study

INTRODUCTION

This study aimed to assess and compare the prevalence of diabetes complications between men and women with Type 2 diabetes (T2D), as well as how gender relates to these complications.

METHODS

In this cross-sectional study, complications of diabetes, including coronary artery disease (CAD), retinopathy, neuropathy and diabetic kidney disease (DKD), were evaluated in 1867 participants with T2D. Additionally, baseline characteristics of the individuals, including anthropometric measurements, metabolic parameters and the use of dyslipidaemia drugs and antihyperglycaemic agents, were assessed. Gender differences in complications were examined using the chi-squared test. Multivariate logistic regression was employed to investigate the relationship between gender and T2D complications, with and without adjusting for the characteristics of the studied population.

RESULTS

In the studied population, 62.1% had at least one complication, and complications were 33.5% for DKD, 29.6% for CAD, 22.9% for neuropathy and 19.1% for retinopathy. The prevalence of CAD and neuropathy was higher in men. However, DKD and retinopathy were more prevalent among women. Odds ratios of experiencing any complication, CAD and retinopathy in men compared with women were 1.57 (95% CI: 1.27-2.03), 2.27 (95% CI: 1.72-2.99) and 0.72 (95% CI: 0.52-0.98), respectively, after adjusting for demographic factors, anthropometric measures, metabolic parameters and the consumption of dyslipidaemia drugs and antihyperglycaemic agents.

CONCLUSION

The prevalence of diabetes complications was significantly higher in men with diabetes, highlighting the need for better treatment adherence. CAD was associated with the male gender, whereas retinopathy was associated with the female gender. Men and women with diabetes should be monitored closely for CAD and retinopathy, respectively, regardless of their age, diabetes duration, anthropometric measures, laboratory findings and medications.

Rumination and Gender in the Relation Between Perceived Threat and State Anxiety During COVID-19

OBJECTIVES

Perception of and subsequent responses to counter threats by disease, such as COVID-19, are essential for engagement in self-protective behaviors. But, associated increases in anxiety that accompany the threat of disease may negatively impact well-being. Therefore, identifying variables that may modulate the association between perceived threat from COVID-19 and anxiety is important. We conducted a study to examine the moderating roles of two subtypes of rumination (brooding and reflection) in the association between perceived threat from COVID-19 and state anxiety. Additionally, as both COVID-19 outcomes and the tendency to ruminate differ across genders, we explored gender as a second moderator.

METHODS

Participants (N = 300; Men = 144) were recruited online in April 2020 and completed measures of state anxiety, brooding and reflective rumination, and perceived threat from COVID-19.

RESULTS

Moderation regression analyses revealed that perceived threat and brooding were independently associated with increased state anxiety. Reflective rumination and gender, however, significantly moderated the relation between perceived threat and state anxiety. For men, reflective rumination strengthened the association between threat and anxiety. For women, reflective rumination weakened this association; women with the highest scores in reflective rumination also reported high state anxiety at low, medium, and high perceived threat levels.

CONCLUSIONS

These findings illuminate gender differences in the relations between perceived threat, rumination, and experienced state anxiety during the pandemic.

Influences on clinical trial participation: Enhancing recruitment through a gender lens - A scoping review

Background

Suboptimal clinical trial recruitment contributes to research waste. Evidence suggests there may be gender-based differences in willingness to participate in clinical research. Identifying gender-based differences impacting the willingness of trial participation may assist trial recruitment.

Objectives

To examine factors that influence the willingness of men and women to participate in clinical trials and to identify modifiable factors that may be targeted to optimise trial participation.

Material and methods

Electronic databases were searched with key words relating to 'gender', 'willingness to participate' and 'trial'. Included studies were English language and reported gender-based differences in willingness to participate in clinical trials, or factors that influence a single gender to participate in clinical trials. Studies were excluded if they described the demographic factors of trial participants or if the majority of participants were pregnant. Extracted data were coded, categorized, analysed thematically and interpreted using Arksey and O'Malley's framework.

Results

Sixty-three studies were included. Two main themes were identified: trial characteristics and participant characteristics. A number of gender-based differences moderating willingness to participate were observed although only one, 'concern for self' was found to influence actual trial participation rates between genders.

Conclusion

The relationship between factors influencing willingness to participate in clinical trials is complex. The influence of gender on willingness to participate, while important, may be moderated by other factors including socioeconomic status, ethnicity and health condition. Exploring factors that influence willingness to participate specific to a study cohort likely offers the most promise to optimise trial recruitment of that cohort.

A Six-Year Longitudinal Study of Parenting and Depressive Symptoms among Taiwanese Adolescents

This study investigated the associations between early parental warmth, harsh discipline, and adolescent depressive symptoms from early to late adolescence, with attention to gender differences in these associations. The sample was drawn from a longitudinal study, the Taiwan Youth Project, including 2,690 Taiwanese adolescents from wave 1 in 2000 (first year in junior high school) to wave 6 (third year in high school) in 2005. The results showed a nonlinear developmental trajectory of adolescent depressive symptoms during the middle- to high-school period. Harsh discipline was associated with the significantly higher initial presence and faster growth rate of depressive symptoms, while parental warmth and monitoring were associated with the significantly lower initial presence of depressive symptoms. In addition, female adolescents displayed a higher initial level of depressive symptoms than males when parents exercised higher levels of monitoring and harsh discipline. Finally, we provided suggestions for practice and research.

Gender differences in the effects of emotion induction on intertemporal decision-making

'Good things come to those who wait' is a popular saying, which goes along with numerous daily life decisions requiring trade-offs between immediate-small and later-larger rewards; however, some individuals have a tendency to prefer sooner rewards while discounting the value of delayed rewards, known as delay discounting. The extant literature indicates that emotions and gender can modulate intertemporal choices, but their interplay remains hitherto poorly investigated. Here, 308 participants were randomized to different conditions, inducing distinct emotions-fear, joy, a neutral state-through standardized movie clips, and then completed a computerized delay discounting task for hypothetical money rewards. Following the induction of fear, women discount the future steeper than men, thus preferring immediate-smaller rewards rather than larger-delayed ones. Also, women were more prone to choose immediate rewards when in a fearful condition than when in a positive state of joy/happiness. By contrast, men were unaffected by their emotional state when deciding on monetary rewards. Our findings provide evidence that fear can trigger different intertemporal choices according to gender, possibly reflecting the adoption of different evolutionary strategies.

Gendered pathways to socioemotional competencies in very young children

Parent-child and teacher-child relationship closeness have been shown to be crucial for children's development of socioemotional competencies from preschool to school-age stages. However, less is known about the importance of developing close relationships with young infants and toddlers attending childcare group settings for their early socioemotional development. The current study aimed to address this gap and to explore how child gender may influence the associations. Participants included 378 Hong Kong Chinese children (196 girls; Mage = 22.05 months, SD = 9.81 months) enrolled in childcare centres, along with their parents and teachers. Parents reported on children's socioemotional competencies as well as their relationship closeness with children; teachers reported on their relationship closeness with children. Multiple group structural equation modelling was used to analyse the results. The findings showed that both parent-child and teacher-child closeness were positively associated with children's social competence, while teacher-child closeness was negatively associated with children's anxiety behaviour. Parents of girls reported greater parent-child closeness, higher levels of social competence, and higher levels of anxiety behaviours compared to parents of boys. Furthermore, teacher-child closeness was significantly associated with social competence exclusively among girls, while parent-child closeness was significantly associated with anxiety behaviours solely among boys. Findings are discussed in terms of the role of child gender in influencing the associations between parent-child closeness, teacher-child closeness, and children's socioemotional competencies in the earliest years.

A study on the influencing factors of mental health of Chinese garden workers: a cross-sectional study

BACKGROUND

Occupational hazards occur in all walks of life. China's horticulture industry is undergoing rapid development. However, the mental health of garden workers has not received much attention. This study investigates the mental health status and influencing factors of Chinese garden workers and provides a basis for promoting their mental health and ensuring the healthy development of Chinese horticulture.

METHODS

A cross-sectional survey of garden workers in Beijing was conducted from 10 July 2021 to 10 October 2021. A total of 3349 valid questionnaires were recovered, with an effective response rate of 95.69%. Descriptive statistical analysis was carried out on the demographic characteristics, job satisfaction, stress, anxiety, and depression of garden workers, and the influencing factors affecting the mental health of Chinese garden workers were found through a t-test, variance analysis, and ordinal multi-class logistic regression analysis.

RESULTS

Survey respondents were mostly male (54.4%) and under the age of 40 (64.1%). The anxiety and depression symptoms of the garden workers were moderate. Among staff members, 40.2% were in a normal state of stress. Gender, three meals on time, monthly income, and job satisfaction were the factors influencing stress, anxiety, and depression symptoms among garden workers.

CONCLUSION

Compared to medical staff and other groups, the stress, anxiety, and depression symptoms of Chinese garden workers are severe. Gender, monthly income, and job satisfaction are important factors affecting their mental health. Managers should continuously improve the working environment of garden workers, provide salaries that match their positions, and improve their job recognition and satisfaction to reduce the impact of negative emotions on personal health.

Tackling Costly Fearful Avoidance Using Pavlovian Counterconditioning

Avoidance behavior constitutes a major transdiagnostic symptom that exacerbates anxiety. It hampers fear extinction and predicts poor therapy-outcome. Pavlovian counterconditioning with a reward could alleviate avoidance better than traditional extinction by reducing negative valence of the feared situation. However, previous studies are scarce and did not consider that pathological avoidance is often costly and typically evolves from an approach-avoidance conflict. Therefore, we used an approach-avoidance conflict paradigm to model effects of counterconditioning on costly avoidance (i.e., avoidance that leads to missing out on rewards). Results from our preregistered Bayesian Mixed Model analyses in 51 healthy participants (43 females) indicated that counterconditioning was more effective in reducing negative valuation and decreasing costly avoidance than traditional extinction. This study supports application of a simple counterconditioning technique, shows that its efficacy transfers to more complex avoidance situations, and suggests treatment may benefit from increasing reward drive in combination with extinction to overcome avoidance. Application in a clinical sample is a necessary next step to assess clinical utility of counterconditioning.

The level of cancer-related concerns and affecting factors in Turkish cancer survivors: A cross-sectional study

AIM

To examine and compare the level of cancer-related concerns and affecting factors between cancer survivors who completed their treatment and those still receiving treatment.

DESIGN

The study has a cross-sectional comparative design.

METHODS

Convenience sampling was used and the study included 350 Turkish cancer survivors. Data were collected between March and June 2022 online with a descriptive characteristics form and the Assessment of Survivor Concerns. Obtained data were analysed with numbers, percentages, mean values, t-test and multiple linear regression analysis.

RESULTS

The cancer survivors who completed their treatment had a significantly higher level of concerns than those who were still on treatment. Female cancer survivors, cancer survivors with less than 5-year time elapsing after diagnosis and gynaecological cancer survivors with completed cancer treatment can also have a higher level of cancer-related concerns.

CONCLUSION

Cancer survivors who have completed their treatment have a higher level of concerns than those who still receive treatment. Gender, time elapsing after diagnosis and type of cancer affect the level of concerns.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Nurses should evaluate psychosocial care and needs of cancer survivors in addition to their physical care. Raising awareness about the concerns of the cancer survivors with completed treatment in addition to those still receiving treatment and providing holistic care to them can reduce their concerns.

IMPACT

It is of great importance to be aware of the factors likely to increase cancer-related concerns during and after cancer treatment. This study identifies cancer-related concerns in cancer survivors who completed or were still receiving treatment and provides a comparison with other studies in the literature.

REPORTING METHOD

We have adhered to STROBE statement using STROBE checklist for cross-sectional studies.

PATIENT OR PUBLIC CONTRIBUTION

There was no patient or public involvement.

Pressurizing or encouraging: Health behaviors among long-distance couples

Couples in long-distance relationships face unique challenges that affect their health outcomes and relationship dynamics in ways that are different from couples in close proximal relationships (PR). The results of previous literature analyzing health outcomes for long-distance relationship (LDR) couples have been mixed, and factors such as couple satisfaction and gender of the individuals contribute to the variance. This study examined the good health practices of couples in LDRs, the ways in which partners influence each other's health, and the health outcomes of these couples as compared to couples in PRs. Multilevel multivariate analysis showed that couples in LDRs had better health practices than those in PRs, and men overall had poorer health practices than women. There was no main effect seen for LDRs when we examined strategies used for influencing health. There was a main effect for gender, though, and we found that women tend to use more collaborative and pressurizing strategies for influencing their partner's health. On health indices, we found that LDR couples tended to have lower levels of fatigue and sleep disturbance as compared to PR couples. In the adjusted model with covariates, which included age, income, couple satisfaction, and married or unmarried couples, we found that lower couple satisfaction and lower income significantly predicted poorer health on all health indices. These results are discussed in light of unequal gender roles, social control, and positive aspects of LDRs on health in an attempt to understand LDRs better and destigmatize the narrative of these relationships as 'less than' PRs. Implications for health and mental health practitioners are also discussed.

Across ages and places: Unpredictability of maternal sensory signals and child internalizing behaviors

BACKGROUND

Patterns of sensory inputs early in life play an integral role in shaping the maturation of neural circuits, including those implicated in emotion and cognition. In both experimental animal models and observational human research, unpredictable sensory signals have been linked to aberrant developmental outcomes, including poor memory and effortful control. These findings suggest that sensitivity to unpredictable sensory signals is conserved across species and sculpts the developing brain. The current study provides a novel investigation of unpredictable maternal sensory signals in early life and child internalizing behaviors. We tested these associations in three independent cohorts to probe the generalizability of associations across continents and cultures.

METHOD

The three prospective longitudinal cohorts were based in Orange, USA (n = 163, 47.2 % female, Mage = 1 year); Turku, Finland (n = 239, 44.8 % female, Mage = 5 years); and Irvine, USA (n = 129, 43.4 % female, Mage = 9.6 years). Unpredictability of maternal sensory signals was quantified during free-play interactions. Child internalizing behaviors were measured via parent report (Orange & Turku) and child self-report (Irvine).

RESULTS

Early life exposure to unpredictable maternal sensory signals was associated with greater child fearfulness/anxiety in all three cohorts, above and beyond maternal sensitivity and sociodemographic factors. The association between unpredictable maternal sensory signals and child sadness/depression was relatively weaker and did not reach traditional thresholds for statistical significance.

LIMITATIONS

The correlational design limits our ability to make causal inferences.

CONCLUSIONS

Findings across the three diverse cohorts suggest that unpredictable maternal signals early in life shape the development of internalizing behaviors, particularly fearfulness and anxiety.

The flashbulb-like nature of memory for the first COVID-19 case and the impact of the emergency. A cross-national survey

Flashbulb memories (FBMs) refer to vivid and long-lasting autobiographical memories for the circumstances in which people learned of a shocking and consequential public event. A cross-national study across eleven countries aimed to investigate FBM formation following the first COVID-19 case news in each country and test the effect of pandemic-related variables on FBM. Participants had detailed memories of the date and others present when they heard the news, and had partially detailed memories of the place, activity, and news source. China had the highest FBM specificity. All countries considered the COVID-19 emergency as highly significant at both the individual and global level. The Classification and Regression Tree Analysis revealed that FBM specificity might be influenced by participants' age, subjective severity (assessment of COVID-19 impact in each country and relative to others), residing in an area with stringent COVID-19 protection measures, and expecting the pandemic effects. Hierarchical regression models demonstrated that age and subjective severity negatively predicted FBM specificity, whereas sex, pandemic impact expectedness, and rehearsal showed positive associations in the total sample. Subjective severity negatively affected FBM specificity in Turkey, whereas pandemic impact expectedness positively influenced FBM specificity in China and negatively in Denmark.

The role of late adolescents' emotion regulation in the experience of COVID-19 lockdown: A longitudinal study

The COVID-19 pandemic may be considered a unique mass-trauma experience. This study examined the relations between Italian late adolescents' emotion regulation strategies, their anxiety states, and their experience of the lockdown (in terms of discomfort related to restrictions, capacities to create new functional daily routines, and to find positive changes in one's own life) during the first wave of this pandemic. We analysed how participants' reports of cognitive reappraisal and expressive suppression were associated with anxiety states during the 2020 Italian COVID-19 lockdown (large scale physical distancing and movement restrictions) and one month after the lockdown restrictions had been removed. We also examined how cognitive reappraisal, expressive suppression, and anxiety states were linked to late adolescents' experience of lockdown. The participants were 497 Italian adolescents, aged from 17 to 24 years (Mage  = 21.11, SD = 1.83). A longitudinal structural equation modelling showed that emotion regulation strategies and anxiety states were not associated across time. Cognitive reappraisal was positively associated with routine reorganization and positive changes. In contrast, participants' expressive suppression was negatively related to their discomfort related to restrictions, ability to functionally reorganise their daily routine, and ability to find positive changes related to the COVID-19 emergency. Anxiety was positively linked to discomfort related to restrictions. The findings are discussed in light of the current literature related to emotion regulation and anxiety. Limitations and implications for practice are presented.

The effect of fear of contagion/being contagious on depression, anxiety and stress levels of university students during the COVID-19 pandemic

BACKGROUND

University students are generally quite active in social life. It is thought that their fear of contagion/being contagious will affect their depression, anxiety and stress levels due to the removal of restrictions and the increase in individual responsibilities. This study aims to determine the effect of fear of contagion/being contagious on depression, anxiety and stress levels of university students during the COVID-19 pandemic.

METHODS

This study, descriptive and cross-sectional. Quantitative data were collected using the Demographic Information Form, the Fear of Contagion/Transmission Scale and the Depression-Anxiety-Stress Scale. The sample included 3500 participants. Descriptive statistics were used for the presentation of the results. The STROBE checklist for cross-sectional studies was used in this study.

RESULTS

This study revealed that the depression, anxiety and stress levels of university students were above normal, and these results were mostly associated with females, those with a chronic disease and high fear of contagion/being contagious.

CONCLUSION

The findings of this study may be useful for precautionary plans to support the psychological health of university students after the COVID-19 pandemic and in the fight against possible new pandemics. Considering the findings of our study, educational programs should be planned for youth in general and university students in particular to deal with depression, anxiety, stress and fears.

RELEVANCE TO CLINICAL PRACTICE

The depression, anxiety and stress levels of university students were above normal. As the fear of contamination and contagion increases, the level of depression, anxiety and stress increases. Those with chronic diseases have high levels of depression, anxiety and stress.

PATIENT OR PUBLIC CONTRIBUTION

Research data were collected through an online questionnaire. Data collection tools were prepared on Google Forms, and then, links were shared with student groups over social media. Students shared the link on their social platforms, allowing it to reach wider audiences.

Validity and reliability of the short Test Anxiety Inventory (TAI-5) in Dutch adolescents

The present study examined the psychometric properties of the short Test Anxiety Inventory (TAI-5) in a Dutch adolescent sample. The sample consisted of 2063 secondary school students (mean age 13.6 years, 48% girls) who filled out a battery of screening questionnaires for a routine health check. We investigated structural validity with a confirmatory factor analysis, scale reliability with internal consistency coefficients, and construct validity with hypotheses testing and convergent validity. The proposed one-factor structure fitted well in the present sample. However, there was an indication of measurement variance for gender. Scale reliability was high (ω = 0.88), and sufficient positive correlations were found between TAI-5 scores and anxiety, depression, worry, executive functioning, and sleep problems (r ranging from 0.36 to 0.56). Girls had significantly higher test anxiety scores than boys (d = 0.47). The present study provided evidence for the validity and reliability of TAI-5 scores in a general population of Dutch adolescents.

Prevalence and predictors of social anxiety disorders among Malaysian secondary school students during the COVID-19 pandemic: Exploring the influence of internet gaming disorder and impulsivity

This study aimed to investigate the prevalence of social anxiety disorder (SAD) among Malaysian secondary school students during the COVID-19 pandemic and to explore its correlations with demographic variables, impulsivity behavior, and internet gaming disorder (IGD). A total of 1574 participants from 12 government secondary schools across five Malaysian states, comprising 569 males and 1005 females, completed an online questionnaire containing validated Malay versions of the Social Interaction Anxiety Scale, Barratt Impulsiveness Scale, and Internet Gaming Disorder Scale - Short Form. The findings revealed a notable SAD prevalence rate of 40.53% among Malaysian adolescents. Logistic regression analysis unveiled significant associations between SAD and factors such as attention impulsiveness (OR = 2.58, p < .001), motor impulsiveness (OR = 1.47, p = .03), female gender (OR = 2, p < .001), Malay ethnicity, and IGD (OR = 1.08, p < .001). In conclusion, this study provides valuable insights into the extent of social anxiety experienced by Malaysian secondary school students during the pandemic, shedding light on the demographic and psychosocial factors linked to its emergence. Furthermore, the research underscores a robust link between IGD and SAD, emphasizing the need for comprehensive interventions addressing both issues concurrently. By recognizing the multifaceted nature of these associations, future interventions can be tailored to provide holistic support for adolescents' mental well-being.

The association between post-traumatic stress disorder (PTSD) and executive functioning

Introduction: Post-Traumatic Stress Disorder (PTSD) is a condition characterised by several disturbances in an individual's executive functioning. We were interested in the link between executive functions and the presence of anxiety and depression in a clinical population with post-traumatic stress disorder.Methods: Our sample comprised 180 participants divided into three groups: 60 with PTSD, 60 trauma-exposed without PTSD, and 60 controls. All participants were assessed on the following dimensions: PTSD, dissociation, executive functions, anxiety, and depression.Results: Consistent with the literature, the results of our study suggest that individuals with PTSD have difficulties in executive functioning. These disturbances are related to levels of anxiety and depression.Conclusion: The severity of PTSD is positively correlated with executive function disturbances, but the observed disturbances, especially in working memory updating, can be explained mainly by the high level of depression, rather than by PTSD alone.

Mental and Physical Health Correlates for Emotional Intimate Partner Violence Perpetration and Victimization: A Meta-Analysis

Approximately 50% of both men and women will experience emotional intimate partner violence (IPV) in their lifetime-a form of violence highly associated with other forms of IPV-making it important to develop further understanding of for assessment and treatment purposes. The bio-psycho-social model was used to guide the study. Utilizing data from 181 studies, yielding 348 effect sizes, we conducted a meta-analysis examining mental and physical health correlates with emotional IPV perpetration and victimization. We also examined if mental and physical health correlates were significantly stronger for emotional IPV perpetration or victimization, as well as if correlates were stronger for men or women. Suicidal ideation, post-traumatic stress, anxiety, depressive symptoms, borderline personality disorder (PD), psychological distress, physical pain, trauma, anger, shame, poor physical health, antisocial PD, and somatic symptoms were significantly associated with emotional IPV victimization. Borderline PD, narcissism, emotional dysregulation, anger, post-traumatic stress, antisocial PD, psychopathy, depressive symptoms, anxiety symptoms, and trauma were significantly associated with emotional IPV perpetration. Anger, emotional dysregulation, and psychopathology were stronger correlates for emotional IPV perpetration compared to victimization, and post-traumatic stress disorder (PTSD) and psychological distress were stronger correlates for victimization. PTSD and suicidal ideation were stronger correlates of IPV victimization for women than men, and anger was a significantly stronger correlate of IPV perpetration for women than men. This study highlights the importance of a holistic approach when working with victims and perpetrators of IPV, focusing on the importance of taking all aspects of the bio-psycho-social model into account.

Gender Differences in Body Satisfaction Perception: The Role of Nutritional Habits, Psychological Traits, and Physical Activity in a Strength-Training Population

The objective of this study is to examine gender disparities in body satisfaction perception, emphasizing the influence of nutritional habits, psychometric assessments, levels of physical activity, and health-related metrics. Employing a sample of 605 strength-trained participants (385 males and 224 females), aged between 20 and 35 years, and regularly engaged in strength training, we conducted a thorough analysis using Google Forms. We evaluated variables including age, anthropometric data, resistance training frequency, food consumption patterns, and psychological profiles. Our findings indicate significant gender-based differences in body satisfaction perception. Females tend to overestimate their muscular size and express heightened concern regarding gluteal shape, while males exhibit a more realistic self-perception, primarily focused on hip width. Dietary patterns also display gender-specific tendencies; females prefer healthier options like vegetables, whereas males consume more milk, fermented products, and carbohydrates. Hydration practices diverge as well, with females showing higher water intake in contrast to males' preference for alcoholic and carbonated beverages. Psychologically, males demonstrate greater extroversion, while females exhibit higher conscientiousness, openness, and a tendency toward negative thoughts and anxiety. Regarding physical activity, females engage in training sessions with greater volume compared to males. This study highlights the intricate interplay of social, cultural, and personal factors shaping gender-specific perceptions of body satisfaction and their subsequent impact on health and lifestyle choices. These insights pave the way for future specialized interventions and research, underscoring the importance of understanding gender-specific nuances to promote healthy body satisfaction and self-perception.

Influence of gender identity on the adoption of religious-spiritual, preventive and emotion-focused coping strategies during the COVID-19 pandemic in Pakistan

BACKGROUND

Academic research has highlighted the gendered impacts and amplifications of gender disparities of COVID-19. Traditionally, Pakistan is a patriarchal society, where it is a parenthood norm to socialize specific gender social roles.

OBJECTIVES

The current research asserts that these normative gender roles may influence individuals throughout their life course, even during the COVID-19 pandemic. Therefore, the present study explored the influence of gender identity in adopting different coping strategies such as religious-spiritual, preventive, emotion-focused and non-constructive coping against the COVID-19 pandemic.

METHODS

Due to the lockdown in various areas of Pakistan, data were collected through an online questionnaire using Qualtrics. In a cross-sectional study, 955 respondents completed responses. Factors analysis and reliability analysis were run to ensure the scales' reliability, validity and robustness for different coping strategies. Multivariate linear regression analysis was used to find model fitness.

CONCLUSIONS

For theoretical explanation, the current study used social role theory that argues that each gender benefits differently from distinct coping behaviours. The findings highlighted that women were more likely to adopt most coping strategies, with the most significant difference in religious-spiritual coping and preventative coping strategies even in the presence of control variables such as level of education, household monthly income, family structure, marital status and family size. There was no gender difference in adopting non-constructive strategies. The empirical evidence suggested that females might be at an increased risk of stress due to the burden of unbalanced household-based social norms and care responsibilities. The current research also expanded the base of coping to religious-spiritual coping, emotion-focused coping and non-constructive coping.

The Russian version of the Abbreviated Math Anxiety Scale: psychometric properties in adolescents aged 13-16 years

This study is the first to assess the internal consistency and factor validity of the Abbreviated Math Anxiety Scale (AMAS) in a sample of Russian adolescents as well as gender differences and gender invariance. The study included 4,218 adolescents in grades 7-9 (M = 14.23, SD = 0.92). Internal consistency, measured with Cronbach's alpha, was high. Analysis of the factor structure revealed the best correspondence of the second-order factor model, which included two scales (learning math anxiety and math evaluation anxiety) and the general scale of math anxiety. There were greater gender differences in the all three scales. Analysis of gender invariance demonstrated that the mathematics anxiety construct was uniform in boys and girls. These findings confirm the reliable psychometric properties and validity of the AMAS, enabling its use in adolescents.

Generalized Anxiety Disorder Associated With Gastroesophageal Reflux Disease Among the Saudi Population

Objectives In Saudi Arabia, the prevalence of generalized anxiety disorder (GAD) was reported to be 29%. As a result, our goal was to examine the association between GAD and gastroesophageal reflux disease (GERD) within the general Saudi Arabian population, as well as to access the risk factors for GAD in order to gain a better understanding. Method This cross-sectional study involved 4,224 participants who completed a questionnaire. Anxiety was assessed using the General Anxiety Disorder-7 (GAD-7) scale, and the GerdQ tool was used to evaluate GERD. Result The prevalence of anxiety among participants was 29% at cutoff 10, with 73% of anxiety-positive participants being female and only 26.9% being male. Furthermore, the associations between anxiety and GERD were significant as 31.4% of participants with anxiety had GERD, compared to 15.0% of those without anxiety. Conclusion In our finding, there was a significant association between anxiety and GERD among the general Saudi population. In terms of anxiety risk factors, female, younger age, social status, body mass index, eating fried food, caffeinated drinks, diabetes miletus, high blood cholesterol, NSAID use, antidepressants, and anti-anxiety medication were found to have a significant association.

PROTOCOL: The FRIENDS preventive programme for reducing anxiety symptoms in children and adolescents: A systematic review

This is the protocol for a Campbell systematic review. The objectives are as follows. The main objective of this review is to answer the following research question: What are the effects of the FRIENDS preventive programme on anxiety symptoms in children and adolescents? Further, the review will attempt to answer if the effects differ between participant age groups, participant socio-economic status, type of prevention (universal, selective or indicated), type of provider (lay or mental health provider), country of implementation (Australia or other countries) and implementation issues in relation to the booster sessions and parent sessions (implemented, partly implemented or not at all).

Methodological approach for an integrated female-specific study of anxiety and smoking comorbidity

Two primary ovarian hormones that fluctuate across the female menstrual cycle-estradiol and progesterone-have been independently linked in separate literatures to nicotine reinforcement and anxiety psychopathology. We identify existing methodological limitations in these literatures, describe an example protocol that was developed to address such limitations, highlight case examples, and offer insights on the resulting advantages and challenges. This protocol was an observational, prospective, within-subjects study of female cigarette smokers who were followed over the course of a complete menstrual cycle. Non-treatment seeking, female cigarette smokers (N = 50), between the ages of 18-40 who have a normal menstrual cycle (25-35 days in length) were recruited from the community. Females with anxiety or mood psychopathology represented 38.0% of the sample. Salivary progesterone and estradiol were assessed each morning via at-home saliva collection methods. Self-reported within-day momentary ratings of anxiety and nicotine reinforcement were collected using ecological momentary assessment (EMA) via a mobile app. Protocol compliance was >85%. Within- and between-subjects heterogeneity was observed in the progesterone and estradiol, anxiety, and nicotine craving measures, especially in the context of anxiety psychopathology. We aimed to integrate the anxiety and nicotine dependence literatures and advance the empirical study of the role of ovarian hormones. This protocol reflects an intensive, yet feasible approach to collecting daily-level naturalistic data related to estradiol, progesterone, anxiety, and nicotine reinforcement.

Thinking twice: examining gender differences in repetitive negative thinking across the adult lifespan

Background

A wealth of literature shows that women report greater levels of repetitive negative thinking, particularly rumination, than men in adolescence and adulthood. However, little research has examined how these gender differences develop or change across the entire adult lifespan.

Methods

The present study addresses these oversights using a nationwide longitudinal probability sample of adults over 12 annual assessment points (N = 64,901; Mage = 42.50, range 18-81; 62.9% women) and a single-item measure of global repetitive negative thinking. Critically, we use multigroup cohort-sequential latent growth modeling to determine whether changes in this construct over time are due to (a) normative aging, (b) generational differences associated with the historical period one was born and raised in, or (c) a combination of these processes.

Results

Our results reveal that rumination peaks in young adulthood for both women and men but declines steadily thereafter, reaching its lowest levels at the end of the adult lifespan. That said, some gender and cohort differences emerged, with young women-particularly young cohorts-reporting higher levels of rumination than their male counterparts and older birth cohorts.

Discussion

Our study suggests that gender differences in rumination may be most prevalent among young birth cohorts, though future research is needed to elucidate the mechanisms underlying these processes.

Morphologic alterations of the fear circuitry: the role of sex hormones and oral contraceptives

Background

Endogenous sex hormones and oral contraceptives (OCs) have been shown to influence key regions implicated in fear processing. While OC use has been found to impact brain morphology, methodological challenges remain to be addressed, such as avoiding selection bias between OC users and non-users, as well as examining potential lasting effects of OC intake.

Objective

We investigated the current and lasting effects of OC use, as well as the interplay between the current hormonal milieu and history of hormonal contraception use on structural correlates of the fear circuitry. We also examined the role of endogenous and exogenous sex hormones within this network.

Methods

We recruited healthy adults aged 23-35 who identified as women currently using (n = 62) or having used (n = 37) solely combined OCs, women who never used any hormonal contraceptives (n = 40), or men (n = 41). Salivary endogenous sex hormones and current users' salivary ethinyl estradiol (EE) were assessed using liquid chromatography - tandem mass spectrometry. Using structural magnetic resonance imaging, we extracted surface-based gray matter volumes (GMVs) and cortical thickness (CT) for regions of interest of the fear circuitry. Exploratory whole-brain analyses were conducted with surface-based and voxel-based morphometry methods.

Results

Compared to men, all three groups of women exhibited a larger GMV of the dorsal anterior cingulate cortex, while only current users showed a thinner ventromedial prefrontal cortex. Irrespective of the menstrual cycle phase, never users exhibited a thicker right anterior insular cortex than past users. While associations with endogenous sex hormones remain unclear, we showed that EE dosage in current users had a greater influence on brain anatomy compared to salivary EE levels and progestin androgenicity, with lower doses being associated with smaller cortical GMVs.

Discussion

Our results highlight a sex difference for the dorsal anterior cingulate cortex GMV (a fear-promoting region), as well as a reduced CT of the ventromedial prefrontal cortex (a fear-inhibiting region) specific to current OC use. Precisely, this finding was driven by lower EE doses. These findings may represent structural vulnerabilities to anxiety and stress-related disorders. We showed little evidence of durable anatomical effects, suggesting that OC intake can (reversibly) affect fear-related brain morphology.

Factors Affecting Fear of COVID-19 Infection in Healthcare Workers in COVID-19 Dedicated Teams: Focus on Professional Quality of Life

This study examined factors related to high fear of coronavirus disease 2019 (COVID-19) infection in healthcare workers (HCWs) in COVID-19 dedicated teams. We assigned 371 HCWs to low, medium, and high COVID-19 infection fear groups, and investigated factors associated with COVID-19 infection fear. High COVID-19 infection fear was significantly associated with being a woman and poor professional quality of life. High COVID-19 infection fear group had higher burnout levels and secondary traumatic stress scores than the low and medium fear groups. These findings deepen our understanding of risk factors for and psychological outcomes of COVID-19 infection fear in HCWs.

A replication and extension of bifactor modelling of perseverative thought in an at-risk community sample: Exploring sex differences in the structure of PT

BACKGROUND

Perseverative thought (PT) is a transdiagnostic construct associated with internalizing disorders. Bifactor models have shown that PT can be split into a general PT factor and lower-order factors for specific forms of PT, such as rumination and worry. No bifactor study to date has investigated if the structure of PT differs across sexes.

METHODS

The study consisted of 280 individuals recruited for a larger study targeting risk factors for suicidal ideation and behaviours. Participants completed a diagnostic interview and self-report questionnaires.

RESULTS

A two-factor model of PT fit best in males, whereas a bifactor model fit best in females. In a structural equation model, worry was associated with generalized anxiety disorder diagnoses in females, but not males. Rumination was associated with depressive disorder diagnoses in females, but not males.

CONCLUSIONS

The present study contributes to a growing literature on PT; we found that dimensionality of PT varied by sex. We also found that relations between PT factors and generalized anxiety disorder differed by sex. Sex differences in the internalizing spectrum and related risk factors need to be considered when examining the structure and function of risk factors.

A mixed-methods review and meta-synthesis of fears of recurrence and progression in people with mental health conditions

A fear that one's physical illness will recur or worsen has received substantial research attention over the past decade, most notably as fear of cancer recurrence. Indeed, such fear is known to be associated with poorer quality of life, adjustment, and psychopathology. However, fear of a recurrence or progression (FORP) of mental health conditions has received comparatively little study. The present review aimed to, 1) systematically review quantitative research on FORP in mental health regarding its association with age, gender, quality of life, mental health outcomes, and health behaviours, and 2) meta-synthesize qualitative research related to FORP to construct a transdiagnostic model. A qualitative meta-synthesis of 19 studies identified four subthemes underlying FORP (fear of symptoms, loss of progress, fear of death, and traumatic experiences). The three themes related to FORP were: inability to trust oneself, hypervigilance, and a low-risk low-reward lifestyle which was comprised of three subthemes (limiting relationships, limiting life goals, and fear of changing treatment). A quantitative systematic review of 15 studies found that FORP was strongly associated with worse quality of life, and greater depression, anxiety, psychotic symptoms, and medication adherence, but was not associated with age or gender. Hence, FORP can be understood transdiagnostically, and is generally associated with poorer mental health outcomes but may also predict adaptive health behaviours, such as appropriate medication adherence.

The Relationship Between Fear and Anxiety Among Chinese Uninfected Residents During the Pandemic: A Conditional Process Analysis

Background

This study aimed to explore the relationship between residents' COVID-19 fear and anxiety, consider whether this relationship is mediated through obsessions and the moderating role of self-efficacy on this mediating pathway.

Methods

This study used an online questionnaire to obtain and assess fear, obsession, anxiety and self-efficacy in 1589 Chinese COVID-19 uninfected residents. A conditional process model was used to examine the relationships between variables.

Results

Higher levels of fear were positively associated with obsession and anxiety. In addition, obsession was positively associated with anxiety, while self-efficacy attenuated the effect of fear on obsession and further mitigated the indirect effect of fear on anxiety through obsession.

Conclusion

During the COVID-19 outbreak, uninfected residents suffered varying degrees of psychological distress. COVID-19 fear may have an effect on anxiety in COVID survivors through obsession, and self-efficacy as a protective factor for individual mental health partially attenuates the effect of COVID-19 fear on obsession and the indirect effect of fear on anxiety.

Inactivation of medial or lateral orbitofrontal cortex during fear extinction did not interfere with fear renewal

Hyperactive orbitofrontal cortical activation is commonly seen in patients of obsessive-compulsive disorder (OCD). Previous studies from our laboratory showed that for rats with aberrant activation of the orbitofrontal cortex (OFC) during the extinction phase, they were unable to use contexts as the reference for proper retrieval of fear memory during renewal test. This result supported the phenomenon that many OCD patients show poor regulation of fear-related behavior. Since there are robust anatomical connections of the OFC with the fear-circuit, we aim to further examine whether the OFC is actively engaged in fear regulation under normal circumstances. In this study, the lateral or medial OFC was inactivated during the extinction phase using the ABA fear renewal procedure. We found that these animals showed intact fear renewal during retrieval test with their freezing levels equivalent to the control rats, revealing that the OFC did not have decisive roles in extinction acquisition. Together with our previous study, we suggest that the OFC only interferes with fear regulation when it becomes pathophysiologically hyperactive.

Lysergic Acid Diethylamide (LSD) for the Treatment of Anxiety Disorders: Preclinical and Clinical Evidence

Anxiety disorders (ADs) represent the sixth leading cause of disability worldwide, resulting in a significant global economic burden. Over 50% of individuals with ADs do not respond to standard therapies, making the identification of more effective anxiolytic drugs an ongoing research priority. In this work, we review the preclinical literature concerning the effects of lysergic acid diethylamide (LSD) on anxiety-like behaviors in preclinical models, and the clinical literature on anxiolytic effects of LSD in healthy volunteers and patients with ADs. Preclinical and clinical findings show that even if LSD may exacerbate anxiety acutely (both in "microdoses" and "full doses"), it induces long-lasting anxiolytic effects. Only two randomized controlled trials combining LSD and psychotherapy have been performed in patients with ADs with and without life-threatening conditions, showing a good safety profile and persisting decreases in anxiety outcomes. The effect of LSD on anxiety may be mediated by serotonin receptors (5-HT1A/1B, 5-HT2A/2C, and 5-HT7) and/or transporter in brain networks and circuits (default mode network, cortico-striato-thalamo-cortical circuit, and prefrontal cortex-amygdala circuit), involved in the modulation of anxiety. It remains unclear whether LSD can be an efficacious treatment alone or only when combined with psychotherapy, and if "microdosing" may elicit the same sustained anxiolytic effects as the "full doses". Further randomized controlled trials with larger sample size cohorts of patients with ADs are required to clearly define the effective regimens, safety profile, efficacy, and feasibility of LSD for the treatment of ADs.

Young men and anxiety: Resisting, reckoning and responding

Anxiety is the most prevalent mental disorder experienced by young men, and when untreated, is predictive of co-morbid mental health challenges and suicide. Despite the rising prevalence, there is a conspicuous absence of qualitative research to distil and theorise young men's anxiety. Twenty-five young Australian men (15-25 years), who had been diagnosed with an anxiety disorder or self-reported anxiety symptoms, took part in individual semi-structured interviews. Interviews were transcribed verbatim and analysed using a constructivist grounded theory approach. A three-process grounded theory (Resisting-Reckoning-Responding; Triple R Anxiety Model) depicted young men's experiences of anxiety, gilded and guided by their masculine socialisation. Initially, young men noticed somatic symptoms (i.e., headaches, nausea and myalgia) but did not connect these symptoms to anxiety. Avoiding anxiety (e.g., denying, distracting) proved unhelpful in the longer term and as symptoms diffused, a subsequent process of reckoning anxiety (i.e., meaning making) ensued. As young men gained insight to the life limiting bounds of their anxiety, some were prompted towards actions of acceptance, seeking help proactively and employing strength-based adaptive coping strategies. This theoretical conceptualisation of young men's anxiety has the capacity to enhance identification and treatment efforts, improving young men's mental health outcomes across the lifespan.

Prevalence and risk factors of anxiety and depression in adult patients with epilepsy: a multicenter survey-based study

Background

Depression and anxiety are the most common psychiatric comorbidities in patients with epilepsy (PWE). However, they are often unrecognized and consequently untreated.

Objective

The study was conducted to evaluate the prevalence and risk factors of anxiety and depression among Chinese adult PWE.

Design

Cross-sectional study.

Methods

Adult PWE were recruited from 13 tertiary epilepsy centers from February to September 2022. Generalized Anxiety Disorder-7 and Neurological Disorders Depression Inventory for Epilepsy were applied to evaluate anxiety and depression, respectively. Both univariate and multivariate logistic regression analyses models were performed to explore the risk factors of anxiety and depression.

Results

A total of 1326 PWE were enrolled in this study. The prevalence of anxiety and depression was 31.45% and 27.30%, respectively. Being female [odds ratio (OR) = 1.467, 95% CI: 1.134-1.899; p = 0.004], focal and focal to bilateral tonic-clonic seizures (TCSZ) (OR = 1.409, 95% CI: 1.021-1.939; p = 0.036), and seizure occurrence in the last 3 months (OR = 1.445, 95% CI: 1.026-2.044; p = 0.036) were the risk factors for anxiety. Focal and focal to bilateral TCSZ (OR = 1.531, 95% CI: 1.094-2.138; p = 0.013) and seizure occurrence in the last 3 months (OR = 1.644, 95% CI: 1.130-2.411; p = 0.010) were the risk factors for depression. In addition, for every 1-year increment of age, the odds of developing depression were decreased by 3.8% (p = 4.12e-5). Nevertheless, up to 70% of PWE did not receive any treatment for comorbidity.

Conclusion

There were approximately 30% of PWE screened positive for anxiety or depression. Both focal and focal to bilateral TCSZ and seizure occurrence in the last 3 months were estimated as risk factors for anxiety and depression. However, the current status of treatment was not optimal.

Psychological Reactions during and after a Lockdown: Self-Efficacy as a Protective Factor of Mental Health

The aim of the present study was to investigate the effects of home confinement/social isolation (i.e., lockdown), imposed to reduce large-scale spread of a disease in the population, on the mental health of individuals. Through an online survey during the lockdown (DL) related to COVID-19 (1085 respondents, 627 females, agerange: 18-82) (Italy, 23 April-2 May 2020), we revealed that situational factors, i.e., the presence of children at home and female gender, and psychological factors, i.e., a greater sense of isolation, lower perception of safety outside the home and higher trait anxiety, predicted higher levels of state anxiety (R2 = 0.58). The same factors, but with young age instead of the presence of children, predicted higher levels of perceived stress (R2 = 0.63). Then, these data were compared with those collected after the lockdown (AL) (174 respondents, 128 females, agerange: 19-78) (Italy, 1 July-31 October 2021). The results showed that along with a reduced sense of isolation (DL = 2.90 vs. AL = 2.10) and an increased perception of safety outside the home (DL = 2.63 vs. AL = 3.05), a reduction in state anxiety (DL = 45.76 vs. AL= 40.88) and stress appeared (DL = 18.84 vs. AL = 17.63). However, the situation was better for men than for women. Perceived self-efficacy emerged as a protective factor for mental health (R2range: 0.03-0.27). The results are discussed in light of the evidence on the effects of lockdown on individuals worldwide. These results may be used to make more educated decisions on targeted help for individuals who may be most adversely affected by the adoption of lockdowns in the future.

Linking sedentary behavior and mental distress in higher education: a cross-sectional study

Background

Sedentary behavior among university students could negatively affect their mental health.

Objective

The aim of this study was to examine the relationship of mental health (anxiety and depression) and sedentary behavior between gender in Health Degrees at the University of Zaragoza.

Design

Cross-sectional descriptive study.

Participants

Sample of 257 University students who completed an online questionnaire.

Methods

Sedentary behavior was assessed with the SBQ questionnaire. Anxiety and depression were assessed with the GADS questionnaire. The Mann-Whitney U test and multiple linear regression models were used.

Results

In comparison to men, female students with symptoms of anxiety spend more time in total engaged in sedentary behaviors (10.56 ± 4.83) vs. (7.8 ± 3.28; p < 0.001) and mentally-passive sedentary activities [2.24 (1.57) vs. 1.15 (0.90; p < 0.005)]. Female students at risk of depression also spend more hours engaged in mentally-passive sedentary behaviors in comparison to men (8.28 ± 50.70 vs. 1.27 ± 1.02; p = 0.009).

Conclusion

Female students at risk of anxiety and/or depression spend more time engaged in sedentary activities in comparison to male students. The risk of anxiety and depression is associated with the total number of hours a day spent engaged in sedentary behaviors and with mentally passive behaviors, but not mentally active behaviors.

Ambivalent toward life, ambivalent toward psychotherapy? An investigation of the helping alliance, motivation for treatment, and control expectancies in patients with suicidal ideation in inpatient psychotherapy

BACKGROUND

Research has found that patients with suicidal ideation (SI) are at high risk for unfavorable outcomes. The present work aimed to expand the knowledge about their characteristics and treatment success.

METHODS

Data were drawn from a routine assessment of N = 460 inpatients. We used patients' self-report data as well as therapists' reports covering baseline characteristics, depression and anxiety symptoms (at the start and end of therapy), psychosocial stress factors, helping alliance, treatment motivation, and treatment-related control expectancies. In addition to group comparisons, we conducted tests of associations with treatment outcome.

RESULTS

SI was reported by 232 patients (50.4% of the sample). It co-occurred with higher symptom burden, more psychosocial stress factors, and negation of help. Patients reporting SI were more likely to be dissatisfied with the treatment outcome (although their therapists were not). SI was related to higher levels of anxiety symptoms after treatment. In regression models of depression and anxiety symptoms, interactions of SI with the external control expectancy powerful others were observed, suggesting that in patients with frequent SI, this control expectancy hindered recovery.

DISCUSSION/CONCLUSION

Patients reporting SI are a vulnerable group. Therapists could support them by addressing (potentially conflicting) motivations and control expectancies.

Factors associated with perceived fear of future pandemics and/or epidemics: a cross-sectional study in Cyprus

This study aims to understand the levels of fear experienced by individuals regarding future pandemics and/or epidemics among the general population of Cyprus and comprehensively examine the diverse factors that influence this perceived fear. The cross-sectional study was conducted from October 1st, 2022, to February 19th, 2023. A proportionate quota sampling method was used for the recruitment, by recruiting a fixed number of participants from each age group, sex, and place of residence. The study collected information on sociodemographic and health-related characteristics, health literacy, trust, COVID-19 vaccination information, and perceived fear of future epidemics and/or pandemics using a self-administered questionnaire. The survey included 1075 participants, with 53.7% of them reporting fear of future pandemics. Logistic regression analysis revealed that women (OR = 2.37, 95% CI 1.78, 3.16) and individuals vaccinated against COVID-19 (OR = 1.57, 95% CI 1.02, 2.43) were significantly more likely to experience fear of future pandemics. Moreover, higher levels of trust (OR = 1.04, 95% CI 1.02, 1.06) and higher health literacy (OR = 1.05, 95% CI 1.03, 1.08) were associated with an increased likelihood of fearing future pandemics. Conversely, unemployment (OR = 0.30, 95% CI 0.13, 0.65) and having a postgraduate education decreased the likelihood of fearing future pandemics (OR = 0.56, 95% CI 0.34, 0.90). The linear regression model revealed that older age (β = - 0.10, 95% CI - 0.14, - 0.05) was negatively associated with a higher score of fear regarding future pandemics. Conversely, being in a vulnerable group (β = 2.02, 95% CI 0.75, 3.28) and having at least one chronic disease (β = 1.76, 95% CI 0.68, 2.84) showed positive associations with increased fear of future epidemics and/or pandemics. The findings emphasize the need for relevant authorities to prioritize mental health and disseminate information in a manner that avoids spreading fear and panic, particularly among vulnerable population groups.

Contact with Nature in Social Deprivation during COVID-19: The Positive Impact on Anxiety

The 2019 outbreak of the novel coronavirus disease (COVID-19) had a devastating impact on millions of people worldwide. Following the constantly changing course of the pandemic, the Italian government massively restricted public and private life to prevent the further spread of the virus. Unfortunately, lockdown policies negatively impacted many people's mental and physical health. Numerous studies recognized an essential role of urban green areas in promoting human well-being. The present study aims to evaluate the effect of personal dispositions towards nature, measured using the connectedness to nature scale (CNS) and actual contact with green spaces (CwN) on human well-being (i.e., anxiety) and medicine intake during COVID-19 lockdowns. A total of 637 Italian residents answered a survey aimed at gathering information about the above variables. A series of path analyses were performed. The results showed that the CNS was positively associated with the CwN, and the latter, in turn, was negatively associated with anxiety. Finally, anxiety was positively related to medicine intake. In sum, these results identify the positive role of person-nature relationships for individual well-being during COVID-19 restrictions.

Sex, anxiety and the interplay with physiological variables of stress: a clinical study of patients about to undergo bronchoscopy

Women often report more anxiety than men, but there are divergent results regarding the putative correlation between physiological variables, such as cortisol, blood pressure and heart rate and the experienced emotional states. The aim of the present study was to evaluate sex differences in anxiety, and the relation to serum cortisol, blood pressure and heart rate. We used data from two pooled studies with participants from the same population (N = 405) facing a real-life stressor, bronchoscopy, as part of examination for lung cancer. At admission, blood pressure and heart rate were recorded, and a blood sample was taken for analysis of serum cortisol. Participants then completed Spielberger's State Trait Anxiety Inventory (STAI). Patients had elevated anxiety measured with STAI state compared to relevant age and sex stratified norm scores. Women had significantly higher STAI state score than men (M = 44.9, SD = 13.2 vs M = 36.2, SD = 10.7; t(403) = 7.25, p < 0.001). Mean serum cortisol, systolic blood pressure and heart rate showed no significant sex difference. There was a weak but significant correlation between state anxiety and heart rate and cortisol but none between blood pressure and anxiety. This study adds an important confirmation of sex differences in anxiety in a real-life setting, where women report significantly more anxiety than men do. However, the physiological markers only show a weak link with experienced anxiety, and exhibit no sex differences.

The effects of everyday-life social interactions on anxiety-related autonomic responses differ between men and women

Social buffering, a phenomenon where social presence can reduce anxiety and fear-related autonomic responses, has been studied in numerous laboratory settings. The results suggest that the familiarity of the interaction partner influences social buffering while also providing some evidence for gender effects. In the laboratory, however, it is difficult to mimic the complexity of real-life social interactions. Consequently, the social modulation of anxiety and related autonomic responses in everyday life remains poorly understood. We used smartphone-based Ecological Momentary Assessment (EMA) combined with wearable electrocardiogram sensors to investigate how everyday-life social interactions affect state anxiety and related cardiac changes in women and men. On five consecutive days, 96 healthy young participants (53% women) answered up to six EMA surveys per day, indicating characteristics of their most recent social interaction and the respective interaction partner(s). In women, our results showed lower heart rate in the presence of a male interaction partner. Men showed the same effect with female interaction partners. Moreover, only women showed decreased heart rate and increased heart rate variability with increasing interaction partner familiarity. These findings specify the conditions under which social interactions reduce anxiety-related responses in women and men.

Individual and Contextual Variables as Predictors of MRI-Related Perceived Anxiety

BACKGROUND

Magnetic resonance imaging (MRI) generates patient anxiety (PA) and, therefore, it is important to understand individual and contextual variables that may cause it. In study one, we explored those anxiety predictors. In study two, we examined the effect of the experience of MRI on PA comparing anxiety pre- to post-MRI.

METHODS

PA was measured with an anxiety and stress scale in an interview format. Data collection occurred at a public hospital with MRI outpatients aged 18 or older. In study one (n = 204), participants answered the questionnaire immediately after experiencing the MRI and the data were analyzed through structural equation modeling. In study two (n = 242), participants answered the questionnaire before and after the examination and the data were analyzed through Bayesian statistics.

RESULTS

Being female, having a higher education level (EL), and not receiving information about the examination predicts higher PA after MRI. Patients with prior information have a decrease in PA from pre- to post-MRI. Those who do not have no change in PA. In low-educated patients, PA also decreases and no changes occur in highly educated patients.

CONCLUSION

This study provides health professionals with valuable indicators about patients who are more likely to perceive and express anxiety during MRI.

Functional neuroimaging of resilience to trauma: convergent evidence and challenges for future research

Resilience is broadly defined as the ability to adapt successfully following stressful life events. Here, we review functional MRI studies that investigated key psychological factors that have been consistently linked to resilience to severe adversity and trauma exposure. These domains include emotion regulation (including cognitive reappraisal), reward responsivity, and cognitive control. Further, we briefly review functional imaging evidence related to emerging areas of study that may potentially facilitate resilience: namely social cognition, active coping, and successful fear extinction. Finally, we also touch upon ongoing issues in neuroimaging study design that will need to be addressed to enable us to harness insight from such studies to improve treatments for - or, ideally, guard against the development of - debilitating post-traumatic stress syndromes.

Racial discrimination and 12-month and lifetime anxiety disorders among African American men and women: Findings from the National Survey of American Life

BACKGROUND

The purpose of this study was to assess the associations between racial discrimination and 12-month and lifetime DSM-IV anxiety disorders among African American men and women.

METHODS

Data was drawn from the African American sample of the National Survey of American Life (N = 3570). Racial discrimination was assessed with the Everyday Discrimination Scale. 12-month and lifetime DSM-IV outcomes were any anxiety disorder, posttraumatic stress disorder (PTSD), generalized anxiety disorder (GAD), panic disorder (PD), social anxiety disorder (SAD), and agoraphobia (AG). Logistic regressions were utilized to assess the relationships between discrimination and anxiety disorders.

RESULTS

The data indicated that racial discrimination was associated with increased odds for 12-month and lifetime anxiety disorders, AG, and PD and lifetime SAD among men. Regarding 12-month disorders among women, racial discrimination was associated with increased odds for any anxiety disorder, PTSD, SAD, and PD. With respect to lifetime disorders among women, racial discrimination was associated with increased odds for any anxiety disorder, PTSD, GAD, SAD, and PD.

LIMITATIONS

The limitations of this study include the utilization of cross-sectional data, self-reported measures, and the exclusion of non-community dwelling individuals.

CONCLUSIONS

The current investigation showed that African American men and women are not impacted by racial discrimination in the same ways. These findings suggest that the mechanisms through which discrimination operates among men and women to influence anxiety disorders is potentially a relevant target for interventions to address gender disparities in anxiety disorders.

Sex differences in anxiety and threat avoidance in GAD65 knock-out mice

Anxiety disorders have been linked to a disbalance of excitation and inhibition in a network of brain structures comprising frontal cortical regions, the amygdala and the hippocampus, among others. Recent imaging studies suggest sex differences in the activation of this anxiety network during the processing of emotional information. Rodent models with genetically altered ϒ-amino butyric acid (GABA) neurotransmission allow studying the neuronal basis of such activation shifts and their relation to anxiety endophenotypes, but to date sex effects have rarely been addressed. Using mice with a null mutation of the GABA synthetizing enzyme glutamate decarboxylase 65 (GAD65-/-), we started to compare anxiety-like behavior and avoidance in male vs. female GAD65-/- mice and their wildtype littermates. In an open field, female GAD65-/- mice displayed increased activity, while male GAD65-/- mice showed an increased adaptation of anxiety-like behavior over time. GAD65-/- mice of both sexes had a higher preference for social interaction partners, which was further heightened in male mice. In male mice higher escape responses were observed during an active avoidance task. Together, female mice showed more stable emotional responses despite GAD65 deficiency. To gain insights into interneuron function in network structures controlling anxiety and threat perception, fast oscillations (10-45 Hz) were measured in ex vivo slice preparations of the anterior cingulate cortex (ACC). GAD65-/- mice of both sexes displayed increased gamma power in the ACC and a higher density of PV-positive interneurons, which are crucial for generating such rhythmic activity. In addition, GAD65-/- mice had lower numbers of somatostatin-positive interneurons in the basolateral amygdala and in the dorsal dentate gyrus especially in male mice, two key regions important for anxiety and active avoidance responses. Our data suggest sex differences in the configuration of GABAergic interneurons in a cortico-amygdala-hippocampal network controlling network activity patterns, anxiety and threat avoidance behavior.

Sex Differences in Opioid Response Linked to OPRM1 and COMT genes DNA Methylation/Genotypes Changes in Patients with Chronic Pain

Analgesic-response variability in chronic noncancer pain (CNCP) has been reported due to several biological and environmental factors. This study was undertaken to explore sex differences linked to OPRM1 and COMT DNA methylation changes and genetic variants in analgesic response. A retrospective study with 250 real-world CNCP outpatients was performed in which data from demographic, clinical, and pharmacological variables were collected. DNA methylation levels (CpG island) were evaluated by pyrosequencing, and their interaction with the OPRM1 (A118G) and COMT (G472A) gene polymorphisms was studied. A priori-planned statistical analyses were conducted to compare responses between females and males. Sex-differential OPRM1 DNA methylation was observed to be linked to lower opioid use disorder (OUD) cases for females (p = 0.006). Patients with lower OPRM1 DNA methylation and the presence of the mutant G-allele reduced opioid dose requirements (p = 0.001), equal for both sexes. Moreover, COMT DNA methylation levels were negatively related to pain relief (p = 0.020), quality of life (p = 0.046), and some adverse events (probability > 90%) such as constipation, insomnia, or nervousness. Females were, significantly, 5 years older with high anxiety levels and a different side-effects distribution than males. The analyses demonstrated significant differences between females and males related to OPRM1 signalling efficiency and OUD, with a genetic-epigenetic interaction in opioid requirements. These findings support the importance of sex as a biological variable to be factored into chronic pain-management studies.