Are comparisons of mental disorders between Chinese and German students possible? An examination of measurement invariance for the PHQ-15, PHQ-9 and GAD-7

The universality of anxiety experiences between Germany, Indonesia, and the US: A measurement invariance analysis

BACKGROUND

Generalized Anxiety Disorder-7 (GAD-7) is a widely used self-report that assesses generalized anxiety disorder symptomatology. Whilst previous studies have reported good-to-excellent psychometric properties across different languages, it remains unclear whether GAD-7 measures the same construct across Western and non-Western countries. Here, we tested the hypothesis that the GAD-7 is measurement invariant across Western and non-Western countries and the hypothesis that a less severe GAD symptomatology can be found in non-Western countries.

METHODS

The present study employed an online survey to examine the GAD-7's measurement invariance (MI) across community samples from Indonesia, Germany, and the USA (N = 2350). MI was computed using multiple-group confirmatory factor analyses with a general factor model of the GAD-7.

RESULTS

The general factor of the GAD-7 had good model fit and configural, metric, scalar, and residual MI across the three countries. No significant differences were found in mean scores (Indonesia, M = 1.78, SD = 0.64, Germany, M = 1.84, SD = 0.69, USA, M = 1.87, SD = 0.79; F (2, 1514) = 3.079, p = 0.046; Games-Howell post-hoc analysis, tGermany-Indonesia = 1.720, p = 0.199; tGermany-USA = 0.750, p = 0.734; tIndonesia-USA = 2.330, p = 0.053).

LIMITATIONS

This study's online nature may have inflated cross-country similarities and reduced data generalizability.

CONCLUSION

The full MI demonstrates the GAD-7 captures the same GAD construct across Western and non-Western countries. Inconsistent with the previous findings GAD severity levels were similar across countries. Despite some possible reservations, the GAD-7 appears to be a culturally fair GAD measure.

Development and Validation of PRE-SARC (PREdiction of SARCopenia Risk in Community Older Adults) Sarcopenia Prediction Model

OBJECTIVE

Reliable identification of high-risk older adults who are likely to develop sarcopenia is essential to implement targeted preventive measures and follow-up. However, no sarcopenia prediction model is currently available for community use. Our objective was to develop and validate a risk prediction model for calculating the 1-year absolute risk of developing sarcopenia in an aging population.

METHODS

One prospective population-based cohort of non-sarcopenic individuals aged 60 years or older were used for the development of a sarcopenia risk prediction model and model validation. Sarcopenia was defined according to the 2019 Asian Working Group for Sarcopenia consensus. Stepwise logistic regression was used to identify risk factors for sarcopenia incidence within a 1-year follow-up. Model performance was evaluated using the area under the receiver operating characteristics curve (AUROC) and calibration plot, respectively.

RESULTS

The development cohort included 1042 older adults, among whom 87 participants developed sarcopenia during a 1-year follow-up. The PRE-SARC (PREdiction of SARCopenia Risk in community older adults) model can accurately predict the 1-year risk of sarcopenia by using 7 easily accessible community-based predictors. The PRE-SARC model performed well in predicting sarcopenia, with an AUROC of 87% (95% CI, 0.83-0.90) and good calibration. Internal validation showed minimal optimism, with an adjusted AUROC of 0.85. The prediction score was categorized into 4 risk groups: low (0%-10%), moderate (>10%-20%), high (>20%-40%), and very high (>40%). The PRE-SARC model has been incorporated into an online risk calculator, which is freely accessible for daily clinical applications (https://sarcopeniariskprediction.shinyapps.io/dynnomapp/).

CONCLUSIONS

In community-dwelling individuals, the PRE-SARC model can accurately predict 1-year sarcopenia incidence. This model serves as a readily available and free accessible tool to identify older adults at high risk of sarcopenia, thereby facilitating personalized early preventive approaches and optimizing the utilization of health care resources.

An artificial intelligence tool to assess the risk of severe mental distress among college students in terms of demographics, eating habits, lifestyles, and sport habits: an externally validated study using machine learning

BACKGROUND

Precisely estimating the probability of mental health challenges among college students is pivotal for facilitating timely intervention and preventative measures. However, to date, no specific artificial intelligence (AI) models have been reported to effectively forecast severe mental distress. This study aimed to develop and validate an advanced AI tool for predicting the likelihood of severe mental distress in college students.

METHODS

A total of 2088 college students from five universities were enrolled in this study. Participants were randomly divided into a training group (80%) and a validation group (20%). Various machine learning models, including logistic regression (LR), extreme gradient boosting machine (eXGBM), decision tree (DT), k-nearest neighbor (KNN), random forest (RF), and support vector machine (SVM), were employed and trained in this study. Model performance was evaluated using 11 metrics, and the highest scoring model was selected. In addition, external validation was conducted on 751 participants from three universities. The AI tool was then deployed as a web-based AI application.

RESULTS

Among the models developed, the eXGBM model achieved the highest area under the curve (AUC) value of 0.932 (95% CI: 0.911-0.949), closely followed by RF with an AUC of 0.927 (95% CI: 0.905-0.943). The eXGBM model demonstrated superior performance in accuracy (0.850), precision (0.824), recall (0.890), specificity (0.810), F1 score (0.856), Brier score (0.103), log loss (0.326), and discrimination slope (0.598). The eXGBM model also received the highest score of 60 based on the evaluation scoring system, while RF achieved a score of 49. The scores of LR, DT, and SVM were only 19, 32, and 36, respectively. External validation yielded an impressive AUC value of 0.918.

CONCLUSIONS

The AI tool demonstrates promising predictive performance for identifying college students at risk of severe mental distress. It has the potential to guide intervention strategies and support early identification and preventive measures.

The association between online learning, perceived parental relationship, anxiety, and depression symptoms among secondary school students: insight from symptom network and cross-lagged panel network approach

INTRODUCTION

Anxiety and depression often co-occur in adolescents, with factors from family and school playing a significant role in the comorbidity. However, network analysis has not examined and clarified the detailed bridge and central symptoms of this comorbidity caused by online learning and perceived parental relationships across different COVID-19 times.

METHODS

Over four months, 2,356 secondary school students completed the Patient Health Questionnaire-9 and Generalized Anxiety Disorder Scale-7. Participants were divided into harmonious and disharmonious groups based on their answers to a question about parental conflicts.

RESULTS

The results indicated that adolescents perceiving more parental conflicts showed a denser comorbidity network after four months of online learning. Significant bridge symptoms decreased from three to two across two waves in the harmonious group, while in the disharmonious group, they increased from two to three. The number of central symptoms increased from one in wave 1 to three in wave 2 for the harmonious group, while four in wave 1 decreased to two in wave 2 for the disharmonious group. Furthermore, the CLPN analysis revealed that the strongest positive cross-lagged edge intensity between symptoms was anhedonia-energy in the harmonious group, with anhedonia being the most trigger symptom. In contrast, for the disharmonious group, guilt-suicide and trouble relaxing-excessive worry were the strongest cross-lagged edge, and trouble relaxing was the most trigger symptom.

CONCLUSION

These findings may have implications for interventions designed to promote adolescent mental health in the context of online learning and parental conflicts.

The Role of Depression and Anxiety in the Relationship Between Arthritis and Cognitive Impairment in Chinese Older Adults

BACKGROUND

Mental disorders and cognitive impairment are common in older patients with arthritis. While it is recognized that mental conditions may play a role in the connection between arthritis and cognitive impairment, the precise underlying relationship remains uncertain.

METHODS

The data was derived from the baseline survey of the Guangdong Mental Health Survey in South China, involving a sample of 3,764 citizens aged 65 and older. An array of aspects were explored, including socio-demographics, lifestyle behaviors, self-reported chronic conditions, depression, anxiety, and cognitive impairment. Logistic regression analyses examined the association between arthritis and cognitive impairment after adjustment for potential confounders. Serial mediation models were used to examine whether depression or anxiety played a mediating role in the arthritis-cognitive impairment linkage.

RESULTS

The prevalence rates of cognitive impairment and arthritis of the older adults were 28.9% and 12.1%, respectively. Compared to those without arthritis, participants with arthritis were at a higher risk of cognitive impairment (OR = 1.322, 95%CI: 1.022-1.709) after adjustment for socio-demographics, lifestyle behaviors, and mental health conditions. Serial mediation analyses indicated that depressive and anxiety symptoms co-played a serial mediating role in the association between arthritis and cognitive impairment (B1 = 0.025, 95%CI: 0.005-0.052; B2 = 0.050, 95%CI: 0.021-0.086).

CONCLUSIONS

Arthritis may heighten cognitive impairment risk in Chinese older adults, and the relationship was potentially mediated by depressive and anxiety symptoms. Future interventions should be considered, integrating mental health assessments into arthritis care frameworks and being alert to possible cognitive impairment.

Psychometric Properties of the Metacognitions About Online Gaming Scale in the Chinese Population and Its Relationship With Internet Gaming Disorder: Cross-Sectional Study

BACKGROUND

Metacognitions about online gaming have been shown to be correlated with Internet Gaming Disorder (IGD). Knowledge of metacognitions about online gaming can help to understand IGD. The Metacognitions about Online Gaming Scale (MOGS) is a reliable and valid tool to measure specific metacognitions about online gaming in both adults and adolescents, which is lacking in China.

OBJECTIVE

This study was conducted to assess the psychometric properties of the Chinese version of the MOGS (C-MOGS) and its relationship with IGD in the Chinese population.

METHODS

A total of 772 Chinese individuals (age: mean 21.70, SD 8.81 years; age range: 13-57 years; 458/772, 59.3% male) completed a web-based questionnaire survey, including the C-MOGS and a battery of validated scales measuring IGD, gaming motives, depression, and anxiety.

RESULTS

Through exploratory and confirmatory factor analyses, the 3-factor structure was confirmed to have adequate model fit and internal consistency reliability (Cronbach α≥.799, Guttman split-half coefficients≥0.754). Concurrent validity of the C-MOGS was supported by its correlations with IGD (P<.001), gaming motives (P<.001), depression (P<.001), and anxiety (P<.001). Furthermore, the incremental validity analysis showed that the C-MOGS predicted 13% of the variance in IGD while controlling for gender, age, weekly gaming hours, gaming motives, depression, and anxiety.

CONCLUSIONS

This study provides evidence that the psychometric properties of the C-MOGS are appropriate and emphasizes its positive association with IGD. The C-MOGS is a reliable and valid instrument for mental health workers to assess metacognitions about online gaming in the Chinese population.

Psychometric properties of the GAD-7 (General Anxiety Disorder-7): a cross-sectional study of the Peruvian general population

BACKGROUND

Anxiety disorders are among the main mental health problems worldwide and are considered one of the most disabling conditions. Therefore, it is essential to have measurement tools that can be used to screen for anxiety symptoms in the general population and thus identify potential cases of people with anxiety symptoms and provide them with timely care. Our aim was to evaluate the psychometric properties of the General Anxiety Disorder-7 scale (GAD-7) in the Peruvian population.

METHOD

Our study was a cross-sectional study. The sample included people aged 12 to 65 years in Peru. Confirmatory factor analysis, analysis of measurement invariance, convergent validity with the Patient Health Questionnaire-9 (PHQ-9) and internal consistency analysis were performed.

RESULTS

In total, 4431 participants were included. The one-factor model showed the best fit (CFI = 0.994; TLI = 0.991; RMSEA = 0.068; WRMR = 1.567). The GAD-7 score showed measurement invariance between men and women and between age groups (adults vs. adolescents) (ΔCFI < 0.01). The internal consistency of the one-factor model was satisfactory (ω = 0.90, α = 0.93). The relationship between depressive symptoms (PHQ-9) and anxiety symptoms (GAD-7) presented a moderate correlation (r = 0.77).

CONCLUSIONS

Our study concluded that the GAD-7 score shows evidence of validity and reliability for the one-factor model. Furthermore, because the GAD-7 score is invariant, comparisons can be made between groups (i.e., by sex and age group). Finally, we recommend the use of the GAD-7 for the general population in the Peruvian context.

Efficacy of Magnesium Sulfate and Labetalol in the Treatment of Pregnancy-Induced Hypertension and Its Effect on Anxiety and Depression: A Retrospective Cohort Study

Background

In this study, the effect of magnesium sulfate and labetalol in treating pregnancy-induced hypertension (PIH) and its influence on anxiety and depression in patients are observed, and new ideas for treating anxiety and depression in PIH are introduced.

Methods

A retrospective cohort study was conducted to select patients with PlH diagnosed from July 2020 to July 2023 from Affiliated Hospital of Electronic Science and Technology University and Chengdu Women' s and Children's Central Hospital in Chengdu of Sichuan Province. The changes in blood pressure, Edinburgh Postnatal Depression Scale (EPDS), and generalized anxiety disorder 7 (GAD-7) in patients with hypertensive pregnancy were collected and analyzed.

Results

In our investigation, 219 patients completed the study, and 36.1% (79/219) of them developed anxiety and depression. According to whether the patients were treated with magnesium sulfate and labetalol, 49 cases were assigned to the magnesium sulfate and labetalol treatment (MSLT) group, and 30 cases were assigned to the conventional treatment (CT) group. Edinburgh Postnatal Depression Scale scores and GAD-7 scores in the MSLT group were significantly lower than those in the CT group, indicating that magnesium sulfate and labetalol can improve anxiety and depression in hypertensive patients during pregnancy. The difference was statistically significant (P < .05). According to the changes in systolic blood pressure, the clinical efficacy of patients was evaluated, and no significant difference in efficacy existed between the MSLT and CT groups.

Conclusion

Magnesium sulfate and labetalol can control the blood pressure of patients with PIH and indirectly improve anxiety and depression in patients with PIH, thereby introducing new ideas for the treatment of PIH accompanied by anxiety and depression.

Related factors to illness perception of individuals with diabetic foot ulcers: A structural equation modelling test

BACKGROUND

Diabetic foot is a common and severe complication of diabetes with limited movement, emotional distress, and poor quality of life. Illness perception was introduced to improve patients' psychological status and quality of life with diabetic foot ulcers. The aim of the study is to explore the related factors of illness perception, and to structure an illness perception model of patients with diabetic foot ulcers.

METHODS

We recruited 208 patients with diabetic foot ulcers from six hospitals from April 2021 to February 2022. A multicentered cross-sectional study was conducted to collect the data. Questionnaires included illness perception, coping behavior, emotional status, and quality of life. We performed multiple linear regression analysis with illness perception as the dependent variable, and evaluated the goodness of fit of the resulting structural equations models based on covariance structural analysis.

RESULTS

Illness perception was negatively related to coping behavior and quality of life, and it was positively correlated with yield-coping behavior, anxiety, and depression. The pain, diabetes duration, quality of life, yield-coping strategy, and sex were the factors that affected illness perception in patients with DFUs (P＜0.05). The resulting model was found to exhibit goodness of fit.

CONCLUSION

Illness perception had an especially strong and direct impact on quality of life, depression, and anxiety. Therefore, it is significant to improve illness perception in patients with DFUs, and provide positive support based on cognitive behavioral therapy to improve illness perception, quality of life, and emotional status.

Three-wave longitudinal prediction of positive mental health in Germany and China

The present study is a follow-up of a prior study examining a broad range of longitudinal predictors of dimensional positive mental health (PMH) and negative mental health (NMH), using cross-cultural data from the Bochum Optimism and Mental Health (BOOM) study. The present study sought to expand prior findings on positive mental health predictors to a longer longitudinal timeframe. The analysis, specifically, tests our prior model using a third time point, The following positive constructs were examined in relation to later positive mental health: resilience, social support, social rhythm, family affluence, physical health and expectations for fertility. Negative predictors depression, anxiety, and stress were also examined in relation to time 3 positive mental health. Participants included university student samples from Germany (N = 591) and China (N = 8,831). Structural equation modeling was used to examine the effects of predictors on mental health. In China, three of the six salutogenic predictors (social rhythm regularity, positive mental health, resilience) at baseline were predictive of positive mental health at both follow-ups with generally small, but significant effects. Social support at baseline predicted more, and stress and anxiety predicted less positive mental health at follow-up 1, with generally small effects. Depression at baseline predicted less positive mental health at follow-up 2. In Germany, two of the six salutogenic predictors (positive mental health, social support) at baseline were predictive of positive mental health at both follow-ups, with generally small effects. Pathogenic predictors were not predictive of positive mental health at either follow-up. According to multi group analysis, the paths from positive mental health baseline to positive mental health follow-up 1 (FU1) as well as the path positive mental health FU1 to positive mental health follow-up 2 (FU2) were found to differ between Germany and China. All other paths could be seen as equivalent in Germany and China. Results indicate prediction of positive mental health over an extended period of time, and in particular by salutogenic predictors. Pathogenic predictors were also (negatively) predictive of PMH, but with more mixed results, underscoring the differential prediction of PMH from salutogenic and pathogenic factors.

New cut-off points of PHQ-9 and its variants, in Costa Rica: a nationwide observational study

The PHQ-9 questionnaire is a screening test worldwide used to measure depression. But it cannot be used in Costa Rica, due to the fact that it has not previously been validated for its population. The present study aims to show the validation of the PHQ-9 questionnaire and its variants (PHQ-2, PHQ-4, PHQ-8) in a population sample of adults residing in Costa Rica. A sample was collected (n = 1162) using a self-administered questionnaire. Confirmatory Factor Analysis (CFA), Receiver Operating Characteristic (ROC) curve, and Multiple Group Confirmatory Factor Analysis (MGCFA) were tested. One factor was found that explained 73.33% of the variance with excellent internal consistency (α = 0.928). Goodness-of-fit measures were adequate (RMSEA = 0.107; CFI = 0.948), as was diagnostic power at a cut-off of 10 (78.60 for Sensitivity and 27.95 for 1-Specificity). External validation indices were good (r = 0.843 with GAD-7, r = - 0.647 with RS14, and r = 0.301 with FCV19S), and the model showed invariance by sex (∆χ2 = 27.90; df = 27; p < 0.001). Additionally, new cut-off points were proposed for PHQ-9 and its variants for Costa Rican male, female, and general populations. The PHQ-9 and its variants (PHQ-2, 4, and 8) are valid tools for detecting depression (and anxiety for PHQ-4) in Costa Rican population. In addition, new cut-off points differentiated by sex are proposed.

Depression, anxiety and insomnia in Chinese older adults and their family caregivers during the COVID-19 pandemic: an actor-partner interdependence model approach

Aims

This study aimed to explore the dyadic effects of depression and anxiety on insomnia symptoms in Chinese older adults and their caregivers living in a community setting.

Methods

Data were collected from 1,507 pairs of older adults and their caregivers who were in the Guangdong Mental Health Survey in China. The 9-item Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder module 7 (GAD-7), and Insomnia Severity Index (ISI) were used to measure depression, anxiety, and insomnia symptoms. Actor-Partner Interdependence Models (APIM) were used to determine whether anxiety or depression symptoms predicted individual or dyadic insomnia.

Results

Older adults' and caregivers' depression and anxiety had significant positive correlations with their own and their caregivers' insomnia symptoms (all P < 0.001). Actor effects were found between depression and insomnia symptoms in both older adults and caregivers (B = 0.695, P < 0.001; B = 0.547, P < 0.001, respectively), with one significant partner effects (B = 0.080, P = 0.007). Actor effects were also found between anxiety and insomnia symptoms in both older adults and caregivers (B = 0.825, P < 0.001; B = 0.751, P < 0.001, respectively), with one significant partner effects (B = 0.097, P = 0.004). However, the caregivers' depression and anxiety were not associated with older adults' insomnia symptoms in the APIM analyses.

Conclusions

Older adults and their caregivers had an interrelationship between psychological distress and insomnia. Consequently, healthcare providers might consider involving dyads when designing programs to reduce insomnia and improve psychological distress for family caregivers.

Medically Unexplained Symptoms among Adults from Russia: An Assessment using the Patient Health Questionnaire-15

Background

The Patient Health Questionnaire-15 (PHQ-15) is one of the most frequently used instruments to measure medically unexplained symptoms in the general population, as well as in groups of patients with mental and physical health problems.

Objective

This study aimed to examine the psychometric properties of the PHQ-15 in assessing a Russian community sample.

Design

A total of 1153 Russian adults age 18 or older participated in this cross-sectional study. They completed the Russian versions of the PHQ-15 and Symptom Check List-90-Revised, SCL-90-R (SCL-90-R). Exploratory and confirmatory factor analyses were used to examine the factor structure of the Russian PHQ-15, and multi-group confirmatory factor analyses were used to test measurement invariance across sex and age. Cronbach's alpha coefficients and Pearsons Correlation Coefficients were used to evaluate the internal reliability and convergent validity of the Russian PHQ-15.

Results

Exploratory factor analysis revealed a three-factor solution highlighting pain-fatigue, gastrointestinal, and cardiopulmonary symptoms. Confirmatory factor analysis confirmed a bifactor structure for the Russian PHQ-15 merging general and specific somatic symptoms. A multi-group confirmatory factor analysis showed partial invariance across sex and age. The Russian PHQ-15 demonstrated acceptable Cronbach's alpha coefficients ranging from 0.72 to 0.75 for specific factors and a good Cronbach's alpha for the total score (a = 0.85), proving the questionnaire's internal reliability. Finally, positive correlations between the PHQ-15 and SCL-90-R dimensions, and positive intercorrelations between PHQ-15 specific factors, suggested convergent validity.

Conclusion

The Russian PHQ-15 is a reliable and valid instrument for assessing medically unexplained symptoms in the general population. This instrument can be used in diagnostic and counseling settings.

Association of mental health status between self-poisoning suicide patients and their family members: a matched-pair analysis

BACKGROUND

The objective of this study was to examine the relationship of mental health status between self-poisoning suicide patients and their family members, and it also sought to identify potential patient's risk and parental factors for the prediction of suicide attempt, anxiety, and depression.

METHODS

In this study, 151 poisoned patients were prospectively included, and they were matched 1:1 with 151 family members. We gathered information on patient's and their matched family member's demographics, lifestyle choices, mental health status, level of intimacy, and history of psychiatry disease. The relationship of patient's and their family member's mental health state was investigated using a correlation matrix. Multivariable analyses (multiple logistic regression) were conducted among patients and their matched family members, to identify potential risk factors for self-poisoning suicide, anxiety, and depression.

RESULTS

Of the total patients, 67.55% (102/151) attempted self-poisoning suicide. Poisoned patients had more severe anxiety and depression symptoms than their matched family members, and this difference was even more pronounced among patients with self-poisoning suicide. Generalized anxiety disorder-7 (GAD-7) score for family members was significantly and favorably correlated with patient's GAD-7 score after eliminating non-suicide patients and their matched family members. The patient health questionnaire-9 (PHQ-9) score showed a similar pattern, and the family member's PHQ-9 score was strongly and favorably associated with patient's PHQ-9 and Beck hopelessness scale-20 (BHS-20) score. Multivariable analysis showed that married marital status (P = 0.038), quitting smoking (P = 0.003), sedentary time of 1 to 6 h (P = 0.013), and participation in a sports more than five times per week (P = 0.046) were all significantly associated with a lower risk of suicide by self-poisoning, while a more serious anxiety state (P = 0.001) was significantly associated with a higher risk of self-poisoning suicide. Multivariable analysis demonstrated that, specifically among self-poisoning suicide patients, married marital status (P = 0.011) and no history of psychiatry disease (P < 0.001) were protective factors for anxiety, while divorced or widowed marital status (P = 0.004), a sedentary time of 1 to 3 h (P = 0.022), and a higher monthly income (P = 0.027) were significant contributors to anxiety. The propensity of additional family-matched characteristics to predict patient's suicidality, anxiety, and depression was also examined.

CONCLUSIONS

Self-poisoning suicide patients have severe mental health issues. Patients who self-poison have a close connection to their family member's mental health, particularly their levels of anxiety and depression. According to the findings, being married and adopting healthy lifestyle habits, such as quitting smoking and drinking, increasing their physical activity levels, and managing their idle time, are able to help patients with mental health concerns and even suicidal thoughts.

Identification of risk factors for attempted suicide by self-poisoning and a nomogram to predict self-poisoning suicide

Purpose

Suicide is a global concern, especially among young people. Suicide prediction models have the potential to make it easier to identify patients who are at a high risk of suicide, but they have very little predictive power when there is a positive value for suicide mortality. Therefore, the aim of the study is to uncover potential risk factors associated with suicide by self-poisoning and further to provide a trustworthy nomogram to predict self-poisoning suicide among poisoned patients.

Methods

This study prospectively enrolled 237 patients who were treated for poisoning at the Fifth Medical Center of PLA General Hospital (Beijing) between May 2021 and May 2022. Patient's basic characteristics, daily activities, mental health status, and history of psychological illnesses were gathered to examine their predictive power for self-poisoning suicide. On developing a prediction model, patients were split 8:2 into a training (n = 196) group and a validation (n = 41) group at random via computer. The training group worked on model development, while the validation group worked on model validation. In this study, the Hosmer and Lemeshow test, accuracy, and area under the curve were the primary evaluation criteria. Shapley Additive exPlanations (SHAP) was determined to evaluate feature importance. To make the prediction model easy for researchers to utilize, it was presented in nomogram format. Two risk groups of patients were identified based on the ideal cut-off value.

Results

Of all poisoned patients, 64.6% committed suicide by self-poisoning. With regard to self-poisoning attempted suicide, multivariate analysis demonstrated that female gender, smoking, generalized anxiety disorder-7 (GAD-7), and beck hopelessness scale-20 (BHS-20) were significant risk factors, whereas married status, relatively higher education level, a sedentary time of 1–3 h per day, higher sport frequency per week, higher monthly income were significant protective features. The nomogram contained each of the aforementioned nine features. In the training group, the area under curve (AUC) of the nomogram was up to 0.938 (0.904–0.972), whereas in the validation group, it reached a maximum of 0.974 (0.937–1.000). Corresponding accuracy rates were up to 0.883 and 0.927, respectively, and the P-values for the Hosmer and Lemeshow test were 0.178 and 0.346, respectively. SHAP demonstrated that the top three most important features were BHS-20, GAD-7, and marital status. Based on the best cut-off value of the nomogram (40%), patients in the high-risk group had a nearly six-time larger likelihood of committing suicide by self-poisoning than patients in the low-risk group (88.68 vs. 15.38%, P &lt; 0.001). The dynamic nomogram was made available at the following address: https://xiaobo.shinyapps.io/Nomogramselfpoisoningsuicide/.

Conclusions

This study proposes a prediction model to stratify patients at a high risk of suicide by self-poisoning and to guide individual preventive strategies. Patients in the high-risk group require further mental health counseling to alleviate anxiety and hopelessness, healthy lifestyle like quitting smoking and exercising more, and restriction of access to poison and psychiatric drugs.

Guanxin Danshen Dripping Pills Improve Quality of Life and Cardiovascular Prognoses of CHD Patients after PCI with Anxiety or Depression (GLAD Study): A Randomized Double-Blind Placebo-Controlled Study

OBJECTIVE

To assess the efficacy and safety of Guanxin Danshen Dripping Pills (GXDS) in the treatment of depression or anxiety in patients with coronary heart disease (CHD) after percutaneous coronary intervention (PCI).

METHODS

From September 2017 to June 2019, 200 CHD patients after PCI with depression and anxiety were included and randomly divided into GXDS (100 cases) and placebo control groups (100 cases) by block randomization and a random number table. Patients in the GXDS and control groups were given GXDS and placebo, respectively, 0.4 g each time, 3 times daily for 12 weeks. The primary outcomes were scores of Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Scale (GAD-7) and the Seattle Angina Pectoris Scale (SAQ). The secondary outcomes included 12 Health Survey Summary Form (SF-12) scores and the first onset time and incidence of major adverse cardiovascular events (MACEs). Other indices including blood pressure, blood lipids, microcirculation and inflammatory-related indices, etc. were monitored at baseline, week 4, and week 12.

RESULTS

In the full analysis set (200 cases), after treatment, the PHQ-9 and GAD-7 scores in the GXDS group were considerably lower than those in the control group (P<0.05). Compared with the baseline, the total PHQ-9 scores of the experimental and control groups decreased by 3.97 and 1.18, respectively. The corrected mean difference between the two groups was -2.78 (95% CI: -3.47, -2.10; P<0.001). The total GAD-7 score in the GXDS group decreased by 3.48% compared with the baseline level, while that of the placebo group decreased by 1.13%. The corrected mean difference between the two groups was -2.35 (95% CI: -2.95, -1.76; P<0.001). The degree of improvement in SAQ score, SF-12 score, endothelin and high-sensitive C-reactive protein levels in the GXDS group were substantially superior than those in the placebo group, and the differences between the two groups were statistically significant (P<0.05). Similar results were obtained in the per protocol population analysis of 177 patients. Three cases of MACES were reported in this study (1 in the GXDS group and 2 in the placebo group), and no serious adverse events occurred.

CONCLUSIONS

GXDS can significantly alleviate depression and anxiety, relieve symptoms of angina, and improve quality of life in patients with CHD after PCI. (Registration No. ChiCTR1800014291).

Playing with temptation: Stopping abilities to chocolate are superior, but also more extensive

Cue-specific inhibitory control is assumed to support balanced food intake, but previous studies with established measures showed inconsistent results. We developed a novel kinematic stop task in virtual reality (VR) and report results from trajectory recordings. The primary objective of this explorative study was to assess the interrelationships between validated measures of food-related inhibitory control and novel measures from the VR task. We hypothesized that healthy female participants show worse inhibitory control when grasping attractive virtual chocolate, compared to non-edible color-and-shape matched objects. We further aimed to quantify the construct validity of kinematic measures (e.g., reaching extent/spatial displacement, movement time after stop-signal, velocity) with established measures of inhibitory control in a keyboard-based adaptive stop-signal task (SST). In total, 79 females with varying levels of chocolate craving participated in an experimental study consisting of self-report questionnaires, subjective chocolate craving, the conventional SST and the kinematic task in VR. Results showed superior stopping ability to chocolate in both tasks. In VR, participants successfully interrupted an initiated approach trajectory but terminated slightly closer to chocolate targets. Stop-signal delay (SSD) was adapted relative to movement onset and appeared later in chocolate trials, during which participants still stopped faster, as was also confirmed by shorter stop-signal reaction time (SSRT) in the conventional task. Yet, SSRT did not correlate with stopping in VR. Moreover, SSRT was related to depressive symptoms whereas measures from VR were related to chocolate craving and subjective hunger. Thus, VR stopping can provide deeper insights into healthy weight individuals' capacity to inhibit cue-specific approach behavior towards appetitive stimuli in simulated interactions. Furthermore, the results support a multi-faceted view of food-specific inhibitory control and behavioral impulsivity.

Effects of interpersonal sensitivity on depressive symptoms in postgraduate students during the COVID-19 pandemic: Psychological capital and sleep quality as mediators

Background

This study aimed to examine depressive symptoms associated with interpersonal sensitivity, sleep quality, and psychological capital among postgraduate students during static campus management after the COVID-19 pandemic in China.

Methods

Research data were obtained during static campus management (10-19 April 2022) after the reappearance of COVID-19 in cities in eastern China. We collected data through an online questionnaire, and the anonymous self-reported questionnaire included the Patient Health Questionnaire, the interpersonal sensitivity subscale of Symptom Checklist-90, the Psychological Capital Questionnaire, and the Pittsburgh Sleep Quality Index. analysis of variance was performed using t-test and ANOVA. The PROCESS macro was used to determine the relationship between interpersonal sensitivity and depression, together with the independent and serial mediating role of psychological capital and sleep quality.

Results

A total of 2,554 postgraduate students were included in this study. The prevalence of mild, moderate, and severe depressive symptoms was 30.97, 6.58, and 1.45%, respectively. Interpersonal sensitivity was significantly associated with depressive symptoms (direct effect = 0.183, p < 0.001). Between interpersonal sensitivity and depressive symptoms, psychological capital and sleep quality played a single mediating role (indirect effect = 0.136 and 0.100, p < 0.001, respectively) and a chain mediating role together (indirect effect = 0.066, p < 0.001).

Conclusion

Interpersonal sensitivity has a significant influence on depression among Chinese graduate students. Psychological capital and sleep quality may not only independently mediate the relationship between interpersonal sensitivity and depression, but also co-play a chain-mediating role in the pathway from interpersonal sensitivity to depression. Positive psychological interventions and sleep guidance may be beneficial in alleviating depressive symptoms.

Randomized clinical trial: the effects of pregabalin for centrally mediated abdominal pain syndrome

Background

Pregabalin is worldwidely licensed for the treatment of a variety of pain syndromes and supposed to be a potential candidate for the centrally mediated abdominal pain syndrome (CAPS).

Objectives

To investigate the efficacy of pregabalin on nociceptive and emotional symptoms in CAPS patients.

Design

This is an open-label randomized controlled trial.

Methods

CAPS patients were randomized to receive pregabalin 75 mg (P group), pinaverium bromide 50 mg (PB group), or pregabalin combined pinaverium bromide regimen (P + PB group) three times daily for 4 weeks. Questionnaires were completed biweekly. The primary outcomes were defined as the average abdominal pain scores of severity and frequency at weeks 2 and 4. Secondary outcomes included the reduction in abdominal pain scores, Somatic Self-rating Scale (SSS), Patient Health Questionnaire-15 (PHQ-15), and Generalized Anxiety Disorder Scale 7 (GAD-7) scales obtained at the end of trial to the baseline.

Results

Totally, 102 eligible patients were recruited and randomized. The mean severity scores of abdominal pain were 1.39 ± 1.28, 0.97 ± 1.43 versus 2.91 ± 1.44 (p < 0.0001) in P or PB + P group versus PB group at week 2 and were 0.90 ± 1.21, 1.28 ± 1.87 versus 2.74 ± 1.75 (p < 0.0001) at week 4. The mean frequency scores were 2.55 ± 2.55, 2.03 ± 2.80 versus 5.12 ± 2.09(p < 0.0001) in P or PB + P group versus PB group at week 2 and were 1.72 ± 2.46, 2.00 ± 2.90 versus 4.55 ± 2.55 (p < 0.0001) at week 4. When comparing the changes in SSS, PHQ-15, and GAD-7 scores, patients accepting pregabalin or pregabalin combination regimen reported a more decrease than pinaverium bromide recipients (p = 0.0002, p = 0.0002, and p = 0.0033).

Conclusion

This trial suggests that pregabalin may be beneficial for CAPS abdominal pain and concomitant somatic or anxiety symptoms.

Registration

www.chictr.org.cn (ChiCTR1900028026).

Cluster-based characterization of consistencies in individuals' thought profiles at rest in a cohort of 1779 French university students

Is ongoing conscious thought spontaneous and situation-related, or is it recurrent and dependent on psychological dispositions? The answer is critical for resting-state functional connectivity (RSFC) paradigms that seek to correlate neuroanatomical states with conscious mental states. The goal of the present study was to characterize individual resting state thought profiles (RSTPs) and identify the recurrent ones, i.e., that could both be predicted by personality traits and predict subsequent negative affective states. The 1779 participants had a mean age of 22.1 years, 71.8% were females, and 71.8% were undergraduates. We collected the form and content of their thoughts during a 15-min RSFC session with a computerized retrospective self-questionnaire (ReSQ 2.0). Subsamples of participants also completed online autoquestionnaires assessing their psychological maturity and trait negative affectivity (with a four-day gap on average, N = 1270) and subsequent depressive and anxious states (1.4 years later on average, N = 922). Based on the multiple correspondence and clustering analyses of the ReSQ 2.0 responses, we identified six RSTPs distinctive by their content scope, temporal orientation, empathetic concern, and emotional valence. Multivariate analyses revealed that the probability of experiencing five of the six RSTPs was predicted by trait negative affectivity interacting with psychological maturity. Among them, a negatively valenced RSTP also increased the likelihood of subsequent negative affective states, suggesting its stable and recurrent nature. Identifying recurrent RSTPs is helpful for the future understanding of RSTPs’ contribution to RSFC. Additionally, it will be relevant to test whether acting on psychological maturity can alter the relationship between ongoing conscious thought and negative affectivity.

Association between Psychological Status and Condylar Bony Changes in Adults: A Retrospective Survey-Based Study

Background: This article studies the association between psychological status and condylar bony changes in adults and assesses psychological questionnaires as an indicator of potential condylar bony changes. It is meaningful because condylar bony changes, a severe subtype of TMD and big concern in orthodontic treatment, would likely be ignored in patients with few TMD symptoms, in which case, even with potential psychological problems (depression, somatization and anxiety) being noticed, orthodontists may underestimate the possibility or severity of condylar bony changes and thus may not perform relevant examinations. Methods: A total of 195 adults (145 female and 50 male) who consulted orthodontists and had clinical records were included in this study. Initial CBCT images taken before orthodontic treatment were used for observing their condylar bony changes, and a comprehensive questionnaire conducted by each adult to evaluate psychological status was collected. Age, sex, TMD symptom history, scores on Patient Health Questionnaire-9 (PHQ-9), PHQ-15 and Generalized Anxiety Disorder-7 (GAD-7), and condylar bony changes of these adults were recorded. Odds ratios (OR) and 95% confidence intervals (CIs) for identifying the independent risk factors associated with condylar bony changes were calculated with univariate and multivariate logistic regression analysis. The kappa statistic was used to assess intraobserver reliability of CBCT analysis. Results: The scores of PHQ-15 (OR: 2.088, 95% CI: 1.061−4.108, p < 0.05) and GAD-7 (OR: 2.133, 95% CI: 1.082−4.204, p < 0.05) were correlated with the condylar bony changes on CBCT. Besides, the probability of having condylar bony changes was positively correlated with the number of psychological problems concomitantly present in an adult (OR: 1.440, 95% CI: 1.10−1.867, p < 0.01). The intraobserver agreement value for CBCT analysis was substantial (κ = 0.732). Conclusions: This study found that positive PHQ-15 (somatization) and GAD-7 (anxiety) scores were associated with condylar bony changes in adults. Moreover, the number of psychological problems concomitantly present in an adult was positively associated with the probability of having condylar bony changes.

Low mental health literacy and its association with depression, anxiety and poor sleep quality in Chinese elderly

BACKGROUND

Mental health literacy (MHL) is rarely reported in the Chinese elderly. This study explored the pattern of MHL in the Chinese elderly in relation to depression, anxiety and poor sleep quality.

METHODS

A cross-sectional study was conducted among older adults in Guangzhou, south China. Participants were investigated face-to-face using the Chinese National Mental Health Literacy Scale, the Patient Health Questionnaire-9 item (PHQ-9), the 7-item Generalized Anxiety Disorder (GAD-7) and the Pittsburgh Sleep Quality Index (PSQI). Mental Health Literacy Scale contains three dimensions: mental health knowledge, mental health skills (such as social support, cognitive reappraisal and attentional distraction) and mental health awareness. Multivariate logistic regression was used for examining the association between MHL and mental health.

RESULTS

A total of 506 older adults were recruited. The percentage of depression, anxiety, and poor sleep quality were 16.6%, 7.9% and 40.9%, respectively. MHL dimensions independently associated with depression included cognitive reappraisal (OR = 1.95, p < .001), attentional distraction (OR = 0.61, p = 0.044) and awareness (OR = 0.56, p = 0.027). MHL dimensions independently associated with anxiety symptoms included cognitive reappraisal (OR = 1.90, p = 0.011) and attentional distraction (OR = 0.44, p = 0.016). MHL dimensions independently associated with poor sleep quality included social support (OR = 0.75, p = 0.022), cognitive reappraisal (OR = 1.55, p = 0.003) and attentional distraction (OR = 0.65, p = 0.016).

CONCLUSION

Given the low MHL and its association with poor mental health in the Chinese elderly, policymakers and health professionals should improve the older adults' MHL, which could be conducive to the prevention and control of their mental health problems.

High prevalence and risk factors of dropout intention among Chinese medical postgraduates

BACKGROUND

A high attrition rate in medical students has exacerbated the physician shortage in China. However, few studies have explored the risk factors of dropout intention in medical postgraduates. This study compared the prevalence of dropout intention and mental distress between medical and non-medical postgraduates in China and investigated risk factors for dropout intention. This study also explored the impact of medical postgraduates' perception of the Chinese healthcare environment on their mental status and dropout intention.

METHODS

This cross-sectional study was conducted using online questionnaires from October 2020 to April 2021. Convenience sampling was used to recruit postgraduates in different majors. Outcomes included dropout intention and potential risk factors, including mental distress, quality of life, and fatigue. Medical postgraduates were additionally assessed for healthcare environment satisfaction, burnout, career choice regret, and experiences of workplace violence. A logistic regression model was constructed to evaluate the association between dissatisfaction, mental distress, and turnover intention.

RESULTS

A total of 740 medical and 670 non-medical postgraduates participated in the survey. The rates of depression symptoms (33.8% vs. 39.0%, p < 0.001), anxiety symptoms (22.2% vs. 32.4%, p < 0.001), and somatic symptoms (34.7% vs. 42.4%, p = 0.004) were lower in medical postgraduates, while more medical postgraduates (58.4% vs. 48.4%, p < 0.001) reported dropout intention. Dissatisfaction with the healthcare environment (odds ratio [OR]: 1.65; 95% confidence interval [CI]: 1.17-2.34, p = 0.005), career choice regret (OR: 6.23; 95% CI: 4.42-8.78, p < 0.001), and high perceived stress (OR: 2.74; 95%CI: 1.90-3.94, p < 0.001) remained independently associated with turnover intention.

CONCLUSIONS

Mental distress is common among postgraduates, calling for timely interventions. Medical postgraduates reported higher turnover intention. Healthcare environment perception also affected the mental health and dropout intentions of medical students. A decent future income, reduced workload, shorter duration medical training, and better doctor-patient relationships are urgently needed.

The study of psychological traits among Chinese college students during the COVID-19 campus lockdown

To investigate the prevalence of interpersonal sensitivity, anxiety, depression symptoms and associated risk factors among a large-scale sample of college students in China during the COVID-19 campus lockdown. The survey was conducted among undergraduate students at a university in eastern part of China in April 2022. The Chi-square test was used to compare the different variable groups and multivariable analysis was performed for the risk factors associated with interpersonal sensitivity, anxiety, and depression symptoms. A total of 12,922 college students were included, with an average age of (20.96 ± 1.66) years. The prevalence of interpersonal sensitivity, anxiety and depression symptoms in this study was 58.1, 22.7, and 46.8%, respectively. Male (OR = 1.16, p &lt; 0.001), 22–23 years (OR = 1.40, p &lt; 0.001), freshman (OR = 1.35, p = 0.002), and non-only child (OR = 1.15, p &lt; 0.001) were positively associated with interpersonal sensitivity. Male (OR = 1.20, p &lt; 0.001), sophomores (OR = 1.27, p = 0.020) and seniors (OR = 1.20, p = 0.027) were positively associated with anxiety symptoms. Compared with female students, male students (OR = 0.89, p &lt; 0.001) were less likely to have depression symptoms. 22–23 years (OR = 1.37, p &lt; 0.001), sophomores (OR = 1.26, p = 0.009) and non-only child (OR = 1.11, p = 0.009) were positively associated with depression symptoms. In addition, college students aged 18–21 years, learning status, skipping breakfast, roommate relationship and sleep quality were associated with interpersonal sensitivity, anxiety and depression symptoms (all p &lt; 0.05). The findings of this study suggest a high prevalence of interpersonal sensitivity, anxiety and depression symptoms among Chinese college students during the COVID-19 campus lockdown. Younger ages, low grades, poor dormitory relationship, negative learning status, skipping breakfast and poor sleep quality were the risk factors for college students’ mental health, which should be concerned by the relevant departments of school during the campus lockdown.

Anxiety, depression, and social connectedness among the general population of eight countries during the COVID-19 pandemic

BACKGROUND

The COVID-19 pandemic affected the mental health of the general population through multiple pathways. The aim of this study was to examine anxiety, depression, self-confidence, and social connectedness among the general population of eight countries during the COVID-19 pandemic, their underlying factors, and vulnerable groups.

METHODS

A web-based survey was administered to persons from the general population of China, Greece, Italy, Netherlands, Russia, Sweden, the United Kingdom, and the United States. The survey included the Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9) and items on self-confidence, social connectedness, and socio-demographics. Data were analyzed with descriptive statistics, exploratory factor analysis and regression analysis.

RESULTS

Twenty-three thousand six hundred twenty-two respondents completed the survey. Overall, 42% of the total sample had mild to severe anxiety symptoms and 43% had mild to severe depression symptoms. 14% to 38% reported suboptimal ratings in self-confidence, social participation, contact with family and friends, and feeling connected to others. In the exploratory factor analyses, in most countries, one dominant factor had a high influence on GAD-7, PHQ-9 sum scores and self-confidence with eigenvalue (% variance) above 3.2 (53.9%). One less dominant factor had a high influence on social connectedness scores with eigenvalue (% variance) ranging above 0.8 (12.8%). Being younger, female, having chronic conditions, perceived as risky to COVID-19 infection, and feeling not very well protected against COVID-19 were significantly associated with the two underlying factors.

CONCLUSIONS

Anxiety, depression, and problems with self-confidence and social connectedness were highly prevalent in the general population of eight countries during the early phase of the COVID-19 pandemic. This highlights the importance of the allocation of additional resources to implement policies to mitigate the impact of the pandemic on mental health.

Native Hawaiian/Pacific Islander alcohol, tobacco and other drug use, mental health and treatment need in the United States during COVID-19

INTRODUCTION

Before COVID-19, Native Hawaiians/Pacific Islanders (NH/PI) endured a heavy burden of alcohol, tobacco and other drug (ATOD) use in prior US data. Responding to reports that many NH/PI communities experienced severe COVID-19 disparities that could exacerbate their ATOD burden, we partnered with NH/PI communities to assess the substance use patterns and treatment needs of diverse NH/PIs during COVID-19.

METHODS

Collaborating with NH/PI community organisations across five states with large NH/PI populations, we conducted a large-scale investigation of NH/PI ATOD use, mental health and treatment need during COVID-19. Between April and November 2021, NH/PI-heritage research staff from our community partners collected data involving 306 NH/PI adults using several community-based recruitment methods (e-mail, telephone, in-person) and two survey approaches: online and paper-and-pencil. Multivariate regressions were conducted to examine potential predictors of NH/PI alcohol use disorder and need for behavioural health treatment.

RESULTS

During COVID-19, 47% and 22% of NH/PI adults reported current alcohol and cigarette use, while 35% reported lifetime illicit substance use (e.g., cannabis, opioid). Depression and anxiety were high, and alcohol use disorder, major depression and generalised anxiety disorder prevalence were 27%, 27% and 19%, respectively. One-third of participants reported past-year treatment need with lifetime illicit substance use, COVID-19 distress and major depression respectively associating with 3.0, 1.2, and 5.3 times greater adjusted odds for needing treatment.

CONCLUSIONS

NH/PI adults reported heavy ATOD use, depression, anxiety and treatment need during COVID-19. Targeted research and treatment services may be warranted to mitigate COVID-19's negative behavioural health impact on NH/PI communities.

An explanatory model of depressive symptoms from anxiety, post-traumatic stress, somatic symptoms, and symptom perception: the potential role of inflammatory markers in hospitalized COVID-19 patients

BACKGROUND

The context of the COVID-19 pandemic has harmed the mental health of the population, increasing the incidence of mental health problems such as depression, especially in those who have had COVID-19. Our study puts forward an explanatory model of depressive symptoms based on subjective psychological factors in those hospitalized for COVID-19 with and without biological markers (i.e., inflammatory markers). Therefore, we aim to evaluate the hypotheses proposed in the model to predict the presence of depressive symptoms.

METHOD

We conducted a cross-sectional study, using a simple random sampling. Data from 277 hospitalized patients with COVID-19 in Lima-Peru, were collected to assess mental health variables (i.e., depressive, anxiety, post-traumatic stress, and somatic symptoms), self-perception of COVID-19 related symptoms, and neutrophil/lymphocyte ratio (NLR) such as inflammatory marker. We performed a structural equation modeling analysis to evaluate a predictive model of depressive symptoms.

RESULTS

The results showed a prevalence of depressive symptoms (11.2%), anxiety symptoms (7.9%), somatic symptoms (2.2%), and symptoms of post-traumatic stress (6.1%) in the overall sample. No association was found between the prevalence of these mental health problems among individuals with and without severe inflammatory response. The mental health indicators with the highest prevalence were sleep problems (48%), low energy (47.7%), nervousness (48.77%), worry (47.7%), irritability (43.7%) and back pain (52%) in the overall sample. The model proposed to explain depressive symptoms was able to explain more than 83.7% of the variance and presented good goodness-of-fit indices. Also, a different performance between the proposed model was found between those with and without severe inflammatory response. This difference was mainly found in the relationship between anxiety and post-traumatic stress symptoms, and between the perception of COVID-19 related symptoms and somatic symptoms.

CONCLUSIONS

Results demonstrated that our model of mental health variables may explain depressive symptoms in hospitalized patients of COVID-19 from a third-level hospital in Peru. In the model, perception of symptoms influences somatic symptoms, which impact both anxiety symptoms and symptoms of post-traumatic stress. Thus, anxiety symptoms could directly influence depressive symptoms or through symptoms of post-traumatic stress. Our findings could be useful to decision-makers for the prevention of depression, used to inform the creation of screening tools (i.e., perception of symptoms, somatic and anxiety symptoms) to identify vulnerable patients to depression.

Changes in bodily complaints (PHQ-15) over six years in a large general population sample

OBJECTIVE

The Patient Health Questionnaire-15 (PHQ-15) is a widely used instrument for measuring bodily complaints. The aims of this study were to analyze changes of bodily complaints over a six-year period in a large general population community sample, to test age and sex differences in these changes, and to examine associations between these changes and changes in other health-related variables.

METHODS

A total of 4821 adult subjects took part this longitudinal study at baseline (t1) and six years later (t2). The participants completed the PHQ-15 and several other questionnaires.

RESULTS

Over the six-year period, the mean score of the complaints increased from 5.18 ± 3.67 to 5.75 ± 3.97. The highest increase in terms of effect sizes was found for sexual pain/problems. While the increase in the PHQ-15 mean score was nearly identical for males and females, there were age differences in these increase rates: Participants of the oldest age group (70 years and above) experienced the greatest increase in complaints. Participants from lower socioeconomic levels also reported high increases in complaints. The correlation between the t1 and the t2 PHQ-15 score was r = 0.66. Changes in complaints from t1 to t2 were associated with changes in multiple other variables such as anxiety, social support, optimism, life satisfaction, and quality of life.

CONCLUSION

The data reported here can be used to better interpret changes in patients' health state over several years.

Mental health, partnerships, and sexual behavior of German university students after the third wave of the COVID-19 pandemic

Objective: This study examined the state of mental health, partnerships, and sexual activity of German university students after the third wave of the COVID-19 pandemic. Participants and methods: In June and July 2021, 928 students (23.6 years; 63.5% female) from four universities in Germany participated in an online survey that assessed depressive and anxiety symptoms as well as data on partnerships and sexuality. Results: Of the students, 56.4% were above the cutoff for clinically relevant depressive symptoms and 35.7% were above the cutoff for clinically relevant anxiety symptoms. Female gender, higher academic-related stress, lower financial resources, higher strain due to COVID-19, and more loneliness were associated with more severe symptoms. A quarter of the students each reported an improvement or deterioration in their partnerships. Conclusions: Student mental health appears to be worse compared to pre-pandemic and first wave data. It should be examined whether symptoms decrease when universities reopen.

The Effect of Regional Factors on the Mental Health Status of Frontline Nurses and Patients With COVID-19 During COVID-19: The Role of Depression and Anxiety

At the end of 2019, Wuhan, Hubei Province, China, experienced the ravages of Coronavirus disease 2019 (COVID-19). In a few months, infected people rose to tens of thousands. This study aimed to explore the mental health status of military nurse personnel assisting (non-Hubei area) in the fight against COVID-19 and local nurse personnel (in the Wuhan area), as well as the differences in mental health status between nurses and COVID-19 patients that provide a reference basis for psychological crisis intervention. A convenience sampling method was used to select frontline nurses and COVID-19 patients (sample size 1,000+) from two mobile cabin hospitals from January to March 2020. The questionnaire consists of socio-demographic information, Patient Health Questionnaire 9 (PHQ-9), Generalized Anxiety Disorder 7 (GAD-7), General Mental Health Service Questionnaire and Work Intensity and Physical Status Questionnaire. The results showed that depression was present in 117 nurses (19.73%) and 101 patients (23.33%) with PHQ-9 scores >10; anxiety was present in 60 nurses (10.12%) and 54 patients (12.47%) with GAD-7 >10. The anxiety and depression levels of nurses in Wuhan area were higher than those in non-Hubei area. The differences in PHQ-9 and GAD-7 scores were also statistically significant (p < 0.001) when comparing patients from different regions, with anxiety and depression rates of 30.19 and 16.04% in local patients and 16.74 and 9.50% in foreign patients. The comparison between nurses and patients showed that the nurses were more depressed than the patients, while the patients were more anxious. Local nurses in Wuhan had a higher workload intensity than aid nurses (77.72 vs. 57.29%). Over 95% of frontline nurses and patients reported that they had not received any form of psychological counseling before the COVID-19 outbreak. 12.87% (26/194) of frontline nurses in Wuhan had a history of taking hypnotic drugs. However, fewer patients (16/212, 7.55%) took medication than frontline nurses. Anxiety and depression levels were far higher among local nurses and patients in Wuhan than in non-Hubei areas. The nurses had higher levels of depression, while the patients had higher anxiety levels. Providing targeted mental health services to healthcare professionals and patients is necessary when experiencing the impact of a major event.

Internet Addiction, Symptoms of Anxiety, Depressive Symptoms, Stress Among Higher Education Students During the COVID-19 Pandemic

Poor mental health is a growing concern among young people during the coronavirus disease 2019 (COVID-19) pandemic. The aim of this study was to assess the associations of Internet addiction with depressive symptoms, anxiety symptoms, and stress in higher education students during the COVID-19 pandemic, as well as to examine these mental health problems in the context of study-related characteristics. The research sample consisted of 3,099 participants from the Czech Republic (CZ: 1,422) and Slovak Republic (SK: 1,677). The Internet Addiction Test (IAT), the Generalized Anxiety Disorder (GAD-7) scale, the Patient Health Questionnaire for depressive symptoms (PHQ-9), and the Perceived Stress Scale (PSS) were used to measure mental health problems. The analyses also included demographic data (gender and age) and study-related characteristics (form of study, degree of study, field of study, distance between college and home, and housing during the semester). Based on the results of frequency and descriptive analyses, the prevalence of mental health problems was high. The most serious levels of Internet addiction (IAT cut-off point ≥ 50), to which attention should be paid, were found in 3.5% of Czech and 6.2% of Slovak students. Using the standard cut-off point of GAD-7 ≥ 10, 14.1% of Czech and 11.6% of Slovak students were identified with anxiety symptoms. Regarding the PHQ-9 with the cut-off point ≥ 10, 23.4% of Czech and 19.1% of Slovak students had depressive symptoms, which should be addressed. Using the PSS cut-off point ≥ 27, 12.9% of Czech students and 9.1% of Slovak students perceived high stress. The quantile regression analysis showed that Internet addiction was positively associated with anxiety symptoms, depressive symptoms, and stress in all of the analyzed cases (p-value < 0.001). In terms of study-related characteristics, the binomial logistic regression analysis revealed that risk factors for mental health problems in Czech and Slovak students were mainly full-time form of study and living away from home during the semester. Internet addiction, anxiety symptoms, depressive symptoms, and stress are issues that require increased attention, and professionals and policy-makers should implement interventions to effectively prevent and help students with psychological problems.

Academic Performance and the Link with Depressive Symptoms among Rural Han and Minority Chinese Adolescents

The objectives of this paper were to examine the risk of depression and depressive symptoms among Han and minority children and adolescents in rural China, the links between academic performance and depressive symptoms, and the prevalence of these links among specific subgroups. A total of 8392 4th, 5th, and 6th grade students at 105 sample rural schools in eight low-income counties and districts in a prefectural-level city in Southwestern China were randomly selected using a three-step sampling strategy. A total of 51% of the sample were female (SD = 0.50), and the age range was 7 to 19 years (mean = 11.35 years; SD = 1.05). Using the Patient Health Questionnaire 8-item depression scale, the prevalence of depressive symptoms in the sample was assessed, while data on students' academic performance (standardized math test) and demographic characteristics were also collected. Our results show that the rates of major depression were 19% for Han students, 18% for Tibetan students, and 22% for Yi students; the rates of severe depression were 2% for Han and Tibetan students, and 3% for Yi students. Yi students were at significantly higher risks for major and severe depression than Han students. We conducted multivariate regression and heterogeneous analyses. Academic performance was negatively and significantly correlated to depressive symptoms. Across the whole sample, students with lower math scores, minority students, boys, younger students, and students with migrant parents were most vulnerable to depressive symptoms. The heterogeneous analysis suggests that among poor-performing students, subgroups at higher risk for depression include boys, non-boarding students, and students whose mothers had graduated from high school or above. These findings indicate a need to improve mental health outcomes of rural Han and minority primary school students, targeting academic performance for possible intervention.

Validation of the patient health questionnaire-9 and the generalized anxiety disorder-7 in Lithuanian student sample

BACKGROUND

The Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder Questionnaire- 7 (GAD-7) are short screening instruments used for detection of depression and anxiety symptoms in various settings, including general and mental health care as well as the general population. The aim of this study is to evaluate psychometric properties and factorial structure of the PHQ-9 and the GAD-7 in a sample of Lithuanian university students.

METHODS

1368 students (mean age 22.5±4.8) completed the PHQ-9 and the GAD-7 questionnaires online; after the completion of the survey, students were asked to provide phone contact for an additional interview. Eligible students were approached later by trained interviewers and completed The Clinical Interview Schedule-Revised for assessment of depressive and anxiety disorders.

RESULTS

Results showed that the PHQ-9 and the GAD-7 are reliable screening tools for depression and anxiety (Cronbach alpha 0.86 and 0.91, respectively). The one-factor structure of the PHQ-9 and the GAD-7 was confirmed by the Confirmatory Factor Analysis. A cut-off of ≥10 for the PHQ-9 resulted in 71% sensitivity and 66% specificity recognizing students with increased risk for mood or anxiety disorder. For the GAD-7, a cut-off ≥9 resulted in 73% sensitivity and 70% specificity recognizing students at risk. The PHQ-9 was sensitive but not specific in recognizing students with depressive disorders. The sensitivity and specificity of the GAD-7 in differentiating students with generalized anxiety disorders were low.

CONCLUSIONS

The PHQ-9 and the GAD-7 have sufficient formal psychometric properties, but their clinical utility as diagnostic tools for recognition of depressive and anxiety disorders in students is limited. Due to low specificity and high false positive rates, both scales are recommended only as an initial screening tool for recognition of subjects with increased risk of mental disorders, however positive cases should be later assessed using more comprehensive instruments.

Factors associated with mental health outcomes among caregivers of older adults in long-term care facilities during COVID-19 post-epidemic era in Shandong, China

BACKGROUND

COVID-19 pandemic has altered the work mode in long-term care facilities (LTCFs), but little is known about the mental health status of caregivers of older adults.

METHODS

A total of 672 formal caregivers of older adults in LTCFs and 1,140 formal patient caregivers in hospitals (comparison group) responded to an online survey conducted from March 25, 2022 to April 6, 2022. Five psychological scales, including Insomnia Severity Index (ISI), Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), The 5-item World Health Organization Wellbeing Index (WHO-5) and Perceived Stress Scale-14 item (PSS-14), were applied to assess participants' mental health status. Factors, including sex, profession, marital status, economic conditions, length of working experience, frequent night shift beyond 1 day per week and having organic diseases, were included in logistic regression analysis to identify associated factors with mental health outcomes of formal caregivers of older adults in LTCFs.

RESULTS

Caregivers of older adults in LTCFs developed similar severe psychological symptoms with patient caregivers in hospital setting. For caregivers of older adults in LTCFs, unmarried status was a potent risk factor for insomnia, anxiety, impaired wellbeing and health risk stress, with odds ratios ranging from 1.91 to 3.64. Frequent night shift beyond 1 day per week was associated with higher risks of insomnia, depression and impaired wellbeing. Likewise, having organic disease or inferior economic condition, and being nurses appeared to be independent predictors for multiple mental health-related outcomes.

CONCLUSION

During COVID-19 post-epidemic era, caregivers of older adults in LTCFs had a higher prevalence of psychological symptoms, especially those with particular risk factors. Special attention should be paid to promote their mental health.

Psychometric Properties of the Generalized Anxiety Disorder Scale-7 Item (GAD-7) in a Large Sample of Chinese Adolescents

Anxiety symptoms are common among adolescents. A well-validated and easy-to-use tool is indispensable to measure and detect anxiety for timely interventions. The Generalized Anxiety Disorder Scale-7 item (GAD-7) is a self-report scale used to measure the severity of anxiety and has been validated in adult populations, but psychometric properties of the GAD-7 remained rarely tested in adolescents. The study aimed to investigate the reliability and validity of the GAD-7 in Chinese adolescents. Sex- and age-specific analyses were conducted in a large sample of adolescents (n = 67,281, aged 10-17 years). Our results showed that the GAD-7 scores were higher in female and older adolescents. The GAD-7 presented good internal consistency and a unidimensional structure across sex- and age-specific groups. The GAD-7 scores were significantly correlated with the scores of the Patient Health Questionnaire-9 item (PHQ-9, a self-reported scale to measure depression symptoms) in all subgroups, indicating acceptable criterion validity. In conclusion, the GAD-7 is a scale with good psychometrics and can serve as a tool for anxiety screening in Chinese adolescents at the populational level.

The influence of sex, gender, age, and ethnicity on psychosocial factors and substance use throughout phases of the COVID-19 pandemic

OBJECTIVES

The SARS-CoV-2 (COVID-19) pandemic has had profound physical and mental health effects on populations around the world. Limited empirical research has used a gender-based lens to evaluate the mental health impacts of the pandemic, overlooking the impact of public health measures on marginalized groups, such as women, and the gender diverse community. This study used a gender-based analysis to determine the prevalence of psychosocial symptoms and substance use (alcohol and cannabis use in particular) by age, ethnicity, income, rurality, education level, Indigenous status, and sexual orientation.

METHODS

Participants in the study were recruited from previously established cohorts as a part of the COVID-19 Rapid Evidence Study of a Provincial Population-Based Cohort for Gender and Sex (RESPPONSE) study. Those who agreed to participate were asked to self-report symptoms of depression, anxiety, pandemic stress, loneliness, alcohol use, and cannabis use across five phases of the pandemic as well as retrospectively before the pandemic.

RESULTS

For all psychosocial outcomes, there was a significant effect of time with all five phases of the pandemic being associated with more symptoms of depression, anxiety, stress, and loneliness relative to pre-COVID levels (p < .0001). Gender was significantly associated with all outcomes (p < .0001) with men exhibiting lower scores (i.e., fewer symptoms) than women and gender diverse participants, and women exhibiting lower scores than the gender diverse group. Other significant predictors were age (younger populations experiencing more symptoms, p < .0001), ethnicity (Chinese/Taiwanese individuals experiencing fewer symptoms, p = .005), and Indigenous status (Indigenous individuals experiencing more symptoms, p < .0001). Alcohol use and cannabis use increased relative to pre-pandemic levels, and women reported a greater increase in cannabis use than men (p < .0001).

CONCLUSIONS

Our findings highlight the need for policy makers and leaders to prioritize women, gender-diverse individuals, and young people when tailoring public health measures for future pandemics.

The role of depression and anxiety in the relationship between poor sleep quality and subjective cognitive decline in Chinese elderly: Exploring parallel, serial, and moderated mediation

BACKGROUND

Poor sleep quality exacerbates subjective cognitive decline (SCD). Mental health may play an important role in the relationship, but the potential underlying mechanisms remain unknown.

METHODS

A cross-sectional study was conducted on older adult residents in Guangdong province, south China from November 2020 to March 2021. A total of 717 adults aged 60 years and over were recruited for a face-to-face investigation on a range of socio-demographic factors, lifestyle behaviors, sleep quality, SCD, depressive and anxiety symptoms. Parallel, serial and moderated mediation models were used to examine whether depression and anxiety mediated in the poor sleep quality-SCD linkage.

RESULTS

Both direct and indirect effects of poor sleep quality on SCD symptoms were found. Anxiety and depressive symptoms mediated the relationship between poor sleep quality and SCD symptoms(β_Anxiety = 0.123, 95%CI: 0.079 to 0.173; β_Depression=0.274, 95%CI: 0.200 to 0.348), respectively. Serial mediation analyses indicated that depressive and anxiety symptoms co-play a serial mediating role in the association of poor sleep quality and SCD symptoms (β_a=0.052, 95% CI: 0.026 to 0.084; β_b=0.077, 95% CI: 0.033 to 0.128). Moderated mediation model revealed that the mediation of depressive symptoms on the relationship between poor sleep quality and SCD symptoms was moderated by anxiety symptoms(β=0.318, 95% CI: 0.164 to 0.472).

LIMITATIONS

The study is the cross-sectional design, which limits the causal inference ability.

CONCLUSIONS

These findings provided new insights into possible avenues for prevention and intervention on SCD through sleep-based treatments with a multi-faceted approach on psychiatric disorders.

Measurement invariance testing of the patient health questionnaire-9 (PHQ-9) across people with and without diabetes mellitus from the NHANES, EMHS and UK Biobank datasets

BACKGROUND

The prevalence of depression is higher among those with diabetes than in the general population. The Patient Health Questionnaire (PHQ-9) is commonly used to assess depression in people with diabetes, but measurement invariance of the PHQ-9 across groups of people with and without diabetes has not yet been investigated.

METHODS

Data from three independent cohorts from the USA (n=1,886 with diabetes, n=4,153 without diabetes), Quebec, Canada (n= 800 with diabetes, n= 2,411 without diabetes), and the UK (n=4,981 with diabetes, n=145,570 without diabetes), were used to examine measurement invariance between adults with and without diabetes. A series of multiple group confirmatory factor analyses were performed, with increasingly stringent model constraints applied to assess configural, equal thresholds, and equal thresholds and loadings invariance, respectively. One-factor and two-factor (somatic and cognitive-affective items) models were examined.

RESULTS

Results demonstrated that the most stringent models, testing equal loadings and thresholds, had satisfactory model fit in the three cohorts for one-factor models (RMSEA = .063 or below and CFI = .978 or above) and two-factor models (RMSEA = .042 or below and CFI = .989 or above).

LIMITATIONS

Data were from Western countries only and we could not distinguish between type of diabetes.

CONCLUSIONS

Results provide support for measurement invariance between groups of people with and without diabetes, using either a one-factor or a two-factor model. While the two-factor solution has a slightly better fit, the one-factor solution is more parsimonious. Depending on research or clinical needs, both factor structures can be used.

Quality of life during the epidemic of COVID-19 and its associated factors among enterprise workers in East China

BACKGROUND

The COVID-19 related lockdown and home confinement might have an important impact on the quality of life in enterprise workers. We investigated the quality of life during the epidemic in enterprise workers who just returned to work, and assessed its potential influencing factors to have a better understanding of the impact of COVID-19 epidemic lockdown and home confinement.

METHODS

This was a cross-sectional study of enterprise workers conducted in Deqing and Taizhou, Zhejiang Province, China. The Chinese version of EQ5D was used to assess life quality, and information about general characteristics and COVID-19 related factors was collected by a structured questionnaire, which was distributed through the social application "WeChat". Multiple liner regression was used to investigate potential influencing factors.

RESULTS

A total of 2420 participants were enrolled, 59.5% of which worked in Deqing. About 50% of the participants reported worries about the COVID-2019 epidemic and 40.2% had a centralized or home quarantine during the epidemic. The mean EQ-5D score and VAS were 0.990 and 93.5. Multiple liner regression showed that the quality of life measures was related to physical activities (β = 0.006) and keeping home ventilation (β = 0.063) in Deqing, and were related to wearing a mask when going out (β = 0.014), keeping home ventilation (β = 0.061), other marital status (β = - 0.011), worry about the epidemic (β = - 0.005) and having a centralized or home quarantine (β = - 0.005) in Taizhou.

CONCLUSIONS

The quality of life for returning enterprise workers in areas with different risks of COVID-19 was affected by different factors. Associated factors identified from this study would help develop proper intervention measures for enterprise workers to reduce the impact of large-scale public health events like the COVID-19 on their quality of life.

Prevalence and predictors of anxiety, depression and stress among university students during the period of the first lockdown in Germany

BACKGROUND

The COVID-19 pandemic exacerbates the risk for mental health issues of university students. The aims of the study were to investigate the prevalence of anxiety, depression and stress among university students during the period of the first lockdown in Germany, and the associations of possible risk and protective factors with all three outcome variables.

METHODS

A total of 2.548 university students were included in the study. The study took place during the period of the first lockdown in Germany. Multiple hierarchical regression analyses were conducted to explore the role of demographic variables, personality traits, psychological capital variables, mindfulness, COVID-19 related variables, and coping strategies on anxiety, depression and stress.

RESULTS

Results showed on average mild depressive and anxiety symptoms, and moderate perceived stress among the students. Alarmingly, 35.9% of the students showed a moderate-to-severe level of depression, 27.7% reported moderate to severe symptoms of anxiety, and 25.1% perceived high stress. Mindfulness and optimism were the most relevant protective factors against depression, anxiety and stress, whereas COVID-related stressors (e.g., worries about study and financial problems, being stressed by the Corona-pandemic and media reporting, quarantine experience) as well as personal characteristics (e.g., neuroticism, older age, being female) were risk factors for increasing mental health issues and/ or stress.

CONCLUSION

The pandemic has negatively affected the mental health of students. The results emphasize the importance of both professional help for students with mental health problems and effective prevention programs on university campuses that promote coping skills, and mental health during the current pandemic.

A Cross-Sectional Study on Mental Health Problems of Medical and Nonmedical Students in Shandong During the COVID-19 Epidemic Recovery Period

Background: The coronavirus disease 2019 (COVID-19) pandemic has resulted in a plethora of psychological problems worldwide since its onset in December 2019. In the upheaval period, compared with medical college students, nonmedical students' psychological state deserves additional concern due to their lack of medical knowledge. Although the epidemic in China has been largely controlled for several months, the mental health problems resulting from the COVID-19 epidemic persist to this day. In this study, we assessed the mental health problems and associated risk factors experienced by nonmedical vs. medical college students in universities of Shandong Province during the COVID-19 epidemic recovery period. Methods: An online survey was conducted over the period from 17 to 19 December 2020. A total of 954 Chinese college students (486 nonmedical and 468 medical students) from three universities of Shandong Province participated in the survey. Mental health variables were assessed with use of Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and Insomnia Severity Index (ISI). Results: Compared with medical students, nonmedical college students had higher prevalence rates of depression (53.9 vs. 46.4%; p = 0.020) and insomnia (28.0 vs. 22.4%, p = 0.049), as well as higher total scores on the PHQ-9 (p = 0.03) and ISI (p < 0.01). Among nonmedical college students, being female and native of non-Shandong were risk factors for anxiety and depression (p < 0.01), while only native of non-Shandong for insomnia (p < 0.01). Among medical students, age (p < 0.01) and living in rural areas (p = 0.04) were risk factors for depression, while only age (p < 0.05) was a risk factor for anxiety and insomnia. Conclusion: Nonmedical college students in the universities of Shandong Province had more mental health problems and more risk factors for developing them during the COVID-19 epidemic recovery period than medical students. These nonmedical students require additional attention and recovery programs to alleviate the increased incidence of psychological problems related to COVID-19.

Relationships between Perceived Stress, Depression and Alcohol Use Disorders in University Students during the COVID-19 Pandemic: A Socio-Economic Dimension

The objective of the study was to examine the effects of perceived stress on depression and subsequently to examine the effects of depression on alcohol use disorders. The data were obtained by an electronic questionnaire survey during the coronavirus disease 2019 (COVID-19) pandemic (n = 1523 Slovak university students). Descriptive, regression, and correlation analysis were used in the analytical processing, while the analyses included students' scores in three diagnostic tools (Perceived Stress Scale (PSS), Patient Health Questionnaire for depression (PHQ 9), and Alcohol Use Disorders Identification Test (AUDIT)), as well as gender and income characteristics. The PSS identified an increased level of perceived stress in female students, while in contrast, the AUDIT showed an increased level of alcohol use disorders in male students. Differences in mental and behavioural disorders between the gender and income categories were significant in most of the analysed cases. In terms of gender-income characteristics, it was possible to confirm a significant positive effect of the PSS score on the PHQ 9 score, as well as a significant positive effect of the PHQ 9 score on the AUDIT score. As a result, efforts to reduce stress will be reflected in a reduction of depressive disorders as well as a reduction of excessive alcohol consumption among students.