Evaluation of psychometric properties of the Chinese Mandarin version State-Trait Anxiety Inventory Y form in Taiwanese outpatients with anxiety disorders

The auditory stimulus facilitates memory guidance in distractor suppression in males with substance use disorder

Introduction

Representations in working memory can affect distractor suppression in human visual search, and this process is modulated by a separate top-down cognitive control. An increasing body of research has demonstrated that patients with substance use disorder (SUD) have deficits in cognitive control over filtering interference by perceptual distractors. However, their ability to resist proactive interference from working memory has received comparatively less attention.

Methods

Here, we investigate this issue by employing a working memory/visual search dual-task paradigm. An intervening gap-location search task was instructed to be performed while participants memorized a written color word, with congruent auditory information present during the memory encoding phase on half of the trials.

Results

Results showed that there was a reliable response time (RT) advantage when the meaning of the memory sample agreed with the color of one of the distractors under the visual alone condition. However, such a result was only found in the control group. More importantly, both groups exhibited comparable facilitation under the audiovisual condition, with the facilitation effect appearing later in the SUD group. Furthermore, the facilitation effect was superior in magnitude and time course under the audiovisual condition to the visual alone condition.

Discussion

These findings highlight how patients with SUD resist distractor interference at the memory level and extend our understanding of how working memory, selective attention, and audiovisual enhancement interact to optimize perceptual decisions in patients with SUD.

The change of state-trait anxiety among patients undergoing orthognathic surgery: A longitudinal study

INTRODUCTION

This study aimed to assess state-trait anxiety level changes in Chinese patients with dentofacial discrepancies before and after orthognathic surgery and to explore the feasibility of developing a reference index for the preoperative screening of postoperative patients with high anxiety.

METHODS

A total of 96 Chinese patients with dentofacial discrepancies who underwent orthognathic surgery were included in this study. Data were collected before orthognathic surgery and at 2 weeks (T2), 3 months, and 6 months (T4) after surgery using the State-Trait Anxiety Inventory. Receiver operating characteristic and linear regression analyses were performed to screen for preoperative indicators of postoperative high-state anxiety.

RESULTS

State-trait anxiety levels in patients with dentofacial discrepancies decreased after surgery (F = 18.95, P <0.01; F = 6.90, P <0.01). Trait Anxiety Inventory can be used to screen patients with high-state anxiety from T2 to T4 (area under cover 95% confidence interval: T2, 0.74 [0.62-0.86]; 3 months, 0.79 [0.69-0.90]; T4, 0.77 [0.66-0.87], P <0.01), corresponding to cutoff values of 48.5, 46.5, and 45.5, respectively.

CONCLUSIONS

All participants' state-trait anxiety levels improved after surgery compared with their preoperative levels. Preoperative trait anxiety levels can be used as a reference indicator to screen patients who may have high-state anxiety levels after orthognathic surgery. The creation of a screening scale will assist health care professionals to more pertinently help patients with high anxiety.

The Comparison of Lifestyles, Mental Risks, and Physical Indices among Individuals with Ultra-High Risk of Psychosis, Patients with Schizophrenia, and the General Public

(1) Background: Early interventions may effectively reduce the risk of mental disorders in individuals with ultra-high risk. Specifying the health needs of individuals with ultra-high risk is crucial before the implementation of successful early intervention. This study aimed to explore the differences in lifestyles, mental risks, and physical indices among individuals with ultra-high risk, patients with schizophrenia, and healthy subjects. (2) Methods: A cross-section design applying seven questionnaires with physical examinations for 144 participants aged 13-45 years old was conducted in this study. The questionnaires included one about personal data, four on mental risks, and two for lifestyles. (3) Results: The individuals with ultra-high risk scored similarly in many dimensions as the patients with schizophrenia, but they displayed lower positive symptoms, lower negative symptoms, lower prodromal symptoms, higher interpersonal deficits, lower nutrition intake, and higher levels of exercise than the patients with schizophrenia. Female individuals with ultra-high risk had lower self-esteem, higher positive symptoms, lower nutrition intake, and higher exercise levels than male ones. (4) Conclusions: The study pinpointed specific health needs with interpersonal deficits, nutrition intake, and physical activity for the individuals with ultra-high risk. Future interventions targeted on improving social function, dietary pattern, and exercise will be beneficial.

Does Mandala Art Therapy Improve Psychological Well-Being of Gynecological Cancer Patients During the Perioperative Period? A Quasi-Experimental Study

BACKGROUND

Women with gynecological cancer often experience psychological distress, particularly in response to surgical procedures. The impact of mandala art therapy (MAT) during the perioperative period for gynecological cancer patients remains uncertain. We aimed to examine the effects of the MAT program in women with gynecological cancer.

METHODS

Employing a quasi-experimental design, we recruited 126 gynecological cancer patients from a university hospital through convenience sampling. Participants were assigned to either receive the MAT program or standard perioperative care. The interventions comprised a three-session MAT program guided by a team of trained mandala psychologists. Generalized estimating equations (GEE) were employed to analyze the effects of MAT over time.

RESULTS

A total of 126 patients were enrolled, and 118 completed the entire study. Over 90% of participants completed the perioperative MAT interventions, reporting relatively high satisfaction with the program (7.70 out of 10). Individuals in the MAT group exhibited improved therapeutic effects on STAI-S, VASS, and vital signs over time. Notably, significant group*time interaction effects were noted in STAI-S scores at both the first evaluation, T1 (β = -4.220, P < .005) and the third evaluation, T3 (β = -3.797, P < .05), and VASS scores at T1 (β = -11.186, P < .005), T2 (β = -9.915, P < .05) and T3 (β = -9.831, P < .05). Regarding vital signs, the multivariate GEE model revealed significant interaction effects in systolic blood pressure values at both T1 (β = -7.102, P < .05) and T3 (β = -10.051, P < .005), diastolic blood pressure values at T3 (β = -6.441, P < .005), and pulse values at T1 (β = -6.085, P < .005). No significant differences were observed between groups for pain, hope, or self-acceptance.

CONCLUSION

This study posited that MAT could serve as a valuable complementary approach in perioperative care for addressing the psychological needs of women with gynecological cancer. Subsequent research employing more robust methodologies and larger, more diverse participant samples will be necessary to validate these conclusions.

Characteristics of white matter structural connectivity in healthy adults with childhood maltreatment

Background: Childhood maltreatment (CM) is a common psychological stressor associated with multiple mental disorders. While CM is associated with vulnerability to depression and anxiety, little is known about the specific mechanism underlying this relationship.Objective: This study aimed to investigate the white matter (WM) of healthy adults with CM and their relationships with depression and anxiety to provide biological evidence for the development of mental disorders in subjects with childhood trauma.Methods: The CM group included 40 healthy adults with CM. The non-CM group included 40 healthy adults without CM. Diffusion tensor imaging (DTI) data were collected, and tract-based spatial statistics (TBSS) were applied to the whole brain to assess WM differences between the two groups; post-hoc fibre tractography was used to characterise the developmental differences; and mediation analysis was used to assess the relationships among the Child Trauma Questionnaire (CTQ) results, DTI indices, and depression and anxiety scores.Results: Relative to the non-CM group, the CM group revealed significantly lower fractional anisotropy (FA) in the right posterior corona radiata (PCR-R), right anterior corona radiata (ACR-R), left super corona radiata (SCR-L), anterior thalamic radiation (ATR), and right posterior limb of the internal capsule (PLIC-R). Additionally, shorter fibre bundles passed through the PCR-R, ACR-R, and ATR in the CM group compared with the non-CM group. Besides, the length of the ACR-R mediated the relationship between CM and trait anxiety.Conclusions: The alteration of white matter microstructure associated with childhood trauma in healthy adults may reflect biomarkers of childhood trauma. Besides, an alteration of WM microstructure in healthy adults with CM mediates the association between CM and trait anxiety, which may represent the vulnerability to developing mental disorders after childhood trauma experiences.

Role of antenatal anxiety in the relationship between maternal exposure to nitrogen dioxide and small for gestational age: A birth cohort study

BACKGROUND

Both Nitrogen dioxide (NO2) exposure and antenatal anxiety have individually been associated with small for gestational age (SGA). Little is known, however, about whether there is effect modification of antenatal anxiety on NO2-related SGA.

METHODS

The prospective birth cohort study included 1823 mother-newborn pairs in Guangzhou, China, from January 2017 to April 2020. Exposure to NO2 during the pre-conceptional and prenatal periods was estimated using an inverse distance weighted method. Antenatal anxiety was assessed by Trait Anxiety Inventory. SGA was determined by the Chinese gestational age- and sex-specific birthweight standards. Cox proportional hazards regression models was used to estimate hazard ratios (HRs) and 95 % confidence intervals (CIs) for SGA as per 10 μg/m3 increase in NO2. Modifying effects of trait anxiety on NO2-related SGA were identified by stratified analyses, and three-dimensional response surface plots and two-dimensional heat maps.

RESULTS

Each 10 μg/m3 increase in NO2 exposure during the third trimester was significantly associated with SGA risk among overall participants (HR = 1.221, 95 % CI: 1.014-1.471) and primipara (HR = 1.271, 95 % CI: 1.023-1.579). We found significant effect modification of anxiety level for NO2-related SGA in the third trimester (Pinteraction < 0.05). Pregnant women with higher levels of trait anxiety were more likely to deliver SGA newborns, particularly for those with high trait anxiety (HR = 1.781, 95 % CI: 1.007-2.945). Primiparous women were more susceptible.

CONCLUSIONS

This study provides evidence that antenatal trait anxiety may modify the effects of maternal NO2 exposure on SGA risk. The third trimester could be a critical window of susceptibility.

Effects of Mindfulness-Based Elder Care (MBEC) on symptoms of depression and anxiety and spiritual well-being of institutionalized seniors with disabilities: a randomized controlled trial

BACKGROUND

Despite the need to incorporate seniors from various settings into mindfulness-based empirical research, issues of geriatric frailties and non-compliance remain. This study aimed to evaluate the effects of a mindfulness-based elder care (MBEC) program on mental health and spiritual well-being among seniors with disabilities in long-term care residential settings.

METHODS

This single-blind, randomized controlled trial (RCT) randomly assigned seventy-seven participants into an MBEC group or control group of an eight-week MBEC program. Participants were assessed every four weeks at baseline (T0), mid-intervention (T1), post-intervention (T2) and follow-up (T3) using the Geriatric Depression Scale Short Form (GDS-SF), the State-Trait Anxiety Inventory (STAI) and the Spiritual Well-Being Scale (SWBS), respectively.

RESULTS

Linear mixed model (LMM) showed that MBEC participants' mental health improved significantly after completing the intervention; compared with controls, the MBEC group exhibited significantly lower anxiety (state-anxiety at T2; trait-anxiety at T2 and T3) and fewer depressive symptoms. Spiritual well-being was also significantly enhanced compared to that in the control group.

CONCLUSIONS

MBEC has positive effects on both mental health and spiritual well-being outcomes among seniors with disabilities. In long-term care facilities, seniors with abilities have the potential to adhere to and engage in activities of a mindfulness-based intervention. This low risk, easily accessible, and effective 8-week program is recommended to be integrated into regular long-term care institutional routines.

TRIAL REGISTRATION

This study was registered with Clinical Trial Registry (ClinicalTrials.gov - U.S. National Library of Medicine #NCT05123261. Retrospectively registered on 07/04/2021.). The CONSORT 2010 guidelines were used in this study for properly reporting how the randomized trial was conducted.

Effects of gender nonconformity and biological sex on the relationship between sexual orientation microaggressions and anxiety and depressive symptoms among lesbian, gay, and bisexual Taiwanese young adults: A moderated-moderation study

BACKGROUND

Sexual orientation microaggressions (SOMs) may negatively affect lesbian, gay, and bisexual (LGB) individuals' mental health. However, the moderating effects of gender nonconformity and biological sex on the relationship between SOMs and anxiety and depressive symptoms has never been examined. We evaluated the moderating effect of gender nonconformity on the association of SOMs with anxiety and depressive symptoms among LGB young male and female adults. We hypothesized that the associations of SOMs with anxiety and depressive symptoms weakened with increasing gender nonconformity among gay and bisexual men but strengthened with increasing gender nonconformity among lesbian and bisexual women.

METHODS

In total, 1000 self-identified LGB young adult individuals participated in the study. The experience of sexual orientation microaggression was assessed using the Sexual Orientation Microaggression Inventory, anxiety was assessed using the State subscale on the State-Trait Anxiety Inventory, and depression was assessed using the Center for Epidemiological Studies-Depression Scale. The two-way moderation models stratified by sex examined the moderating effects of gender nonconformity on the association between SOMs and anxiety symptoms in the male and female participants. The three-way moderated moderation models were used to determine whether gender nonconformity and sex jointly moderated the associations between SOMs and anxiety and depressive symptoms.

RESULTS

In the two-way moderation models stratified by sex, gender nonconformity exerted opposite moderating effects on the association between SOMs and anxiety and depressive symptoms in the male and female participants. For the male participants, the association between SOMs and anxiety (β = -0.08) and depressive symptoms (β = -0.09) weakened with increasing gender nonconformity. For the female participants, the association between SOMs and anxiety (β = 0.08) and depressive symptoms (β = 0.13) strengthened with increasing gender nonconformity. The three-way moderated moderation models further confirmed that sex moderated the moderating effects of gender nonconformity on the associations between SOM and anxiety (β = -0.16, p = .047) and depressive symptoms (β = -0.22, p < .001).

LIMITATION

The cross-sectional study design limited the inferences that could be made concerning the temporal relationship between SOMs and mental health problems.

CONCLUSIONS

The association between SOMs and anxiety and depressive symptoms weakened with increasing gender nonconformity in gay and bisexual men, whereas the association between SOMs and anxiety and depressive symptoms strengthened with increasing gender nonconformity in lesbian and bisexual women.

Amygdala-based functional connectivity mediates the relationship between thought control ability and trait anxiety

Thought control ability (TCA) refers to the ability to exclude unwanted thoughts. There has been consistent evidence on the protective effect of TCA on anxiety, that higher TCA is associated with lower anxiety. However, the underlying neural mechanism remains unclear. In this study, with a large sample (N = 495), we investigated how seed-based resting-state functional connectivity (RSFC) mediates the relationship between TCA and anxiety. Our behaviour results replicated previous findings that TCA is negatively associated with trait anxiety after controlling for gender, age, and depression. More importantly, the RSFC results revealed that TCA is negatively associated with the left amygdala - left frontal pole (LA-LFP), left amygdala - left inferior temporal gyrus (LA-LITG), and left hippocampus - left inferior frontal gyrus (LH-LIFG) connectivity. In addition, a mediation analysis demonstrated that the LA-LFP and LA-LITG connectivity in particular mediated the influence of TCA on trait anxiety. Overall, our study extends previous research by revealing the neural bases underlying the protective effect of TCA on anxiety and pinpointing specific mediating RSFC pathways. Future studies could explore whether targeted TCA training (behavioural or neural) can help alleviate anxiety.

The exploration of a screen model for detecting undergraduates at higher risk for developing psychosis: A cross-sectional study in a medical university

PURPOSE

To examine a screen model for detecting undergraduates with higher risk for developing psychosis (HRDP).

DESIGN AND METHODS

A cross-sectional design with convenience sampling was used. The screen model included exploration stage by self-report scales and confirmation stage by face-to-face interviews.

FINDINGS

A total of 273 students were detected from 4744 surveys during 4 years. Of them, 120 students with HRDP were identified and 7 had been diagnosed as schizophrenia or bipolar disorders at 12-month follow-up.

PRACTICE IMPLICATIONS

This screen model can be used in early detection for undergraduates with HRDP from large general samples.

Financial Crisis in Management Stress: From the Perspective of Crisis Anxiety of Others

The crisis anxiety of others is a phenomenon that goes hand in hand with the spread of the occupational health pandemic. It is becoming increasingly important to better understand its emergence process, especially in the era of greater uncertainty. This study aims to examine the impact of the external financial crisis on managerial stress among financial employees. The sample consists of 347 senior managers and financial employees from companies in China. The empirical analysis shows that external financial crises have significant effects on anxiety levels, especially external corporate crisis, debt crisis and growth crisis both have mediating effect on the relationship between anxiety level and pressure management and the relationship between external financial crisis and pressure management. This study explores the rules for the emergence of anxiety among corporate managers and expands the scope of environmental factors that need to be discussed in the study of corporate financial management. This study provides theoretical implications for the psychological study of Financial Management and practical implications for corporate financial management.

Associations among Perceived Sexual Stigma from Family and Peers, Internalized Homonegativity, Loneliness, Depression, and Anxiety among Gay and Bisexual Men in Taiwan

This study aimed to examine the moderating factors of the association between perceived sexual stigma from family and peers and internalized homonegativity, as well as to compare the effects of perceived sexual stigma from family and peers and internalized homonegativity on loneliness, depression, and anxiety in gay and bisexual men. In total, 400 gay and bisexual men participated in this study. The experiences of perceived sexual stigma from family and peers on the Homosexuality subscale of the HIV and Homosexuality Related Stigma Scale, internalized homonegativity on the Measure of Internalized Sexual Stigma for Lesbians and Gay Men, loneliness on the UCLA Loneliness Scale (Version 3), depression on the Center for Epidemiological Studies-Depression Scale, and anxiety on the State subscale of the State-Trait Anxiety Inventory were collected. The results indicated that perceived sexual stigma from family and peers was significantly associated with internalized homonegativity in both gay and bisexual men, and that sexual orientation moderated the association. Moreover, the association between internalized homonegativity and loneliness was significantly greater than that between perceived sexual stigma from family and peers and loneliness, although no significant differences were observed in their associations with depression and anxiety. Intervention programs that promote changes in the attitudes toward gay and bisexual men among the general population are needed to help prevent the development of internalized homonegativity and further loneliness, depression and anxiety.

Internalized Sexual Stigma among Lesbian, Gay, and Bisexual Individuals in Taiwan: Its Related Factors and Association with Mental Health Problems

Internalized sexual stigma (ISS) is one of the major issues that can compromise the health of sexual minority populations. This quantitative study aimed to examine: (1) the relationships of individual factors (gender, age, education level, sexual orientation, and age of identification of sexual orientation) and perceived family support with ISS; and (2) the associations of ISS with mood problems and the moderating effects of gender on the associations among Taiwanese young adult lesbian, gay, and bisexual (LGB) individuals. In total, 500 male and 500 female young adult LGB individuals aged between 20 and 30 years participated in this study. The experience of ISS, individual (e.g., gender, age, education level, sexual orientation, and age of identification of sexual orientation) and environmental factors (perceived family), mood problems (e.g., anxiety and depression) were collected. The individual and environmental factors related to ISS and the associations of ISS with mood problems were examined using multivariate linear regression analysis. The results indicated that gender, sexual orientation, age of identification of sexual orientation, and perceived family support were significantly associated with all or some dimensions of ISS in LGB individuals. Various dimensions of ISS had different relationships with anxiety and depression. Gender had moderating effects on the association between the identity dimension of ISS and sexual orientation as well as between the social discomfort dimension of ISS and anxiety. Various dimensions of ISS among LGB individuals should be routinely assessed by mental health service units. Intervention programs should be provided for LGB individuals, especially those with factors related to ISS.

The Effects of Acupressure on Improving Health and Reducing Cost for Patients Undergoing Thoracoscopic Surgery

OBJECTIVES

This study aimed to assess the effectiveness of practicing acupressure on the Shenmen and Neiguan acupoints with a view to reduce anxiety and improve the comfort and physical health of patients undergoing thoracoscopic surgery.

METHODS

A total of 100 hospitalized patients undergoing thoracoscopic surgery were assigned randomly into the experimental (n = 49) and control groups (n = 51). Subjects in the experimental group received routine care plus acupressure on the Shenmen and Neiguan acupoints, while those in the control group received regular routine care. The data were collected using demographic information, physical and surgical data, the Visual Analog Scale (VAS)-A, the State-Trait Anxiety Inventory Y Form (STAI-Y1), and Shortened General Comfort Questionnaire scores. The linear mixed model was used to examine the influences of acupressure on VAS-A and STAI-Y1 scores at different time points before and after the surgery to observe group-by-time interactions.

RESULTS

The mean age of the subjects was 60.97 years. All subjects had mild-to-moderate anxiety after surgery and showed a statistically significant decline in regression coefficients on the first and second days after the intervention (β = -11.61, p = 0.002; β = -18.71, p < 0.001). Similarly, for STAI-YI scores, the data showed a significant difference in the pre-test and post-test interactions between the two groups (β = 4.72, p = 0.031). Conversely, acupressure did not have a statistically significant difference on comfort (F = 2.953, p = 0.057). Compared with the control subjects, the experimental subjects used less morphine and developed side effects less frequently (p < 0.01). They were also able to get out of bed after surgery 163.79 min earlier (p < 0.05).

CONCLUSIONS

Acupressure is a simple and easy-to-practice treatment. Acupressure on the Shenmen and Neiguan acupoints reduces anxiety and improves recovery in patients after undergoing thoracoscopic surgery.

Relationships of Sexual Orientation Microaggression with Anxiety and Depression among Lesbian, Gay, and Bisexual Taiwanese Youth: Self-Identity Disturbance Mediates but Gender Does Not Moderate the Relationships

The aims of this cross-sectional survey study were to examine the association between sexual orientation microaggression and anxiety and depression among young adult lesbian, gay, and bisexual (LGB) individuals in Taiwan, as well as to examine the mediating effect of self-identity disturbance and the moderating effect of gender. In total, 1000 self-identified LGB individuals participated in the study. The experience of sexual orientation microaggression was assessed using the Sexual Orientation Microaggression Inventory, self-identity disturbance was assessed using the Self-Concept and Identity Measure, anxiety was assessed using the State subscale on the Chinese version of the State-Trait Anxiety Inventory, and depression was assessed using the Center for Epidemiological Studies-Depression Scale. Structural equation modeling (SEM) was used to examine relationships between the variables. The SEM results demonstrated that sexual orientation microaggression was directly associated with increased anxiety and depression, as well as being indirectly associated with increased anxiety and depression via the mediation of self-identity disturbance among young adult LGB individuals. Gender did not moderate the relationships between any of the variables. Both sexual orientation microaggression and self-identity disturbance warrant program interventions for enhancing mental health among LGB individuals.

Efficiency of an Online Health-Promotion Program in Individuals with At-Risk Mental State during the COVID-19 Pandemic

Mental health issues caused by the COVID-19 pandemic greatly impact people’s daily lives. Individuals with an at-risk mental state are more vulnerable to mental health issues, and these may lead to onset of full psychotic illnesses. This study aimed to develop and evaluate an online health-promotion program for physical and mental health of the individuals with at-risk mental state during the COVID-19 pandemic. A single group study with pre- and post-tests was conducted in 39 young adults with at-risk mental state. The participants were provided with the online health-promotion program after completing the pretest. Via social media, the online counseling program released one topic of material (about 15–20 min) every two weeks and provided interactive counseling for specific personal health needs on the platform. Study questionnaires, physiological examination, and blood serum examination were completed at both pre- and post-tests. The participants showed significant improvements in mental risk, anxiety, and physical activity after participating in the program. Furthermore, those who did not complete the program had significantly more severe negative symptoms. These results imply that the online health-promotion program is effective and accessible under certain barriers such as the COVID-19 pandemic, but not for individuals with higher risk of more negative mental health symptoms.

Experience of Sexual Orientation Microaggression among Young Adult Lesbian, Gay, and Bisexual Individuals in Taiwan: Its Related Factors and Association with Mental Health Problems

Experiences of sexual orientation microaggression (SOM) are prevalent in lesbian, gay, and bisexual (LGB) individuals. The aims of this quantitative cross-sectional survey study were to examine the factors, including demographics, sexual orientation characteristics, and perceived social support related to SOM, as well as the relationships of SOM with anxiety, depression, and suicidality among young adult LGB individuals in Taiwan. In total, 1000 self-identified young adult LGB individuals (500 men and 500 women) participated in this study. The experience of SOM was assessed using the Sexual Orientation Microaggression Inventory. We also collected demographic and sexual orientation characteristics; perceived general family support, using the Family APGAR Index; anxiety on the State-Trait Anxiety Inventory; depression on the Center for Epidemiological Studies-Depression Scale; and suicidality on the suicidality module of the Kiddie-SADS. The factors related to SOM and the associations of SOM with anxiety, depression, and suicidality were examined using multivariate linear regression analysis. The results indicated that males experienced greater SOM than females, and that younger age of identification of sexual orientation and perceived lower general family support were significantly associated with greater SOM. Greater SOM was significantly associated with greater anxiety, depression, and suicidality. The experiences of SOM in LGB individuals with mental health problems warrant assessment and intervention that take the related factors into account.

Acupuncture Treatment Associated with Functional Connectivity Changes in Primary Dysmenorrhea: A Resting State fMRI Study

Primary dysmenorrhea (PDM) is the most commonly encountered gynecological problem in reproductive-age women. Acupuncture has been suggested as an effective treatment of PDM that may modulate descending pain modulation systems. In the present study, we used resting-state functional magnetic resonance imaging to investigate possible changes in descending pain modulation systems after acupuncture treatment in women with PDM. Thirty-four right-handed adult women with PDM participated in this randomized, single-blinded, sham-controlled study. Each patient was randomly allocated to an 8-week verum or sham acupuncture intervention on the bilateral Sanyinjiao (SP6). Resting-state functional magnetic resonance imaging was conducted before, during, and after the intervention to measure the spontaneous activity in brain. After the 8-week intervention, both verum and sham groups reported decreased menstrual pain. However, the cessation of decreased functional connectivity (FC) between periaqueductal gray matter and the regions associated with affective pain modulation and attention-related pain modulation were found in the verum but not in the sham group after the 8-week intervention. More decreased FC has been found in the region associated with non-specific effects of acupuncture intervention after the early stage of acupuncture intervention. These results indicated that verum acupuncture may intercept the altered FC in descending pain modulation systems in PDM.

Effects of the Health-Awareness-Strengthening Lifestyle Program in a Randomized Trial of Young Adults with an At-Risk Mental State

Background: Increasing health awareness in health promotion is considered as one of the less stigmatized interventions for improving help-seeking behaviors and total well-being. This study aimed to explore the short-term and long-term effectiveness of the health-awareness-strengthening lifestyle (HASL) program on Taiwanese young adults with at-risk mental state. Methods: A pre- and post-test randomized trial was conducted on 92 young adults with at-risk mental state. The HASL program was provided to the experimental group as intervention, and it was only provided to the control group passively by request after the post-test for ethical reasons. The program was conducted once every six weeks, 60–90 min per session, for a total of three times. Mental health risk, anxiety level, health promotion lifestyles, quality of life, physiological index, and physical exercises were assessed one week before and after the program for both groups and followed up to 6 and 12 months for experimental group only. Results: Compared to the control group, those in the experimental group showed significant improvements regarding anxiety level, health promotion lifestyles, and quality of life one week after participating in the program. Furthermore, the experimental group also showed an additional long-term positive effect on mental risk, physical exercises, and physical health after the follow-ups. Conclusions: The outcomes highlighted the interventions of the HASL program leading to more positive health effects on young adults with at-risk mental state. The implementation of similar clinical service is recommended for young adults with at-risk mental state.

Effects of Online Bodyweight High-Intensity Interval Training Intervention and Health Education on the Mental Health and Cognition of Sedentary Young Females

This study aimed to assess the effectiveness of an online high-intensity interval training (HIIT) intervention and health education on the behaviors, mental health, and cognitive function of sedentary young females. A single-blinded, six-week, randomized controlled pilot trial involving 70 sedentary young Chinese females, aged 18-30 years, was conducted. An intervention group (IG) (n = 33) underwent a HIIT intervention and health education, while a waitlist group (WG) (n = 37) only received health education. In pre-, mid-, and post-tests, both groups filled out questionnaires about physical activity, sedentary behavior, and mental health. Cognitive functions were assessed at the pre- and post-tests by computer-administered cognitive tests. A mixed-effect model with repeated measures was used to analyze outcomes of interest. The retention rate of the IG and WG was 100% and 78.38%, respectively. The IG were found to have significantly increased rates of moderate-to-vigorous physical activity (MVPA) (M_diff = 940.61, p < 0.001, 95% confidence interval (95% CI): 576.67, 1304.55) from pre-test to post-test, while the WG demonstrated a more marked reduction in sedentary time (M_diff = -73.02, p = 0.038, 95% CI: -141.90, -4.14) compared with the IG in the post-test. Moreover, anxiety and stress levels were shown to significantly reduce in the IG over the six-week period (M_diff = -4.73, p = 0.002, 95% CI: -7.30, -2.15 and M_diff = -5.09, p = 0.001, 95% CI: -8.29, -1.89, respectively). In addition, we observed a significant improvement in verbal ability (p = 0.008, ηp2 = 0.19) following the HIIT intervention and effects of the interaction with time on processing speed (p = 0.050, ηp2 = 0.10) and episodic memory (p = 0.048, ηp2 = 0.11). Moreover, the IG had better global cognitive performance than the WG in the post-test (M_diff = 8.28, p = 0.003, 95% CI: 3.06, 13.50). In summary, both an online bodyweight HIIT intervention combined with health education, or health education alone, can effectively improve health-related behaviors, but the behavioral consequences may differ based on the emphasis of different intervention modalities. Furthermore, the "bodyweight HIIT plus health education" modality might be a more promising online intervention strategy to mitigate against negative emotions and improve cognitive function.

Psychometric Properties of the Chinese Version of the 10-Item Ruminative Response Scale Among Undergraduates and Depressive Patients

Objective: Rumination is considered as a key process in the mechanism of depression. Assessing rumination is important for both research and clinical practice. The Ruminative Response Scale (RRS) is a widely-used instrument to measure rumination. This study aimed to examine the psychometric properties of the Chinese 10-item Ruminative Response Scale (RRS-10) in a large sample of Chinese undergraduates and depressive patients. Methods: A total of 1,773 university students and 286 clinical patients with major depressive disorder finished the Chinese version of the RRS10, State Trait Anxiety Inventory (STAI), and Beck Depression Inventory (BDI). A confirmatory factor analysis (CFA) was performed to examine the two-factor structure (reflection and brooding) of the RRS-10. The correlations among RRS-10, STAI, and BDI were explored in two samples. In addition, the measurement invariance of the RRS-10 across gender, time, and groups with and without depressive symptoms were further investigated. The internal consistency and test-retest reliability were also evaluated. Results: Confirmatory Factor Analysis revealed that the two-factor structure of RRS-10 fitted reasonably both in undergraduates (CFI = 0.933, TLI = 0.905, RMSEA = 0.071, SRMR = 0.035) and depressive patients (CFI = 0.941, TLI = 0.910, RMSEA = 0.077, SRMR = 0.057). The results of the multi-group confirmatory factor analysis supported the full strict invariance across genders and across groups (undergraduates and depressive patients). The full strong invariance over time was also supported by MGCFA. Besides, the RRS-10 showed acceptable internal consistency and good stability. Conclusions: The RRS-10 has good reliability and validity in different samples and over time, which demonstrated that RRS-10 is a valid measurement instrument to assess rumination.

A preliminary study on the effectiveness of a stress management program for healthcare-related undergraduates with at-risk mental state

PURPOSE

This study aimed to examine the effects of a stress management program on stress perception and coping strategies for healthcare-related undergraduates with at-risk mental state (ARMS).

DESIGN AND METHODS

A randomized experimental design with pretest and posttest was used. Of the 2812 students screened, 65 were identified as having ARMS, 52 enrolled in the study, and 49 (75%) completed the study.

FINDINGS

Significance was found for subjects with schizotypal traits in emotion expression and problem-avoidance coping strategies. Subjects with trait anxiety improved significantly in interpersonal deficits after the program.

PRACTICE IMPLICATIONS

Students with different trait risks reported benefits in different stress-coping strategies from the program.

Factor Structure and Gender Invariance of Chinese Version State-Trait Anxiety Inventory (Form Y) in University Students

Background

Anxiety can be classified as state anxiety and trait anxiety which present the current level of anxiety and the generalized anxiety tendencies of individuals, respectively. The State-Trait Anxiety Inventory form Y (STAI-Y) is a reliable instrument used to test both the levels of state and trait anxiety across various countries. However, the optimal factor structure of STAI-Y in different populations is not consistent and is not clear in Chinese university students. In addition, the gender invariance is the premise for comparing the scores of STAI-Y between men and women which also need to be verified. Therefore, this study explored the optimal factor structure of STAI-Y and examined whether the optimal factor structure satisfied measurement invariance across gender in Chinese university students.

Method

A sample of 2117 Chinese university students participated in this study including 748 men and 1369 women. The optimal factor structure was decided by singer group confirmatory factor analysis (CFA) and exploratory structural equation modeling (ESEM). Furthermore, the configural invariance, metric invariance, scalar invariance, and strict invariance models were administrated in multigroup CFA to detect the measurement equivalence of STAI-Y across gender in Chinese university students. The reliability of STAI-Y was tested by Cronbach’s alpha coefficient and McDonald’s omega coefficients.

Results

The optimal factor structure of STAI-Y was four-factor model and reached strict gender invariance in Chinese university students. Moreover, the STAI-Y also had adequate reliability in Chinese university students.

Conclusion

This study explored the factor structure and gender invariance of STAI-Y in Chinese university students. In sum, the four-factor structure of STAI-Y obtained the best goodness-of-fit and satisfied gender invariance which deepened the understanding of STAI-Y in Chinese university students.

Knowledge about benefits and risks of undergoing cataract surgery among cataract patients in Southern China

PURPOSE

To develop a theoretical framework for assessing knowledge about the possible outcomes of undergoing cataract surgery, and explore the association of knowledge level with psychological status and decision quality among patients with cataract in Southern China.

METHODS

The details of the knowledge scale were based on the health education information booklet provided by National Eye Institute, NIH. We used a theory-based approach to assess gist knowledge, which comprises 12 questions related to knowledge of the possible surgical outcomes. The scale was then used in a cross-sectional study to assess the association of knowledge score with psychological status and decision quality among cataract patients.

RESULTS

A total of 489 participants with age-related cataract were included in this study, and 10.2% (50/489) of them had adequate level of knowledge. The knowledge scale was significantly associated to the levels of worry (Odds Ratio (OR) = 0.36, 95%CI: 0.18, 0.70; P = 0.003), anxiety (beta coefficient = - 5.36, 95%CI - 8.88, - 1.84; P = 0.003), inaction regret (OR = 0.49, 95%CI: 0.28, 0.88; P = 0.016) and decision conflict (beta coefficient = - 7.93, 95%CI - 12.81, - 3.04; P = 0.002) in multivariate analyses adjusted for age, sex, education level and literacy level.

CONCLUSION

Knowledge adequacy with cataract surgery outcomes was negatively associated with cataract worry, anxiety and decisional conflict. Patients with adequate knowledge were more likely to postpone cataract surgery.

Effects of anxiety on dental students' noncognitive performance in their first objective structured clinical examination

Patient-dentist discourse is a core nonoperational competency in dental education. The skills of querying patients and responding to questions are noncognitive attributes, and their evaluation by the standardized patient objective structured clinical examination (OSCE) is particularly necessary. However, it is not clear whether students' test anxiety affects these attributes. This study aims to examine the relationship between dental students' state-trait anxiety, noncognitive performance, and examination results during their first OSCE. A single dental school cohort (n = 226) of 5 year students attending their first clinical examination from 2014 to 2017 was studied. Participants completed the Chinese Mandarin Version State-Trait Anxiety Inventory Y form before taking the OSCE. The difference between state and trait anxiety levels was compared by paired t test. Gender differences and the effect of age group in these anxiety levels were analyzed using multivariate analysis of variance. Moreover, gender, age group, state anxiety, and trait anxiety scores were compared with the OSCE items of noncognitive performance using a chi-square test. Students showed significantly higher state anxiety than trait anxiety levels; moreover, women showed significantly higher state anxiety than men. Furthermore, gender, age group, state anxiety, and trait anxiety had no association with the noncognitive performance examination results. Most participants showed moderate state and trait anxiety levels during their first OSCE. Further, the state-trait anxiety had no significant effect on their noncognitive performance. However, 26.5% of participants did not pass the examination; therefore, dental educators should increase communication skill training courses during clerkship training to improve students' noncognitive attributes.

A Preliminary Study of the Comfort in Patients with Leukemia Staying in a Positive Pressure Isolation Room

Background and Aim: Patients with leukemia who are isolated in positive pressure rooms for infection prevention usually experience significant physical and psychological distress. This study aimed to examine changes in leukemia patients' comfort level during chemotherapy in isolation wards. Methods: A longitudinal survey was conducted with measures which were repeated four times. Data were collected before chemotherapy, on the first and second week after receiving chemotherapy in positive pressure isolation rooms, and on the third week in the non-isolated hematology ward. Each patient received six questionnaires measuring demographic data, comfort status, functional status, fatigue related to cancer therapy, anxiety level, and distress symptoms. A mixed model with repeated measure analysis was used to examine the changing trajectories in physical and psychological health. Results: Twenty-one patients completed the study. During the process, the highest score for comfort level was shown before chemotherapy, and this decreased from the second week under isolation. Anxiety and uncertainty (p < 0.05) declined over time, and emotional states improved during the recovery period in the third and fourth weeks outside isolation. Physical well-being (p < 0.01), cancer-related fatigue (p < 0.05), hemoglobin (p < 0.01) and white blood cell count (p < 0.05) began to rise two weeks after chemotherapy. Conclusion: Comfort levels declined after chemotherapy until the third week of treatment. Anxiety, fatigue and distress symptoms varied across the four time points of chemotherapy from isolation to return to the non-isolated ward. Health care professionals should be aware of psychological symptoms when patients are in isolation rooms, and interventions for promoting a humanized environment, quality of life, and comfort should be considered and provided along with the treatment stages of chemotherapy.

Validity and reliability of State-Trait Anxiety Inventory in Danish women aged 45 years and older with abnormal cervical screening results

Background

State Trait Anxiety Inventory (STAI) scale was developed in the 1980’s and has been widely used both in clinical settings and in research. However the Danish version of STAI has not been validated. The aim of this study was to assess the validity and reliability of STAI - state anxiety scale in Danish women aged 45 years and older with abnormal cervical cancer screening results.

Methods

Women ≥45 years referred with an abnormal cervical cytology and healthy volunteers (n = 12) underwent cognitive interview after completing STAI. Further, STAI was sent out in an electronic questionnaire to women (n = 109) seen at the gynecological department with abnormal cervical cancer screening test during 2018. Validity and reliability of STAI was evaluated according to the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) checklist by examining internal consistency, test-retest reliability, measurement error, floor and ceiling, construct validity and content validity.

Results

In the cognitive interviews the content validity was evaluated to be very good. The internal consistency of the scale was excellent with Cronbach’s α = 0.93. Test-retest reliability was good with an intra-class correlation coefficient of 0.80 and the systematic difference between test-retest results was negligible. The construct validity was good.

Conclusion

To our best knowledge, this is the first validation study of the Danish translation of STAI-state anxiety scale. This version of STAI demonstrates an acceptable reliability and validity when used in a gynecological setting.

The Effects of Continuous Care Model of Information-Based Hospital-Family Integration on Colostomy Patients: a Randomized Controlled Trial

The purpose of this research was to examine the effects of continuous care model of information-based hospital-family integration on colostomy patients. Miles' operation is a major operative method for treating low rectal cancer, and this operation results in a permanent colostomy. It is difficult for patients to adapt to their colostomy. Previous studies have applied generally conventional nursing models to colostomy patients. This was a single-blind randomized controlled trial study. The sample of 155 patients who met the inclusion criteria was randomly assigned to either the experimental (n = 81) or control group (n = 74). The control group was provided with a routine standard of care. The experimental group was provided with an experimental treatment that consisted of an information-based (WeChat, blog, QQ, telephone, etc.) hospital-family integration continuous care model. Study variables were collected and instruments were selected as follows: basic information, State-Trait Anxiety Inventory (STAI), a self-efficacy scale, a colostomy complication assessment table, a quality of life scale, and a table of the degree of satisfaction. No statistically significant differences were found in demographic information between the experimental and control groups. In comparison with the control group, subjects in the experimental group had less anxiety and could better cope with anxiety, had a better self-efficacy and quality of life scores, and had fewer complications. The patients in the experimental group were shown to be more satisfied with the care model. In addition, the most useful and popular service is the online social tools WeChat and QQ, because they can communicate with video, and they are more real-time, efficient, and cheap. The continuous care model of information-based hospital-family integration significantly strengthened patients' self-efficacy and confidence, which decreased colostomy complications, ultimately improving the quality of life.

Screening nursing students to identify those at high risk of poor mental health: a cross-sectional survey

OBJECTIVES

This study aimed to identify those at high risk of poor mental health among nursing students and to examine the relationships and consistency among five mental health assessments.

DESIGN

A cross-sectional design with purposive sampling was used. Four mental health screening tools plus previous mental health history/information were conducted during June 2015 to October 2016.

SETTING

A nursing major university in Taiwan.

PARTICIPANTS

A total of 2779 participants aged between 19 and 45 years were recruited.

MAIN OUTCOME MEASURES

Five mental health risks were identified: increased risk for ultra-high risk, putative prepsychosis states, high trait anxiety, high state anxiety with genetic risk and depression.

RESULTS

Out of the 3395 collected questionnaire, 2779 (82%) were found valid and included in the study. 612 (22%) of the participants were identified to be at mental health risk. 12 of them appeared positive in four, 79 in three, 148 in two and 373 in one of the adopted mental health screening tools. 69 participants had the experience of seeking medical help due to mental health issues, and 58% of them were identified to be at risk of mental health during the screening. Trait and state anxiety scored the highest in correlation analysis (r(2620)=0.76, p<0.001). Correlations were observed in the scores on the subscales of Chinese Version of Schizotypal Personality Questionnaire-Brief (CSPQ-B) and those of Brief self-report Questionnaire for Screening Putative Prepsychotic States (BQSPS), and the highest correlation coefficients was (r(2740)=0.70, p<0.001). Although both of the screening tools are used to assess mental illness risk at its prodromal phase, but CSPQ-B in general appeared to have more rigorous screening criteria than BQSPS.

CONCLUSION

For expediting early identification high risk of poor mental health, easy-to-use screening questionnaires can be adopted to assess the mental health state of nursing students whose mental well-being and overall health are of vital importance to the entire healthcare industry.

High risk of depression, anxiety, and poor quality of life among experienced fathers, but not mothers: A prospective longitudinal study

BACKGROUND

Mental distress patterns in first-time or experienced mothers and fathers during the transition to parenthood have been inadequately studied. This longitudinal study thus investigated changes in depression, anxiety, and health-related quality of life in both parents from early pregnancy until 1 year postpartum. Parity effects were specifically examined.

METHODS

In total, 531 pregnant women and their partners were recruited in Taiwan during early prenatal visits from 2011 to 2015, with five follow-ups from midpregnancy to 1 year postpartum. The participants' self-reported data were collected and analyzed using generalized estimating equation models.

RESULTS

Maternal mental distress levels were highest at 1 month postpartum. During postpartum periods, depression scores increased and social relations domain scores decreased in men. Although mental distress levels were higher in mothers than in fathers, parity evidently affected men. Experienced fathers were independently associated with a 70% higher risk of perinatal depression (odds ratio [OR] = 1.7, 95% confidence interval [CI] = 1.2-2.3) and anxiety (OR = 1.7, 95% CI = 1.2-2.6). Experienced fathers also exhibited significantly lower perinatal scores than first-time fathers in the physical health and social relations domains.

LIMITATIONS

Selection of both parents in metropolitan areas with higher socioeconomic status may restrict the generalizability of our findings.

CONCLUSIONS

In addition to maternal mental distress during the transition to parenthood, we highlighted experienced fathers' psychological difficulties throughout perinatal periods. Such trends may indicate unsatisfied needs and could guide timely intervention to prevent adverse consequences.

Interactions of BDNF Val66Met Polymorphism and Menstrual Pain on Brain Complexity

The irregularity and uncertainty of neurophysiologic signals across different time scales can be regarded as neural complexity, which is related to the adaptability of the nervous system and the information processing between neurons. We recently reported general loss of brain complexity, as measured by multiscale sample entropy (MSE), at pain-related regions in females with primary dysmenorrhea (PDM). However, it is unclear whether this loss of brain complexity is associated with inter-subject genetic variations. Brain-derived neurotrophic factor (BDNF) is a widely expressed neurotrophin in the brain and is crucial to neural plasticity. The BDNF Val66Met single-nucleotide polymorphism (SNP) is associated with mood, stress, and pain conditions. Therefore, we aimed to examine the interactions of BDNF Val66Met polymorphism and long-term menstrual pain experience on brain complexity. We genotyped BDNF Val66Met SNP in 80 PDM females (20 Val/Val, 31 Val/Met, 29 Met/Met) and 76 healthy female controls (25 Val/Val, 36 Val/Met, 15 Met/Met). MSE analysis was applied to neural source activity estimated from resting-state magnetoencephalography (MEG) signals during pain-free state. We found that brain complexity alterations were associated with the interactions of BDNF Val66Met polymorphism and menstrual pain experience. In healthy female controls, Met carriers (Val/Met and Met/Met) demonstrated lower brain complexity than Val/Val homozygotes in extensive brain regions, suggesting a possible protective role of Val/Val homozygosity in brain complexity. However, after experiencing long-term menstrual pain, the complexity differences between different genotypes in healthy controls were greatly diminished in PDM females, especially in the limbic system, including the hippocampus and amygdala. Our results suggest that pain experience preponderantly affects the effect of BDNF Val66Met polymorphism on brain complexity. The results of the present study also highlight the potential utilization of resting-state brain complexity for the development of new therapeutic strategies in patients with chronic pain.

Psychometric Properties of the State-Trait Anxiety Inventory (Form Y) among Malaysian University Students

Health Ministry statistics showed mental health problems among Malaysian students increased from one in ten individuals in year 2011 to one in five in 2016. Anxiety and depression were cited as the main causes of mental health problems among students in Malaysia. However, an anxiety measure that has been validated for use with Malaysian students is still lacking. Thus, the main objective of the current study is to examine the psychometric proprieties of the State-Trait Anxiety Inventory (Form Y) (STAI), and to assess the suitability of the factorial model in the context of Malaysia. The STAI contains separate scales for measuring state and trait anxiety. A Confirmatory Factor Analysis (CFA) was conducted to test and to compare the two-factor model (State Anxiety and Trait Anxiety) and the four-factor model (State Anxiety Present, State Anxiety Absent, Trait Anxiety Present, and Trait Anxiety Absent) of STAI. In addition, the reliability and validity of the model were also tested. The sample consisted of 341 university students from one of the universities in Kota Kinabalu, Sabah. The results supported a better fit to the data for the four-factor model of STAI. To improve composite reliability and the average variance extracted (AVE) of the constructs, one item was removed from each of the State Anxiety Present factor, Trait Anxiety present factor, and Trait Anxiety Absent factor. Convergent validity for the four-factor model was also improved by the removal of the three items. The findings also suggested that the STAI may have some discriminant validity issues. In the framework of psychology of sustainability and sustainable development, research and intervention regarding this topic should also be enhanced from a primary prevention perspective to improve the quality of life of every human being, fostering wellbeing at all different levels, from individuals to organizations.

The Effects of an Exercise Program on Anxiety Levels and Metabolic Functions in Patients With Anxiety Disorders

The purpose of this study was to evaluate the effects of a home-based (HB) exercise program on anxiety levels and metabolic functions in patients with anxiety disorders in Taiwan. Purposive sampling was used to recruit 86 participants for this randomized, experimental study. Participants were asked to complete a pretest before the 3-month exercise program, a posttest at 1 week, and a follow-up test at 3 months after the exercise program. Study measures included four Self-Report Scales and biophysical assessments to collect and assess personal data, lifestyle behaviors, anxiety levels, and metabolic control functions. Of the 86 study participants, 83 completed the posttest and the 3-month follow-up test, including 41 in the experimental group and 42 in the control group. Participants in the experimental group showed significant improvements in body mass index, high-density lipoprotein cholesterol levels, and the level of moderate exercise after the program relative to the control group, as analyzed by generalized estimating equations mixed-model repeated measures. State and trait anxiety levels were also significantly improved from pretest to follow-up test in the experimental group. Finally, the prevalence of metabolic syndrome declined for participants in the experimental group. The HB exercise program produced positive effects on the metabolic indicators and anxiety levels of Taiwanese adults with anxiety disorders. Health providers should consider using similar HB exercise programs to help improve the mental and physical health of patients with anxiety disorders in their communities.

The Relationship between Cortisol Activity during Cognitive Task and Posttraumatic Stress Symptom Clusters

Background

The latest development in the dimensional structure of posttraumatic stress disorder (PTSD) is a novel 6-factor model, which builds on the newly released DSM-5. One notable gap in the literature is that little is known about how distinct symptom clusters of PTSD are related to hypothalamic–pituitary–adrenal (HPA) axis activity when people perform a relatively less stressful cognitive task. The purpose of this study was to investigate the relationship between cortisol activity when individuals perform cognitive tasks in the laboratory and a contemporary phenotypic model of posttraumatic stress symptomatology in earthquake survivors.

Methods

Salivary cortisol while performing cognitive tasks was collected and analyzed in 89 adult earthquake survivors. The PTSD Checklist for the DSM-5 (PCL-5) was used to assess the severity of total PTSD as well as six distinct symptom clusters. Regression analyses were conducted to examine the associations between the six distinct PTSD symptom clusters and cortisol profiles.

Results

The results showed that the score of the negative affect symptom cluster, but not anhedonia or other clusters, was positively associated with cortisol levels before and during the cognitive tasks.

Conclusion

The results showed that higher cortisol levels before and during cognitive tasks might be specifically linked to a distinct symptom cluster of PTSD—negative affect symptomatology. This suggests that a distinction should be made between negative affect and anhedonia symptom clusters, as the 6-factor model proposed.