Factor structure of the depression anxiety stress Scale-21 (DASS-21): Unidimensionality of the Arabic version among Egyptian drug users

The risk of repeated suicidal presentations following residential treatment for substance use disorders: A recurrent event analysis using linked administrative data

BACKGROUND

Individuals seeking alcohol and other drug (AOD) treatment consistently experience higher rates of suicidal behaviours and death by suicide when compared to the general population. By linking residential AOD treatment data to administrative healthcare and death datasets, we aimed to examine suicide-related behaviours and identify risk and protective factors for these events following discharge from residential treatment.

METHODS

Participants included 1056 individuals aged 18-69 (M = 32.06, SD = 9.55, male = 696,65.9 %) admitted to three residential treatment facilities in Queensland, Australia from January 1, 2014 to December 31, 2016. Treatment data was linked to administrative hospital, emergency department (ED), mental health service, and Registry of Deaths data 2-years post-discharge. ICD-10 codes were used to identify and analyse suicide-related events.

RESULTS

Within 2-years post-discharge, 175 (16.6 %) individuals had a suicide-related event (n = 298 episodes). The highest proportion of episodes (11.1 %) occurred within 1-month of discharge. Higher risk of a recurrent suicide-related event was associated with receiving a Disability Support Pension (aHR = 1.69 (95%CI:1.10,2.59), two or more previous episodes of residential AOD treatment (aHR = 1.49 (95%CI:1.30,2.15). Completing residential treatment was associated with a lower risk of suicide-related events (aHR = 0.54 (95%CI:0.35,0.83).

LIMITATIONS

The amalgamation of suicidal ideation, attempts, and death into a single outcome oversimplifies their complex nature and interplay. The exclusive focus on one service provider limits generalisability, and data constraints and missingness preclude many analyses.

CONCLUSIONS

Understanding suicidal behaviours and critical risk periods following discharge from residential treatment is crucial for improving continuing care, developing effective suicide prevention, and implementing targeted interventions among this high-risk population.

Development, reliability, and validity assessment of a fall concerns scale for people who use wheelchairs and scooters (FCS-WC/S)

PURPOSE

To evaluate the psychometric properties of a Fall Concerns Scale for people who use Wheelchairs and Scooters (FCS-WC/S).

MATERIALS AND METHODS

Developed by fall prevention experts, FCS-WC/S underwent refinement through interdisciplinary reviews and focus groups with researchers, clinicians, and individuals who use WC/S full-time. The psychometric evaluation involved adults who used WC/S for ≥1 year and had ≥1 fall in the previous 3 years, recruited between April and September 2022.

RESULTS

The FCS-WC/S evaluates fall concerns among people with various health conditions who use WC/S full-time across 33 daily activities. One hundred and twenty-four participants responded to the baseline survey. A subgroup of 63 people repeated the FCS-WC/S a week later. The FCS-WC/S demonstrated excellent internal and good test-retest reliability (α ≥ 0.90, ICC = 0.86-0.9), as well as concurrent validity (Spearman's rho = 0.72) with the Spinal Cord Injury Falls Concern Scale (SCI-FCS). It effectively differentiated fear of falling levels from an established measure (ORs 4.1, 25.8, 46.7). Factor and parallel analysis revealed three factors, two of which were retained for further analysis.

CONCLUSIONS

Preliminary findings support FCS-WC/S validity and reliability for assessing fall concerns among individuals with various conditions who use WC/S. Further scale construction analysis is recommended.

The Depression Anxiety Stress Scale 8: investigating its cutoff scores in relevance to loneliness and burnout among dementia family caregivers

The global trend of advanced aging comes at the cost of amplified onset of age-related diseases. Dementia is a common multifactorial age-related neurodegenerative disorder, which manifests with progressive declines in cognitive functioning and ability to perform activities of daily living. As polices discourage institutionalized care, family members act as primary caregivers and endure increased vulnerability to physical and mental health problems secondary to care-related changes in life routine and relationships. Targeting clinically significant distress at earlier stages through valid brief measures may promote caregivers' wellbeing and dementia care continuity/quality. This study aimed to determine the optimal cutoff score of the Depression Anxiety Stress Scale 8-items (DASS-8) in a convenience sample of 571 European caregivers (Mean age = 53 ± 12 years, Italian = 74.4%, Swiss = 25.6%) through three methods. K-means clustering classified the sample into high- and low-distress clusters based on DASS-8 score of 19. Receiver operator curve (ROC) analysis using 48 and 7 cutoffs of the Zarit Burden Interview (ZBI) and the Three-Item University of California, Los Angeles, Loneliness Scale-version 3 (UCLALS3), revealed two DASS-8 cutoffs (12.5 and 14.5, area under the curve (AUC) = 0.85 and 0.92, p values < .001, 95% CI 0.82-0.88 and 0.89 to 0.94, sensitivity = 0.81 and 0.78, specificity = 0.76 and 0.89, Youden index = 0.57 and 0.67, respectively). Decision modeling produced two DASS-8 cutoffs (9.5 and 14.5) for predicting low and high caregiving burden and loneliness, respectively. According to the median of all DASS-8 cutoffs (14.5) the prevalence of mental distress was 50.8%. Distress correlated with key mental problems such as burnout and loneliness-in path analysis, DASS-8 scores were predicted by the ZBI, UCLALS3, care dependency, and receiving help with care, especially among older, female, and spouse caregivers. Further diagnostic workup should follow to confirm psycho-pathogenicity among caregivers with DASS-8 scores above 14.5. Investigations of the DASS-8 in other countries/populations may confirm the validity of this cutoff score.

Validity and reliability of an Arabic-language version of the postpartum specific anxiety scale research short-form in Jordan

OBJECTIVE

The English-language Postpartum Specific Anxiety Scale (PSAS) is a valid, reliable measure for postpartum anxiety (PPA), but its 51-item length is a limitation. Consequently, the PSAS Working Group developed the PSAS Research Short-Form (PSAS-RSF), a statistically robust 16-item tool that effectively assesses PPA. This study aimed to assess and validate the reliability of an Arabic-language version of the PSAS-RSF in Jordan (PSAS-JO-RSF).

METHODS

Using a cross-sectional methodological design, a sample of Arabic-speaking mothers (N = 391) with infants aged up to 6 months were recruited via convenience sampling from a prominent tertiary hospital in northern Jordan. Factor analysis, composite reliability (CR), average variance extracted (AVE), McDonald's ω, and inter-item correlation measures were all examined.

RESULTS

Explanatory factor analysis revealed a four-factor model consistent with the English-language version of the PSAS-RSF, explaining a cumulative variance of 61.5%. Confirmatory factor analysis confirmed the good fit of the PSAS-JO-RSF (χ2/df = 1.48, CFI = 0.974, TLI = 0.968, RMSEA = 0.039, SRMR = 0.019, p < 0.001). The four factors demonstrated acceptable to good reliability, with McDonald's ω ranging from 0.778 to 0.805, with 0.702 for the overall scale. The CR and AVE results supported the validity and reliability of the PSAS-JO-RSF.

CONCLUSION

This study establishes an Arabic-language version of the PSAS-JO-RSF as a valid and reliable scale for screening postpartum anxieties in Jordan.

Effectiveness of Cognitive Behavioral Therapy (CBT) on Psychological Distress among Mothers of Children with Autism Spectrum Disorder: The Role of Problem-Solving Appraisal

Mothers of children with autism spectrum disorder (ASD) face considerable psychological distress. Cognitive behavioral therapy (CBT) has shown promise in reducing caregiver burden, but evidence in the Arab world is lacking. Problem-solving appraisal training may optimize CBT's benefits. This study evaluated a tailored CBT program emphasizing the role of problem-solving appraisal in managing distress through the process of CBT. Sixty mothers were randomly allocated in a 1:1 ratio to either the CBT intervention group or the control group. The CBT group received 3-month sessions incorporating problem-solving appraisal training within a CBT curriculum from October 2022 to April 2023. Problem-solving techniques are focused on equipping individuals with the skills to identify, approach, and effectively resolve problems, leading to a reduction in stress levels and an improved capacity to cope with difficult situations. All mothers completed assessments of socio-demographics such as age, level of education, marital status, occupation, and adequacy of family income, the Depression Anxiety Stress Scale (DASS-21) and the Problem-Solving Inventory (PSI) before and after the program. The CBT group showed significant pre-to-post reductions in depression, anxiety, stress, and general psychological distress compared to controls (all p < 0.05). They also exhibited significant improvements in problem-solving confidence, approach-avoidance style and personal control (all p < 0.05). The customized CBT program markedly improved psychological well-being for mothers of children with ASD in Egypt. Incorporating problem-solving techniques may optimize CBT's benefits cross-culturally. These findings have implications for the implementation of evidence-based support programs for families impacted by ASD worldwide.

The mediating role of health literacy between the presence of chronic disease and psychological distress among older persons in Xi'an city of China

BACKGROUND

The increased number of older persons in China, and the prevalence of most chronic diseases raised with age significantly increased the total disease burden. When a person ages, psychological distress happens when they are faced with stressors that they cannot cope with. Psychological distress refers to non-specific symptoms of depression, anxiety, and stress. Health literacy influences several health outcomes, such as emotional functioning among the population. The primary purpose of this study is to examine the mediator role of health literacy between the presence of chronic disease and psychological distress among older persons living in Xi'an city. Thus, this study used the Cognitive Behavior Theory (CBT) as a combination of the basic behavioral and cognitive psychology principles to explain the cognitive processes associated with psychological distress.

METHODS

This study employs a quantitative research design using a cross-sectional survey of 300 older persons over 60 years living in the six urban districts of Xi'an city. Data were collected using the Health Literacy Questionnaire (HLQ) and the Depression Anxiety Stress Scale (DASS-21). This study employed descriptive statistics and inferential methods to analyze the data. The inferential methods applied structural equation modeling (SEM) to test the hypothesis of the mediator role of health literacy between the presence of chronic disease and psychological distress.

RESULTS

In this study, chronic disease had an effect on health literacy among older persons living in Xi'an city (β=-0.047, p < 0.01); chronic disease impact on psychological distress among older persons living in Xi'an city (β = 0.047, p < 0.01); health literacy was identified effect on psychological distress among older persons in Xi'an city (β=-0.738, p < 0.001); health literacy as a partial mediator between chronic disease and psychological distress (β = 0.07, p < 0.01).

CONCLUSION

Psychological distress among older persons is affected by chronic disease and health literacy. Health literacy had a partial mediating effect on the presence of chronic disease and psychological distress. Improved health literacy measures should be considered when treating older persons with psychological distress.

Psychometric evaluation of the depression, anxiety, and stress scale-21 (DASS-21) among Chinese primary and middle school teachers

BACKGROUND

Teachers in high-stress roles face increasing psychological distress such as anxiety and depression, underscoring the need for validated assessment instruments. Given the current absence of a comprehensive, designated, and time-efficient scale capable of evaluating depression, anxiety, and stress among the teacher population, the Depression, Anxiety, and Stress Scale-21 (DASS-21) presents itself as a promising alternative. Despite the widespread application of the DASS-21 for assessing psychological distress across various populations, its validity among teachers, along with questions about its factor structure and its potential property of time equivalence, remain unverified. This study endeavors to address these considerations by investigating the psychometric properties of the DASS-21 specifically within the population of Chinese primary and middle school teachers.

METHODS

Cross-sectional (n = 9,030) and longitudinal surveys (n = 1,642) were conducted using a non-probability sampling method. In addition to the DASS-21, the Chinese version of Chinese Teachers' Job Burnout Questionnaire (CTJBO) was utilized to evaluate the criterion validity of this scale. Three different approaches, namely confirmatory factor analysis, Rasch analysis, and network analysis, were employed to evaluate internal reliability, construct validity, as well as time invariance of the DASS-21.

RESULTS

The DASS-21 demonstrated a high degree of internal consistency (Cronbach's α > 0.85) as well as excellent convergent validity, despite poor discriminant validity as determined by average variance extracted. Confirmatory factor analysis and network analysis further supported convergent validity. The three-factor structure outperformed one- and two-factor alternatives, establishing time invariance. Rasch analysis at the item level identified six inappropriate items within the anxiety and stress subscales, which were subsequently removed. Network analysis presented a better revised network. Regression analysis with emotional exhaustion as the criterion provided logical and accurate results.

CONCLUSION

The DASS-21 was found to be a reliable and valid tool for measuring the mental health of teachers over time. To assess the instrument's psychometric properties, a combination of confirmatory factor analysis, Rasch analysis, and network analysis was utilized, which proved effective and is recommended for evaluating contentious instruments. Based on the results of the study, researchers and healthcare professionals are recommended to use the DASS-21 for assessing teachers' psychological distress. However, certain items identified in the study may need to be removed to enhance the instrument's appropriateness for this specific population.

Prevalence and associated factors with mental health symptoms among semi-professional cricket players after the resumption of sporting activities following an extensive lockdown

Background

Mental health of cricket players has been a topic of debate for a considerable time across the globe.

Objectives

The purpose of this study was to investigate the prevalence of mental health symptoms among semi-professional male cricket players experienced during COVID-19, as well as the relationship between age and the Depression, Anxiety, Stress Scale (DASS-21) sub-scale.

Methods

Mental health symptoms were assessed among cricket players (n = 90) using the following instruments, respectively: Depression, Anxiety, Stress Scale - 21 (DASS - 21); Athlete Burnout Questionnaire (ABQ) and Satisfaction with Life Scale (SWLS). Descriptive (means ± standard deviations) and inferential (Spearman's correlations) statistics were calculated using SPSS (IBM Version 27.0) at a significance level of p < 0.05.

Results

The study reported that 5.6% (n = 5) of cricketers believed life was futile, and 10% (n = 9) thought they were useless most of the time. However, on the anxiety sub-scale, 27% (n = 24) of cricketers indicated low confidence. In addition, 23% (n = 21) of cricketers reported being stressed. Spearman's correlations revealed a positive and significant association between the DASS-21 sub-scales and that cricketers' DASS-21 sub-scale symptoms are unrelated to age.

Conclusion

The study found that there were moderate levels of anxiety, a reduced sense of achievement and a neutral feeling towards satisfaction with life. Reducing mental health symptoms would extend the playing careers of cricket players. De-stigmatising mental health may result in more robust and accurate self-reports of mental health illness among elite athletes, which can enable sustainable change.

COVID-19-associated mental health impact on menstruation physiology: A survey study among medical students in Jordan

BACKGROUND

The coronavirus disease 2019 pandemic has been an extraordinarily stressful situation in recent years. Stress is a physiological reaction to negative stimuli that is regulated by different neuroendocrine pathways. The female reproductive function is maintained by the menstrual cycle, which is negatively affected by hyperstimulation of stress signals.

OBJECTIVES

This study evaluates the effect of the coronavirus disease 2019 outbreak on menstrual function and mental health, exploring the relationship between them.

DESIGN

The current study uses a cross-sectional, survey-based design.

METHODS

During this cross-sectional study, an online self-completion questionnaire was conducted among a sample of 385 Jordanian female medical students during the pandemic. The survey compared menstrual characteristics, depression, anxiety, and stress 10 months after the coronavirus disease 2019 pandemic with 10 months prior. Paired t-test, McNemar's test, Pearson's correlation, and multiple linear regression model were employed to analyze data using SPSS software.

RESULTS

The mean age of female medical student respondents was 19.89 years. Data showed that the menstrual cycle length significantly increased during the coronavirus disease 2019 pandemic compared with 10 months prior (32.23 days versus 30.02 days, p = 0.019). The average number of heavy bleeding days also increased during the coronavirus disease 2019 pandemic (2.82 days versus 2.42 days, p = 0.002). The proportion of females with heavy bleeding amount was more than doubled during the pandemic of coronavirus disease 2019 compared with before (27.3% versus 10.4%, p = 0.000). Unpleasant menstrual signs such as nausea and/or vomiting, breast pain, and urinary urgency were significantly increased during the pandemic (p = 0.000, p = 0.008, and p = 0.024, respectively). During coronavirus disease 2019, a positive association between total Depression, Anxiety, and Stress Scale-21 Questionnaire score and heavy bleeding was identified (p < 0.05). The findings also indicated that mental disorders and the incidence of amenorrhea, nausea and/or vomiting, and urinary urgency were positively correlated during the coronavirus disease 2019 pandemic. The multiple regression analysis revealed associations between several menstrual characteristics such as amenorrhea and severity of bleeding with coronavirus disease 2019-related depression, anxiety, and stress.

CONCLUSION

This study revealed that the stress related to the pandemic of coronavirus disease 2019 could affect the female menstrual cycle and hence the quality of women's life. Therefore, this study could serve as a baseline for planning and introducing stress mitigation interventions in crisis situations to improve the physiological and mental well-being of females and improve their quality of life.

Psychometric evaluation of the Depression Anxiety Stress Scale 8 among women with chronic non-cancer pelvic pain

Psychiatric comorbidity and abusive experiences in chronic pelvic pain (CPP) conditions may prolong disease course. This study investigated the psychometrics of the Depression Anxiety Stress Scale 8 (DASS-8) among women with CPP (N = 214, mean age = 33.3 ± 12.4 years). The DASS-8 expressed excellent fit, invariance across age groups and menopausal status, good know-group validity (differentiating women with psychiatric comorbidity from those without comorbidity: U = 2018.0, p = 0.001), discriminant validity (HTMT ratios < 0.85), excellent reliability (alpha = 0.90), adequate predictive and convergent validity indicated by strong correlation with the DASS-21 (r = 0.94) and high values of item-total correlations (r = 0.884 to 0.893). In two-step cluster analysis, the DASS-8 classified women into low- and high-distress clusters (n = 141 and 73), with significantly higher levels of distress, pain severity and duration, and physical symptoms in cluster 2. The DASS-8 positively correlated with pain severity/duration, subjective symptoms of depression/anxiety, experiences of sexual assault, fatigue, headache severity, and collateral physical symptoms (e.g., dizziness, bloating, fatigue etc.) at the same level expressed by the parent scale and the DASS-12, or even greater. Accordingly, distress may represent a target for early identification of psychiatric comorbidity, CPP severity, experiences of sexual assault, and collateral physical complaints. Therefore, the DASS-8 is a useful brief measure, which may detect mental distress symptoms among women with CPP.

Psychometric evaluation of the depression anxiety stress scale 8-items (DASS-8)/DASS-12/DASS-21 among family caregivers of patients with dementia

Patients with dementia express a set of problematic and deteriorating symptoms, along with self-care dependency. Over time, the mental health of family caregivers of persons with dementia may be affected, putting them at a high risk for psychopathology, which may be associated with endangered wellbeing of people with dementia. This cross-sectional instrumental design study examined the psychometric properties of the Depression Anxiety Stress Scale 8-items (DASS-8), DASS-12, and DASS-21 in a convenient sample of 571 caregivers from northern Italy and southern Switzerland (mean age = 53 years, SD = 12, range = 24-89 years). A bifactor structure of the three measures had the best fit; some items of the DASS-12/DASS-21 failed to load on their domain-specific factors. The three-factor structure was invariant across various groups (e.g., gender and education), expressed adequate reliability and convergent validity, and had strong positive correlation with the three-item UCLA Loneliness Scale (UCLALS3). Distress scores did not differ among carers of different types of dementia (Alzheimer's disease vs. other types, e.g., vascular dementia). However, distress scores were significantly high among female individuals, adult children caregivers, those caring for dependent patients, and those who received help with care. For 54.9 and 38.8% of the latter, care was provided by relatives and health professionals, respectively. Since the DASS-8 expresses adequate psychometrics comparable with the DASS-21, it may be used as a brief measure of distress in this population.

Impact of the COVID-19 pandemic on nurses mental health status in Iraq

BACKGROUND

The COVID-19 pandemic is a major health crisis that has changed the life of millions globally. Coronaviruses are viruses' group that can contract animals and humans and the cause of severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), and COVID-19. Nurses are the primary service providers in the health care; nurses who are in close contact with infectious patients need to get their mental health checked and supervised on a regular basis, particularly with regard to stress, anxiety, and suicidal ideation, so that they can provide optimal quality of life and healthy mental health to have good care for patients to assess the impact of the pandemic on mental health status for nurses in Iraq.

MATERIALS AND METHODS

A total of sample study (1000) nurses in Iraq completed an online questionnaire between March and May 2021. Psychological impact was assessed using the depression anxiety stress scale (DASS21).

RESULTS

The study revealed impact COVID-19 on mental health status (anxiety stress) and no impact COVID-19 on mental health status (depression) for nurses was (P value = 0.040 and P value = 0.045, respectively).

CONCLUSION

The impact COVID-19 on mental health status for nurses. Protecting the nursing staff from chronic stress, anxiety, and depression, which constitutes a psychological burden on health during the outbreak of the COVID-19 pandemic, by clarifying the disease and how to prevent it, as well as providing the personal protective equipment to decrease stress, anxiety, and depression during the pandemic.

Work Addiction and Depression, Anxiety, and Stress: the Mediating Role of Food Addiction Among Lebanese Young Adult Workers

Work addiction is considered a public health concern, as it can lead to negative and harmful health outcomes. However, patterns leading from work addiction to mental health concerns remain so far largely unknown and under-studied. We aimed to verify whether the relationship between work addiction and psychological distress (i.e., depression, anxiety, and stress) is mediated by food addiction among young adult workers in the context of Lebanese culture. The second objective was to validate the Arabic version of the Bergen Work Addiction Scale (BWAS). The online cross-sectional survey was conducted among 1268 Lebanese young adult workers (65.1% females, mean age 26.18 years) using the Bergen Work Addiction Scale, the Depression Anxiety and Stress Scale, the Yale Food Addiction Scale, and the Three-Factor Eating Questionnaire. The PROCESS SPSS Macro version 3.4, model four, was used to compute the mediation analysis. Findings revealed that 175 (13.8%) were presented as work-addicted individuals, and 226 (17.8%) exhibited addictive-like eating behaviors. Bivariate analyses showed that higher degree of work addiction and food addiction was significantly associated with higher levels of depression, anxiety, and stress. The results of the mediation analysis showed that the association between work addiction and depression, anxiety, and stress was mediated by food addiction. In light of our findings, we cautiously suggest that the link of work addiction to psychological distress via food addiction implies that strategies targeting food addiction might mitigate the harmful effects of work addiction on workers' mental health.

Validation of the Arabic version of the modified Yale Food Addiction Scale in the general population in Lebanon

BACKGROUND

Although the definition of food addiction is not agreed upon, it is characterized by eating more than expected without being hungry, not being able to visit certain places associated with overeating or unsuccessfully trying to cut down on the consumption of certain foods. The modified YFAS (mYFAS 2.0) version, instrument available to evaluate food addiction, was shown to have good psychometric properties. Our objective was to assess the psychometric properties of the Arabic version of the mYFAS (mYFAS-Ar-Leb) in the Lebanese population.

METHODS

This cross-sectional study enrolled 1268 persons residing in Lebanon (September-November 2020). The mean age of the participants was 26.18 years (SD = 11.17; min: 18; max: 85), with 65.1% females. The percentage of participants with food addiction was 226 (17.8%) in the total sample. A confirmatory factor analysis was run on the one-factor structure among the total sample.

RESULTS

The fit indices of the confirmatory factor analysis of the scale were excellent. The Cronbach's alpha value was good for the total scale. The mYFAS-Ar-Leb score was positively and strongly associated with stress, anxiety and depression.

CONCLUSION

Our study findings highlighted that the use of the mYFAS-Ar-Leb in Lebanese population might help estimate food addiction prevalence and stress on the need for effective treatment and preventive measures to craving for addictive foods.

Psychological distress and associated factors among healthcare professionals in Ethiopia during the COVID-19 pandemic: a cross-sectional study

OBJECTIVES

The objective of the study was to assess psychological distress (depression, anxiety and stress) and associated factors among healthcare professionals working at the University of Gondar Comprehensive Specialized Hospital, Ethiopia.

DESIGN

Institution-based cross-sectional study.

SETTING

This study was conducted at the University of Gondar Comprehensive Specialized Hospital.

PARTICIPANTS

Study participants were healthcare professionals from University of Gondar Comprehensive Specialized Hospital. They were selected for the study using a stratified sampling technique.

MEASUREMENT

Data were collected using a self-administered questionnaire. The 21-item Depression, Anxiety and Stress Scale was used to assess the depression, anxiety and stress levels. Descriptive and analytical statistics were used to present the findings. To determine the predictor variables for depression, anxiety and stress, a binary logistic regression model was fitted. Finally, variables with p value <0.05 in the final model were declared as significantly associated with psychological distress.

RESULT

Almost half (49.5) of the participants have psychological distress. The prevalence of depression, anxiety and stress during the COVID-19 pandemic among healthcare workers was 167 (42.7%), 201 (51.4%) and 242 (61.9%), respectively. In multivariable analysis, respondents found in the ages between 35 and 44; unmarried marital status; educational status with specialty, subspecialty and PhD holders; anaesthesia professionals; and healthcare professionals with known medical illness were significantly associated with depression. Unmarried marital status, anaesthesia professional, laboratory technologist and living with family were significantly associated with anxiety. Unmarried marital status; educational status with specialty, subspecialty and PhD holders; and anaesthesia professional were also statistically significant with stress.

CONCLUSION AND RECOMMENDATION

The prevalence of depression, anxiety and stress during the COVID-19 pandemic among the Gondar University healthcare professionals was high. This could contribute to implementation of mitigation measures in a standardised and sustainable manner and emphasis should be given to this aspect of health even for future similar and unanticipated events.

The association between psychological burden related to COVID-19 and addictive social media use: Testing the mediational role of anxious affect

INTRODUCTION

The COVID-19 pandemic has had a substantial impact on the normalcy of life. Similarly, social media use (SMU) has increased exponentially. This study examined the association between individuals' perception of the psychological burden related to the pandemic and addictive SMU.

METHOD

A cross-sectional study was conducted between February and May 2021 in two national contexts, Egypt, and the United Arab Emirates. Data were gathered from a sample of 1322 participants drawn from a university population who completed measures of psychological burden related to COVID-19, anxious affect, and addictive SMU. Preliminary analyses of the potential association between the study variables were conducted using bivariate correlations followed by a pre-specified mediation model.

RESULTS

At a correlational level, all three study variables were positively associated with each other (r values ranged from .18 to .50 and all p values were < .05). A further mediation analysis confirmed that the total effect of psychological burden on addictive SMU was significant (β = .654, SE = .033, 95% CI .589-.720), and this relationship remained significant with inclusion of the mediator. Significant mediation was evident across the total sample as well as within each country-specific subsample.

CONCLUSION

These results provide insight into the factors that contribute to the development of addictive SMU in relation to the COVID-19 pandemic. Findings are discussed in relation to the emotion regulation function that SMU might play for individuals in the midst of emotional distress.

Psychometric properties of the 21-item Depression, Anxiety, and Stress Scale (DASS-21) among Malaysians during COVID-19: a methodological study

Depression, anxiety, and stress continue to be among the largest burdens of disease, globally. The Depression, Anxiety, and Stress Scale-21 Items (DASS-21) is a shortened version of DASS-41 developed to measure these mental health conditions. The DASS-41 has strong evidence of validity and reliability in multiple contexts. However, the DASS-21, and the resulting item properties, has been explored less in terms of modern test theories. One such theory is Item Response Theory (IRT), and we use IRT models to explore latent item and person traits of each DASS-21 sub-scale among people living in Malaysia. Specifically, we aimed to assess Classical Test Theory and IRT properties including dimensionality, internal consistency (reliability), and item-level properties. We conducted a web-based cross-sectional study and sent link-based questionnaires to people aged 18 and above in a private university and requested to roll out the link. Overall and individual sub-scales' Cronbach's alpha of the DASS-21 indicates an excellent internal consistency. The average inter-item correlation and corrected inter-item correlations for each of the sub-scales indicated acceptable discrimination. On average, DASS-21 total scores and sub-scale scores were significantly higher among female participants than males. The Graded Response Model had better empirical fit to sub-scale response data. Raw summated and latent (IRT estimated) scores of the Depression, Anxiety, and Stress sub-scales, and overall DASS-21 were strongly correlated. Thus, this study provides evidence of validity supporting the use of the DASS-21 as a mental health screening tool among Malaysians. Specifically, standard error of measurement was minimized to provide robust evidence of potential utility in identifying participants who are and are not experiencing these mental health issues. Additional research is warranted to ensure that test content culturally appropriate and accurately measuring cultural norms of depression, anxiety, and stress.

The Psychological Impact of Quarantine During the COVID-19 Pandemic on Quarantined Non-Healthcare Workers, Quarantined Healthcare Workers, and Medical Staff at the Quarantine Facility in Saudi Arabia

Background

COVID-19 is a viral infectious disease that spreads quickly through droplets. It is highly contagious and could overwhelm the health system. Because of that, many governments established health quarantines for suspected infected people to minimize the spread of this disease.

Objective

This study aimed to assess the prevalence of depression, anxiety, and stress symptoms and to address the associated risk factors among quarantined non-healthcare workers, quarantined healthcare workers, and medical staff in the Ministry of Health quarantine facility.

Patients and Methods

We conducted an analytical cross-sectional study at the health quarantine in Jazan, Saudi Arabia. The total number of participants was 301 individuals. Furthermore, the study questionnaire was composed of three sections, the first two were the background and clinical characteristics, and the last one was DASS 21 scale. Also, we used SPSS software to analyze the data. Lastly, we implemented logistic regression to assess the predictors of depression, anxiety, and stress symptoms.

Results

The prevalence of depression, anxiety, and stress symptoms among quarantined non-healthcare workers were 51.9%, 60.2%, and 40.6%, respectively. These prevalences were 25.0%, 29.8%, and 16.9% among quarantined healthcare workers and 20.5%, 20.5%, and 27.3% among the medical staff. The predictors of depression, anxiety, and stress symptoms among the study participants were female gender, perceived COVID-19 stigma, presence of other relatives in quarantine, comorbidities, and abnormal sleep duration.

Conclusion and Recommendations

Health quarantine is an environment that could negatively affect people’s mental health. The quarantined non-healthcare workers were the most affected study participants inside this environment. Therefore, the availability of mental health services there could minimize their depression, anxiety, and stress symptoms. Moreover, a home quarantine would be better to reduce these negative symptoms whenever possible.

The Arabic Version of the Impact of Event Scale-Revised: Psychometric Evaluation among Psychiatric Patients and the General Public within the Context of COVID-19 Outbreak and Quarantine as Collective Traumatic Events

The Coronavirus Disease-19 (COVID-19) pandemic has provoked the development of negative emotions in almost all societies since it first broke out in late 2019. The Impact of Event Scale-Revised (IES-R) is widely used to capture emotions, thoughts, and behaviors evoked by traumatic events, including COVID-19 as a collective and persistent traumatic event. However, there is less agreement on the structure of the IES-R, signifying a need for further investigation. This study aimed to evaluate the psychometric properties of the Arabic version of the IES-R among individuals in Saudi quarantine settings, psychiatric patients, and the general public during the COVID-19 outbreak. Exploratory factor analysis revealed that the items of the IES-R present five factors with eigenvalues > 1. Examination of several competing models through confirmatory factor analysis resulted in a best fit for a six-factor structure, which comprises avoidance, intrusion, numbing, hyperarousal, sleep problems, and irritability/dysphoria. Multigroup analysis supported the configural, metric, and scalar invariance of this model across groups of gender, age, and marital status. The IES-R significantly correlated with the Depression Anxiety Stress Scale-8, perceived health status, and perceived vulnerability to COVID-19, denoting good criterion validity. HTMT ratios of all the subscales were below 0.85, denoting good discriminant validity. The values of coefficient alpha in the three samples ranged between 0.90 and 0.93. In path analysis, correlated intrusion and hyperarousal had direct positive effects on avoidance, numbing, sleep, and irritability. Numbing and irritability mediated the indirect effects of intrusion and hyperarousal on sleep and avoidance. This result signifies that cognitive activation is the main factor driving the dynamics underlying the behavioral, emotional, and sleep symptoms of collective COVID-19 trauma. The findings support the robust validity of the Arabic IES-R, indicating it as a sound measure that can be applied to a wide range of traumatic experiences.

The Bergen Facebook Addiction Scale: its psychometric properties and invariance among women with eating disorders

OBJECTIVE

Facebook addiction is increasing, giving rise to limited real-life social networks, loneliness, poor work and academic performance, psychopathology, and low well-being. Facebook entails numerous factors that increase the risk for disordered eating attitudes and behaviors (e.g., use time and Facebook activities such as social grooming and photo sharing). This study aimed to evaluate the psychometric properties of the Bergen Facebook Addiction Scale (BFAS) among patients with eating disorders (EDs) given lack of validation of Facebook addiction measures in this population.

METHODS

A cross-sectional study involving 123 inpatient and outpatient women with EDs (Mean age = 27.3, SD = 10.6, range = 14-59 years) used confirmatory factor analysis (CFA), multigroup CFA, structural equation modeling (SEM), Spearman's rho Spearman's analysis, McDonald's Omega (ω), Cronbach's alpha (α), and item-total correlations to examine the structure, invariance, criterion validity, reliability, and discriminant validity of the BFAS.

RESULTS

Correlating the residuals of items 2, 3, and 5 resulted in an excellent fit of a one-factor structure of the BFAS (χ2(7) = 8.515, p = .289, CFI = .998, TLI = .996, RMSEA = .042, SRMR = .0099). The BFAS was invariant at the configural, metric, and scalar levels across groups of EDs, age, education, and marital status. High values of ω and α (.96) as well as item-total correlations (.851-.929) indicated excellent reliability and high discrimination index of the BFAS.  Criterion validity is noted by strong positive correlation with the Six-item Internet Addiction Test (S-IAT, r = .88) and SEM using the S-IAT to predict the BFAS (χ2(49) = 103.701, p = .001, CFI = .975, TLI = .966, RMSEA = .096, SRMR = .0317)..

CONCLUSION

The BFAS is a reliable unidimensional measure. Its high discrimination index and invariance across different groups make it useful for detecting Facebook addiction among patients with ED.

The Depression Anxiety Stress Scale 8-Items Expresses Robust Psychometric Properties as an Ideal Shorter Version of the Depression Anxiety Stress Scale 21 Among Healthy Respondents From Three Continents

To examine the cultural limitations and implications in the applicability of the Depression Anxiety Stress Scale 8-items (DASS-8)—a shortened version of the DASS-21 recently introduced in an Arab sample—this study evaluated its psychometric properties, including measurement invariance, among healthy subjects from the United States, Australia, and Ghana. Confirmatory factor analysis revealed good fit of the DASS-8 relative to a 12-item version (DASS-12). Both the DASS-8 and the DASS-12 were invariant at all levels across genders, employment status, and students vs. non-students. The DASS-8/DASS-12 also expressed invariance at the configural and metric levels across all countries, albeit scalar invariance was not maintained due to misspecification of the factor loadings in the Ghanian sample. Mann–Whitney U test revealed significantly lower levels of mental symptomatology on the DASS measures among Ghanian students than in English-speaking respondents (both students and non-students). The DASS-8 expressed excellent internal consistency (coefficient alpha = 0.89), good convergent validity—noted by high values of item-total correlations (r = 0.87 to 0.88), good predictive validity—indicated by significantly strong correlation with the DASS-21 and its subscales (r = 0.95 to 0.80), and adequate discriminant validity—indicated by heterotrait–monotrait ratio of correlations <0.85. The DASS-8 correlated with the Internet Gaming Disorder-9, the Adult attention-deficit/hyperactivity disorder Self-Report Scale, and the Individualism and Collectivism Scale/Culture Orientation Scale at the same level as the DASS-21 and the DASS-12, denoting its adequate criterion validity. The DASS-8 can be used as a brief alternative to the DASS-21 to screen for mental symptomatology in English-speaking and African cultures. However, the same scores on the DASS-8 and the DASS-12 may not always indicate the same level of symptom severity in subjects from different countries. Further inter-cultural evaluations of the DASS-8 are needed.

The psychometric properties of the Depression Anxiety Stress Scale-21 (DASS-21) Bangla version

The Bangla version of the Depression Anxiety Stress Scale-21 (DASS-21-BV) draws huge attention among the researchers to assess the mental health status in various situations among the Bangladeshi adults. Since no published research article to date has assessed the psychometric properties of the scale (Bangla version), this study (n = 980 Bangladeshi adults) aimed to assess the psychometric characteristics of this scale utilizing both classical test theory (CTT) and item response theory (IRT) approaches. Item analysis results (item-total correlations in CTT and slope coefficients of the graded response model in IRT) suggested that items had satisfactory discrimination indices. The confirmatory factor analysis results supported the three-factor correlated model of the DASS-21-BV. This scale had good internal consistency reliabilities (alpha, omega, Rho coefficient, etc.) in both approaches. Additionally, multigroup confirmatory factor analysis results suggested strict invariance of this scale between males and females. Although the convergent and divergent validity of the DASS-21-BV were not assessed in this study, it was still proposed as a psychometrically sound tool to assess depression, anxiety, and stress in the non-clinical sample Bangladesh.

COVID-19-Associated Mental Health Impact on Menstrual Function Aspects: Dysmenorrhea and Premenstrual Syndrome, and Genitourinary Tract Health: A Cross Sectional Study among Jordanian Medical Students

The physiology of reproduction is affected by psychological distress through neuroendocrine pathways. Historically, COVID-19 is one of the most stressful events with devastating consequences. This research aims to investigate the relationship between dysmenorrhea, PMS, and reproductive tract health on one hand, and COVID-19-related anxiety, depression, and stress on the other among medical students in Jordan. Medical students were invited through teaching platforms and social media to complete an online survey. SPSS software was used to analyze data. A total of 385 medical students participated in this research. Hence, 49.9% of the study population reported severe dysmenorrhea during COVID-19 compared to 36.9% before COVID-19 (p = 0.000). Dysmenorrhea was significantly associated with disruptions of sport and daily activities during COVID-19 (p = 0.015 and p = 0.002, respectively). The prevalence of PMS components, e.g., mastalgia, fatigue, headache, palpitation, and emotional and sleep disturbances, was raised during COVID-19 compared with before (p < 0.05). Symptoms of genitourinary tract infections, such as lower abdominal pain, vaginal discharge, genitalia rash/ulcers and itching, and urgency, were significantly increased after COVID-19 (p < 0.05). Positive Pearson correlations between COVID-19-associated mental health disorders and dysmenorrhea severity, PMS, and genital tract health abnormalities were observed (p < 0.05). The multiple linear regression model revealed that dysmenorrhea severity, PMS symptoms like palpitation, and genitourinary symptoms like lower abdominal pain and urgency were associated with worsening of depression, while dysuria was associated with a protective effect against depression. Moreover, it was observed that dysmenorrhea severity, PMS symptoms, such as headache and palpitation, and urinary urgency were associated with aggravation of anxiety. However, food craving and dysuria were protective against anxiety. Finally, dysmenorrhea severity, PMS symptoms of headache and palpitation, lower abdominal pain, and urgency were related to worsening of stress, whereas the premenstrual symptom of breast pain was a protective factor against stress. This work showed that COVID-19 pandemic-related psychological distress and menstrual, premenstrual, and genitourinary symptoms are closely related. Further future work is required to evaluate the long lasting-effects of the pandemic on mental health and the physiology of reproduction.

Psychometric properties of the Persian version of Depression Anxiety Stress Scale-21 Items (DASS-21) in a sample of health professionals: a cross-sectional study

Background

Although the Depression Anxiety Stress Scale-21 Items (DASS-21) has been used in different countries and translated into different languages, the Persian version of this scale has not been validated for healthcare professions in Iran. Therefore, the purpose of this study was to examine the psychometric properties of the Persian version of DASS-21 for nurses.

Methods

This cross-sectional study was conducted among 1135 nurses working in public hospitals, who were selected through convenience sampling. DASS-21, which consists of 21 items and three dimensions (depression, anxiety, and stress), has been translated into Persian, and there is an online version available. A confirmatory factor analysis (CFA) was performed to examine the factor structure of this scale. Cronbach’s alpha coefficient was also measured to establish internal consistency. Besides, the intraclass correlation coefficient (ICC) was calculated to assess the test-retest reliability.

Results

The Cronbach’s alpha coefficient was acceptable for anxiety (0.79), stress (0.91), and depression (0.93). An acceptable test-retest reliability (0.740-0.881, P < 0.01) was also reported for DASS-21 and its three dimensions. The results of CFA showed acceptable model fit (χ²/(df) = 1457/(186), P < 0.001), root mean square error of approximation (RMSEA = 0.078), Tucker-Lewis index (TLI = 0.906), comparative fit index (CFI = 0.917), and standardized root mean square residual (SRMR = 0.047). Fifty-seven nurses were included in the test-retest. The ICCs for all dimensions ranged from 0.75 to 0.86, indicating the acceptable test-retest reliability of the scale.

Conclusion

The Persian version of DASS-21 showed good psychometric characteristics, and it was confirmed as a valid and reliable tool for evaluating depression, anxiety, and stress among Iranian nurses. However, further validation studies of the Persian DSASS-21 are needed among other healthcare professionals, including physicians, midwives, and allied health professionals.

COVID-19-Related Psychological Trauma and Psychological Distress Among Community-Dwelling Psychiatric Patients: People Struck by Depression and Sleep Disorders Endure the Greatest Burden

COVID-19 has created a general state of worry and distress, especially among vulnerable groups such as those with psychiatric diagnoses. Worldwide, psychiatric care provision has drastically suffered during the pandemic, with many patients unable to access proper care, which may have implications for increased mental health consequences in patients with psychiatric disorders (e.g., relapse and suicide). This cross-sectional study used structural equation modeling to investigate COVID-19-related trauma and distress among Arab psychiatric population during COVID-19 quarantine. Patients with pre-existing psychiatric disorders (N = 168) completed an online survey that comprised the Depression Anxiety Stress Scale 21 (DASS-21), the Impact of Event Scale-Revised (IES-R), and a questionnaire on COVID-19-related attitudes/perceptions, sources of information, used protective measures, and socio-demographic information. Respondents commonly reported feeling down-hearted/blue, trouble concentrating, along with symptoms of avoidance and rumination related to the pandemic. Patients with depression and sleep disorders expressed higher COVID-19-related trauma than patients with other disorders. Perceived physical health mediated the effect of co-morbid chronic physical disorders on COVID-19 trauma, psychological distress, perceived vulnerability to COVID-19, and perceived likelihood of recovery in case of contracting COVID-19. Perceived physical health and perceived vulnerability to COVID-19 were strong direct predictors of COVID-19-related trauma and psychological distress. Staying at home negatively predicted COVID-19 trauma and exerted an indirect negative effect on psychological distress via COVID-19 trauma. COVID-19 trauma, age, and marital status directly predicted psychological distress, with COVID-19 trauma being the strongest predictor. Educational level, income, having family members working in the medical field, keeping up to date with the news on deaths/infected cases or the development of COVID-19 drugs or vaccines, satisfaction with available information on COVID-19, and using different protective measures were not associated with significant differences in COVID-19 trauma and psychological distress scores. Immuno-psychiatric interventions should be designed to target COVID-19-trauma and distress among younger single patients with perceived poor physical health, especially those diagnosed with depression and sleep disorders.

Influencing Factors of Mental Health Status of Dentists Under COVID-19 Epidemic

OBJECTIVE

To investigate dentists' psychological status and influencing factors in Shaanxi Province during the COVID-19 epidemic and assess their perceived wellness.

METHODS

The study was conducted among dentists from Shaanxi Province in China. The basic information was collected through the network questionnaire star platform. Depression, Anxiety, and Stress Scales (DASS-42) and Perceived Wellness Survey (PWS) were used to assess subjects' psychological status and perceived wellness. Univariate linear regression analysis and multivariate analysis were performed on the influencing factors of depression, anxiety, and stress, and t-test and analysis of variance were used to analyze the perceived wellness results.

RESULTS

The results demonstrated that 33.2% of the surveyed dentists were in a state of depression, 37.1% were anxious, and 34.4% reported stress among 256 subjects. Linear Regression analysis results showed that: "years of working," "the impact of COVID-19 on their life, work, and sleep," "worrying about occupational exposure/virus infection," "lacking the awareness of prevention and control measures," "overtime work during the epidemic," "worrying about participating in the supporting work," and "continuous exhaustion from work" were significant contributors to depression, anxiety, and stress status. In addition, the results of PWS found that each dimension of PWS was correlated with depression, anxiety, and stress state, which indicates the individual's physical and mental health state was associated with multiple factors.

CONCLUSION

COVID-19 has significantly impacted dentists' mental health in Shaanxi Province. With these findings, we aim to educate and promote targeted interventions that can be utilized to improve dentists' mental health by analyzing the influencing factors.

Predictors of Nutritional Status, Depression, Internet Addiction, Facebook Addiction, and Tobacco Smoking Among Women With Eating Disorders in Spain

Eating disorders (EDs) are a complex group of psychiatric conditions that involve dysfunctional eating patterns, nutritional alterations, and other comorbid psychopathologies. Some women with EDs may develop problematic internet use while they attempt to get information on dieting/weight control or get online support from people with similar problems. They may also drift toward tobacco smoking as a method to regulate their weight or to cope with their weight-related dysphoria. The occurrence of these conditions in EDs may prolong disease course and impede recovery. This study used structural equation modeling to investigate nutritional status (noted by body mass index, BMI), depression psychopathology, internet addiction (depicted by the Internet Addiction Test), Facebook addiction (depicted by the Bergen Facebook Addiction Scale), and smoking among 123 Spanish women diagnosed with EDs (mean age = 27.3 ± 10.6 years). History of hospitalization, marital status, age, and the level of education predicted BMI in certain ED groups. BMI did not predict depression, but it predicted internet addiction, Facebook addiction, and smoking in certain ED groups. Depression did not predict BMI, internet/Facebook addition, or smoking in any ED group. Some sociodemographic and clinical variables had indirect effects on depression, internet addiction, and Facebook addiction while age was the only variable expressing a direct effect on all outcome measures. Age, education, and history of prolonged treatment predicted smoking in certain ED patients. The findings signify that a considerable target for interventional strategies addressing nutritional and addictive problems in EDs would be women with high BMI, history of hospitalization, history of prolonged treatment, who are particularly young, single, and less educated. Replication studies in larger samples, which comprise various subtypes of EDs from both genders, are warranted to define the exact interaction among the addressed variables.

The Six-Item Version of the Internet Addiction Test: Its Development, Psychometric Properties, and Measurement Invariance among Women with Eating Disorders and Healthy School and University Students

Internet addiction (IA) is widespread, comorbid with other conditions, and commonly undetected, which may impede recovery. The Internet Addiction Test (IAT) is widely used to evaluate IA among healthy respondents, with less agreement on its dimensional structure. This study investigated the factor structure, invariance, predictive validity, criterion validity, and reliability of the IAT among Spanish women with eating disorders (EDs, N = 123), Chinese school children (N = 1072), and Malay/Chinese university students (N = 1119). In school children, four factors with eigen values > 1 explained 50.2% of the variance, with several items cross-loading on more than two factors and three items failing to load on any factor. Among 19 tested models, CFA revealed excellent fit of a unidimensional six-item IAT among ED women and university students (χ2(7) = 8.695, 35.038; p = 0.275, 0.001; CFI = 0.998, 981; TLI = 0.996, 0.960; RMSEA = 0.045, 0.060; SRMR = 0.0096, 0.0241). It was perfectly invariant across genders, academic grades, majors, internet use activities, nationalities (Malay vs. Chinese), and Malay/Chinese female university students vs. Spanish women with anorexia nervosa, albeit it was variant at the scalar level in tests involving other EDs, signifying increased tendency for IA in pathological overeating. The six-item IAT correlated with the effects of internet use on academic performance at a greater level than the original IAT (r = -0.106, p < 0.01 vs. r = -0.78, p < 0.05), indicating superior criterion validity. The six-item IAT is a robust and brief measure of IA in healthy and diseased individuals from different cultures.

A One-Year Longitudinal Study: Changes in Depression and Anxiety in Frontline Emergency Department Healthcare Workers in the COVID-19 Pandemic

Frontline healthcare workers (HCWs) fighting COVID-19 have been associated with depression and anxiety, but there is limited data to illustrate these changes over time. We aim to quantify the changes in depression and anxiety amongst Emergency Department (ED) HCWs over one year and examine the factors associated with these changes. In this longitudinal single-centre study in Singapore, all ED HCWs were prospectively recruited face-to-face. Paper-based surveys were administered in June 2020 and June 2021. Depression and anxiety were measured using DASS-21. The results of 241 HCWs who had completed both surveys were matched. There was significant improvement in anxiety amongst all HCWs (Mean: 2020: 2.85 (±3.19) vs. 2021: 2.54 (±3.11); Median: 2020: 2 (0–4) vs. 2021: 2 (0–4), p = 0.045). HCWs living with elderly and with concerns about infection risk had higher odds of anxiety; those living with young children had lower odds of anxiety. There was significant worsening depression amongst doctors (Mean: 2020: 2.71 (±4.18) vs. 2021: 3.60 (±4.50); Median: 2020: 1 (0–3) vs. 2021: 3 (0–5), p = 0.018). HCWs ≥ 41 years, living with elderly and with greater concerns about workload had higher odds of depression. HCWs who perceived better workplace support and better social connectedness had lower odds of depression. In summary, our study showed significant improvement in anxiety amongst ED HCWs and significant worsening depression amongst ED doctors over one year. Age, living with elderly, and concerns about workload and infection risk were associated with higher odds of depression and anxiety.

The Association Between Depressive Symptomology, Psychological Burden Related to COVID-19, and Engagement in Physical Exercise Among College Students

Introduction: The coronavirus (COVID-19) pandemic has resulted in substantial changes to the normalcy of daily life. Research conducted in Western Europe point to elevated levels of depression, rumination and worry as well psychological burden. These in turn impact the capacity of individuals to adhere to lockdown measures and health-protective behaviours. Investigations of these pandemic-related mental health constructs in the Middle East appears sparse. Moreover, there is an immense need to investigate the potential for simple strategies that might be used by individuals whilst in lockdown to combat the onset of mental health difficulties. Regular physical exercise may prove valuable in this regard. Objective: To investigate the potential mediational role of engagement in physical exercise on the association between depression and psychological burden related to COVID-19. Method: A sample of 1,322 participants (mage = 19.50 years, SD = 1.54) completed measures of depression and psychological burden related to COVID-19 and self-reported their frequency of physical exercise. Data were collected between February and May 2021 in Egypt and the United Arab Emirates. Results: Analyses revealed statistically significant associations between depression and psychological burden as well as between elevated depression and reduced physical exercise. Mediation analyses in which the potential mediational role of physical exercise was examined were not significant. Conclusions: Depression and psychological burden related to the pandemic appear to be prevalent in these Middle Eastern locations. Whilst physical exercise appears to be beneficial in combating depression, it does not appear to be a sufficient strategy for impeding the experience of psychological burden. Investigation of the contribution of additional strategies is required.

Prevalence and associated factors of stress among primary health care nurses in Saudi Arabia, a multi-center study

Background:

Nursing practice has been identified as one of the most stressful professions within the healthcare systems. The current study aimed to determine the prevalence of stress and its associated factors among primary healthcare nurses.

Materials and Methods:

This analytical cross-sectional study was conducted among 200 Saudi nurses in the government primary health care centers in Medina city, Saudi Arabia. Stress was measured by the stress subscale of the 21-Item Depression, Anxiety and Stress Scale. Sources of stress were assessed by 15 items.

Results:

The majority were females (68.0%) and aged less than 40 years (72.5%). Thirty percent had severe or very severe stress. Stress was associated significantly with the presence of chronic diseases (P = 0.037) and with working in night shifts (P = 0.042). All sources of stress in the workplace were associated significantly and positively with stress (P < 0.01).

Conclusion:

About one-third of the participants had stress. Improving work conditions and minimizing stress in the workplace should be a priority in the primary health care setting.

The Depression Anxiety Stress Scale 21: Development and Validation of the Depression Anxiety Stress Scale 8-Item in Psychiatric Patients and the General Public for Easier Mental Health Measurement in a Post COVID-19 World

Despite extensive investigations of the Depression Anxiety Stress Scales-21 (DASS-21) since its development in 1995, its factor structure and other psychometric properties still need to be firmly established, with several calls for revising its item structure. Employing confirmatory factor analysis (CFA), this study examined the factor structure of the DASS-21 and five shortened versions of the DASS-21 among psychiatric patients (N = 168) and the general public (N = 992) during the COVID-19 confinement period in Saudi Arabia. Multigroup CFA, Mann Whitney W test, Spearman's correlation, and coefficient alpha were used to examine the shortened versions of the DASS-21 (DASS-13, DASS-12, DASS-9 (two versions), and DASS-8) for invariance across age and gender groups, discriminant validity, predictive validity, item coverage, and internal consistency, respectively. Compared with the DASS-21, all three-factor structures of the shortened versions expressed good fit, with the DASS-8 demonstrating the best fit and highest item loadings on the corresponding factors in both samples (χ2(16, 15) = 16.5, 67.0; p = 0.420, 0.001; CFI = 1.000, 0.998; TLI = 0.999, 0.997; RMSEA = 0.013, 0.059, SRMR = 0.0186, 0.0203). The DASS-8 expressed configural, metric, and scalar invariance across age and gender groups. Its internal consistency was comparable to other versions (α = 0.94). Strong positive correlations of the DASS-8 and its subscales with the DASS-21 and its subscales (r = 0.97 to 0.81) suggest adequate item coverage and good predictive validity of this version. The DASS-8 and its subscales distinguished the clinical sample from the general public at the same level of significance expressed by the DASS-21 and other shortened versions, supporting its discriminant validity. Neither the DASS-21 nor the shortened versions distinguished patients diagnosed with depression and anxiety from each other or from other psychiatric conditions. The DASS-8 represents a valid short version of the DASS-21, which may be useful in research and clinical practice for quick identification of individuals with potential psychopathologies. Diagnosing depression/anxiety disorders may be further confirmed in a next step by clinician-facilitated examinations. Brevity of the DASS-21 would save time and effort used for filling the questionnaire and support comprehensive assessments by allowing the inclusion of more measures on test batteries.

An Examination of the Conceptual Structure of Long-Term Goal Striving

Long-term goal striving has been recognized as an important stage in goal achievement. Compared with the development of measurements of goal setting, researchers tended to measure goal striving in different manners. This study examined the conceptual structure of goal striving and validated a new scale to operationalize the construct within academic learning contexts. A 25-item scale was validated with 522 Chinese university students to assess its factor structure, reliability, gender invariance, criterion-related validity, and incremental validity. Confirmatory factor analysis results supported both the first-order and second-order model. Overall, the scale showed good reliability, validity, and invariance across gender. We suggested that this new scale could be used as an effective measure to assess the level of goal striving among university students in a Chinese context.

The Arabic Version of the Cohen Perceived Stress Scale: Factorial Validity and Measurement Invariance

University students experience high levels of stress due to university transition, academic commitments, and financial matters. Higher stress perceptions along with limited coping resources endanger mental health for a considerable number of students and may ruin their performance. The current study evaluated the psychometric properties of the Cohen Perceived Stress Scale (10 items), PSS-10, in a sample of 379 female Emeriti students. Exploratory factor analysis resulted in two factors with eigenvalues of 3.88 and 1.19, which explained 60.6% of the variance. Confirmatory factor analysis revealed good model fits of two correlated factors (Comparative Fit Index (CFI) = 0.962, Tucker–Lewis Index (TLI) = 0.950, standardized root-mean-square residual (SRMR) = 0.0479, and root mean-square error of approximation (RMSEA) = 0.067). Internal consistency of the PSS-10 and its positive and negative subscales was acceptable (coefficient α = 0.67, 0.79, and 0.86, respectively). Multigroup analysis revealed that the PSS-10 holds invariance across different groups of age, marital status, and financial status (average monthly expenditure). Convergent and concurrent validity tests signify the importance of considering scores of subscales of the PSS-10 along with its total score.

Confirmatory Factor Analysis of Three Versions of the Depression Anxiety Stress Scale (DASS-42, DASS-21, and DASS-12) in Polish Adults

Background: The Depression Anxiety Stress Scales (DASS) are designed to identify quickly and differentiate between the symptoms of depression and anxiety in the non-clinical population. Different versions (original and short) were validated in many cultures. Nevertheless, there are no data of factorial validity of the different versions of this scale in Polish culture. Thus, the aim of this study was to evaluate the factor structure using confirmatory factor analysis (CFA) and internal consistency of DASS-42 (original version) and two short versions (DASS-21 items and DASS-12 items) in the Polish population. Methods: The DASS-42 was administered to a non-clinical sample, broadly representative of the general Polish adult population (n = 1,021) in terms of demographic variables. The DASS-21 and DASS-12 version used in this study comprise seven and four items from each of the following corresponding three subscales of the Polish version of DASS-42. Results: There were two models that fitted best for DASS-42: (a) modified three correlated factors (depression, anxiety, and stress) with cross-loadings and (b) second order (general factor of psychological distress) and three factors with cross-loadings. There were also two models that fitted best for DASS-21 and DASS-12: (a) modified three correlated factors (depression, anxiety, and stress) and (b) second order (general factor of psychological distress) and three factors. Conclusions: All three versions of DASS appear to have an acceptable factorial structure. However, the shorter versions (DASS-21 and DASS-12) may be more feasible to use in general medical practice and also be less burdensome to participants.

Intermittent Fasting, Dietary Modifications, and Exercise for the Control of Gestational Diabetes and Maternal Mood Dysregulation: A Review and a Case Report

Gestational diabetes mellitus (GDM) is a common pregnancy-related condition afflicting 5-36% of pregnancies. It is associated with many morbid maternal and fetal outcomes. Mood dysregulations (MDs, e.g., depression, distress, and anxiety) are common among women with GDM, and they exacerbate its prognosis and hinder its treatment. Hence, in addition to early detection and proper management of GDM, treating the associated MDs is crucial. Maternal hyperglycemia and MDs result from a complex network of genetic, behavioral, and environmental factors. This review briefly explores mechanisms that underlie GDM and prenatal MDs. It also describes the effect of exercise, dietary modification, and intermittent fasting (IF) on metabolic and affective dysfunctions exemplified by a case report. In this patient, interventions such as IF considerably reduced maternal body weight, plasma glucose, and psychological distress without any adverse effects. Thus, IF is one measure that can control GDM and maternal MDs; however, more investigations are warranted.

COVID-19: A pandemic that threatens physical and mental health by promoting physical inactivity

Ever since the outbreak of Coronavirus disease 2019 (COVID-19) in late 2019, it has killed millions of people worldwide. Even people not stricken by this disease are not spared from its negative economic, social, and health-related drawbacks. This commentary provides insight into the potential mechanisms involved in the development of depression and emotional negativity escalating during the current pandemic. In particular, preventive measures of COVID-19, such as staying at home, are sedentarism measures that decrease physical activity. Physical inactivity alters gut microbiome structure in a fashion that promotes gut dysbiosis and flaring of systemic inflammation, leading to the buildup of body fat. Obesity, which contributes to a trail of health-depleting disorders, furthers gut microbial disintegration while fat tissue stimulates the release of cytokines, promotes metabolic resistance, and alters signaling involved in the production of antioxidants. As a result, the body gets flooded by toxic molecules such pro-inflammatory mediators, free radicals, and advanced glycation end products. These toxic molecules alter cellular function in all body tissues, including those of the brain. Neuroinflammation is associated with progressive declines in cognitive and motor functions along with dysregulation in emotions. Counteracting the sedentarism enforced by the COVID-19 pandemic through the participation in suitable indoors activities and the intake of healthy food is likely to protect against or revert physiological impairments that may affect people retreating to their homes during the current crisis, eventually restoring physical and mental health.

Psychological Climacteric Symptoms and Attitudes toward Menopause among Emirati Women

Menopause is an inevitable developmental event that women encounter at an age of 42–54 years. The drop of estrogen levels that accompanies cessation of menstruation is associated with multiple vasomotor, physical, neuropsychological, and sexual symptoms, which may hamper quality of life. This study aimed to examine the severity of psychological symptoms and their correlates among peri- and postmenopausal Emirati women (N = 60, mean age = 54.88 ± 6 years). Participants were interviewed using the Menopause-Specific Quality of Life (MENQOL) and attitudes toward menopause scale (ATMS). In four path analysis models, vasomotor symptoms, weight gain, and fatigue had significant direct effects on symptoms of anxiety, depression (only weight gain and fatigue), and psychological distress. Fatigue significantly mediated the effects of vasomotor symptoms and weight gain on symptoms of anxiety, depression (only vasomotor symptoms), psychological distress, and memory problems. These models explained 47.6%, 44.5%, 56.6%, and 29.1% of the variances in anxiety, depression, psychological distress, and memory problems, respectively. Participants with more severe menopausal symptoms expressed more negative attitudes toward menopause though regression analysis revealed that only vasomotor symptoms could significantly contribute to ATMS scores. In conclusion, psychological distress is widespread among menopausal women, and it is associated with vasomotor symptoms, fatigue, and change of body composition (obesity). Psychological symptoms, along with vasomotor symptoms, express a key link to negative attitudes toward menopause. Therefore, interventional strategies that target psychological distress may promote coping with midlife transition and improve mental health among menopausal women.

The Depression Anxiety Stress Scale-21 in Chinese Hospital Workers: Reliability, Latent Structure, and Measurement Invariance Across Genders

The Depression Anxiety Stress Scale-21 (DASS-21) is an instrument in the assessment of mental health status. The current study recruited 1,532 Chinese hospital workers [74.4% female; mean age = 31.97 (SD = 9.70) years] to examine the reliability, latent structure, and measurement invariance of the DASS-21 between genders. The Cronbach’s α values were greater than 0.90 for total score. This study examined four possible models of the DASS-21 using the confirmatory factor analysis (CFA) in Chinese hospital workers. The results from CFA revealed that the latent structure of the DASS-21 in medical staffs is best represented by a one-factor model. Then we used the one-factor model to examine measurement invariance across genders by using a multiple-group categorical CFA. All values of root mean square error approximation (RMSEA) were less than 0.08, all Comparative Fix Index (CFI) and Tucker–Lewis Index values were greater than 0.90, all ΔCFI (changes in CFI) values were less than 0.010, and ΔRMSEA (the changes in RMSEA) were less than 0.015. These findings supported the gender invariance of the DASS-21 among Chinese hospital workers.