The Efficacy of Computerized Cognitive Behavioral Therapy for Depressive and Anxiety Symptoms in Patients With COVID-19: Randomized Controlled Trial

Digital Psychological Interventions for Adults in the COVID-19 Pandemic: A Systematic Review and Meta-Analysis

This study evaluates the effect of digital psychological interventions on anxiety, depression, and stress symptoms in adults affected by the pandemic. A systematic search across five digital databases, from 1 January 2020 to 6 March 2024, identified 36 studies encompassing 8,662 participants. Compared with all control conditions, random-effects meta-analyses indicated that digital psychological interventions significantly reduced anxiety (g = -0.374; 95% CI, -0.529 to -0.218), depression (g = -0.568; 95% CI, -0.776 to -0.360), and stress (g = -0.452; 95% CI, -0.608 to -0.295). Smaller effect sizes were observed when compared with active controls than with inactive controls. Notable heterogeneity across three outcomes was observed. Publication bias was noted in depression symptoms. Several moderators were identified compared with inactive controls, including participant type for anxiety (psubgroup = 0.005), and region for depression symptoms (psubgroup = 0.000). Larger sample sizes (b = 0.0004; p = 0.028) related to stronger effects on depression symptoms. Publication year positively correlated with effects on stress (b = 0.1573; p = 0.032). This study supports the efficacy of digital psychological interventions in alleviating anxiety, depression, and stress symptoms for adults during the pandemic, offering insights for developing targeted mental health strategies in future public health crises.

Work Disability Prevention and Management

OBJECTIVE

This abbreviated version of the American College of Occupational and Environmental Medicine's (ACOEM) Work Disability Prevention and Management Guideline reviews the available evidence and provides recommendations to clinicians regarding interventions to help patients remain at or return to work.

METHODS

Systematic literature reviews were conducted. Studies were graded and evidence tables were created, with involvement of a multidisciplinary expert panel that evaluated the evidence and finalized recommendations for all clinical questions. Extensive peer review was performed. Consensus recommendations were formulated when evidence was lacking.

RESULTS

Evidence-based recommendations have been developed to guide work disability prevention and management.

CONCLUSIONS

Clinicians should utilize quality evidence in determining treatment methods to prevent and alleviate work disability for workers. This guideline offers an evidence-based framework for preventing and mitigating work disability for individual adults in the active workforce. It is designed for use by healthcare clinicians who desire to minimize the negative impact of health conditions on working people's lives and livelihoods.

Discovery of the microbiota-gut-brain axis mechanisms of acupuncture for amnestic mild cognitive impairment based on multi-omics analyses: A pilot study

OBJECTIVES

Acupuncture is a promising therapy for amnestic mild cognitive impairment (aMCI). Growing evidence suggest that alterations in the microbiota-gut-brain (MGB) axis contribute to the development and progression of aMCI. However, little is known about whether and how acupuncture change the MGB axis of aMCI individuals.

METHODS

This was a randomized, controlled, clinical trial. Forty patients with aMCI were randomly allocated to either the acupuncture group or the waitlist group. The primary outcome was the change in the Alzheimer's Disease Assessment Scale-Cognitive Scale (ADAS-Cog) score. In addition, multi-omics was performed to detect changes in brain function, gut microbiota, and serum metabolites. Generalized estimating equations were used to estimate the outcomes, and correlational analyses were performed to explore the relationships between the clinical and multi-omics data.

RESULTS

Compared to a mean baseline to week 12 change of -3.94 in the acupuncture group, the mean change in the waitlist group was 1.72 (net difference, -5.66 [95 % CI, -6.98 to -4.35]). Compared to the waitlist group, acupuncture's MGB axis modulatory effect exhibited altered the regional homogeneity values of Frontal_Med_Orb_L, Cingulum_Mid_L, and Frontal_Sup_Medial_L, relative abundance of gut Ruminococcus_sp_AF43_11 and s_Eubacterium_coprostanoligenes, and levels of serum (11E,15Z)-9,10,13-trihydroxyoctadeca-11,15-dienoic acid, dipropylene glycol dimethyl ether, N6-Me-dA, and DPK, which correlated with changes in ADAS-Cog scores.

CONCLUSIONS

Our data imply that acupuncture ameliorates overall cognitive function, along with changes in brain activity, gut microbiota, and serum metabolites, providing preliminary evidence of the mechanisms acting through the MGB axis underlying the effects of acupuncture on aMCI.

Effectiveness of psychological crisis interventions during infectious disease outbreaks in low- and middle-income countries: a systematic review of Randomized Control Trials

The huge mental health treatment gap in low- and middle-income countries (LMICs) is further exacerbated when infectious disease outbreaks occur. To address the increasing mental health needs during outbreaks, the availability of flexible and efficient mental health interventions is paramount, especially in low-resource settings where outbreaks are more common. Psychological interventions may help to address these mental health needs with efficient implementation costs. However, there is a huge paucity of quality evidence to inform psychosocial interventions during outbreaks. This systematic review sought to update the existing evidence to inform the effectiveness of psychological interventions that addresses mental health issues during outbreaks in LMICs. Six electronic databases were searched - Scopus, PubMed, PsycINFO, Embase, Cochrane library and CINAHL. We included randomised controlled trials of psychological interventions aimed to address common mental health conditions among adults affected by infectious disease outbreaks in LMICs. Studies were excluded if they were done among all age groups, used mixed interventions with pharmacotherapies, addressed severe mental health conditions and were published other than in English. The quality of evidence in the included trials was assessed using the Cochrane Collaboration risk of bias tool. We included 17 trials that examined the effectiveness of psychological interventions among outbreak-affected adults in LMICs. The quality of studies was generally average but tended to provide evidence that brief psychoeducational interventions based on cognitive restructuring, mindfulness, relaxation and stress management techniques were effective in reducing perceived stress and anxiety symptoms, and in improving resilience and self-efficacy. Similarly, mindfulness-based interventions and mindfulness stress reduction treatments were effective in addressing depression, anxiety and generalised anxiety disorder. Brief psychological interventions that can be delivered by non-specialists could have value in addressing the huge mental health needs in outbreak contexts.

The efficacy of auricular acupressure combined with emotional freedom techniques on the postoperative pain and anxiety state of patients with lower limb fractures: A randomized clinical controlled trial

BACKGROUND

Lower limb fractures cause local pain, swelling, ecchymosis, and dysfunction. Clinically, incision and reduction surgery are often employed to treat lower limb fractures. However, postoperative pain can be intense, leading to adverse emotions that hinder subsequent recovery.

METHODS

A total of 99 postoperative patients with lower limb fractures were randomly divided into 3 groups: the control group (routine care, 33 patients), the auricular acupressure group (routine care plus auricular acupressure, 33 patients), and the combined group (routine care, auricular acupressure, and emotional freedom techniques [EFT], 33 patients). Pain levels were measured using the visual analog scale (VAS), and anxiety levels were measured using the self-rating anxiety scale (SAS) at various time points post-intervention. Patient satisfaction with nursing care was also evaluated at the end of the intervention.

RESULTS

The VAS scores in the combined group were significantly lower than those in the auricular acupressure and control groups at 4, 12, 24, and 48 hours post-intervention (P < .05). Additionally, the SAS scores in the combined group were significantly lower than those in the auricular acupressure and control groups at 72 hours post-intervention (P < .05). The combined group also reported significantly higher satisfaction with nursing care compared to the other 2 groups at the end of the intervention (P < .05).

CONCLUSION

Auricular acupressure combined with EFT effectively reduces pain levels, alleviates anxiety, and increases patient satisfaction with nursing care in postoperative patients with lower limb fractures.

Effects of internet-based cognitive behavioral therapy on anxiety and depressive symptoms among patients with cardiovascular and cerebrovascular diseases: a systematic review and meta-analysis

Background

This study aimed to evaluate the effectiveness of Internet-based Cognitive Behavioral Therapy (ICBT) in reducing anxiety and depressive symptoms among patients with cardiovascular diseases (CVDs) and to explore how intervention characteristics, such as module number and program duration, influence treatment outcomes.

Methods

A systematic review and meta-analysis were conducted by searching eight databases, including PubMed, Embase, and Cochrane Library, for randomized controlled trials (RCTs) published up to December 2023. Studies involving adult CVD patients with anxiety or depressive symptoms who underwent ICBT interventions were included. Statistical analyses used random-effects models, with subgroup analyses performed to assess the impact of intervention format, module number, and program duration. Sensitivity and publication bias assessments ensured the robustness of the findings.

Results

Eight RCTs with 1177 participants were included. ICBT significantly reduced depressive symptoms (SMD = -0.32, 95% CI [-0.56, -0.08], p < 0.015) and anxiety symptoms (SMD = -0.37, 95% CI [-0.68, -0.06], p < 0.001). Subgroup analysis indicated that self-guided ICBT was more effective than therapist-guided ICBT. Programs with fewer than eight modules were more effective for anxiety, while those with eight or more modules were more effective for depression. Shorter programs (< 9 weeks) were better for anxiety, whereas longer programs (≥ 9 weeks) were more effective for depression.

Conclusions

ICBT is an effective intervention for managing anxiety and depression in CVD patients. Tailoring ICBT interventions based on symptom type, module number, and program duration can optimize outcomes. Future research should explore personalized, long-term strategies to enhance effectiveness and safety.

Effect of Shengyang Yiwei Decoction combined with selective serotonin reuptake inhibitor antidepressants on HAMD-17 score and somatic symptoms in patients with depression

Objective

To investigate the efficacy of Shengyang Yiwei Decoction (SYD) combined with selective serotonin reuptake inhibitor(SSRI) antidepressants on the total score and scores of factors of the Hamilton Rating Scale for Depression(HAMD-17) and somatic symptoms in patients with depression.

Methods

This was a retrospective study. One hundred and twenty patients with depression were treated in Hebei Provincial Mental Health Center between December 2020 and May 2022 and randomly divided into the experimental group and the control group, with 60 patients in each group. Patients in the control group were treated with selective serotonin reuptake inhibitor (SSRI) antidepressants and those in the experimental group were treated with modified SYD in addition to SSRIs for eight weeks. Explored the efficacy and adverse drug reactions of the two treatment options.

Results

After eight weeks of treatment, there was no statistically significant difference in the total efficacy between the two groups(p>0.05); the total score of HAMD-17 and scores of factors except body weight were decreased in the experimental group compared with those in the control group, and the differences were statistically significant(p<0.05). The SSI score of the experimental group was decreased compared with that of the control group, and the difference was statistically significant(p<0.05).

Conclusion

SYD combined with SSRI antidepressants in the treatment of depression can reduce the total score and the scores of factors of HAMD-17 without increasing the incidence of adverse drug reactions. This combination can be used as an integrated traditional Chinese and Western medicine treatment for depression.

Comprehensive nursing care improves symptoms and quality of life in elderly patients with postherpetic neuralgia

This study evaluates the clinical impact of comprehensive nursing care on senior patients suffering from postherpetic neuralgia (PHN), a chronic neuropathic pain condition resulting from the reactivation of the varicella-zoster virus. A total of 102 elderly patients diagnosed with PHN and treated at our hospital were divided into two groups: the control group, which received conventional nursing care, and the intervention group, which received comprehensive nursing care. Comparative analyses were conducted on pain levels, sleep quality, symptoms of depression and anxiety before and after the intervention. After a two-month period of nursing care, both groups exhibited a significant reduction in pain levels (p < 0.05), with the intervention group demonstrating a more substantial decrease (p < 0.001). Sleep quality improved in both groups (p < 0.05), with the intervention group showing a significantly greater improvement (p < 0.05). Additionally, the intervention group experienced a notable reduction in anxiety and depression ratings compared to the control group. Comprehensive nursing care interventions may effectively alleviate clinical symptoms, and diminish levels of depression and anxiety, while improving sleep quality in elderly patients with PHN. These findings underscore the potential benefits of employing a comprehensive approach to managing PHN in the elderly population.

A digital intervention for cognitive deficits following COVID-19: a randomized clinical trial

Post-COVID-19 cognitive deficits are common, persistent, and disabling. Evidence on effective treatments is limited. The goal of this study was to investigate the efficacy of a digital intervention to reduce cognitive and functional deficits in adults with persistent post-COVID-19 cognitive dysfunction. We used the remotely-delivered intervention in a randomized clinical trial conducted from July 13, 2021 to April 26, 2023. We hypothesized that participants in the intervention group would improve in measures of cognition and daily functioning. Participants were adults with cognitive deficits persisting >4 weeks following acute COVID-19 illness. Of 183 participants screened, 110 were enrolled; 98 participants (78.6% female; mean age = 48.1) completed at least one study visit. Participants were randomized 1:1 to the intervention (AKL-T01) or waitlist control. AKL-T01 is a digital therapeutic using a videogame interface to target attention and executive control. The intervention was delivered remotely for 6 weeks. The primary outcome was change in performance on a sustained attention measure (Digit Symbol Matching Task). The difference in the primary outcome between the intervention (n = 49) and controls (n = 49) was not statistically significant (F [3,261] = 0.12, p = 0.95). Secondary cognitive outcomes of task-switching (F[3,262] = 2.78, p = 0.04) and processing speed (F[3,267] = 4.57, p = 0.004) improved in the intervention relative to control. Secondary measures of functioning also improved in the intervention relative to control, including disability (F[1,82] = 4.02, p = 0.05) and quality of life (F[3,271] = 2.66, p = 0.05). Exploratory analyses showed a greater reduction in total fatigue (F[1,85] = 4.51, p = 0.04), cognitive fatigue (F[1,85] = 7.20, p = 0.009), and anxiety (F[1,87] = 7.42, p = 0.008) in the intervention relative to control. Despite the lack of improvement in sustained attention, select post-COVID-19 cognitive deficits may be ameliorated by targeted cognitive training with AKL-T01, with associated improvements in quality of life and fatigue. If replicated, the scalable nature of this digital intervention may help address substantial need for accessible, effective treatments among individuals with long COVID.

Effects of cognitive training and group psychotherapy on cognitive performance of post COVID-19 patients: an exploratory and non-randomized clinical trial

Cognitive complaints are common signs of the Post COVID-19 (PC) condition, but the extent and type of cognitive impairment may be heterogeneous. Little is known about neuropsychological treatment options. Preliminary evidence suggests cognitive symptoms may improve with cognitive training and naturally over time. In this clinical trial, we examined whether participation in a weekly group consisting of cognitive training and group psychotherapy is feasible and would exert beneficial effects on cognitive performance in PC and whether improvements were associated with intervention group participation or represented a temporal improvement effect during syndrome progression. 15 PC patients underwent an 8-week intervention. Cognitive performance was assessed before and after each intervention group participation. A control group of 15 PC patients with subjective neurocognitive or psychiatric complaints underwent two cognitive assessments with comparable time intervals without group participation. To attribute changes to the intervention group participation, interaction effects of group participation and time were checked for significance. This is an exploratory, non-randomized, non-blinded controlled clinical trial. Within the intervention group, significant improvements were found for most cognitive measures. However, significant time x group interactions were only detected in some dimensions of verbal memory and visuo-spatial construction skills. Significant time effects were observed for attention, concentration, memory, executive functions, and processing speed. The intervention setting was feasible and rated as helpful and relevant by the patients. Our results suggest that cognitive symptoms of PC patients may improve over time. Patients affected by both neurocognitive impairments and mental disorders benefit from group psychotherapy and neurocognitive training. The present study provides evidence for a better understanding of the dynamic symptomatology of PC and might help to develop further studies addressing possible therapy designs. The main limitations of this exploratory feasibility trial are the small sample size as well as the non-randomized design due to the clinical setting.

Depression, anxiety and insomnia among isolated covid-19 patients: tele occupational therapy intervention vs. conventional one: a comparative study

BACKGROUND

COVID-19 is known to cause psychological problems. Psychological rehabilitation can be performed to reduce anxiety, depression, and insomnia. Facing patients with infectious diseases can be difficult for medical staff. Therefore, this study compared the effects of psychiatric tele-rehabilitation (TR) and conventional psychiatric rehabilitation (CR) in isolated patients with COVID-19.

METHODS

This randomized controlled study, conducted at a single community-based hospital, included 40 patients (24 in the psychiatric tele-rehabilitation group [TRG] and 16 in the conventional psychiatric rehabilitation group [CRG]) with COVID-19 were recruited from November 18, 2021, to April 7, 2022. Psychiatric rehabilitation is an occupation-based intervention in which patients perform meaningful activities and tasks. Patients in the TRG selected activities, received counseling, and underwent monitoring over the phone, while those in the CRG participated in face-to-face sessions. The interventions were conducted for 50 min each day during an isolation period of 7 days in both groups, and all participants received the interventions individually. The primary outcome was anxiety assessed using the Visual Analog Scale (VAS) and the Zung Self-Rating Anxiety Scale (SAS). Secondary outcomes include the Visual Analog Scale (VAS) and the Patient Health Questionnaire-9 (PHQ-9) to evaluate depression, the Multidimensional State Boredom Scale-8 (MSBS-8) to assess boredom. The Korean version of the Insomnia Severity Index (ISI-K) was used to assess the quality of sleep, and the World Health Organization Quality of Life Assessment Instrument-BRIEF (WHOQOL-BREF) was used to evaluate quality of life. Questionnaires were administered at admission, discharge, and at the 6-month follow-up.

RESULTS

In the time × group analysis, the SAS total score (p = .033) and the VAS score for depression (p = .012) in the CRG were significantly lower than those in the TRG at the time of discharge. The VAS score for anxiety (p = .007), total SAS score (p = .050), and VAS score for depression (p = .003) in the CRG were also significantly lower than those in the TRG at the 6-month follow-up. The PHQ-9, MSBS-8, ISI-K, and WHOQOL-BREF scores showed no significant interactions in the time × group analysis.

CONCLUSIONS

TR was effective in reducing anxiety and improving quality of life during hospitalization, but had no remained effects after discharge. Otherwise, CR was more effective than TR for anxiety and depression during hospitalization and had remained effects at 6-month follow-up. However, considering the characteristics of infectious conditions that involve risk in contact, TR will still play an important role, and efforts will be needed to improve the effect that remained.

TRIAL REGISTRATION

The trial was registered with the Korea Clinical Trials Registry (KCT0006714, Date of registration 08/11/2021).

Manual therapy and dry needling improve mobility, pain and reduce fear of COVID-19 in temporomandibular disorder patients: Randomized controlled trial

BACKGROUND AND PURPOSE

The COVID-19 pandemic exacerbated pain and joint mobility outcomes in patients with temporomandibular disorders (TMD), being that effective treatments are of clinical interest. We aimed to evaluate the effects of manual therapy (MT) and dry needling (DN), compared to cognitive-behavioral therapy/control (CO), on pain, articular mobility, and fear of COVID-19 in patients with TMD.

MATERIALS AND METHODS

Sixty participants with myofascial TMD were randomly assigned to three groups: MT, DN, and CO. Participants received four weeks of treatment (30 min per week). The participants completed the Fear of COVID- 19 Scale, the Visual Analog Scale, and mandibular mobility was assessed. Data were collected before the intervention (T1), after the last treatment session (T2), and 30 days after the end of treatment (T3). The data were analyzed using two-way Mixed-Design ANOVA, considering the group effect (DN x MT x CO), time (T1, T2, and T3), and the interaction time × group in the observed variance of outcomes.

RESULTS

We observed an interaction effect of time × group for maximum mouth opening, protrusion, and pain. The maximum mouth opening increased in the DN and MT groups (p = 0.005), while protrusion increased in the DN group (p = 0.007; test power = 97%, large effect size). A decrease in pain scores over time was observed in the DN and MT groups (p < 0.001; test power>99%, large effect size). The fear of COVID-19 score decreased in the DN and MT groups after 30 days (p = 0.033).

CONCLUSION

DN and MT improve pain, joint mobility, and fear of COVID-19 in patients with TMD.

From theory to practice: Revealing the real-world impact of cognitive behavioral therapy in psychological disorders through a dynamic bibliometric and survey study

Background

Cognitive behavior therapy (CBT) is a proven treatment for many psychological disorders. It has been extensively studied and is effective for anxiety, depression, and schizophrenia. However, a bibliometric analysis of the CBT literature for these disorders is needed. This study reviewed this field's research and identifies key trends, influential studies, and gaps.

Methods

Using MeSH-generated keywords and PRISMA guidelines, the Scopus database retrieved bibliographic data without temporal or geographical constraints. Data-driven studies were analyzed for performance, collaborative pattern, impact, co-word frequency, knowledge structure, and trending topics using R-package-based Bibliometrix and VOSviewer applications. The current study applied bibliometric and statistical analyses.

Results

Scopus yielded 2757 studies since inception in 1979. The polynomial regression coefficient of 0.945 (R2) indicates a strong positive trend, and the research has increased at an annual rate of 12.67 %. Scholars from five countries had a noteworthy production of CBT research in treating PsD, namely the United States, the United Kingdom, Germany, Australia, and the Netherlands. Depression, oppositional defiant disorder, schizophrenia, and implementation are the clusters in the CBT research map. The thematic map needed to meet the desired criteria for representing all anticipated themes. Thematic evolution is evidence of noticeable changes that contributed to the creation of new research clusters and the disappearance of some of them. COVID-19 has significantly impacted the adoption and efficacy of internet-based interventions for mental health. The cross-sectional study provides valuable insights into the development and dissemination of CBT in Saudi Arabia, emphasizing the importance of training, awareness, and research.

Conclusions

This study proposes that further investigation be conducted in contemporary literature to create a comprehensive framework for enhancing policy decisions regarding CBT.

Psychological treatments for mental health symptoms associated with COVID-19 infection: A scoping review

The aim of this scoping review was to synthesize published studies and ongoing clinical trials of psychological interventions for mental health problems associated with COVID-19 infection. The study protocol was developed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Extension for Scoping Reviews. We conducted systematic searches for studies published or registered between January 2020 and October 2022 using eight scientific databases and clinical trial registries, which identified 40 complete published studies and 53 ongoing clinical trials. We found that most studies were randomized controlled trials (74%) while the remaining used study designs of lower methodological quality. Most studies investigated interventions for acute COVID-19 patients (74%) and others explored post-COVID conditions (PCC) or recovered patients. Cognitive and behavioral therapies were the main intervention approaches (31%), followed by multidisciplinary programs (21%) and mindfulness (17%). The most frequently evaluated outcomes were anxiety (33%), depression (26%), quality of life (13%), and insomnia (10%). No studies on youths, older people, or marginalized communities were found. These findings summarize the burgeoning research on a range of psychological interventions for individuals infected with COVID-19. However, the field is in its infancy and further research to develop an evidence base for targeted care is necessary. The gaps identified in the current study also highlight the need for more research on youths, older people, and members of marginalized communities, and PCC patients. It is important to ascertain interventions and delivery strategies that are not only effective and affordable but also allow high scalability and accessibility.

Value of combining targeted emergency nursing with psychological nursing in children with febrile convulsions

BACKGROUND

Febrile convulsions are a common pediatric emergency that imposes significant psychological stress on children and their families. Targeted emergency care and psychological nursing are widely applied in clinical practice, but their value and impact on the management of pediatric febrile convulsions are unclear.

AIM

To determine the impact of targeted emergency nursing combined with psychological nursing on satisfaction in children with febrile convulsions.

METHODS

Data from 111 children with febrile convulsions who received treatment at Nantong Maternal and Child Health Care Hospital between June 2021 and October 2022 were analyzed. The control group consisted of 44 children who received conventional nursing care and the research group consisted of 67 children who received targeted emergency and psychological nursing. The time to fever resolution, time to resolution of convulsions, length of hospital stays, Pittsburgh Sleep Quality Index, patient compliance, nursing satisfaction of the parents, occurrence of complications during the nursing process, and parental anxiety and depression were compared between the control and research groups. Parental anxiety and depression were assessed using the Hamilton Rating Scale for Depression (HAMD) and the Hamilton Rating Scale for Anxiety (HAMA).

RESULTS

The fever resolution, convulsion disappearance, and hospitalization times were longer in the control group compared with the research group (P < 0.0001). The time to falling asleep, sleep time, sleep quality, sleep disturbance, sleep efficiency, and daytime status scores were significantly better in the research group compared with the control group (P < 0.0001). The HAMD and HAMA scores for parents of children in the research group were lower than the scores in the control group after nursing (P < 0.05). Compliance with treatment of children in the research group was higher than in the control group (P < 0.05). Parental satisfaction with nursing in the research group was higher than in the control group (P < 0.05). The total complication rate of children in the control group was higher than in the research group (P < 0.05).

CONCLUSION

Combining psychological nursing with targeted emergency nursing improved the satisfaction of children's families and compliance with treatment and promoted early recovery of clinical symptoms and improvement of sleep quality.

Effectiveness of Rehabilitation Interventions in Individuals With Emerging Virtual Respiratory Tract Infectious Disease: A Systematic Review and Meta-Analysis

OBJECTIVE

Assessing rehabilitation effectiveness for persistent symptoms post-infection with emerging viral respiratory diseases.

DATA SOURCES

Systematic review of seven databases (MEDLINE, EMBASE, Cochrane Library, PEDro, MedRxiv, CNKI, Wanfang) until 30 December 2023.

REVIEW METHODS

Evaluated 101 studies (9593 participants) on respiratory function, exercise capacity, and quality of life. Methodological quality was assessed using the Cochrane Collaboration's Risk of Bias tool for randomized controlled trials (RCTs), the Newcastle-Ottawa Scale (NOS) for observational studies and non-RCTs, and the NIH Quality Assessment Tools for before-after studies.

RESULTS

The most common rehabilitation program combined breathing exercises with aerobic exercise or strength training. Rehabilitation interventions significantly enhanced respiratory function, as evidenced by improvements on the Borg Scale (MD, -1.85; 95% CI, -3.00 to -0.70, low certainty), the mMRC Dyspnea Scale (MD, -0.45; 95% CI, -0.72 to -0.18, low certainty), and the Multidimensional Dyspnoea-12 Scale (MD, -4.64; 95% CI, -6.54 to -2.74, moderate certainty). Exercise capacity also improved, demonstrated by results from the Six-Minute Walk Test (MD, 38.18; 95% CI, 25.33-51.03, moderate certainty) and the Sit-to-Stand Test (MD, 3.04; 95% CI, 1.07-5.01, low certainty).

CONCLUSION

Rehabilitation interventions are promising for survivors of viral respiratory diseases, yet gaps in research remain. Future investigations should focus on personalizing rehabilitation efforts, utilizing remote technology-assisted programs, improving research quality, and identifying specific subgroups for customized rehabilitation strategies to achieve the best outcomes for survivors.

Post-sepsis psychiatric disorder: Pathophysiology, prevention, and treatment

Post-sepsis psychiatric disorder, encompassing anxiety, depression, post-traumatic stress disorder and delirium, is a highly prevalent complication secondary to sepsis, resulting in a marked increase in long-term mortality among affected patients. Regrettably, psychiatric impairment associated with sepsis is frequently disregarded by clinicians. This review aims to summarize recent advancements in the understanding of the pathophysiology, prevention, and treatment of post-sepsis mental disorder, including coronavirus disease 2019-related psychiatric impairment. The pathophysiology of post-sepsis psychiatric disorder is complex and is known to involve blood-brain barrier disruption, overactivation of the hypothalamic-pituitary-adrenal axis, neuroinflammation, oxidative stress, neurotransmitter dysfunction, programmed cell death, and impaired neuroplasticity. No unified diagnostic criteria for this disorder are currently available; however, screening scales are often applied in its assessment. Modifiable risk factors for psychiatric impairment post-sepsis include the number of experienced traumatic memories, the length of ICU stay, level of albumin, the use of vasopressors or inotropes, daily activity function after sepsis, and the cumulative dose of dobutamine. To contribute to the prevention of post-sepsis psychiatric disorder, it may be beneficial to implement targeted interventions for these modifiable risk factors. Specific therapies for this condition remain scarce. Nevertheless, non-pharmacological approaches, such as comprehensive nursing care, may provide a promising avenue for treating psychiatric disorder following sepsis. In addition, although several therapeutic drugs have shown preliminary efficacy in animal models, further confirmation of their potential is required through follow-up clinical studies.

Long COVID-19 Enigma: Unmasking the Role of Distinctive Personality Profiles as Risk Factors

Background: The COVID-19 (Coronavirus disease 2019) pandemic has prompted extensive research into lingering effects, especially in 'Long COVID' patients. Despite exploration, contributing factors remain elusive; Objective: This study explores the potential link between distinctive personality profiles, particularly type D personality, and an increased risk of Long COVID; Methods: A retrospective cross-sectional study at Tel-Aviv Sourasky Medical Center's Post-COVID clinic analyzed data from 373 Long COVID patients through comprehensive questionnaires covering Long COVID syndrome, Fibromyalgia criteria, personality assessments, social support, and subjective evaluations of cognitive decline, health and life quality. In total, 116 out of 373 patients completed the questionnaire, yielding a 31% participation rate; Results: Cluster analysis revealed two groups, with Cluster 1 (N = 58) exhibiting Type D personality traits while Cluster 2 (N = 56) not meeting criteria for Type D personality. In comparison to Cluster 2, Cluster 1 patients reported heightened anxiety, depression, reduced social support, increased pain symptoms, manifestations of fibromyalgia, cognitive decline, and poor sleep quality, contributing to a diminished quality-of-life perception; Conclusions: findings highlight diverse personality profiles among Long COVID patients, emphasizing the need for tailored care. This approach shows potential for improving Long COVID patient care, aligning with the evolving personalized medicine paradigm.

Proposal to apply a "Positive Emotion, Engagement, Relationships, Meaning, and Accomplishment (PERMA)" based approach to manage the COVID-19-related mental health problems in the era of long COVID

Long COVID (LC)-related health problems are highly concerned. Many patients seem to have "recovered" from an acute SARS-CoV-2 infection, however, they might experience various symptoms, almost involving all organs and systems. Of those, neuropsychiatric symptoms like depression, anxiety, and post-traumatic stress disorder (PTSD) are not rare. These problems significantly impact the quality of life (QOL) of patients, family, and caregivers, even lead a tragic suicide outcome. Other than the conventional psychological and medical approaches, here, we proposal a positive emotion, engagement, relationships, meaning, and accomplishment (PERMA)-based approach to fight against these COVID-19-related mental health problems (CRMHPs). This approach is characterized by positive psychological interventions and self-achievements, which has been proved to be a powerful tool against mood disorders in common people. Nowadays, abolishment of certain prophylactic measures (such as isolation, lockdown, compulsorily wearing a mask and maintaining social distance, measures to avoid crowding) enables us to have more opportunities to contact patients and implement the PERMA-based approach to the patients with CRMHPs. We believe that application of PERMA-based approach is conducive to alleviate the influence of the CRMHPs and improve their QOL.

Effectiveness of Cognitive Behavioral Therapy on Fear of Cancer Recurrence in Breast Cancer: A Systematic Review and Meta-analysis

BACKGROUND

Fear of cancer recurrence is one of the psychological distresses that seriously affects the quality of life of breast cancer patients. However, the evidence for cognitive behavioral therapy on fear of cancer recurrence in breast cancer is limited.

OBJECTIVE

The aim of this study was to evaluate the effectiveness of cognitive behavioral therapy in reducing breast cancer patients' fear of cancer recurrence.

METHODS

Seven databases were searched for randomized controlled studies on cognitive behavioral therapy for fear of cancer recurrence in cancer patients from the inception of the database to April 30, 2023, with no language restrictions. Meta-analysis was performed using Stata MP 17. The Cochrane Risk of Bias Tool version 2 was used to assess the quality of the included studies. The quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation method.

RESULTS

This review includes a total of 13 randomized controlled trials with 1447 breast cancer patients and survivors. When compared with controls, meta-analysis revealed that cognitive behavioral therapy significantly reduced the fear of cancer recurrence (g = -0.44; 95% confidence interval, -0.75 to -0.13; P < .001), whereas subgroup analysis revealed that only mindfulness-based cognitive therapy was significant. The overall risk of bias was high. The Grading of Recommendations, Assessment, Development and Evaluation assessment showed a low overall quality of evidence.

CONCLUSIONS

Cognitive behavioral therapy may be effective in reducing fear of cancer recurrence in breast cancer patients, and mindfulness-based cognitive therapy is particularly worthy of implementation.

IMPLICATIONS FOR PRACTICE

Mindfulness-based cognitive therapy may be used as an additional strategy to help manage breast cancer patients' fears of cancer recurrence.

Mental health and psychosocial interventions to limit the adverse psychological effects of disasters and emergencies in China: a scoping review

Exposure to disasters and public health emergencies negatively affects mental health. Research documenting the psychosocial responses to these calamities in China increased dramatically after the 2008 Wenchuan earthquake. However, there is no comprehensive assessment of the available literature on China's mental health and psychosocial support (MHPSS) responses to these events. This scoping review systematically maps existing published research and grey literature sources regarding MHPSS to disasters and emergencies in China. We examined relevant literature in English and Chinese from six databases and official websites from Jan 1, 2000, to Aug 13, 2021, and included 77 full-text records in this review. The main types of interventions reported included a) stepped care intervention models, b) individual structured psychotherapy and pharmacotherapy, c) mental health education, d) psychological counselling, and e) government-based policy interventions. Most interventions were evaluated using quantitative methods that assessed the treatment of common mental disorders. The review found that rapid national mobilization, emphasis on resilience-strengthening interventions, and the widespread use of step-care models were essential components of reducing the adverse psychosocial effects of disasters. The review also identified remaining gaps, including a) a lack of integration of disaster-related services with the pre-existing health care system, b) inadequate supervision of MHPSS providers, and c) limited monitoring and evaluation of the services provided. These results show where additional research is needed in China to improve mental health services. It also provides a framework that other countries can adapt when developing and evaluating MHPSS policies and plans in response to disasters.

Exploring the Use of Mobile Health for the Rehabilitation of Long COVID Patients: A Scoping Review

The COVID-19 pandemic has led to a substantial revolution in the incorporation of digital solutions in healthcare. This systematic review investigates the enduring physical and psychological consequences individuals experience up to two years post-recovery. Additionally, it focuses on examining the influence of mHealth interventions on these effects. Significantly, 41.7% of survivors experience lingering symptoms that have not been addressed, while 14.1% encounter difficulties in returning to work. The presence of anxiety, compromised respiratory functioning, and persistent symptoms highlight the immediate requirement for specific therapies. Telehealth, particularly telerehabilitation, presents itself as a possible way to address these difficulties. The study thoroughly examines 10 studies encompassing 749 COVID-19 patients, investigating the efficacy of telerehabilitation therapies in addressing various health markers. Telerehabilitation-based breathing exercises yield substantial enhancements in functional performance, dyspnea, and overall well-being. The results emphasize the potential of telerehabilitation to have a favorable effect on patient outcomes; however, more research is needed to strengthen the existing evidence base, as one of the most important limitations is the limited number of trials and the evaluation of varied therapies. This analysis highlights the significance of digital solutions in post-COVID care and calls for ongoing research to improve the comprehension and implementation of telehealth interventions in a swiftly changing healthcare environment.

Guiding future research on psychological interventions in people with COVID-19 and post COVID syndrome and comorbid emotional disorders based on a systematic review

Objective

The COVID-19 pandemic has been emotionally challenging for the entire population and especially for people who contracted the illness. This systematic review summarizes psychological interventions implemented in COVID-19 and long COVID-19 patients who presented comorbid emotional disorders.

Methods and measures

3,839 articles were identified in 6 databases and 43 of them were included in this work. Two independent researchers selected the articles and assessed their quality.

Results

2,359 adults were included in this review. Severity of COVID-19 symptoms ranged from asymptomatic to hospitalized patients; only 3 studies included long COVID-19 populations. Similar number of randomized controlled studies (n = 15) and case studies (n = 14) were found. Emotional disorders were anxiety and/or depressive symptoms (n = 39) and the psychological intervention most represented had a cognitive behavioral approach (n = 10). Length of psychological programs ranged from 1-5 sessions (n = 6) to 16 appointments (n = 2). Some programs were distributed on a daily (n = 4) or weekly basis (n = 2), but other proposed several sessions a week (n = 4). Short (5-10 min, n = 4) and long sessions (60-90 min, n = 3) are proposed. Most interventions were supported by the use of technologies (n = 18). Important risk of bias was present in several studies.

Conclusion

Promising results in the reduction of depressive, anxiety and related disorders have been found. However, important limitations in current psychological interventions were detected (i.e., duration, format, length, and efficacy of interventions were not consistently established across investigations). The results derived from our work may help to understand clinical practices in the context of pandemics and could guide future efforts to manage emotional suffering in COVID-19 patients. A stepped model of care could help to determine the dosage, length and format of delivery for each patient.Systematic review registration: PROSPERO 2022 CRD42022367227. Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022367227.

Impact of COVID-19 on Anxiety and Depression - Biopsychosocial Factors

Anxiety and depression are prevalent mental disorders around the world. The etiology of both diseases is multifactorial, involving biological and psychological issues. The COVID-19 pandemic settled in 2020 and culminated in several changes in the routine of individuals around the world, affecting mental health. People infected with COVID-19 are at greater risk of developing anxiety and depression, and individuals previously affected by these disorders have worsened the condition. In addition, individuals diagnosed with anxiety or depression before being affected by COVID-19 developed the severe illness at higher rates than individuals without mental disorders. This harmful cycle involves several mechanisms, including systemic hyper-inflammation and neuroinflammation. Furthermore, the context of the pandemic and some previous psychosocial factors can aggravate or trigger anxiety and depression. Disorders are also risks for a more severe picture of COVID-19. This review discusses research on a scientific basis, which brings evidence on biopsychosocial factors from COVID-19 and the context of the pandemic involved in anxiety and depression disorders.

Anxiety prevalence and associated factors among frontline nurses following the COVID-19 pandemic: a large-scale cross-sectional study

INTRODUCTION

Nurses are more likely to experience anxiety following the coronavirus 2019 epidemic. Anxiety could compromise nurses' work efficiency and diminish their professional commitment. This study aims to investigate nurses' anxiety prevalence and related factors following the pandemic in multiple hospitals across China.

METHODS

An online survey was conducted from April 16 to July 3, 2023, targeting frontline nurses who had actively participated in China. Anxiety and depression symptoms were assessed using the Self-rating Anxiety Scale and the Self-rating Depression Scale (SDS), respectively. Multivariable logistic regression analysis was employed to identify factors linked with anxiety.

RESULTS

A total of 2,210 frontline nurses participated in the study. Overall, 65.07% of participants displayed clinically significant anxiety symptoms. Multivariable logistic regression revealed that nurses living with their families [2.52(95% CI: 1.68-3.77)] and those with higher SDS scores [1.26(95% CI: 1.24-1.29)] faced an elevated risk of anxiety. Conversely, female nurses [0.02(95% CI: 0.00-0.90)] and those who had recovered from infection [0.05(95%CI: 0.07-0.18)] demonstrated lower rates of anxiety.

DISCUSSION

This study highlights the association between SDS score, gender, virus infection, living arrangements and anxiety. Frontline nurses need to be provided with emotional support to prevent anxiety. These insights can guide interventions to protect the mental well-being of frontline nurses in the post-pandemic period.

The effects of psychosocial and behavioral interventions on depressive and anxiety symptoms during the COVID-19 pandemic: a systematic review and meta-analysis

Psychosocial and behavioral interventions have been shown to significantly reduce depressive and anxiety symptoms in different populations. Recent evidence suggests that the mental health of the general population has deteriorated significantly since the start of Coronavirus Disease 2019 (COVID-19) pandemic. We conducted a systematic review and meta-analysis of studies on the therapeutic effects of psychosocial and behavioral interventions on depression and anxiety during the COVID-19 pandemic. We systematically searched six electronic databases between December 2019 and February 2022 including PubMed, PsycINFO, Scopus, Web of Science, CNKI, and Wanfang Data. We included randomized clinical trials of psychosocial and behavioral interventions in individuals with depressive or anxiety symptoms during the COVID-19 outbreak compared to various control conditions. A total of 35 eligible studies with 5457 participants were included. The meta-analysis results showed that psychosocial and behavioral interventions had statistically significant moderate effects on depression [SMD =  - 0.73, 95% CI (- 1.01, - 0.45), I2 = 90%] and large effects on anxiety [SMD =  - 0.90, 95% CI (- 1.19, - 0.60), I2 = 92%], especially in the general population and COVID-19 survivors. Exercise and cognitive behavioral therapy were found to be the most effective treatments with moderate-to-large effect size for depression and anxiety during the outbreak of COVID-19. We also found the internet-based approach could also achieve almost equally significant effects on depression and anxiety compared with face-to-face traditional approach. Our findings suggest that cognitive behavioral therapy and physical exercise intervention are significantly effective for depression and anxiety related to the COVID-19 pandemic regardless of the delivery modes, and gender differences should be taken into consideration for better implementation of interventions in clinical and community practice.

Benefits of Urban Forest Healing Program on Depression and Anxiety Symptoms in Depressive Patients

Depression is considered a widespread mental health problem worldwide. Moreover, anxiety symptoms are very closely related to depression in patients, and it is known that the coexistence rate of depression and anxiety diagnosed simultaneously is high. Treatment and preventive management of depression and anxiety are essential for public health. Forest healing is attracting attention as a form of low-cost preventive medicine that is safe and has no side effects. However, although the physiological and psychological effects have been scientifically proven, it is insufficient to reveal a direct relationship between forest healing and depression. This study investigated the benefits of an urban forest healing program on depression and anxiety symptoms in depressive disorders. We employed a randomized controlled trial design. Forty-seven depressive patients were randomly divided into an urban forest healing program group and a control group. Measures included the Montgomery-Asberg depression rating scale (MADRS), the Hamilton Anxiety Rating Scale (HARS), and the State-Trait Anxiety Inventory (STAI) questionnaires. Our results revealed that the combination of general treatment and forest healing programs for patients with depression is more effective in improving depression and anxiety than routine treatment alone. We expect our work to serve as a starting point for more sophisticated research discussing the availability of non-pharmacological treatments in forest healing.

Effects of contralateral controlled functional electrical stimulation combined with mirror therapy on motor recovery and negative mood in stroke patients

OBJECTIVE

To investigate the effect of contralateral controlled functional electrical stimulation (CCFES) combined with mirror therapy on motor function and negative mood in stroke patients.

METHODS

Medical records of 94 stroke patients in Baoji Central Hospital admitted from April 2020 to October 2022 were retrospectively analyzed. Among them, 45 patients receiving routine rehabilitation training combined with mirror therapy were included in a control group, and 49 patients receiving CCFES combined with mirror therapy were in an observation group. Observation indexes included changes in Fugl-Meyer Assessment (FMA), Berg Balance Scale (BBS), Hamilton Anxiety Rating Scale (HAMA), Hamilton Depression Rating Scale (HAMD), Stroke Specific Quality of Life Scale (SS-QoL) score, and Barthel Index score before and after treatment. Patients with HAMA score >14 and HAMD score ≥20 after the treatment were included in a negative mood group, and logistics regression was used to analyze the risk factors for negative mood.

RESULTS

The observation group had a significantly higher overall response rate after treatment compared to the control group. In addition, the observation group exhibited significantly higher scores in the FMA and BBS after treatment, indicating better physical function (P<0.001). Furthermore, the observation group showed lower HAMA and HAMD scores after treatment, suggesting reduced anxiety and depression levels (P<0.001). The quality-of-life scores measured by the SS-QoL and the Barthel Index score were both increased in the observation group after treatment, indicating better overall well-being and functional independence (P<0.001). Logistic regression analysis revealed that age, post-treatment SS-QoL scores, and post-treatment Barthel Index were identified as influencing factors for the onset of adverse emotions in patients (P<0.05).

CONCLUSION

CCFES plus mirror therapy can effectively ameliorate limb function and lessen anxiety and depression in stroke patients, exerting beneficial effects on rehabilitation.

Effects of digital psychotherapy for depression and anxiety: A systematic review and bayesian network meta-analysis

OBJECTIVE

To evaluate the effectiveness of digital psychotherapies for depression and anxiety. We conducted a systematic review and network meta-analyses (NMA) to make comparisons of digital psychotherapies.

METHODS

A bayesian NMA was conducted in this study. The databases including PubMed, Embase, Web of Science, the Cochrane Central Register of Controlled Trials and CINAL were searched for all eligible randomized controlled trials (RCTs) published from Jan 1, 2012 to Oct 1, 2022. We used the Cochrane Collaboration's Risk of bias tool for quality assessment. The primary outcomes were set as a standardized mean difference model in efficacy to describe continuous outcomes. We used STATA and WinBUGS to conduct a bayesian network meta-analysis of all interventions based on a random-effects model. This study was registered with PROSPERO, number CRD42022374558.

RESULTS

From the retrieved 16,750 publications, we included 72 RCTs (13,096 participants) with the overall medium quality and above. In terms of depression scale, cognitive behavioral therapy (CBT) was more effective than TAU (SMDs 0.53) and NT (SMDs 0.98). In terms of anxiety scale, CBT (SMDs 0.68; SMDs 0.72) and exercise therapy (ERT) (SMDs 1.01; SMDs 1.05) were more effective than TAU and NT.

LIMITATIONS

Uneven quality of literature, simple network, and subjective judgment.

CONCLUSION

Based on NMA results, we suggest that CBT, which is the most commonly used digital technology, should be preferred among digital psychotherapy for relieving depression and anxiety symptoms. Digital exercise therapy is an effective strategy to relieve some anxiety problems in the context of COVID-19.

The Effect of Internet-Based Cognitive Behavioral Therapy on Major Depressive Disorder: Randomized Controlled Trial

BACKGROUND

Many people living with major depressive disorder (MDD) in China do not receive treatment owing to a lack of mental health services, along with significant stigma toward mental illness. Internet-based cognitive behavioral therapy (ICBT) has been proposed to increase access to mental health care for people with MDD.

OBJECTIVE

The aims of this study were to (1) evaluate the efficacy of ICBT for depressive symptoms in patients with MDD; (2) evaluate the effect of ICBT on anxiety symptoms, nonspecific psychological distress, general self-efficacy, depression stigma, social function, and health-related quality of life (HRQoL); and (3) explore the acceptability of and satisfaction with the ICBT program among participants.

METHODS

Patients with MDD were enrolled and randomized to the ICBT group or the waiting-list control (WLC) group. The ICBT group received ICBT delivered through a WeChat mini-program with general support by nonspecialists. Participants in the 2 groups were self-evaluated online at baseline and posttreatment for changes in the primary outcome (ie, depressive symptoms) and secondary outcomes (ie, anxiety symptoms, nonspecific psychological distress, general self-efficacy, depression stigma, social functional impairment, and HRQoL). Changes in outcomes were measured by changes in overall scores on respective scales, and response and remission rates were calculated based on depressive symptoms. The acceptability of and satisfaction with the ICBT program were measured by treatment adherence and participants' feelings (ie, modules seriously completed, perceived benefit, and satisfaction).

RESULTS

We included 40 patients who were randomly assigned to the ICBT group and 44 who were assigned to the WLC group. Compared with the WLC group, the ICBT group had fewer depressive symptoms, fewer anxiety symptoms, less nonspecific psychological distress, and greater general self-efficacy. Moreover, the ICBT group had higher response (18/31, 58%) and remission rates (17/31, 55%). The adherence rate in the ICBT group was 78% (31/40), and the majority of participants who completed all ICBT modules were satisfied with the ICBT program.

CONCLUSIONS

ICBT demonstrated greater improvements in depressive symptoms, anxiety symptoms, nonspecific psychological distress, and general self-efficacy among selected patients with MDD in comparison with the findings in waiting-list controls. The ICBT program in this study had good acceptability and satisfaction among participants.

TRIAL REGISTRATION

Chinese Clinical Trial Registry (ChiCTR2100046425); https://tinyurl.com/bdcrj4zv.

Efficacy of Pulmonary Rehabilitation in Post-COVID-19: A Systematic Review and Meta-Analysis

BACKGROUND

This systematic review and meta-analysis examines how pulmonary rehabilitation impacts in patients suffering from subacute and long COVID-19 infections, gauging enhancements in of dyspnea, physical function, quality of life, psychological state (anxiety and depression), and fatigue.

METHODS

Three electronic databases (PubMed, Web of Science, Cochrane Library) were systematically searched for full-text articles published from inception to January 2023. Randomized, quasi-experimental, and observational studies were included, with adults diagnosed with subacute or long COVID-19 who received pulmonary rehabilitation as intervention. Outcomes related to dyspnea, physical function, quality of life, fatigue, and psychological status were included. Risk of bias was assessed with Cochrane Risk of Bias Tool for Randomized Controlled Trials and Risk of bias in non-randomized studies of intervention. The review was registered before starting in PROSPERO (CRD: 42022373075).

RESULTS

Thirty-four studies were included, involving 1970 patients with subacute and long COVID-19. The meta-analysis demonstrated moderate to large effects on dyspnea, physical function, quality of life, and depressive symptoms compared to usual care intervention. No significant differences were found in fatigue compared to usual care, nor in anxiety levels after pulmonary rehabilitation intervention.

CONCLUSIONS

Pulmonary rehabilitation has the potential to improve health outcomes in patients with subacute and long COVID-19. However, due to the high risk of bias of included studies, conclusions should be taken with caution.

Correlation analysis between sleep quality and the mental health status of female sex workers during the COVID-19 pandemic in Hubei Province

Objective

Female sex workers (FSWs) in entertainment venues are subject to condemnation and rejection by their families and the outside world. As a result, they are prone to psychological problems, including anxiety and even suicidal tendencies. The aim of the current study was to understand the sleep and mental health status of local FSWs and to identify associated risk factors, so as to provide a scientific basis for improving the social recognition of FSWs and establishing effective psychological interventions.

Methods

A stratified cluster random sampling method was used to select women engaged in commercial sex in bathing, sauna, karaoke halls and other entertainment venues. A self-designed questionnaire assessing mental health-related factors was administered face-to-face with the respondents. 90 participants were randomly selected for blood tests to analyze the relationship between biological indicators and sleep quality.

Results

The rates of depression, anxiety and somnipathy among FSWs were 32.7%, 43.1% and 8.6%, respectively. The correlation coefficients (r) between sleep quality and depression, anxiety and social support were 0.07, 0.09 and -0.09, respectively. Divorce or widowhood, technical secondary school education, alcohol consumption and exercise were independent risk factors for depression in FSWs (p< 0.05) while living in urban areas and counties and having a sense of social support were protective factors (P< 0.05). Quarantining due to the pandemic and exercise were independent risk factors for anxiety in FSWs (P< 0.05) while living in counties and having a sense of social support were protective factors (P< 0.05). Quarantining due to the pandemic was an independent risk factor for somnipathy in FSWs (P< 0.05) while being married was a protective factor (P< 0.05). NE/NA was a protective factor for sleep disorders (OR=0.042, P=0.05), with an AUC of 0.87.

Conclusion

FSWs should appropriately adjust their work form during the pandemic period, maintain a positive and optimistic attitude, establish long-term stable social relationships, and seek a greater sense of social support. The government should provide comprehensive bio-psycho-social interventions to address the mental and physical health status of this population.

Recent Advancements on Long COVID in China: A Narrative Review

The COVID-19 pandemic is a huge public health crisis in the 21st century. In addition to the acute symptoms, a considerable proportion of patients worldwide have suffered from post-COVID-19 syndrome, commonly known as Long COVID. The impact of Long COVID on individual and public health burden cannot be ignored. According to recent researches, Long COVID has been affecting multiple organ systems throughout the body, with respiratory, mental, nervous and digestive symptoms often seen in Chinese population. Clinical studies have proved that symptoms were alleviated by a variety of treatments, such as physical therapy, rehabilitation training, psychological support, behavioral cognitive therapy, stem cell therapy, etc. Based on the current clinical evidence, it is recommended to strengthen the scientific research on Long COVID and actively carry out early monitoring and intervention in the future, so as to effectively prevent the long-term disease burden and economic pressure.

Effects of electroacupuncture at Baihui and Dazhui on perioperative neurocognitive impairment and S100-β, LC3-II, Beclin-1 in patients with colon cancer

OBJECTIVE

To investigate the effects of electroacupuncture pre-stimulation on perioperative neurocognitive disorders (PNDs) in patients undergoing colon cancer surgery.

METHODS

A total of 80 elderly patients with colon cancer undergoing elective surgery were selected as subjects. Patients in an observation group (N=40) were given electroacupuncture pre-stimulation at Baihui and Dazhui points, while those in a control group (N=40) were given sham electroacupuncture pre-stimulation. The Mini-Mental State Examination (MMSE), self-rating anxiety scale (SAS), Activity of Daily Living Scale (ADL), as well as the levels of microtubule-associated protein light chain 3II (LC3-II), Bcl-2 homologous domain protein antibody 1 (Beclin-1) and central nerve specific protein S100β before and after treatment were compared.

RESULTS

Compared with those before treatment, no significant differences were found in the scores of MMSE, SAS and ADL at 7 d after treatment in both groups, while MMSE scores were significantly lower and the scores of SAS and ADL were obviously more at 1 d and 3 d after treatment in both groups. Moreover, at 1 d and 3 d after treatment, the MMSE score in the observation group was significantly higher than that in the control group, while the scores of SAS and ADL in the observation group were lower than those in the control group (all P<0.05). Compared with those after treatment in the control group, the level of S100β was significantly decreased, while the levels of LC3-II and Beclin-1 were obviously increased in the observation group (all P<0.05).

CONCLUSION

Electroacupuncture pre-stimulation at Baihui and Dazhui points could effectively reduce neurological damage and prevent PNDs in patients undergoing colon cancer surgery through improving the cognitive functions, anxiety states and self-care ability. The observed changes in levels of S100β, LC3-II and Beclin-1 may be associated with the beneficial effects of electroacupuncture pre-stimulation on PNDs in these patients.

[Outpatient rehabilitative care for patients with Long-COVID - a guideline-based clinical practice guideline]

BACKGROUND

Even after weeks and months, persisting and also newly occurring symptoms after SARS-CoV-2 infection are common and lead in many cases to a broad spectrum of impairments and participation restrictions in all areas of daily life. Scientific evidence on therapeutic options still is limited. The aim of this work is therefore to provide pragmatic treatment recommendations analogous to the current therapeutic appliances guideline.

METHOD

In addition to a search in six electronic databases, the experiences from the treatment of more than hundred affected persons from the post-COVID outpatient rehabilitation service were used. Additionally, experiences with patients with similar symptoms from other diseases were included. All authors worked together to develop the pragmatic recommendations for the treatment of the main symptoms within the framework of outpatient therapy measures. A list of recommended diagnostics and functional assessments prior to therapy was also developed.

RESULTS

For the main symptoms fatigue, dyspnoea and cognitive impairment, the catalog of therapeutic products offers a wide range of therapeutic options under the diagnosis U09.9. The therapy packages should be composed individually and adapted to the patient's performance level that regularly should be (re-)assessed. Informing the patient about possible relapses and deteriorations and how to deal with them should be also part of the treatment regimen.

DISCUSSION

Physical modalities and rehabilitation interventions should be used in out-patient rehabilitation setting for the treatment of Long-COVID. In this regard, it is also important to take into account and treat serious complications after the disease, such as post-intensive care syndrome. Due to the rapid evolution of the knowledge a frequent review of scientific papers and recommendations should be conducted. High-quality intervention studies are necessary to achieve greater evidence in this field.

Mediating effect of anxiety and depression between family function and hope in patients receiving maintenance hemodialysis: a cross-sectional study

OBJECTIVES

This study aimed to explore the levels of hope in patients receiving maintenance hemodialysis (MHD), and whether anxiety and depression mediate the relationship between family function and hope.

METHODS

The family APGAR index, hospital anxiety and depression scale, and Herth hope index were recorded using the self-reported questionnaires completed by 227 MHD patients.

RESULTS

The family function can directly predict hope, positively predict hope through depression (β = 0.052, p = 0.001), and positively predict hope through the chain mediating of anxiety and depression (β = 0.087, p = 0.001), according to chain mediation analysis. The total effect size was 28.31%. The total indirect effect value was 0.139, and the total effect value was 0.491.

CONCLUSIONS

Our findings suggest that family function had a direct impact on MHD patients' hope, and that lowering anxiety and depression can help to feel more hopeful.

Sensa Mobile App for Managing Stress, Anxiety, and Depression Symptoms: Pilot Cohort Study

BACKGROUND

An increase in depression, anxiety, and stress symptoms worldwide, attributed to the COVID-19 pandemic, has been reported. If not treated, it may negatively affect a person's everyday life by altering physical and social well-being and productivity and increasing expenditure on health care. Cognitive behavioral therapy (CBT)-based interventions are gaining popularity as a means to reduce stress and alleviate anxiety and depression symptoms. Moreover, CBT delivered through a mobile app has the same elements as traditional CBT training (eg, guided discovery). However, unlike conventional training, users of mobile apps are allowed to tailor their own experience at their own speed and schedule.

OBJECTIVE

This study aims to analyze Sensa users' retrospective data and explore the dose-duration effect to find the optimal usage time when the user showed results.

METHODS

The study cohort comprised 381 consecutive community-based nonclinical users who started using Sensa between October 2021 and March 2022. All users included in the study took the Depression Anxiety Stress Scale-21 (DASS-21) assessment at least 2 times. Other parameters from the database containing all self-reported data were gender, number of active days, total time of use, and age. The primary outcome of the study was a change in the DASS-21 score. Statistical analyses were performed using GraphPad Prism (version 9, GraphPad Software). In addition, a logistic regression model was created to predict how the obtained independent parameters influenced the DASS-21 score.

RESULTS

The main finding of our study was that the majority of participants who started using Sensa were experiencing depression, anxiety, and stress symptoms (92.13%, 80.05%, and 87.93%, respectively). There was a statistically significant decrease of the DASS-21 subdomain scores after the use of the application (anxiety: mean 7.25, SD 4.03 vs mean 6.12, SD 4.00; P=.001; depression: mean 11.05, SD 4.26 vs mean 9.01, SD 4.77; P=.001; stress: mean 11.42, SD 3.44 vs mean 9.96, SD 3.65; P<.001). Finally, the logistic regression model showed that users who were using the app for more than 24 days and had at least 12 active days during that time had 3.463 (95% CI 1.142-11.93) and 2.644 (95% CI 1.024-7.127) times higher chances to reduce their DASS-21 subdomain scores of depression and anxiety, respectively.

CONCLUSIONS

Using the Sensa mobile app was related to decreased depression, anxiety, and stress symptoms.

Depression and Anxiety During the COVID-19 Pandemic: Epidemiology, Mechanism, and Treatment

The Coronavirus Disease 2019 (COVID-19) pandemic has had an adverse impact on the physical and mental health of the public worldwide. In addition to illness in patients with COVID-19, isolated people and the general population have experienced mental health problems due to social distancing policies, mandatory lockdown, and other psychosocial factors, and the prevalence of depression and anxiety significantly increased during the pandemic. The purpose of this review is to elucidate the epidemiology, contributing factors, and pathogenesis of depression and anxiety. during the pandemic. These findings indicate that physicians and psychiatrists should pay more attention to and identify those with a high risk for mental problems, such as females, younger people, unmarried people, and those with a low educational level. In addition, researchers should focus on identifying the neural and neuroimmune mechanisms involved in depression and anxiety, and assess the intestinal microbiome to identify effective biomarkers. We also provide an overview of various intervention methods, including pharmacological treatment, psychological therapy, and physiotherapy, to provide a reference for different populations to guide the development of optimized intervention methods.

Promoting Recovery from Disasters, Pandemics, and Trauma: A Systematic Review of Brief Psychological Interventions to Reduce Distress in Adults, Children, and Adolescents

A substantial number of survivors of disasters, pandemics, and other severe stressors develop persistent distress that impairs mental health and well-being. However, only a few brief psychological interventions target distress or subclinical symptoms. This systematic review aimed to identify and describe brief psychological interventions to reduce distress or subclinical symptoms in survivors of disasters, pandemics, and other severe stressors. Based on a systematic literature search (MEDLINE, PsycINFO, PSYNDEX, PTSDpubs, and Web of Science), we reviewed published studies and study protocols on self-help, psychosocial support, or brief psychotherapeutic interventions to reduce distress and/or subclinical symptoms following natural hazards and man-made disasters, pandemics, or other traumatic events. We included 27 published studies or study protocols (n = 15 RCTs, n = 3 controlled pre-post studies, and n = 9 uncontrolled pre-post studies) describing 22 interventions. We found evidence for reducing psychological distress and/or subclinical symptoms in 9 out of 15 RCTs, 2 out of 3 controlled pre-post studies, and 9 out of 9 uncontrolled pre-post studies. One RCT provided evidence of increasing well-being. Innovative brief interventions have been developed to reduce distress and/or subclinical symptoms that have an emerging evidence base.

Mediating role of resilience in the relationship between COVID-19 related stigma and mental health among COVID-19 survivors: a cross-sectional study

BACKGROUND

The global coronavirus disease 2019 (COVID-19) has caused many negative effects on physical and mental health of patients who have survived COVID-19. Apart from some long-lasting physical sequelae, those COVID-19 survivors are also suffering stigma and discrimination at different levels around the world. The current study aims to assess the role resilience played in stigma and mental disorders among COVID-19 survivors.

METHODS

The cross-sectional study was carried out among former COVID-19 patients in Jianghan District (Wuhan, China) from June 10 to July 25, 2021. The demographic questions, the Impact of Events Scale-Revised, the Generalized Anxiety Disorder Questionnaire, the Patient Health Questionnaire, the Resilience Style Questionnaire and the Short Version of COVID-19 Stigma Scale of 12 items were used to collect relevant information of the participants. Descriptive analyses, Pearson correlation analysis and Structural Equation Modeling were used to make data description and analysis.

RESULTS

A total of 1541 out of 1601 COVID-19 survivors (887 females and 654 males) were included in the analysis. Perceived stigma of those COVID-19 survivors correlates significantly with anxiety (r = 0.335, P < 0.001), depression (r = 0.325, P < 0.001) and post-traumatic stress disorder (PTSD) (r = 0.384, P < 0.001). It has a direct effect on COVID-19 survivors' anxiety (β = 0.326, P < 0.001), depression (β = 0.314, P < 0.001), PTSD (β = 0.385, P < 0.001) and their resilience (β = - 0.114, P < 0.01). Resilience partially mediated the association between perceived stigma and anxiety (β = 0.020, P < 0.01), depression (β = 0.020, P < 0.01), and PTSD (β = 0.014, P < 0.01) among COVID-19 survivors.

CONCLUSION

Stigma has a significant negative impact on mental health, while resilience plays a mediator role in the relationship between stigma and mental health among COVID-19 survivors. Based on our study, we suggested that when designing psychological interventions for COVID-19 survivors, consideration should be taken into account to reduce stigma and improve resilience.

Effectiveness of Digital Mental Health Tools to Reduce Depressive and Anxiety Symptoms in Low- and Middle-Income Countries: Systematic Review and Meta-analysis

BACKGROUND

Depression and anxiety contribute to an estimated 74.6 million years of life with disability, and 80% of this burden occurs in low- and middle-income countries (LMICs), where there is a large gap in care.

OBJECTIVE

We aimed to systematically synthesize available evidence and quantify the effectiveness of digital mental health interventions in reducing depression and anxiety in LMICs.

METHODS

In this systematic review and meta-analysis, we searched PubMed, Embase, and Cochrane databases from the inception date to February 2022. We included randomized controlled trials conducted in LMICs that compared groups that received digital health interventions with controls (active control, treatment as usual, or no intervention) on depression or anxiety symptoms. Two reviewers independently extracted summary data reported in the papers and performed study quality assessments. The outcomes were postintervention measures of depression or anxiety symptoms (Hedges g). We calculated the pooled effect size weighted by inverse variance.

RESULTS

Among 11,196 retrieved records, we included 80 studies in the meta-analysis (12,070 participants n=6052, 50.14% in the intervention group and n=6018, 49.85% in the control group) and 96 studies in the systematic review. The pooled effect sizes were -0.61 (95% CI -0.78 to -0.44; n=67 comparisons) for depression and -0.73 (95% CI -0.93 to -0.53; n=65 comparisons) for anxiety, indicating that digital health intervention groups had lower postintervention depression and anxiety symptoms compared with controls. Although heterogeneity was considerable (I²=0.94 for depression and 0.95 for anxiety), we found notable sources of variability between the studies, including intervention content, depression or anxiety symptom severity, control type, and age. Grading of Recommendations, Assessments, Development, and Evaluation showed that the evidence quality was overall high.

CONCLUSIONS

Digital mental health tools are moderately to highly effective in reducing depression and anxiety symptoms in LMICs. Thus, they could be effective options to close the gap in depression and anxiety care in LMICs, where the usual mental health care is minimal.

TRIAL REGISTRATION

PROSPERO CRD42021289709; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=289709.

A community-based cross-sectional study of anxiety and metabolic syndrome

BACKGROUND

The prevalence of anxiety and other psychological disorders has increased during the COVID-19 pandemic, especially among the elderly. Anxiety and metabolic syndrome (MetS) may aggravate each other. This study further clarified the correlation between the two.

METHODS

Adopting a convenience sampling method, this study investigated 162 elderly people over 65 years of age in Fangzhuang Community, Beijing. All participants provided baseline data on sex, age, lifestyle, and health status. The Hamilton Anxiety Scale (HAMA) was used to assess anxiety. Blood samples, abdominal circumference, and blood pressure were used to diagnose MetS. The elderly were divided into MetS and control groups according to the diagnosis of MetS. Differences in anxiety between the two groups were analysed and further stratified by age and gender. Multivariate logistic regression analysis was used to analyse the possible risk factors for MetS.

RESULTS

Compared with the control group, anxiety scores of the MetS group were statistically higher (Z = 4.78, P < 0.001). There was a significant correlation between anxiety levels and MetS (r = 0.353, P < 0.001). Multivariate logistic regression revealed that anxiety (possible anxiety vs no anxiety: odds ratio [OR] = 2.982, 95% confidence interval [CI] 1.295-6.969; definite anxiety vs no anxiety: OR = 14.573, 95%CI 3.675-57.788; P < 0.001) and BMI (OR = 1.504, 95% CI 1.275-1.774; P < 0.001) were possible risk factors for MetS.

CONCLUSION

The elderly with MetS had higher anxiety scores. Anxiety may be a potential risk factor for MetS, which provides a new perspective on anxiety and MetS.

Non-Pharmacological Therapies for Post-Viral Syndromes, Including Long COVID: A Systematic Review

BACKGROUND

Post-viral syndromes (PVS), including Long COVID, are symptoms sustained from weeks to years following an acute viral infection. Non-pharmacological treatments for these symptoms are poorly understood. This review summarises the evidence for the effectiveness of non-pharmacological treatments for PVS.

METHODS

We conducted a systematic review to evaluate the effectiveness of non-pharmacological interventions for PVS, as compared to either standard care, alternative non-pharmacological therapy, or placebo. The outcomes of interest were changes in symptoms, exercise capacity, quality of life (including mental health and wellbeing), and work capability. We searched five databases (Embase, MEDLINE, PsycINFO, CINAHL, MedRxiv) for randomised controlled trials (RCTs) published between 1 January 2001 to 29 October 2021. The relevant outcome data were extracted, the study quality was appraised using the Cochrane risk-of-bias tool, and the findings were synthesised narratively.

FINDINGS

Overall, five studies of five different interventions (Pilates, music therapy, telerehabilitation, resistance exercise, neuromodulation) met the inclusion criteria. Aside from music-based intervention, all other selected interventions demonstrated some support in the management of PVS in some patients.

INTERPRETATION

In this study, we observed a lack of robust evidence evaluating the non-pharmacological treatments for PVS, including Long COVID. Considering the prevalence of prolonged symptoms following acute viral infections, there is an urgent need for clinical trials evaluating the effectiveness and cost-effectiveness of non-pharmacological treatments for patients with PVS.

REGISTRATION

The study protocol was registered with PROSPERO [CRD42021282074] in October 2021 and published in BMJ Open in 2022.

Post-COVID-19 Syndrome Comprehensive Assessment: From Clinical Diagnosis to Imaging and Biochemical-Guided Diagnosis and Management

The COVID-19 outbreak was first reported in 2019, causing massive morbidity and mortality. The majority of the COVID-19 patients survived and developed Post-COVID-19 Syndrome (PC19S) of varying severity. Currently, the diagnosis of PC19S is achieved through history and symptomatology that cannot be explained by an alternative diagnosis. However, the heavy reliance on subjective reporting is prone to reporting errors. Besides, there is no unified diagnostic assessment tool to classify the clinical severity of patients. This leads to significant difficulties when managing patients in terms of public resource utilization, clinical progression monitorization and rehabilitation plan formulation. This narrative review aims to review current evidence of diagnosis based on triple assessment: clinical symptomatology, biochemical analysis and imaging evidence. Further assessment tools can be developed based on triple assessment to monitor patient's clinical progression, prognosis and intervals of monitoring. It also highlights the high-risk features of patients for closer and earlier monitoring. Rehabilitation programs and related clinical trials are evaluated; however, most of them focus on cardiorespiratory fitness and psychiatric presentations such as anxiety and depression. Further research is required to establish an objective and comprehensive assessment tool to facilitate clinical management and rehabilitation plans.

Prevalence and Associated Factors of Depression Among Frontline Nurses in Wuhan 6 Months After the Outbreak of COVID-19: A Cross-Sectional Study

BACKGROUND Due to the COVID-19 pandemic, frontline nurses have experienced psychological problems. However, the depression of frontline nurses in Wuhan 6 months after the outbreak of COVID-19 has not been studied adequately. The purpose of this study was to investigate the depression of frontline nurses in Wuhan 6 months after the COVID-19 outbreak and to analyze possible risk and protective factors. MATERIAL AND METHODS Data were collected through Wenjuanxing from 612 frontline nurses in Wuhan national COVID-19-designated hospitals between July 27, 2020, and August 12, 2020. The levels of depression, family functioning, and psychological resilience were assessed among frontline nurses in Wuhan with a depression scale, family function scale, and 10-item psychological resilience scale, respectively. The factors associated with depressive symptoms were identified using the chi-square test and binary logistic regression analysis. RESULTS A total of 126 respondents were included in the study. The overall prevalence of depression was 25.2%. The need for mental health services was a potential risk factor for depressive symptoms, while family functioning and psychological resilience were potential protective factors. The COVID-19 pandemic poses a major challenge to the depressive symptoms of frontline nursing in Wuhan, highlighting the need for all frontline nurses in Wuhan to be screened for depression regularly for timely intervention. CONCLUSIONS To mitigate the impact of the pandemic on depression, psychological interventions for frontline nurses need to be implemented to preserve their mental health.

Acupuncture combined with pricking and cupping therapy is effective in patients with chronic spontaneous urticaria

OBJECTIVE

To determine the effects of acupuncture combined with pricking and cupping therapy on the balance of Th1/Th2 cytokines in patients with chronic spontaneous urticaria (CSU).

METHODS

The medical records of 75 patients with CSU treated in The First Affiliated Hospital of Hebei College of Traditional Chinese Medicine from January 10, 2021 to January 10, 2022 were collected and analyzed retrospectively. Among them, 35 patients treated with traditional therapy were assigned to a control group, and 40 patients treated with acupuncture combined with pricking and cupping therapy to an observation group. The clinical efficacy and adverse reactions in the two groups were compared after therapy. The two groups were also compared in terms of the levels of immunoglobulin (Ig)-E, interleukin (IL)-4 and interferon-γ (INF-γ) before and after therapy. In addition, the visual analogue scale (VAS) for pruritus was adopted for recording the pruritus degree of patients before and after therapy. The Dermatology Quality of Life Index (DLQI) was adopted to compare the quality of life between the two groups before and after therapy. The Hamilton anxiety scale (HAMA) and Hamilton depression rating scale (HAMD) were adopted for comparison of the anxiety and depression between the two groups before and after therapy. Moreover, the Pittsburgh sleep quality index (PSQI) was used to compare sleep quality between the two groups before and after therapy.

RESULTS

The control group showed a significantly lower total response rate than the observation group (P<0.05). Compared with the control group, the observation group showed significantly lower levels of IgE and IL-4, and a higher IFN-γ level and had significantly lower pruritus-VAS, DLQI, HAMA, HAMD and PSQI scores (P<0.05). Additionally, the two groups were not greatly different in adverse reactions (nausea, sleepiness, ecchymosis and dizziness) (P>0.05).

CONCLUSION

Acupuncture combined with pricking and cupping therapy is highly effective in CSU, because it can significantly alleviate the symptoms as well as negative emotions, and improve the quality of life, sleep quality and the balance of Th1/Th2 cytokine in patients.

Characteristics of Depression Clinical Trials Registered on ClinicalTrials.gov

Background

Mental disorders are among the leading causes of the global health-related burden, and depression is one of the most disabling mental disorders. The emergence of the COVID-19 pandemic has created an environment where many determinants of mental health are exacerbated. Many studies have been registered and conducted over the past 16 years, but how to choose the proper design for depression clinical trials remains the main concern. This study aimed to characterize the current status of global depression clinical trials registered on ClinicalTrials.gov.

Methods

We examined all the trials registered on ClinicalTrials.gov from 2007 to 2021.

Results

Overall, 7623 depression clinical trials were identified for analysis. Of those trials, 6402 (83.98%) were intervention trials and 1212 (15.90%) were observational trials. The majority of intervention types were behavioral (35.2%) and drug (28.55%), with very few procedures, dietary supplements, and diagnostic test studies. In addition, 55.53% of trials enrolled <100 participants. The proportions of trials registered in North America were higher than on other continents. Furthermore, the trials that involved only females (12.6%) were more than only males (0.87%) from 2019 to 2021.

Conclusion

Depression clinical trials registered on ClinicalTrials.gov were dominated by small sample size trials, and there is a lack of trials related to COVID-19. The choice of study design is crucial, and properly designed trials can help improve study efficiency and reduce the likelihood of study failure. Given the increased number of RCT trials, the trial quality is gradually improving over the years. In addition, depression trials concentrating on children and older adults need more scientific attention. Further studies related to COVID-19 are needed, given the great damage that causes to people's physical and mental health.

Effect of resistance training on heart rate variability of anxious female college students

Introduction

Female college students are a group with high incidence of anxiety, and anxiety will lead to the disorder of autonomic nervous system (ANS), which will adversely affect their study and life. Resistance training plays a positive role in improving anxiety, but there is little evidence on whether resistance training can improve ANS of anxious female college students. Heart rate variability (HRV) has gained widespread acceptance in assessing ANS modulation. Therefore, the objective of this study aimed to investigate the effects of resistance training on heart rate variability (HRV) in anxious female college student.

Methods

A randomized controlled study of resistance training intervention was conducted in 27 anxious female college students that assigned randomly into an intervention group (n = 14) and a control group (n = 13). The intervention group was intervened by cluster training for 8 weeks. Self-rating anxiety scale (SAS) was used. ANS is evaluated by short-term HRV. Muscle strength was assessed by 1 RM indirect method. Independent-sample t-test was used to test post-test-pre-test scores between the intervention and control groups.

Results

After the intervention, SAS score of the intervention group was significantly decreased (P < 0.05), SDNN of the intervention group was significantly increased (P < 0.05) and LF/HF was significantly decreased (P < 0.05).

Conclusion

The resistance training intervention adopted in this study significantly increased the HRV of anxious female college students and improved their autonomic nervous disorder.

Anxiety and depression and their interdependent influencing factors among medical students in Inner Mongolia: the cross-sectional survey

BACKGROUND

Mental health has become a global problem, among which anxiety and depression disorder were ranked as the first and sixth leading causes of disability, respectively, according to the World Health Organization (WHO). Medical students experienced higher levels of anxiety and depression than the general population. But there was a lack of research on the emotional situation among medical students in Inner Mongolia. The main objectives of this study were to investigate the prevalence of anxiety and depression symptoms as well as the factors that influence them among medical students in Inner Mongolia.

METHODS

A cross-sectional study was conducted on 1282 students from a university in Inner Mongolia, China, ranging in age from 16 to 27 years. They were assessed demographic indicators, the disorder of anxiety and depression using Zung's Self-Rating Anxiety Scale and Self-Rating Depression Scale (SAS and SDS) by an anonymous, self-administered questionnaire. The internal reliability and validity of the questionnaire were determined using Cronbach's alpha coefficient, Kaiser-Meyer-Olkin (KMO), and Bartlett's sphericity. T-tests and one-way ANOVA were used to explore factors, including demographic and behavioral information influencing anxiety and depression disorder. According to the above results of exploring the influencing factors based on univariate analysis, significant factors (p < 0.05) were entered into multiple linear regressions that sequentially fitted to predictors associated with anxiety and depression. The collected data were entered into EpiData for windows and analyzed using SPSS 26.0. The p < 0.05 was considered to be significantly different.

RESULTS

The questionnaire was completed by 1187 students with a 92.59% response rate. The prevalence of anxiety and depression symptoms among medical students were 10.36% and 24.43%, and the mean ± standard deviation (M ± SD) anxiety and depression scores were 39.60 ± 7.81 and 48.23 ± 9.06, respectively, among the medical students. The specific contributions of the two scales with good reliability and validity were 60.58% and 63.59%, respectively. For univariate analysis, age, whether the daily meal was at a fixed time, grade, the birthplace of students, average daily eating habits, were the factors that influenced both the total score of SAS and SDS (p < 0.05). For further analysis, the results showed that "Birthplace of students" and "Whether daily meals at a fixed time" were significantly associated with anxiety and depression. Furthermore, "Age" and "Mode of delivery" were independent risk factors for depressive disorder.

CONCLUSION

Our findings revealed that high prevalence of mental health problems among medical students in Inner Mongolia. The Ministry of Medical Education should make a targeted intervention for specific risk factors of this study to improve psychological well-being and face uncertain future challenges among university students in Inner Mongolia.

Online psychosocial interventions for improving mental health in people during the COVID-19 pandemic: A systematic review and meta-analysis

BACKGROUND

During the COVID-19 pandemic, interventions for public mental health were mostly delivered through online modalities. Although many studies have explored the effectiveness of online psychosocial interventions through randomized controlled trials, there is a lack of quantitative synthesis of the effectiveness of online psychosocial interventions and an examination of their overall application.

OBJECTIVE

To understand the commonly used psychosocial interventions during the COVID-19 pandemic and the effectiveness of the interventions.

METHODS

Risk bias was assessed in the included studies according to the Cochrane Collaboration criteria, and data from post-test and follow-up were combined for standardized mean differences using Stata 16.0 software, and sources of heterogeneity were explored by subgroup analysis, and risk bias was assessed in the included studies using Review Manager 5.4 software. The study was written in strict accordance with PRISMA specifications, and registration was completed on the PROSPERO platform (CRD42022302917).

RESULTS

The online psychosocial intervention had an ameliorating effect on anxiety (SMD = -0.78), depression (SMD = -0.80), and insomnia (SMD = -0.19) in the public during the COVID-19 pandemic, was ineffective for the intervention on stress, and the effectiveness of the intervention on depression continued at follow-up. Subgroup analyses showed that the type of intervention, intervention form, Duration of intervention, and setting of the control group influenced the trial results to some extent, with cognitive behavioral therapy being the most effective intervention for anxiety and depressive symptoms, self-help interventions being more effective than interventions with therapist interventions, and 1-4 week interventions being more effective than 5-8 week interventions. Due to the limited number of studies included in the analysis and variability in quality, more randomized controlled trials are needed to test the findings.

CONCLUSION

Online psychosocial interventions can be effective in improving symptoms of anxiety, depression, stress, and insomnia in the public during the COVID-19 pandemic. However, additional randomized controlled trial studies are needed to determine which types of interventions are more appropriate for which populations and how they can be implemented to achieve better intervention outcomes.