The relationship between levels of self-esteem and the development of depression in young adults with mild depressive symptoms

Coupling Bio-Resonance Neurotechnology (BRNT) and Dual Hemispheric Repetitive Transcranial Magnetic Stimulation (rTMS) Reduces Comorbid Major Depressive Disorder (MDD) and Generalized Anxiety Disorder (GAD) as Demonstrated by PHQ-9 and GAD-7: Pilot Case Series

Major Depressive Disorder (MDD) and Generalized Anxiety Disorder (GAD) are prevalent comorbidities related to a greater likelihood of poor treatment outcomes and prolonged treatment for Reward Deficiency Syndrome (RDS) behaviors. The current exploratory case study of a small cohort (n=3; f=2 m=1) used novel neurotechnology to treat co-occurring MDD and GAD with a multifaceted intervention that combines the novel bio-resonance neurotechnology (BRNT) referred to as NuCalm®, to restore autonomic nervous system balance and dual hemispheric repetitive transcranial magnetic stimulation (rTMS) of the ipsilateral Dorsal Lateral Prefrontal Cortex (DLPFC) to treat the disrupted structural components of the brain. Neuroacoustic brainwave entrainment, electromagnetic frequency bio-resonance, and light-blocking combine to place patients into a parasympathetic dominant state. The paired t-tests indicated a significant decrease in comparing before and after the intervention. The Patient Health Questionnaire PHQ-9 scores from the first to the last time-point (mean difference = 20, t(2) = 6.55, p = 0.0226), with a 95% confidence interval of mean difference ranging from 6.86 to 33.14. Similarly, there was a significant decrease in General Anxiety Disorder GAD-7 questionnaire scores from the first to the last time point (mean difference = 18.67, t(2) = 12.85, p = 0.0060), with a 95% confidence interval of the mean difference ranging from 12.42 to 24.92. After applying the Bonferroni correction, the corrected p-values for PHQ-9 and GAD-7 are 0.0452 and 0.0120, respectively. Cohen's d standardized effect size indicated that the main effect size was 5.47 and 13.8 times the noise (variability), respectively, for the initial versus final PHQ-9 and GAD-7. Further, more extensive, much larger sham-controlled and blinded studies are required to confirm these encouraging results and explore this multifaceted intervention.

The Impact of Anxiety and Depressive Symptomatology on Greek Practicing Lawyers' Self-Esteem

BACKGROUND/OBJECTIVES

This study examines the impact of anxiety and depressive symptomatology on self-esteem among Greek practicing lawyers. The high-stress environment of the legal profession is known to heighten the risk of mental health issues, yet limited research exists on Greek lawyers. The study aims to explore associations between anxiety, depressive symptoms, and self-esteem, hypothesizing that increased anxiety and depression correlate with reduced self-esteem.

METHOD

The study utilized a correlational design with a sample of 80 Greek lawyers, recruited through professional associations. Participants completed the Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), and Rosenberg Self-Esteem Scale (RSES). Descriptive statistics, correlation analysis, and multiple regression were used to assess the relationships between anxiety, depression, and self-esteem.

RESULTS

The findings indicated significant negative correlations between self-esteem and both depressive (r = -0.631, p < 0.001) and anxiety symptoms (r = -0.405, p < 0.001). Multiple regression analysis demonstrated that both depression (β = -0.558, p < 0.001) and anxiety (β = -0.225, p = 0.014) were significant predictors of lower self-esteem, explaining approximately 44% of the variance in self-esteem scores.

CONCLUSIONS

The study concludes that higher levels of anxiety and depressive symptoms significantly lower self-esteem among Greek lawyers, underscoring the need for mental health support within this profession. Addressing mental health issues in legal professionals may promote better self-esteem and overall well-being, with potential benefits for both lawyers and their clients.

Exploring the association between mental health climate and depression: the protective role of positive mental health and sense of belonging among Black college students

Objective: To explore relationships between mental health climate, positive mental health, sense of belonging, and depression among a U.S. national sample of Black college students. Participants: 1303 Black undergraduate and graduate students from 15 colleges and universities throughout the U.S. Methods: Data were from the 2018-2019 Healthy Minds Study. Analysis included hierarchical regression models. Results: A more positive perception of mental health climate and higher levels of both positive mental health and sense of belonging were significantly associated with lower levels of depression. Significant interactions existed between positive mental health and climate and sense of belonging and climate with buffering effects being most pronounced for students reporting high levels of positive mental health. Conclusion: Black college students' perceptions of an institution's mental health climate are associated with psychological outcomes. College health stakeholders should consider the buffering effects of protective factors on mental health when designing initiatives for Black college students.

Substance Use and Mental Health in Emerging Adult University Students Before, During, and After the COVID-19 Pandemic in Mexico: A Comparative Study

BACKGROUND

The COVID-19 pandemic significantly impacted mental health and substance use patterns, particularly among young adults.

OBJECTIVE

This study aimed to assess changes in anxiety, depression, self-esteem, and substance use among university students in Mexico before, during, and after the pandemic.

METHODS

Using a repeated cross-sectional design, this study was conducted with university students in Mexico across three periods: pre-pandemic (2017 and 2019); during the pandemic (2021); and post-pandemic (2023). A total of 2167 students were interviewed during one of the three periods. Standardized scales measured anxiety, depression, self-esteem, Erotic Response and Sexual Orientation Scale (EROS), and substance use.

RESULTS

showed a marked and significant increase in the proportion of students with anxiety (40.0%, 71.7%, and 79.6%) and depression (14.4%, 61.9%, and 62.6%) during the pre-pandemic, pandemic, and post-pandemic periods, respectively. Self-esteem significantly decreased during and after the pandemic, compared to pre-pandemic, particularly among females. The proportion of students categorized as moderate/high-risk for their substance use changed over time, showing a reduction in alcohol use (from 29.9% to 20.2%) and tobacco use (from 26.0% to 18.2%) but an increase in sedative use (from 7.1% to 11.7%), before vs after the pandemic, respectively. Multivariate analysis revealed that anxiety, low self-esteem, and increased sedative use were consistently linked to a heightened risk of depression during and after the pandemic. Notably, anxiety and depression levels remained in a proportion significantly elevated even in the post-pandemic period.

CONCLUSIONS

These findings underscore the enduring impact of the COVID-19 pandemic on the mental health of university students, highlighting the urgent need for targeted interventions, early detection strategies, and customized educational programs to effectively support students' mental well-being in the ongoing post-pandemic era.

The relationship between academic procrastination and anxiety symptoms among medical students during the COVID-19 pandemic: exploring the moderated mediation effects of resilience and social support

BACKGROUND

Medical students have experienced increased anxiety symptoms during the pandemic of COVID-19. However, there is a paucity of investigation on the effect of academic procrastination, and personal resources (such as social support and resilience) on anxiety symptoms among this population.

OBJECTIVE

The main objective of this research was to evaluate the link between academic procrastination and anxiety symptoms among medical students during the pandemic of COVID-19 and clarify how resilience and social support mediate or moderate the relations between academic procrastination and anxiety symptoms.

METHODS

With a cross-sectional stratified sampling, 595 participants completed a self-administered questionnaire to assess anxiety symptoms and associated factors. The study used the Generalized Anxiety Disorder 7-item Scale (GAD-7 cutoff ≥ 10), the Academic Procrastination Scale (PASS), Connor Davidson Resilience Scale (CD-RISC),and Perception Social Support Scale for measurements.

RESULTS

The results of the study showed that 26.4% (157/595) of medical students exhibited symptoms of anxiety. Regression analysis revealed an inverse relationship between resilience, social support, and anxiety symptoms (β = -0.058, P < 0.05). As revealed by the analysis results, the study found a total effect of 0.338, a direct effect of 0.270, and resilience exhibited a mediating effect of 0.068. The direct effect (0.270) accounted for 79.59% of the total effect (0.338), while the mediating effect (0.068) contributed to 20.12% of the total effect (0.338). This further supports the role of psychological resilience in mediating the link between academic procrastination and anxiety symptoms.

CONCLUSION

The study implies that promoting resilience may be an effective intervention to lessen the detrimental consequences of academic procrastination on anxiety symptoms, and social support might provide a defense against the negative influence of academic procrastination on anxiety symptoms.

The reciprocal relationship between depressive symptoms and deliberate self-harm among Chinese rural adolescents: a cross-lagged panel analysis

Background

While the association between depressive symptoms and deliberate self-harm in adolescence is extensively documented, the nature, bi-directionality, and longitudinal dynamics of this relationship remain underexplored. This study aims to investigate the causal and reciprocal relationship between depressive symptoms and deliberate self-harm among rural adolescents in western China.

Methods

A 2-year panel study was conducted among 1,840 adolescents aged 10-18 attending rural junior and senior high schools in Sichuan Province, China. The Center for Epidemiologic Studies-Depression Scale (CES-D) and a global measure of self-reported deliberate self-harm were utilized to examine the relationship between depressive symptoms and deliberate self-harm using both classic and random intercept cross-lagged panel models. Multi-group comparisons were carried out for the gender, pubertal stage, and academic performance subgroups.

Results

Positive and statistically significant correlations were found between depressive symptoms and deliberate self-harm both within and across the three waves of the panel survey, after adjusting for covariates, among rural adolescents in western China (Range: 0.05-0.28, p < 0.05). As anticipated, depressive symptoms positively predicted later deliberate self-harm, which in turn reciprocally predicted subsequent depressive symptoms, both between and within individuals. While the cross-lagged effects were invariant by gender and academic performance, the effect of baseline depressive symptoms on later deliberate self-harm was stronger for adolescents in the early pubertal stage (β = 0.19, 95% Confidence Interval: 0.08 to 0.30) than for those in the middle-to-late pubertal stage (β = 0.13, 95% CI: 0.06 to 0.19).

Conclusion

There is a causal and reciprocal relationship between depressive symptoms and deliberate self-harm among rural adolescents in China. Not only does this finding lend further credence to a growing body of research on adolescents' self-harming behaviors but also informs early intervention strategies aimed at improving behavioral health of rural adolescents in western China.

The Functional Profile, Depressive Symptomatology, and Quality of Life of Older People in the Central Alentejo Region: A Cross-Sectional Study

Background: Europe's aging population presents challenges such as a shrinking labor force, pressure on health services, and increased demand for long-term care. This study assesses the functional profile, depressive symptoms, and quality of life of older adults in the Central Alentejo region of Portugal. Methods: A cross-sectional, descriptive study was conducted with a convenience sample of 868 older adults in Portuguese long-term care facilities across the Évora district. A structured questionnaire collected sociodemographic data, elderly nursing core set patient information, a health questionnaire with nine responses, and WHO Quality of Life Assessment (short version) scores. Results: Nearly half of the participants needed assistance with care. Women (OR = 1.46) and those with cognitive impairment (OR = 10.83) had higher impaired functionality, while education (OR = 0.52) and being overweight (OR = 0.52) were inversely related to functional dependence. Quality of life scores ranged from 56.4 (physical) to 66.6 (environmental). Moderate depressive symptoms were found in 17.1% of participants, with 9% having moderately severe to severe symptoms. Higher dependence doubled the likelihood of depressive symptoms (OR = 2.18). Discussion and Conclusions: High rates of depression and functional dependence correlate with a low perception of quality of life, highlighting the need for research to promote and protect the health of older adults.

Serotonin in depression and Alzheimer's disease: Focus on SSRI's beneficial effects

Depression is a complex and pervasive mental health disorder affecting millions globally. Serotonin, a critical neurotransmitter, plays a central role in the pathophysiology of depression. This review explores serotonin's multifaceted role in depression, focusing on its synthesis, bioavailability, receptor interactions, and the impact of various factors, including diet, stress, and gender differences. This review aims to provide a comprehensive understanding of serotonin's role in depression by examining its synthesis and structure, its bioavailability and dietary influences, and its interactions with stress and immune responses. Additionally, it investigates the influence of age, socioeconomic status, and gender on depression, and integrates findings from animal research to elucidate serotonin's impact on mood disorders and cognitive decline. A literature review was conducted using PubMed, Google Scholar, and Embase databases. Key focus areas included serotonin synthesis and receptor interactions, dietary effects on serotonin bioavailability, and the relationship between serotonin, immune responses, and stress. Gender differences, age-related factors, and socioeconomic influences on depression were also examined. Studies were thematically categorized and analyzed to provide a cohesive overview. Our review highlights that serotonin synthesis involves a complex enzymatic process, with recent structural studies revealing intricate receptor interactions. Dietary factors significantly impact serotonin levels, with interventions potentially modulating mood disorders. Stress and immune responses are linked to serotonin dynamics, with chronic stress exacerbating mood disorders and influencing cognitive decline. Animal studies underscore serotonin's role in mood regulation and cognitive function, while human research reveals how age, gender, and socioeconomic factors affect depression. The findings emphasize the need for a multidimensional approach to understanding and treating depression. Various factors, including diet, stress, and immune responses, influence serotonin's role in mood disorders. The review suggests potential therapeutic pathways involving dietary interventions and stress management. Furthermore, gender-specific considerations and the impact of age and socioeconomic status on depression outcomes highlight the need for tailored treatment strategies.

Mediating effect of depression between self-esteem, physical appearance comparison and intuitive eating in adults

The first aim of the study is to clarify the associations between intuitive eating, self-esteem, physical appearance and psychological distress; and second, to assess the mediating effect of psychological distress on the relationship between self-esteem/physical appearance comparison and intuitive eating. A total of 359 Lebanese participants from several Lebanese governorates were enrolled in this cross-sectional study between September and November 2022. The data was collected through an online questionnaire that included the following scales: Intuitive Eating Scale‑2, Depression Anxiety Stress Scale, Rosenberg Self-Esteem Scale, and Physical Appearance Comparison Scale. The results of the mediation analysis showed that depression partially mediated the association between self-esteem / physical appearance comparison and intuitive eating. Higher self-esteem was significantly associated with lower depression; higher depression was significantly associated with more intuitive eating. Also, higher self-esteem was directly and significantly associated with more intuitive eating. On another hand, higher physical appearance comparison was significantly associated with higher depression; higher depression was significantly associated with more intuitive eating. Finally, higher physical appearance comparison was directly and significantly associated with less intuitive eating. The current study shows how significantly intuitive eating, an adaptive eating pattern, and psychological variables are interrelated and possibly affect each other. It helps shed light on intuitive eating, a somewhat unfamiliar eating pattern within the Lebanese population. These findings allow practitioners to promote healthy eating behaviors and psychological health by educating and guiding patients and clients about intuitive eating.

The impact of depression and anxiety on mobile phone addiction and the mediating effect of self-esteem

Mobile phone addiction has become a widespread phenomenon in Chinese society, attracting significant social attention. However, there is still limited understanding of complexities and relationships concerning anxiety, depression, self-esteem, and mobile phone addiction (MPA) among college students. To better understand the relationships among depression, anxiety, self-esteem, and mobile phone addiction, the aim of this study was to explore these relationships, analyze the factors influencing mobile phone addiction, and examine the mediating effects of anxiety and self-esteem on the relationship between depression and mobile phone addiction. Data from 2023 were collected, and the SDS depression scale, SAS anxiety scale, mobile phone addiction scale, and Robert self-esteem scale were employed. Pearson correlation analysis and structural equation modeling revealed significant associations between depression, anxiety, self-esteem, and mobile phone addiction. Further analysis indicated that anxiety mediated the relationship between depression and mobile phone addiction, meanwhile, self-esteem mediated the relationship between depression and mobile phone addiction. Self-esteem also mediated the relationship between anxiety and mobile phone addiction. Additionally, anxiety and self-esteem played sequential mediating roles in mobile phone addiction. These findings contribute to a better understanding of the mechanisms underlying the relationship between depression and mobile phone addiction. The discussion provides practical and effective recommendations for the prevention and intervention of mobile phone addiction among college students.

Correlation between psychological traits and the use of smart medical services in young and middle-aged adults: An observational study

BACKGROUND

Psychological problems affect economic development. However, there is a huge gap between mental health service resources and mental health service needs. Existing mental health service technology and platforms cannot meet all the diverse mental health needs of people. Smart medicine is a new medical system based online that can effectively improve the quality and efficiency of medical services and make mental health services accessible.

AIM

To explore the level of intelligent medical use among young and middle-aged people and its correlation with psychological factors.

METHODS

Convenience sampling was used to select 200 young and middle-aged patients with medical experience at the Third People's Hospital of Chengdu between January 2022 and January 2023 as the research subjects. The general condition Questionnaire, Eysenck Personality Questionnaire, Symptom Checklist-90, General Health Questionnaire, and Smart Medical Service Use Intention Questionnaire were used to collect data. Pearson's correlation was used to analyze the correlation between the participants' willingness to use smart medical services and their personality characteristics, psychological symptoms, and mental health.

RESULTS

The results revealed that the mental health of young and middle-aged people was poor, and some had psychological problems such as anxiety, depression, and physical discomfort. Familiarity, acceptance, and usage of smart healthcare in this population are at a medium level, and these levels correlate with psychological characteristics. Acceptance was positively correlated with E, and negatively correlated with P, anxiety, fear, anxiety/insomnia, and social dysfunction. The degree of use was negatively correlated with P, obsessive-compulsive symptoms, depression, anxiety, hostility, paranoia, and somatic symptoms.

CONCLUSION

The familiarity, acceptance, and usage of smart medical services among the middle-aged and young groups are related to various psychological characteristics.

Long-term trajectories of depressive symptoms in deployed military personnel: A 10-year prospective study

BACKGROUND

Military missions, especially those involving combat exposure, are associated with an increased risk of depression. Understanding the long-term course of depressive symptoms post-deployment is important to improve decision-making regarding deployment and mental health policies in the military. This study investigates trajectories of depressive symptoms in the Dutch army, exploring the influence of factors such as demographics, early-life trauma, posttraumatic stress disorder (PTSD) symptoms, and deployment stressors.

METHODS

A cohort of 1032 military men and women deployed to Afghanistan (2005-2008) was studied from pre- to 10 years post-deployment. Depressive and PTSD symptoms were assessed using the Symptom CheckList-90 and the Self-Rating Inventory for PTSD. Demographics, early trauma, and deployment experiences were collected at baseline and after deployment, respectively. Latent Class Growth Analysis was used to explore heterogeneity in trajectories of depressive symptoms over time.

RESULTS

Four trajectories were found: resilient (65%), intermediate-stable (20%), symptomatic-chronic (9%), and late-onset-increasing (6%). The resilient group experienced fewer deployment stressors, while the symptomatic-chronic group reported more early life traumas. Trajectories with elevated depressive symptoms consistently demonstrated higher PTSD symptoms.

LIMITATIONS

Potential nonresponse bias and missing information due to the longitudinal design and extensive follow-up times.

CONCLUSIONS

This study identified multiple trajectories of depressive symptoms in military personnel up to 10 years post-deployment, associated with early trauma, deployment stressors, adverse life events and PTSD symptoms. The prevalence of the resilient trajectory suggests a substantial level of resilience among deployed military personnel. These findings provide valuable insights and a foundation for further research.

The Relationship Between Trait Mindfulness and Depression in Elementary Pre-Service Teachers: The Sequential Mediating Role of Flow Experience and Learning Engagement

Objective

The purpose of this study is to investigate the relationship between trait mindfulness, flow experience, learning engagement, and depression among elementary pre-service teachers.

Methods

We employed the Five Facet Mindfulness Questionnaire, Flow Experience Scale, Learning Engagement Scale, and Center for Epidemiologic Studies Depression Scale to assess 614 elementary pre-service teachers.

Results

Trait mindfulness in elementary pre-service teachers negatively predicts depression. Trait mindfulness indirectly impacts depression through flow experience and learning engagement. Furthermore, flow experience and learning engagement serve as mediating factors in the relationship between trait mindfulness and depression among elementary pre-service teachers.

Conclusion

Flow experience and learning engagement play a mediating role in the relationship between trait mindfulness and depression among elementary pre-service teachers. This study enriches our understanding of depression cognitive theory, emphasizing the positive influence of internal resources on depression prevention. Additionally, it provides a deeper explanation of the mechanism through which trait mindfulness affects depression, offering valuable insights for future depression intervention programs.

Recent tobacco smoking, restaurant and in-car secondhand smoke exposure are associated with depressive symptoms among young adults: a population-based cross-sectional analysis

The purpose of this study was to evaluate the association between recent tobacco smoking, household secondhand smoke exposure, confined space secondhand smoke exposure and depressive symptoms in young adults after adjustments for each other. Data from NHANES 2013-2018 were extracted. A total of 4129 young adults age 18-35 years (mean age 26.11 ± 5.39 years, 2021 males and 2108 females) were included. Depressive symptoms were screened by PHQ-9. Recent tobacco smoking was assessed through question "smoked tobacco in the last 5 days?". Household secondhand smoke exposure was assessed through question "living with a smoker who smoked inside the house?". Confined space secondhand smoke exposure was assessed by SSEQ. Binary logistic regression models were performed to analyze the associations. Significant association were observed in recent tobacco smoking (OR = 1.593, 95% CI 1.318-1.926) and confined space secondhand smoke exposure (OR = 1.399, 95% CI 1.185-1.651), but not in household secondhand smoke exposure (P = 0.108). Among the different settings of confined space secondhand smoke exposure, restaurant (OR = 1.732, 95% CI 1.120-2.678) and in-car (OR = 1.350, 95% CI 1.102-1.652) exposure were significantly associated with depressive symptom after after fully adjustments.

Associations between problem technology use, life stress, and self-esteem among high school students

BACKGROUND

Adolescence is a critical period for development, with many risk factors resulting in long-term health consequences, particularly regarding mental health. The purpose of this study was to examine the associations between problem technology use, life stress, and self-esteem in a representative sample of adolescents residing in Ontario, Canada.

METHODS

Self-reported data were obtained from a cross-sectional sample of 4,748 students (57.9% females) in grades 9 to 12 (mean age: 15.9 ± 1.3 years) who participated in the 2019 Ontario Student Drug Use and Health Survey. Problem technology use was measured using the 6-item Short Problem Internet Use Test, life stress was assessed using an item from the British Columbia Adolescent Health Survey and self-esteem was assessed using a global measure from the Rosenberg Self-Esteem Scale. Ordinal logistic regression models were adjusted for age, sex, ethnoracial background, subjective socioeconomic status, body mass index z-score, tobacco cigarette smoking, alcohol consumption and cannabis use.

RESULTS

We found that 18.3% of participants reported symptoms of moderate-to-high problem technology use, although symptoms were more common in females than males (22% vs. 14.7%, respectively). Moderate-to-high problem technology use was associated with 2.04 (95% CI: 1.77-2.35) times higher odds of reporting high life stress and 2.08 (95% CI: 1.76-2.45) times higher odds of reporting low self-esteem compared to all other response options.

CONCLUSIONS

Findings from this study show that problem technology use is strongly associated with higher life stress and lower self-esteem in adolescents. This study supports the importance of developing and implementing effective strategies that help to mitigate the adverse effects of problem technology use on adolescent mental health.

Mood assessments of family caregivers of patients with severe brain injury in China

OBJECTIVES

Long-term care of severe brain injury patients places a significant mental burden on family caregivers, yet few studies have reported the situation in China. We aimed to describe the mood states of family caregivers of patients with severe brain injury and examine the influencing factors that affect caregivers' moods.

METHODS

Cross-sectional survey was used to assess the mood profiles of Chinese family caregivers between February 2019 and February 2020. Demographic data of caregivers and patients, the Patient Health Questionnaire (PHQ-9) and the Generalized Anxiety Disorder scale (GAD-7) were used to assess the level of depressive and anxiety symptoms. The quality of life score was also assessed by a visual analog scale, and the Coma Recovery Scale-Revised was used to assess the patient's consciousness.

RESULT

One hundred and one patients with severe brain injury (57 unresponsive wakefulness syndrome, UWS) between the age of 14 and 70 and their main family caregivers were enrolled in the study. Most caregivers displayed depressive (n = 62) and anxiety symptoms (n = 65), with 17 and 20 of these family caregivers reporting (moderately) severe depressive symptom and severe anxiety symptom, respectively. The caregiver's depressive symptom level significantly decreased as the patient's injury lasted longer (r =  - 0.208, P = 0.037). Moreover, the age of the patient negatively related to the levels of depressive (r =  - 0.310, P = 0.002) and anxiety symptoms (r =  - 0.289, P = 0.003) in caregivers. There was a significant positive correlation between anxiety and depressive symptoms scores in family caregivers (r = 0.838, P < 0.001). The higher the level of anxiety (r =  - 0.273, P = 0.006) and depressive symptoms (r =  - 0.265, P = 0.007), the worse the quality of life.

CONCLUSION

Many family caregivers of patients with severe brain injury experience various levels of anxiety and depressive symptoms in China. Tailor-made psychological help seems imperative. Researchers and doctors can provide information about patient's conditions to assist family members in discussing rehabilitation options for patients in different states of consciousness will help to ease anxiety of family caregivers.

Impact of COVID-19 on the self-esteem, psychological and dental esthetics of dental students

BACKGROUND

Coronavirus disease 2019 (COVID-19) has badly affected the mental health, quality of life, and self-esteem of students worldwide.

OBJECTIVE

The current study aimed to evaluate the psychological impact and self-esteem of dental students using Rosenberg self-esteem scale and PIDAQ during the COVID-19 pandemic.

METHOD

This cross-sectional research was conducted amongst the dental students studying at various dental colleges in Karachi, Pakistan from January to May 2022. Evaluation of psychological aspect and self-esteem of students was carried out using "Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ)", and "Rosenberg self-esteem scale" as perceived by students during the pandemic. For data analysis SPSS v24 was used. Data analysis comprised of descriptive analysis, Spearman correlation, One-way Anova and Linear regression. The level of significance of p value was less than 0.05.

RESULTS

Overall 332 students participated, among which there were 181 females (54.5%), 151 males (45.5%). Dental self-confidence showed a negative relationship with social influence, psychological effect, and aesthetic concern, while it was positively linked with self-esteem during the pandemic. Social impact demonstrated association with psychological impact, aesthetic concern, and self-esteem, while it was negatively correlated with dental confidence. Rosenberg score showed positive correlation with all the variables. Statistically significant association was identified for variables when compared with gender. Regression analysis indicated association of age with dental confidence and RSS, while gender with social influence.

CONCLUSION

The pandemic, aside from affecting the health of individuals worldwide, also badly affected the well-being, mental health, and self-esteem of the dental students. Dental aesthetics plays a crucial role in the mental wellbeing and self-esteem of the students.

Influence of physical education on anxiety, depression, and self-esteem among college students

BACKGROUND

Physical education is pivotal in our country's education reform. Urban schools have notably enhanced the intensity of physical education in recent years. However, the effects of physical education on students' anxiety, depression, and self-esteem levels, as well as their interrelations, remain unexplored.

AIM

To analyze the influence of physical education on students' anxiety, depression, and self-esteem.

METHODS

This study employed a cross-sectional design. A stratified cluster sampling method was used to select 478 first-year university students. Self-administered questionnaires were used to investigate the physical education status and basic information of college students. We used the Physical Activity Rank Scale-3 (PARS-3), Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS), and Self-Esteem Scale (SES) to assess the level of exercise, anxiety, depression, and self-esteem. Multiple Logistic regression was used to analyze the factors influencing anxiety, depression, and low self-esteem. The receiver operating characteristic curve and area under the curve (AUC) were used to evaluate the predictive ability of PARS-3 scores for anxiety, depression, and low self-esteem. Spearman's correlation was used to analyze the correlations among the PARS-3, SAS, SDS, and SES.

RESULTS

Compared with the domestic norms, SAS and SDS scores were higher, and SES scores were lower (P < 0.05). Among the participants, 210 (43.93%) had PARS-3 scores below 20, 94 (19.67%) had scores of 20-42, and 174 (36.40%) had scores above 42. After adjusting for daily sleep time, gender, being an only child, major, father's educational background, mother's educational background, and family residence, PARS-3 scores were independent influencing factors for anxiety, depression, and low self-esteem (P < 0.05). The AUC of PARS-3 scores predicting anxiety, depression, and low self-esteem were 0.805 (0.760-0.849), 0.799 (0.755-0.843), and 0.831 (0.788-0.874), respectively. The sensitivities were 0.799, 0.801, and 0.748, and the specificities were 0.743, 0.716, and 0.814, respectively. PARS-3 was negatively correlated with SAS and SDS scores (r = -0.566, -0.621, both P < 0.001) and positively correlated with SES scores (r = -0.621, P < 0.001). SES scores were negatively correlated with SAS and SDS scores (r = -0.508, r = -0.518, both P < 0.001).

CONCLUSION

The amount of physical activity is negatively correlated with anxiety and depression degree and positively correlated with self-esteem degree.

Determinants of Depressive Symptoms Among Patients with Rheumatoid Arthritis in China: A Structural Equation Model

Background

This study aimed to examine how personality traits, social support and clinical features including pain, disease activity, functional status, sleep quality, and fatigue influence on depressive symptoms in Chinese rheumatoid arthritis (RA) patients.

Methods

This study was conducted from November, 2022 to June, 2023 among Chinese RA patients. Pain, disease activity, functional status, sleep quality, fatigue, social support, personality traits, and depressive symptoms were assessed. The following relationships among three hypotheses were analyzed by structural equation model (SEM): H1: clinical features have a direct effect on depressive symptoms; H2: personality traits might work as a mediator between clinical features and depression; H3: social support is related to depressive symptoms, being a direct effect or an indirect effect through clinical features or personality traits.

Results

The final model including 326 RA patients presented a good fit (χ2=103, χ2/df=1.69; GFI=0.96; AGFI=0.93; CFI=0.97; TLI=0.96; RMSEA=0.046). Clinical features had a total effect of 0.59 on depressive symptoms, of which β=0.33 (P=0.013) was an indirect effect through personality traits, indicating a mediating influence between this relationship; moreover, there was a significant direct association between clinical features and depressive symptoms (β=0.26; P=0.022). Personality traits (β=-0.65; P<0.001) had a much stronger relation with depressive symptoms than with clinical features. Social support had a total effect of 0.81 on personality traits, being a direct effect of β=0.52 (P<0.001) and an indirect effect of β=0.29 (P<0.001) through clinical features. The final proposed model explained 77% of the variance of depressive symptoms.

Conclusion

Personality traits had a considerable influence upon depressive symptoms, while social support seemed to have a major effect on personality traits. It is necessary to apply comprehensive assessment and interventions of patients' personality traits, clinical features, as well as social support, which could optimize their mental health.

Effectiveness of online cognitive behavioural therapy on quality of life in adults with depression: A systematic review

WHAT IS KNOWN ON THE SUBJECT

Depression is a leading cause of disability worldwide that negatively impacts quality of life. Talk therapy such as cognitive behavioural therapy is an effective treatment for depression. The Internet is an important tool for mental healthcare delivery. Internet-delivered or online talk therapy interventions are associated with lower costs and improved accessibility. Current reviews do not address the effectiveness of Internet-delivered cognitive behavioural therapy (iCBT) on quality of life (QoL).

WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE

Interventions for iCBT have better QoL improvements for individuals with greater depressive symptom severity, females, young adults and individuals with complex comorbid disorders. Support from a healthcare provider for iCBT interventions have better outcomes than self-guided therapy interventions. Tailoring the iCBT intervention to the specialized needs of the population is beneficial.

WHAT ARE THE IMPLICATIONS FOR PRACTICE

There is potential to address treatment gaps for managing the care of individuals with depression. Utilizing iCBT promotes the integration of accessible mental healthcare in clinical settings. Healthcare providers can have a more comprehensive approach to delivering iCBT by considering adaptations relevant to the clinical population being treated.

ABSTRACT

INTRODUCTION: Major depressive disorder (MDD) is a leading cause of disability resulting from social, psychological and biological factors affecting quality of life (QoL). Cognitive behavioural therapy (CBT) is an effective psychotherapy for MDD. Internet-delivered CBT (iCBT) is associated with lower costs and improved accessibility.

AIM

We aimed to examine the effectiveness of iCBT on QoL in adults with depression.

METHOD

PubMed, Embase and PsycINFO were searched between 2010 and 2022. Inclusion criteria were experimental designs, adults ≥18 years old, depression diagnosis or valid self-report measure, iCBT intervention; and QoL outcome. Exclusion criteria were studies without depression analysis and intellectual disabilities or psychosis.

RESULTS

Seventeen articles were included, with a negative correlation between depression severity and QoL. Sex, age and physical comorbidity positively influenced effectiveness. Depressive severity, dysfunctional attitude and negative thinking were predictors and moderators of QoL. Clinician support can impact social interactions and sense of belonging.

DISCUSSION

Internet-delivered cognitive behavioural therapy is effective for improving QoL in adults with MDD. Severe depression, females, younger age and comorbid disorders were associated with greater QoL improvements.

IMPLICATIONS FOR PRACTICE

The findings suggest iCBT could address depression treatment gaps related to improving QoL. Utilizing iCBT potentially improves the care continuum for individuals with complex disorders.

Self-Esteem Trajectories After Occupational Injuries and Diseases and Their Relation to Changes in Subjective Health: Result From the Panel Study of Workers' Compensation Insurance (PSWCI)

BACKGROUND

Occupational injuries and diseases are life events that significantly impact an individuals' identity. In this study, we examined the trajectories of self-esteem among victims of occupational injury and disease and their relation to health.

METHODS

The Panel Study of Workers' Compensation Insurance conducted annual follow-ups on workers who had experienced occupational injury or disease. A total of 2,000 participants, who had completed medical care, were followed from 2013 to 2017. Growth mixture modeling was utilized to identify latent classes in the self-esteem trajectory. Additionally, logistic regressions were conducted to explore the association between trajectory membership, baseline predictors, and outcomes.

RESULTS

Three distinct trajectory classes were identified. Total 65.8% of the samples (n = 1,316) followed an increasing self-esteem trajectory, while 31.1% (n = 623) exhibited a constant trajectory, and 3.1% (n = 61) showed a decreasing trajectory. Individuals with an increasing trajectory were more likely to have a higher educational attainment (odds ratio [OR], 1.86; 95% confidence interval [CI], 1.20-2.88), an absence of a moderate-to-severe disability rating (OR, 0.49; 95% CI, 0.25-0.96), no difficulty in daily living activities (OR, 0.81; 95% CI, 0.75-0.88), and were economically active (re-employed: OR, 2.46; 95% CI, 1.52-3.98; returned to original work: OR, 4.46; 9% CI, 2.65-7.50). Those with a decreasing self-esteem trajectory exhibited an increased risk of poor subjective health (OR, 1.89; 95% CI, 0.85-4.85 in 2013 to OR, 3.17; 95% CI, 1.04-13.81 in 2017), whereas individuals with an increasing trajectory showed a decreased risk (OR, 0.54; 95% CI, 0.43-0.68 in 2013 to OR, 0.44; 95% CI, 0.33-0.57 in 2017).

CONCLUSION

Our findings emphasize the diversity of psychological responses to occupational injury or disease. Policymakers should implement interventions to enhance the self-esteem of victims.

Depression screening in patients with vascular disease

OBJECTIVES

Major depression is associated with increased morbidity and mortality in vascular surgery patients. The US Preventive Services Task Force and American Heart Association recommend routine depression screening for adults, especially those with cardiovascular disease. Since routine depression screening has not been implemented in most vascular surgery clinics across the nation, we sought to determine the feasibility of depression screening and understand the prevalence and predictors of depression in patients presenting to a single institution's vascular surgery clinic over a 4 month period.

METHODS

From June to September 2020, vascular surgery clinic patients were administered a 26-item survey that included validated scales for depression (PHQ-9), pain, frailty, alcohol dependence, and nicotine dependence. Although not validated, the Rosenberg Self-Esteem Scale was also administered. Patient charts were reviewed for demographic information and medical history. 9-digit patient zip codes were used to determine Area Deprivation Index, a measure of socioeconomic status. Univariate and multivariate analyses were performed to understand the factors associated with increased depression prevalence in the study population.

RESULTS

A total of 140 (36.4%) of 385 patients met study inclusion criteria. 35.7% of them screened positive for mild to severe depression (PHQ-9 scores ≥5). On univariate analysis, major depression was significantly associated with lower socioeconomic status (p = 0.007), higher frailty (p < 0.001), lower self-esteem (p < 0.001), higher daily pain (p < 0.001), health problems that interfere with social activities (p < 0.001), fatigue (p < 0.001), unmarried status (p = 0.031), and lack of primary care provider (p = 0.048). Multivariate analyses significantly predicted higher frailty (B= 0.487, p = 0.007) and lower self-esteem (B= -0.413, p < 0.001) in patients with depression. Depression was not associated with gender, age, employment status, smoking status, alcohol use, or type of vascular disease.

COCLUSIONS

More than one-third of vascular surgery clinic patients have comorbid depression. Higher frailty and lower self-esteem are significant risk factors for depression. Prevention and early identification of frailty may improve outcomes. Depression screening in vascular surgery clinics is feasible and could be useful in determining which patients may benefit from more frequent follow-up and monitoring for associated comorbidities. Vascular surgeons may play an important role in screening for depression and referring patients for psychotherapy and/or pharmacotherapy.

The Ongoing Mental Health Plight of Depressed College Students: Clinical Recommendations and the Importance of Early Screening and Detection

The COVID-19 pandemic disrupted the lives of college students. The psychological distress from the pandemic increased risk for provisional rates of Major Depression Disorder (MDD) during an already crucial developmental period. Using an online survey, participants were assessed for a provisional diagnosis of MDD using a validated screening tool, along with Generalized Anxiety Disorder (GAD) and psychosocial correlates. Findings showed a significant increase in the prevalence of MDD, and significant differences in social support, loneliness, substance use, GAD and suicidality were identified. Early screening and detection for potential MDD symptoms can reduce the severity, duration, and reoccurrence of future MDD episodes for college students.

Effects of neurofeedback on the self-concept of children with learning disorders

Children with learning disorders (LDs) often have a lower self-concept than their typically developing peers. Neurofeedback (NFB) treatments seem to improve the cognitive and academic performance of these children, but the effects on self-concept have not been studied. In this exploratory study, 34 right-handed children (8-11 y.o.) with LD and delayed electroencephalographic maturation responded to the Piers-Harris Children's Self-Concept Scale. One group received NFB (n = 20), and another group (n = 14) served as control, which included 9 children treated with sham-NFB and 5 on a waiting-list. A nonparametric permutation approach was used to compare the academic performance and self-concept difference (postscores - prescores) between the NFB and control groups. Given the smaller size of the control subgroups, a comparison of the percent changes between sham-NFB and the waiting-list was performed with the non-overlap of all pairs (NAP) technique. In the NFB group, the scores of reading, math, and global self-concept increased significantly, highlighting the self-concept subdomains of physical appearance, nonanxiety, popularity, and happiness. Additionally, the sham-NFB subgroup showed better outcomes than the waiting-list subgroup, perhaps due to noncontrolled factors. We found improved academic performance and self-concept in children with LDs who received NFB treatment. This study is an important exploratory step in studying a relevant treatment that seems to ameliorate symptoms of LDs such as anxiety and low self-concept.

Association between Negative Life Events and Somatic Symptoms: A Mediation Model through Self-Esteem and Depression

The purpose of this study was to investigate the serial multiple mediation of self-esteem and depression in the relationship between negative life events and somatic symptoms in Chinese medical students. We recruited a total of 3383 medical students for this study, and used the Patient Health Questionnaire-15 to assess the somatic symptoms of subjects; the Adolescent Self-Rating Life Events Check List to assess negative life events; the Rosenberg Self-Esteem Scale to assess self-esteem; and the Patient Health Questionnaire for depression. Descriptive analysis and statistical tests were then performed on the collected data. We showed that 39.17% of the medical students had mild somatic symptoms, 24.14% had moderate somatic symptoms, and 5.66% had severe somatic symptoms; we observed significant differences in somatic symptoms among genders, living expenses, and one-child. For negative life events, interpersonal stress was the most important predictor of somatization during the regression analysis. In addition, we observed significance for both the direct and part of the indirect paths from negative life events to somatic symptoms using mediation model analysis. However, we noted that there was no significance for the path through negative life events and self-esteem to somatic symptoms. This study revealed a high prevalence of somatic symptoms among Chinese medical students, and the findings suggested that interventions aimed at reducing somatization in this population should consider the impact of negative life events, particularly those related to interpersonal stress. One potential approach to mitigating the effects of negative life events on somatization is to enhance self-esteem and decrease the level of depression among medical students.

Mental Health of Working Adults during the COVID-19 Pandemic: Does Physical Activity Level Matter?

The purpose of this study is to investigate the associations between physical activity levels and the psychological outcomes of depression and anxiety. In 2022, Hong Kong was still exercising strict measures to control the spread of COVID-19. In this connection, major events and almost all large-scale sports events were suspended. Most recreational facilities were closed and repurposed as vaccination venues. As a result, a reduction in physical activity was expected. A cross-sectional survey was conducted among 109 working adults in Hong Kong. The International Physical Activity Questionnaire-Short Form was adopted as it continues to be the most widely used scale to measure physical activity. Almost a quarter of respondents exercised regularly. On average, respondents engaged in less than an hour's physical activity per week. Findings showed that even low to moderate levels of physical activity were positively associated with perceived self-esteem and perceived mental well-being. More specifically, self-esteem and perceived mental well-being were negatively associated with depression and anxiety. A full mediation effect between engagement in low levels of physical activity and anxiety was found. Light exercises may ultimately lead to lower anxiety via an indirect effect, with perceived mental well-being acting as a mediator. There was no direct relationship between low levels of physical activity and anxiety. In a similar vein, moderate levels of physical activity may lead to amelioration of symptoms related to depression and anxiety through indirect effects, with self-esteem as a mediator. Apart from engagement in low levels of physical activity, moderate levels of physical activity, such as swimming, jogging, and dancing, which have associations with self-esteem and mental health, could also be considered for attention.

Health-Related Quality of Life in Adolescent and Young Adult Retinoblastoma Survivors

Background: Retinoblastoma (RB) is a malignant intraocular tumor diagnosed in early childhood that requires extensive medical and surgical treatment at a young age. Health-related quality of life (HRQOL) is thought to be diminished due to visual impairment, facial deformities, and fear of recurrence or secondary cancer. However, few studies have identified variables associated with HRQOL among those with RB. Purpose: To compare HRQOL of adolescents and young adults (AYAs) with RB to matched controls and to identify predictors of HRQOL in RB survivors. Methods: Using a cross-sectional design, 198 AYAs (101 RBs and 97 controls) completed HRQOL (PROMIS®-29 profile) and psychosocial questionnaires (Rosenberg self-esteem scale, multidimensional scale of perceived social support, and Hollingshead index for socioeconomic status). Clinical variables (age at diagnosis, visual acuity, laterality, heredity, treatment regime, and anesthesia exposure) were extracted from the medical record. Correlates of HRQOL were estimated using linear regression models. Results: RB survivors reported similar HRQOL compared to controls. Physical function (p < .001), social support (p = .013), and self-esteem (p = .028) were lower in the RB group compared to controls. Visual acuity and self-esteem accounted for 52% of the variance in PROMIS physical health summary scores and self-esteem accounted for 38% of the variance in mental health summary scores. Conclusion: Despite deficits in physical function and self-esteem HRQOL in RB survivors was comparable to healthy counterparts. However, the majority of RB survivors in this study had normal visual acuity. Clinicians should explore ways to enhance self-esteem in RB survivors.

A scoping review and evaluation of instruments used to measure resilience among post-secondary students

As mental health problems continue to increase among post-secondary populations, the need to develop effective initiatives designed to bolster students' resilience has increasingly been identified as a priority. Therefore, access to valid tools with which to measure the efficacy of these interventions is imperative. To date, a comprehensive assessment of existing instruments used to evaluate the construct of resilience among post-secondary student populations has not been conducted. The purpose of this study was to fill this gap by conducting a scoping review of literature detailing the use of resilience instruments and evaluating their quality based on suitability for use in the post-secondary setting and associated psychometric evidence. We identified a total of 78 records published between 2010 and 2022, extracting a total of 12 instruments. Using detailed criteria frameworks, each instrument was assessed in terms of suitability and quality of associated psychometric evidence for validity and reliability. The results of our study suggest that many of the instruments currently being used to assess resilience among post-secondary students may not be appropriate. The majority of the instruments included in our review were developed for use among general adult populations and not specifically designed for use in the post-secondary setting. Most instruments did not assess resilience in a comprehensive, holistic matter that addressed the ability to bounce back from adversity by drawing upon psychological, social, cultural, and environmental resources, as defined by recent research. Further, no instruments included in our review had published evidence in support of a complete psychometric analysis. The results of our evaluation suggest that the Connor-Davidson Resilience Scale (CD-RISC) is the most suitable instrument for measuring resilience among post-secondary populations due to its suitability, comprehensive assessment of the construct of resilience, and demonstrably strong psychometric properties for both the 25- and 10-item versions of the tool.

Suicidal ideation in college students having major depressive disorder: Role of childhood trauma, personality and dysfunctional attitudes

BACKGROUND

Suicide in college students is a major public health concern. Suicidal ideation (SI) is associated with childhood trauma, personality, dysfunctional attitudes and depressive symptoms, but how they interact to predict SI remains unclear.

METHODS

Using cross-sectional design and convenience sampling method, a survey was conducted among 565 college students having major depressive disorder (MDD). The Childhood Trauma Questionnaire, Eysenck Personality Questionnaire, Dysfunctional Attitudes Scale and Hamilton Depression Scale assessed participants' psychosocial factors. Chi-square test, t-test, Pearson correlation, and Structural Equation Model were used in data analysis.

RESULTS

Overall, 66.02% of participants with MDD had SI. Those with SI showed significant differences in physical abuse, emotional abuse, physical neglect, emotional neglect, psychoticism, neuroticism, extroversion, dysfunctional attitudes and depressive symptoms compared with those without SI. Childhood trauma, psychoticism, neuroticism, extroversion and dysfunctional attitudes affected SI through chain mediation. In addition, depressive symptoms, psychoticism, neuroticism and extroversion directly affected SI.

LIMITATIONS

The convenience sampling method may limit the generalizability of the findings. Results may be biased due to the self-report nature of the data collection procedure, the number of research subjects and differences in suicide risk assessment. The cross-sectional study cannot be used to infer causality.

CONCLUSIONS

The factors of childhood trauma, personality and dysfunctional attitudes affect SI through chain mediation. In addition, depressive symptoms and personality independently predict the occurrence of SI.

Factors Predicting the Quality of Life of University Students in Japan Amidst COVID-19: A Cross-Sectional Study

Owing to the COVID-19 pandemic, classes and club activities in Japanese universities have been canceled; this may increase students' perceived stress and adversely affect their quality of life. This study investigated the factors that influence Japanese university students' quality of life during the pandemic. An online questionnaire collating data related to demographic characteristics, the perceived stress scale (PSS), sense of coherence (SOC), number of social supports, and quality of life (Short Form Health Survey; SF-8) was distributed to university students. Participants were divided into two groups: those who entered university before (seniors) and after (juniors) the onset of the pandemic. Their scores on the two sub-domains (physical and mental) of the SF-8 were evaluated. Multiple regression analysis was performed to identify factors associated with the composite mental summary of the SF-8. Regression analysis indicated that the predictor model of the composite mental summary differed between juniors and seniors. Among seniors, the composite mental summary was significantly indicated by the composite physical summary (β = 0.549, p < 0.0001) and PSS (β = 0.422, p < 0.0001). Among juniors, it was significantly indicated by the composite physical summary (β = 0.531, p < 0.0001), PSS (β = 0.390, p < 0.0001), and number of social supports (β = -0.148, p = 0.006). The factors associated with quality of life differed between seniors and juniors. Universities must provide opportunities for students to find more friends, especially for juniors who have limited socialization opportunities owing to the pandemic.

Cognitive-behavioral group therapy in major depressive disorder with focus on self-esteem and optimism: an interventional study

BACKGROUND

Major depressive disorder is a common psychological condition that can lead to negative individual and social consequences, the management of which is very important in treating the patients. The present study aimed to determine the effect of cognitive-behavioral group therapy on self-esteem and optimism in patients with major depressive disorder.

METHODS

This is a single-blinded, randomized controlled trial in which a total of 64 patients with major depressive disorder were recruited using convenience sampling and then randomly assigned to two groups of Cognitive-Behavioral Group Therapy (CBGT) and Treatment-As-Usual (TAU). Data collection tools consisted of a demographic questionnaire, the Rosenberg Self-Esteem Scale (RSES), and the Revised Life Orientation Test (LOT-R). In the pretest stage, participants in both groups completed the above questionnaires before the intervention. Patients in the CBGT group received eight 90-min sessions of cognitive-behavioral therapy during four weeks (two sessions a week). Then participants re-completed RSES and LOT-R immediately, three months, and six months after the intervention. Data were analyzed with SPSS software version 16.0 using chi-squared test, independent-samples t-test, and repeated measures Analysis of Variance. The significance level (p-value) was considered to be less than 0.05.

RESULTS

It was indicated that there was a statistically significant difference in the mean scores of self-esteem and optimism between the two groups immediately, three months, and six months after the intervention (p < .05). The mean scores of self-esteem and optimism in the CBGT group increased significantly after the intervention compared to before it, although these scores gradually decreased over the three measurement time points after the intervention.

CONCLUSIONS

Based upon the results, it was concluded that the level of optimism and self-esteem increased significantly in the CBGT group after the intervention, although the levels of the above variables dropped again in the long run after the intervention due to the discontinuity of CBGT sessions. Therefore, it is necessary to take particular measures to regularly hold the sessions of CBGT for patients with major depressive disorder.

TRIAL REGISTRATION NUMBER

IRCT20140212016564N15 , The date of registration: 20-09-2021, Retrospectively registered.

The Influence of Perfectionism, Self-Esteem and Resilience on Young People's Mental Health

The current study explored whether maladaptive perfectionism and low self-esteem constituted reliable risk factors of student mental illness, as well as determining whether resilience moderates these predictive relationships. 434 University undergraduate students were recruited. Depression and anxiety were measured using the Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder Assessment (GAD-7). Perfectionism, self-esteem and resilience were analyzed in relation to the PHQ9 and GAD-7 scores via a regression analysis. Perfectionism discrepancy, self-esteem and resilience all significantly predicted depression and anxiety. Hierarchical regression analysis revealed a statistically significant amount of additional variance to be explained by resilience for depression and anxiety, than for perfectionism and self-esteem alone. Maladaptive perfectionism and low self-esteem predispose an individual to depression and anxiety, though resilience may act as a protective factor against development of mental illness.

The relationship between protective factors and common mental disorders among female urban slum dwellers in Ibadan, Nigeria

BACKGROUND

On the African continent, many people live in conditions of adversity known to be associated with the onset of mental disorders, yet not all develop a mental disorder. The prevalence of common mental disorders such as depression and anxiety in the general population of Nigeria is comparatively low. Prevalence data of mental disorders in slum settings in Nigeria is sparse. There is a need to better understand the relationship between protective factors and the occurrence of common mental disorders in the Nigerian slum context. This study aimed to describe the relationship between protective factors and the occurrence of common mental disorders among female urban slum dwellers in Ibadan, Nigeria.

METHODS AND FINDINGS

A cross sectional household survey of 550 women was conducted in slum settlements in Ibadan, Nigeria. Interviewer administered questionnaires were completed to elicit information on protective factors (social connectedness, self-esteem, social support, resilience) and common mental disorders (depression, anxiety and stress). The DASS-21 was used to measure common mental disorders and protective factors were measured using the Social Connectedness Scale, Multidimensional Scale of Perceived Social Support, Resilience scale and the Rosenberg Self Esteem Scale. A multivariable logistic regression model was employed to examine associations while adjusting for relevant confounders. Common mental disorders were reported by 14.0% of the respondents. Resilience and social support were found to be protective against reporting symptoms of common mental disorders. Women who reported higher levels of social support and resilience were less likely to report common mental disorders (OR:0.96, 95% CI 0.93, 0.98) and (OR:0.95, 95% CI 0.91, 0.99) respectively. Women who were 65 years and older were also less likely to report the occurrence of common mental disorders (OR:0.38, 95% CI 0.15, 0.98) compared to those aged 18-34 years.

CONCLUSION

Social support and resilience appear to be protective against common mental disorders among these respondents. Further research should be conducted to explore the pathways through which protective factors reduce the likelihood of the occurrence of common mental disorders. This would be important in the development of mental health interventions.

Prevalence of COVID-19 Pandemic, Self-Esteem and Its Effect on Depression Among University Students in Saudi Arabia

Background and Aims

University students are commonly identified as susceptible, suffering from higher anxiety, stress, and depression than the overall population. During the Corona Virus Disease pandemic (COVID), education was shifted to the virtual learning environment. Students' ambiguity regarding academic accomplishment, imminent careers, changes in social life, and other concerns all these factors played a role in amplifying their stress levels, anxiety, and depression worldwide. This study investigates university students' self-esteem and depressions after they have been online learning for over 1 year due to the COVID-19 pandemic in Saudi Arabia.

Methods

For this research, an adapted questionnaire of Rosenberg (Self-Esteem Scale) and Zung (Self-Rating Depression Scale) was used to get the responses of the participants of public and private universities in Saudi Arabia during March-April 2021. We received a total of 151 valid responses from respondents. For data analysis, we used descriptive statistics, ANOVA, multiple regression and binary logistic regression.

Findings

The results showed that 75% of the students experienced different levels of depressions, with half (37.5%) having moderate to extreme levels of depression. A total of 41% of students experienced low self-esteem (38% females and 45% males). The regression results indicated depressive symptoms for low self-esteem. Furthermore, results of logistic regression showed that high self-esteem reduces the chances of getting depressive symptoms by 17%. The depressive symptoms were higher in female students than their male counterparts; furthermore, males experienced depressive symptoms less than females by 38%.

Conclusions

Based on the current research results, it is concluded that the presence of the COVID-19 pandemic has dramatically increased the depressive symptoms in students, especially in female students. The findings suggested instant consideration and support for students. It is also suggested to the quest for potential managing policies that have been known and effective during the pandemic. Moreover, training should be provided for students to shift their educational experience mindset to an adaptive mindset, which can help them adapt to the new ways of learning and education.

Association Between Socio-Affective Symptoms and Glutathione and CD4 and CD8 Lymphocytes in College Students

Background: The prevalence of anxiety and depression in young students is associated with biosocial factors and scholastic stress. However, few studies have evaluated emotional-affective symptoms that are related to the immune system and antioxidant parameters in young individuals without diagnoses of affective disorders. Aim: This study aims to assess the relationship between emotional-affective symptoms and glutathione concentrations and CD4 and CD8 lymphocyte counts in college students. Methods: College students (n = 177) completed standardized psychometric instruments, including the Perceived Stress Scale, Hamilton Anxiety Scale, Beck Depression Inventory, Familiar Social and Friends Support Scale, and Rosenberg Scale. Blood samples were biochemically analyzed. Analyses of variance were conducted between four groups according to symptom severity. Results: A considerable prevalence of stress, anxiety, and depression symptoms was observed and negatively correlated with self-esteem and socio-familiar support. Perceived stress was sexually dimorphic. Although biochemical parameters were within reference ranges, glutathione, CD4, and CD8 tended to be lower in participants with anxiety and depression symptoms, which may be of predictive value. Conclusion: The relationship between antioxidant/immune parameters and socio-affective scores is latent in undiagnosed college students who might develop affective disorders. The findings suggest that during the initial development of affective disorders, stress management strategies should be implemented to help college students cope with the academic load and monitor negative changes in their physiological state.

The Influence of Self-Esteem and Psychological Flexibility on Medical College Students' Mental Health: A Cross-Sectional Study

BACKGROUND

Mental health problems has become a major public health issue among medical students. Self-esteem and psychological flexibility were important associated factors for mental health, but their relations have not been discussed in medical students. The present study aimed to assess the status of mental health problems among medical students and identified whether psychological flexibility had a mediating role in the effects of self-esteem on the top three most common psychological symptoms.

METHODS

A total of 810 undergraduate students from 18 classes comprised in the sample. Nine dimensions of psychological symptoms was assessed by the Symptom Checklist-90-revised (SCL-90-R). Self-esteem was measured by the Self-esteem Scale (SES) and psychological flexibility was evaluated by the Acceptance and Action Questionnaire 2nd Edition (AAQ-II) and Cognitive Fusion Questionnaire (CFQ-F). Univariate analysis and logistic regression analysis were used to determine the relationship among the top three common psychological symptoms, self-esteem, psychological flexibility, and participants' characteristics. The mediating effect of psychological flexibility between self-esteem and psychological symptoms was detected by bootstrap method.

RESULTS

57.8% of the medical undergraduate students reported positive at least one of the nine psychological symptom dimensions assessed by the SCL-90-R and 13.8% of students had moderate or more severe symptoms. The symptoms of obsessive-compulsiveness, interpersonal sensitivity, and depression were the three most common psychological symptoms among the medical students. Meanwhile, self-esteem and psychological flexibility were negatively associated to the symptoms of obsessive-compulsiveness, interpersonal sensitivity, and depression. And, almost 50% effects of self-esteem on these three symptoms in medical students exert indirect effects through psychological flexibility.

CONCLUSIONS

Psychological distress was quite common in the Chinese medical students. The three most common psychological symptoms were successively obsessive-compulsiveness, interpersonal sensitivity, and depression. Low self-esteem and psychological inflexibility might be the risk factors for these top three symptoms, and psychological flexibility might play a mediating role in the effects of self-esteem on these psychological symptoms.

Relationships among adverse childhood experience patterns, psychological resilience, self-esteem and depressive symptoms in Chinese adolescents: A serial multiple mediation model

Adverse childhood experiences (ACEs) and adolescent depression are both prevalent social problems that can increase the risk of several negative health consequences throughout life. The original definition of ACEs misdirects the focus of intervention efforts for ACEs to only family dysfunction and parenting practices. We used a broader definition of ACEs and a latent class analysis (LCA) model to examine ACE patterns, aiming to overcome the shortcomings of cumulative and single adversity approaches based on the special social context of China. The data were derived from a middle school in Huaibei City of Anhui Province in 2019 and 2020, which was a prospective study involving 1687 junior high school students. At the initial evaluation (T1), ACEs, psychological resilience, self-esteem, and depressive symptoms were assessed by the students. At Time 2 (T2), the depressive symptoms of students were assessed. LCA and mediation analyses were conducted with Mplus version 8.2. The LCA identified the following three heterogeneous ACE classes: "low adversity" (36.4%), "moderate adversity" (44.2%), and "high adversity" (19.4%). The mediation analysis showed that the ACE patterns affected depressive symptoms through the following two mediation paths only in the moderate but not in the high adversity class: self-esteem alone and a path combining psychological resilience and self-esteem. Psychological resilience separately did not mediate the association between ACE patterns and depressive symptoms. To reduce depressive symptoms, interventions for students with ACEs need to improve self-esteem through many channels.

Greater variability in daily sleep efficiency predicts depression and anxiety in young adults: Estimation of depression severity using the two-week sleep quality records of wearable devices

OBJECTIVES

Sleep disturbances are associated with both the onset and progression of depressive disorders. It is important to capture day-to-day variability in sleep patterns; irregular sleep is associated with depressive symptoms. We used sleep efficiency, measured with wearable devices, as an objective indicator of daily sleep variability.

MATERIALS AND METHODS

The total sample consists of 100 undergraduate and graduate students, 60% of whom were female. All were divided into three groups (with major depressive disorder, mild depressive symptoms, and controls). Self-report questionnaires were completed at the beginning of the experiment, and sleep efficiency data were collected daily for 2 weeks using wearable devices. We explored whether the mean value of sleep efficiency, and its variability, predicted the severity of depression using dynamic structural equation modeling.

RESULTS

More marked daily variability in sleep efficiency significantly predicted levels of depression and anxiety, as did the average person-level covariates (longer time in bed, poorer quality of life, lower extraversion, and higher neuroticism).

CONCLUSION

Large swings in day-to-day sleep efficiency and certain clinical characteristics might be associated with depression severity in young adults.

Validation of the Korean version of the Perinatal Infant Care Social Support scale: a methodological study

Purpose

The purpose of this study was to develop and test the validity and reliability of the Korean version of the Perinatal Infant Care Social Support (K-PICSS) for postpartum mothers.

Methods

This study used a cross-sectional design. The K-PICSS was developed through forward-backward translation. Online survey data were collected from 284 Korean mothers with infants 1-2 months of age. The 19-item K-PICSS consists of functional and structural domains. The functional domain of social support measures infant care practices of postpartum mothers. Exploratory factor analysis (EFA) and known-group comparison were used to verify the construct validity of the K-PICSS. Social support and postpartum depression were also measured to test criterion validity. Psychometric testing was not applicable to the structural social support domain.

Results

The average age of mothers was 32.76±3.34 years, and they had been married for 38.45±29.48 months. Construct validity was supported by the results of EFA, which confirmed a three-factor structure of the scale (informational support, supporting presence, and practical support). Significant correlations of the K-PICSS with social support (r=.71, p<.001) and depression (r=-.40, p<.001) were found. The K-PICSS showed reliable internal consistency, with Cronbach's α values of .90 overall and .82-.83 in the three subscales. The vast majority of respondents reported that their husband or their parents were their main sources of support for infant care.

Conclusion

This study demonstrates that the K-PICSS has satisfactory construct validity and reliability to measure infant care social support in Korea.

International Students' Mental Health Care in China: A Systematic Review

International students in China are facing difficulties while adapting their Chinese culture, and their life is influenced by the widespread of the Coronavirus Disease 2019 (COVID-19), and caring for their mental health is currently challenging. As a result, our aim is to explore the current mental health care of this minority in China and to provide useful suggestions for future research and institutes. We used the systematic review method, and it was conducted on 11 existing pieces of literature. Our results confirm the unsatisfying psychological situation of international students and the lack of research in this area. We focus on the causes and symptoms of mental problems and explore the effectiveness of methods.

The syndemic condition of psychosocial problems related to depression among sexually transmitted infections patients

BACKGROUND

The prevalence of depression in sexually transmitted infections (STIs) patients is much higher than general public. However, studies focusing on comprehensive psychosocial effects on depression among STIs patients are limited. This study aimed to examine association of multiple psychosocial syndemic conditions with depression among STIs patients in Shanghai, China.

METHODS

We conducted a cross-sectional study and recruited 910 STIs patients from Shanghai Skin Disease Hospital. Participants self-reported their demographics and themselves completed the scales of depression, self-esteem, loneliness, social support, entrapment, defeat and interpersonal needs. Logistic regressions were performed to detect the possible contributing psychosocial factors for depression and to verify the syndemic conditions of psychosocial problems.

RESULTS

Of the STIs patient sample, the prevalence of depression was 17.9%. Multivariable analysis showed low-level self-esteem (odds ratio [ORm]: 2.18, 95% CI [1.19-4.00]) and social support (ORm: 2.18, 95% CI [1.37-3.46]), high-level entrapment (ORm: 6.31, 95% CI [3.75-10.62]) and defeat (ORm: 2.60, 95% CI [1.51-4.48]) increased the risk of depression. Psychosocial syndemic conditions magnified effect in fusing depression (adjusted odds ratio [AOR]: 11.94, 95% CI [7.70-18.53]). Participants with more than 4 psychosocial problems were about 22 times more likely to have depression (AOR: 22.12, 95% CI [13.19-37.09]).

CONCLUSIONS

The psychosocial problems syndemic magnifying the risk of depression was confirmed and psychosocial interventions to prevent depression is needed among STIs patients.

Generalized Anxiety Disorder and Depressive Symptoms among Pakistani Population during the Second Wave of the COVID-19 Pandemic: A Regression Analysis

Over a span of 1 year, with millions infected, COVID-19 has spread to every part of the world and now poses a health threat to each and every one of us. The outbreak has consequently resulted in multiple health problems such as stress, anxiety, depressive symptoms, insomnia, panic, and denial globally. Several factors have contributed to this rising number of psychiatric consults all over the world. The primary objective of this study was to investigate the impact of COVID-19 pandemic on the mental health of Pakistani population during the second wave of the pandemic in this region. We conducted an online web-based cross-sectional survey comprising 500 participants. The questionnaire assessed the demographic information, attitude, and knowledge concerning COVID-19 outbreak in addition to generalized anxiety disorder (GAD) utilizing the GAD-7 scale and depressive symptoms using the Center for Epidemiology Scale for Depression (CES-D) scale. The response rate of the study was 90.9%. The results of the survey indicated a prevalence of 25.4% of GAD, and 18.8% of depressive symptoms. Furthermore, nearly 34.8% of participants feared contracting COVID-19, 62.8% obtained constant critical updates regarding COVID-19, while 17.6% did not understand the knowledge regarding COVID-19. In the multivariate regression models, GAD was significantly associated with gender, age, and checking constantly of critical updates regarding COVID-19. Similarly, participants under 30 years had a higher risk of developing depressive symptoms than those above (> 30 years). Lastly, participants with no formal education were also found to be more prone to developing depression. We identified a potential threat to mental health during the pandemic.

Psychological and Social Effects of Oral Health and Dental Aesthetic in Adolescence and Early Adulthood: An Observational Study

Background: Is well known that oral health and dental aesthetic have significant effects on the sociality of human beings. The aim of the present study was to assess some aspects of oral health with possible repercussions in adolescent and youth, with particular reference to gender differences. Methods: A total of 190 subjects with female prevalence (F = 62.6%, M = 37%) and ages between 14 and 29 years old (Mean = 23.8; SD = 3.27) participated. Evaluation was carried using standardized instruments to assess quality of oral life (PIDAQ), negative impact of oral conditions (OHIP-14), and self-esteem (Rosenberg Self Esteem Scale). Correlational and difference analyses and linear regressions were performed. Results: Significant gender differences were found in terms of gender, in reference to variables such as self-confidence and convictions. Positive correlations emerged between psychological impact and social impact, aesthetic concern and social impact, convictions and self-confidence, oral health with psycho-social impact, and aesthetic concern, self-esteem with oral health. Inverse correlations emerged between psycho-social impact and self-confidence, aesthetic concern and self-confidence, oral health, and self-confidence. Multivariate linear regression indicated relations between age and psychological impact, sex and self-confidence, crooked teeth and conviction. Conclusions: The impact of oral health on the psychological well-being of young people is relevant. These factors, if considered within clinical practice, can improve the quality of life of the subject.

Deep graph neural network-based prediction of acute suicidal ideation in young adults

Precise remote evaluation of both suicide risk and psychiatric disorders is critical for suicide prevention as well as for psychiatric well-being. Using questionnaires is an alternative to labor-intensive diagnostic interviews in a large general population, but previous models for predicting suicide attempts suffered from low sensitivity. We developed and validated a deep graph neural network model that increased the prediction sensitivity of suicide risk in young adults (n = 17,482 for training; n = 14,238 for testing) using multi-dimensional questionnaires and suicidal ideation within 2 weeks as the prediction target. The best model achieved a sensitivity of 76.3%, specificity of 83.4%, and an area under curve of 0.878 (95% confidence interval, 0.855-0.899). We demonstrated that multi-dimensional deep features covering depression, anxiety, resilience, self-esteem, and clinico-demographic information contribute to the prediction of suicidal ideation. Our model might be useful for the remote evaluation of suicide risk in the general population of young adults for specific situations such as the COVID-19 pandemic.

The relationship between childhood emotional abuse and depressive symptoms among Chinese college students: The multiple mediating effects of emotional and behavioral problems

BACKGROUND

This study aims to explore the mediational effects of emotional and behavioral problems on the association between childhood emotional abuse and depressive symptoms among college students.

METHODS

Data were drawn from 60 universities from 10 provinces in China (n=30,374). Information about childhood maltreatment, depressive symptoms, emotional and behavioral problems were gathered through the Childhood Trauma Questionnaire-Short Form (CTQ-SF), the Center for Epidemiologic Studies Depression Scale (CES-D) and the Strengths and Difficulties Questionnaire (SDQ), respectively. Univariable and multivariable logistic regression models and mediating models were used.

RESULTS

After controlling for demographic factors, childhood emotional abuse was the strongest risk factor for depressive symptoms (adjusted odds ratio (aOR)=2.54, 95%CI=2.27-2.85). The relationship between childhood emotional abuse and depressive symptoms was partially mediated by emotional and behavioral problems with 68.7% total indirect effect. Among the 5 identified subtypes of emotional and behavioral problems, the mediating effects of emotional problems (57.3%) and hyperactivity (28.6%) were higher than peer problems (7.8%) and prosocial behavior (3.6%). Conduct problems did not show a significant mediating effect (p>0.05).

LIMITATIONS

The cross-sectional design is limited to make inferences about causality.

CONCLUSIONS

Childhood emotional abuse was strongly associated with depressive symptoms in college students. Of the five identified subtypes of emotional and behavioral problems, four subtypes mediated the relationship between childhood emotional abuse and depressive symptoms, including emotional problems, hyperactivity, peer problems and prosocial behavior.

Influence of Personality, Resilience and Life Conditions on Depression and Anxiety in 104 Patients Having Survived Acute Autoimmune Thrombotic Thrombocytopenic Purpura

Autoimmune thrombotic thrombocytopenic purpura (iTTP) is a life-threatening, relapsing disease in which an acquired deficiency of the enzyme ADAMTS13 leads to generalised microvascular thrombosis. Survivors have a high prevalence of depression and impaired cognitive function. The aim of this study was to determine whether life circumstances and personality have an influence on the development and severity of depression and anxiety in iTTP patients and how they impact the quality of life. With validated questionnaires, we examined the prevalence of depression and anxiety symptoms in 104 iTTP patients, as well as parameters of subjective cognitive deficits, quality of life, attitude to life and resilience. iTTP patients had significantly more depressive symptoms (p < 0.001), a tendency to have anxiety disorders (p = 0.035) and a significantly worse cognitive performance (p = 0.008) compared to the controls. Sex, age, physical activity and partnership status had no significant influence on depression, whereas the number of comorbidities did. Lower scores of resilience, attitude to life and quality of life were reported by patients compared to controls. iTTP patients had a high prevalence of depression and anxiety, as well as a more negative attitude to life and low resilience. Resilience correlated negatively with the severity of the depression. Furthermore, quality of life and cognitive performance were significantly reduced.