Stress and anxiety in nursing students during the first wave of the COVID-19 pandemic / Estrés y ansiedad en estudiantes de enfermería durante la primera ola de la pandemia de COVID-19

Objetivo: Comparar los niveles de ansiedad y estrés agudo entre los/las estudiantes de enfermería que se incorporaron al trabajo durante la primera ola de la pandemia de COVID-19 y aquellos que no lo hicieron. Métodos: Estudio descriptivo transversal multicéntrico realizado en tres universidades públicas españolas. Un total de 216 estudiantes de enfermería participaron en nuestro estudio. La recopilación de datos se realizó mediante un formulario en línea. Se recopilaron variables relacionadas con las condiciones para ingresar al mercado laboral y se incluyó la Escala de Autoevaluación de Ansiedad de Zung y el Cuestionario de Reacción Aguda al Estrés de Stanford. Se llevaron a cabo análisis univariados y multivariados. Resultados: El 42,6% de los estudiantes ingresaron al mercado laboral. La puntuación global de ansiedad fue x?=36,31 (DE=5,71) y la puntuación de estrés fue x?=82,39 (DE=30,84). Los niveles más bajos de ansiedad se encontraron en aquellos que se incorporaron al mercado laboral (x?=35,67; DE=5,78), en comparación con aquellos que no lo hicieron (x?=36,73; DE=5,67). El 92,4% del total de alumnos presentaron estrés agudo. El estrés agudo fue mayor en aquellos que no trabajaron (x?=84,35; DE=32,38), y significativamente en mujeres. Conclusiones: Los estudiantes de enfermería mostraron ser capaces de hacer frente al estrés en situaciones como la pandemia de COVID-19. No se puede descartar un efecto del trabajador sano. El estrés y ansiedad de los estudiantes de enfermería deben tenerse en cuenta por los tutores de prácticas clínicas y cuando se incorporan al mercado laboral por primera vez (AU)

Objective: To compare anxiety and acute stress levels among nursing students who joined the labour market during the first wave of the COVID-19 pandemic and those who did not.Methods: A cross-sectional, multicentre descriptive study across three Spanish public universities. A total of 216 nursing students participated in our study. Data collection was carried through an online questionnaire, that included variables on conditions for entering the labour market, the Zung Anxiety Self-Assessment Scale and the Stanford Acute Stress Reaction Questionnaire. We performed univariate and multivariate analyses. Results: Overall, 42.6% (n=92) of the students entered the labour market during the first wave of the COVID-19 pandemic. The global anxiety score was x̄=36.31 (SD=5.71) and the stress score was x̄=82.39 (SD=30.84). Lower anxiety levels were observed among those who joined the labour market (x̄=35.67; SD=5.78) as compared to those who did not (x̄=36.73; SD=5.67). Overall 92.4% of the students were acutely stressed. Acute stress was higher among those who did not work (x̄=84.35; SD=32.38) and significantly in women. Conclusions: Nursing students were able to cope with stress in situations such as the COVID-19 pandemic. A healthy worker effect could not be ruled out. Stress and anxiety among nursing students should be considered by clinical practice preceptors and at the time students first enter the labour market (AU)

Perfiles de Personalidad en adolescentes con Trastornos por Ansiedad en Población General y Clínica / Personality Profiles in Adolescents with Anxiety Disorders in General and Clinical population

La personalidad es el trasfondo que determina la forma de pensar, sentir y comportarse e influye en la psicopatología. En este contexto, resulta relevante el estudio de la relación entre personalidad y ansiedad en la adolescencia. El principal objetivo de nuestro estudio es analizar las diferencias entre casos con Trastornos por Ansiedad (TA) y una muestra de población general (PG) en los diferentes perfiles / prototipos de personalidad (PRP) derivados del el Inventario clínico para adolescentes de Millon (MACI). Un segundo objetivo fue estudiar el modelo más parsimonioso de PRP capaz de predecir TA. Para responder a estos objetivos se utilizó un diseño observacional analítico y se realizó un muestreo aleatorio de adolescentes en PG (n = 461) y consecutivo de pacientes con TA, valorados según criterios DSM-5 (n = 77). Los instrumentos de medida utilizados fueron el MACI y Adolescent Symptom Inventory. Los PRP Introvertidos, Inhibidos, Pesimistas, Sumisos, Oposicionistas, Autopunitivos y Límites presentan una media significativamente mayor en TA y los PRP Histriónico y Egocéntrico en PG. El modelo más parsimonioso de PRP que mejor predice TA está conformado por tener mayor edad y los PRP más límite y menos rebelde. El estudio ofrece una imagen novedosa de los PRP en casos de TA que invitan a su estudio clínico, favoreciendo nuevos caminos de investigación que incluyan la personalidad en la heterogeneidad del trastorno. (AU)

Personality is the background that determines the way we think, feel and behave and influences psychopathology. In this context, the study of the relationship between personality and anxiety in adolescence is important. The main objective of our study is to analyse the differences between cases with Anxiety Disorders (AD) and a sample of general population (GP) in the different personality profiles / prototypes (PRP) derived from the Millon Adolescent Clinical Inventory (MACI). Secondary objective: to study the most parsimonious predictive model of PRP to predict AD. To respond to these objectives, an observational analytical design was used and a random sampling of adolescents in GP (n = 461) and consecutive sampling of patients with AD, assessed according to DSM-5 criteria (n = 77) was performed. The measurement instruments used were the MACI and the Adolescent Symptom Inventory. Introverted, Inhibited, Doleful, Submissive, Oppositional, Self-demeaning and Borderline PRPs present a significantly higher mean in AD and the Dramatizing and Egotistic PRPs in GP. The most parsimonious PRP model that best predicts AD is shaped by having older age and the most Borderline and least Unruly PRPs. The study offers a novel picture of PRPs in AD cases that invite their clinical study, favoring new paths of research that include personality in the heterogeneity of the disorder. (AU)

The interrelation between anxiety and quality of life among patients with ulcerative colitis in remission / La interrelación entre ansiedad y calidad de vida en pacientes con colitis ulcerosa en remisión

Objective: To determine if anxiety and depression are associated with a lower QoL in patients with UC in remission. Patients and methods: We included consecutive patients with a previously confirmed diagnosis of UC in remission for at least 12 months and who answered complete questionnaires: IBDQ-32, HAD. Clinical and sociodemographic characteristics were obtained. We performed non-parametric tests, and correlations between HADS and IBDQ-32 were analyzed using Spearman's correlation coefficient (r). A p-value of less than 0.05 was considered significant. Results: Among 124 patients, 65% were men, with a median evolution of UC of 10 years (IQR: 5–79 years). Prevalence for anxiety was 15.3% and 2.4% for depression. Global QoL was 192 (IQR: 175–208). Lower QoL was associated with anxiety (p=0.002) and depression (p=0.013). Depression represented lower QoL at the digestive level than no depression (p=0.04). Anxiety negatively correlated with QoL (r=−0.54; p<0.001). Conclusions: Anxiety is frequent in patients with UC in remission; therefore, timely diagnosis and treatment must be implemented to improve QoL. (AU)

Objetivo: Determinar si la ansiedad o depresión están asociados con pobre calidad de vida en pacientes con colitis ulcerosa en remisión. Pacientes y métodos: Se incluyó a pacientes de manera consecutiva con diagnóstico establecido de colitis ulcerosa en remisión de al menos 12 meses y quienes completaron los cuestionarios de manera completa como el IBDQ-32, HAD. Las características sociodemográficas y clínicas fueron recabadas. Se utilizaron pruebas no paramétricas y se realizó correlación de HADS y IBDQ-32 con la prueba de Spearman (r). Un valor de p < 0,05 fue considerado como significativo. Resultados: De los 124 pacientes, el 65% fueron hombres con una media de 10 años de evolución (IQR: 5-79 años). La prevalencia para la ansiedad fue del 15,3% y el 2,4% para depresión. La calidad de vida global fue de 192 puntos (IQR: 175-208). La pobre calidad de vida estuvo asociada con la ansiedad (p = 0,002) y la depresión (p = 0,013). La depresión estuvo representada como pobre calidad de vida a nivel de las esferas digestiva (p = 0,04). La ansiedad se correlacionó de manera negativa con la calidad de vida (r = –0,54; p < 0,001). Conclusiones: La ansiedad es frecuente en pacientes con colitis ulcerosa en remisión; no obstante, el diagnóstico y el tratamiento oportuno debe ser implementado para mejorar la calidad de vida. (AU)

Role of the intraparietal sulcus (IPS) in anxiety and cognition: Opportunities for intervention for anxiety-related disorders

Our objective was to review the literature on the parietal cortex and intraparietal sulcus (IPS) in anxiety-related disorders, as well as opportunities for using neuromodulation to target this region and reduce anxiety. We provide an overview of prior research demonstrating: 1) the importance of the IPS in attention, vigilance, and anxious arousal, 2) the potential for neuromodulation of the IPS to reduce unnecessary attention toward threat and anxious arousal as demonstrated in healthy samples; and 3) limited data on the potential for neuromodulation of the IPS to reduce hyper-attention toward threat and anxious arousal among clinical samples with anxiety-related disorders. Future research should evaluate the efficacy of IPS neuromodulation in fully powered clinical trials, as well as the value in augmenting evidence-based treatments for anxiety with IPS neuromodulation. (AU)

Applicability of the cognitive model of generalized anxiety disorder to adolescents’ sleep quality: A cross-sectional and longitudinal analysis

Background: Poor sleep quality is a prevalent health issue among adolescents, and few studies have examined the variables affecting adolescents’ sleep quality from the perspective of the co-occurrence of sleep issues and anxiety disorders. Therefore, the current study investigated whether the cognitive model of generalized anxiety disorder applies to adolescents’ sleep quality. Method: In Study 1, a total of 2042 adolescents were recruited and they completed questionnaires relating to worry, intolerance of uncertainty (IU), negative problem orientation (NPO), cognitive avoidance (CA), and sleep quality. In Study 2, a total of 379 adolescents participated in a six-month longitudinal survey to verify the model that was obtained in Study 1. Results: Study 1 showed the modified cognitive model of generalized anxiety disorder can be applied to adolescents’ sleep quality. Specifically, IU was a higher-order vulnerability factor that directly affected worry, and indirectly fostered worry via NPO and CA, where worry only mediated the relationships between IU, NPO, and sleep quality. However, CA exerted no independent effect on worry or sleep quality beyond the influences of IU and NPO, therefore, it dropped out of the final model. Study 2 partially confirmed the above model again from the longitudinal perspective. Conclusion: The present study constructs a new model to explain adolescents’ sleep quality, providing a foundation for future interventions. (AU)

Explorando la relación entre las somatizaciones, la ansiedad y la regulación emocional. El efecto mediador de las estrategias desadaptativas / Exploring the relationship between somatizations, anxiety and emotional regulation. The mediating effect of maladaptive strategies

Los trastornos emocionales como la ansiedad, la depresión o las somatizaciones son los más frecuentes en la población mundial. En el caso concreto de los trastornos de ansiedad y por somatización la incidencia se sitúa en el 11 y 12%, respectivamente. La relación entre sendos trastornos ha sido ampliamente estudiada, mostrando la existencia de una relación bidireccional entre ambos. Sin embargo, los mecanismos que explican dicha interrelación todavía requieren de mayor estudio. El objetivo del presente trabajo es estudiar el rol mediador de las estrategias cognitivas de regulación emocional adaptativas y desadaptativas en la relación entre la ansiedad y los síntomas somáticos. Para ello, se ha utilizado una muestra de 1,730 participantes españoles. La muestra fue recogida mediante encuestas online dentro de un diseño observacional transversal. Para analizar los datos recogidos se plantean análisis correlacionales de las variables implicadas, así como tres modelos de mediación multivariable entre los síntomas de ansiedad (ansiedad generalizada, ansiedad cognitivo-afectiva o ansiedad somática), las estrategias cognitivas de regulación emocional adaptativas y desadaptativas, y los síntomas somáticos. Los resultados muestran que las estrategias de regulación emocional desadaptativas juegan un rol mediador solo entre la ansiedad de tipo somático y los síntomas somáticos, mientras que este efecto no se observó entre los síntomas de ansiedad generalizada y ansiedad cognitiva. Se debaten las implicaciones clínicas a la hora de abordar los trastornos de ansiedad y las somatizaciones.(AU)

Emotional disorders such as anxiety, depression or somatization are the most frequent in the world’s population. In the specific case of anxiety and somatoform disorders, the incidence is 11% and 12%, respectively. The relationship between the two disorders has been extensively studied, showing the existence of a bidirectional relationship between them. However, the mechanisms that explain this interrelationship still require further study. The aim of the present work is to study the mediating role of adaptive and maladaptive cognitive strategies of emotional regulation in the relationship between anxiety and somatic symptoms. For this purpose, a sample of 1,730 Spanish participants was used. The sample was collected through online surveys within a cross-sectional observational design. In order to analyze the data collected, correlational analyses of the variables involved, as well as three multivariate mediation models between anxiety symptoms (generalized anxiety, cognitive-affective anxiety or somatic anxiety), adaptive and maladaptive cognitive strategies of emotional regulation, and somatic symptoms are proposed. Results show that maladaptive emotional regulation strategies play a mediating role only between somatic-type anxiety and somatic symptoms, whereas this effect was not observed between generalized anxiety and cognitive anxiety symptoms. Clinical implications for addressing anxiety disorders and somatization are discussed.(AU)

Reducing the anxiety of patients undergoing an oral biopsy by means of graphic novels: an open-label randomized clinical trial

Background: The use of graphic novels is a trending topic in health communication as a new form of visual storytelling which explores narratives of health care, cancer, healing, and disability. The objective of the present study was to evaluate - for the first time in the literature - the effect of graphic novels in reducing the anxiety of patients waiting for an incisional biopsy in an oral oncology setting. Material and Methods: This open-label randomized clinical trial comprised 50 patients with a clinical suspicion of oral potentially malignant disorders. Twenty-five patients were randomly allocated to the test group, and a colourful graphic novel was provided. Subsequently, the Beck Depression Inventory and the Depression Anxiety Stress Scales-21 were administered to all 50 recruited patients, after which a biopsy was performed on each patient. Results: No statistically significant difference was observed between the test and control groups for the variables regarding the demographic data (p>0.2). There was a significant difference after the introduction of the graphic novel, regardless of which questionnaire was used. The graphic novel demonstrated an improvement in the ability of the test group to tolerate anxiety while waiting for an oral biopsy in both psychological tests (p<0.05). Conclusions: In light of these initial positive results, the authors of this study would like to suggest the use of graphic novels in oral oncology, dentistry, and medicine with the aim of reducing patient anxiety. (AU)

Psychological impact after treatment in patients with head and neck cancer

Background: Cancer is the second cause of death all over the world and it causes considerable morbidity, disability, and treatment sequela, which often lead to post-treatment pain and disfigurement. This study aims to evaluate such physical sequelae, and their psychological, (cognitive and emotional), impact, in a cohort of patients treated for Head and Neck (HNC) cancer, in search for methods to help such patients deal effectively with the psychological effects of their cancer treatments adverse consequences. Material and methods: The sample consists of 56 subjects, 47 men and 9 women, ranging from 47 years to 86 years of age, who were treated for head and neck cancers at Spanish Public General Hospital in the Otolaryngology Unit, Surgery Section. Two types of questionnaires were used in the study: the Questionnaire of Sequelae after Treatment of head and neck carcinoma and the State-Trait Anxiety Inventory (STAI-E and R). Results: With respect to anxiety, the study found high levels of state anxiety which was significantly associated with the degree of perception of social stigma but was not associated with the post-treatment sequelae themselves nor with the level of discomfort that such symptomatic sequelae produced. The presence of a post-surgical stoma with cannula, increased patient's stigma (both components: external rejection and self-rejection) and state anxiety ratings, while there was no difference in state anxiety between cannulated and non-cannulated patients. There are few differences between men and women in terms of the presence of anxiety and their responses are similar in terms of the after-effects of surgery. Conclusions: Our study confirmed that current treatments for Head and Neck carcinoma generate adverse symptomatic sequela that impose significant psychological and physical burden for these patients. We will discuss the various pathways for preventive intervention that these findings open up. (AU)

Factores de complejidad de cuidados asociados a la reconsulta en un servicio de urgencias / Care complexity factors associated with revisits to an emergency department

Objetivo: Analizar la prevalencia de factores de complejidad de cuidados en los pacientes atendidos en el servicio de urgencias y determinar su relación con las reconsultas durante los 30 días posteriores a la vista inicial. Método: Estudio observacional transversal correlacional. Se incluyeron de forma consecutiva todos aquellos pacientes adultos que consultaron al servicio de urgencias de un hospital de tercer nivel durante un periodo de 6 meses. Las variables principales del estudio fueron la reconsulta a los 30 días y 26 factores individuales de complejidad de cuidados categorizados en 5 fuentes (psicoemocional, mental-cognitiva, sociocultural, evolutiva, comorbilidades-complicaciones). Los datos fueron recogidos de la historia clínica electrónica. Resultados: Se incluyeron un total de 15.556 episodios de pacientes. El 82,4% (12.811) presentó algún factor de complejidad de cuidados y el 11,9% (1.088) de los pacientes dados de alta reconsultaron durante los 30 días posteriores. La presencia de mayor número de factores de complejidad de cuidados se asoció a la reconsulta a los 30 días (OR: 1,26; IC 95%: 1,11-1,43; p < 0,05), y los siguientes factores se asociaron con reconsulta: incontinencia, inestabilidad hemodinámica, riesgo de hemorragia, extremo de edad, ansiedad y temor, deterioro de funciones cognitivas y analfabetismo (p < 0,05). Conclusiones: La prevalencia de factores de complejidad de cuidados en pacientes que consultan en el servicio de urgencias es elevada. Los pacientes que reconsultaron a los 30 días presentaron mayor número de factores de complejidad, por lo que su identificación precoz podría ayudar a estratificar los pacientes y diseñar estrategias preventivas para disminuir la incidencia de reconsultas. (AU)

Objectives: To analyze the prevalence of care complexity factors (CCFs) in patients coming to an emergency department (ED) and to analyze their relation to 30-day ED revisits. Methods: Observational, correlational, and cross-sectional study. Consecutive patients seeking care from a tertiarylevel hospital ED were included over a period of 6 months. The main variables studied were 30-day revisits to the ED and 26 CCFs categorized in 5 domains: psychoemotional, mental-cognitive, sociocultural, developmental, and comorbidity/complications. Data were collected from hospital records for analysis of descriptive and inferential statistics. Results: A total of 15 556 patient episodes were studied. A CCF was recorded in 12 811 patient records (82.4%), and 1088 (11.9%) of the patients discharged directly from the ED revisited within 30 days. The presence of more CCFswas associated with 30-day revisits (odds ratio, 1.26; 95% CI, 1.11-1.43; P < .05). The CCFs that were significantly associated with revisits were incontinence, hemodynamic instability, risk for bleeding, anxiety, very advanced age, anxiety and fear, cognitive impairment, and illiteracy. Conclusions: The prevalence of CCFs is high in patients who seek ED care. Patients revisiting within 30 days of an episode have more CCFs. Early identification of such patients would help to stratify risk and develop preventive strategies to decrease the incidence of revisiting. (AU)

Acceptance and Commitment Therapy for improving the performance of chess players suffering from anxiety disorders

Previous research has suggested that brief protocols based on acceptance and commitment therapy (ACT) are efficacious in improving elite chess players' performance without clinical problems. These promising results warranted the examination of the effect of longer ACT interventions with chess players suffering from emotional difficulties. This study advances in this direction by presenting two case studies of elite chess players experiencing anxiety disorders. Each participant was matched to a control participant with similar characteristics. The ACT interventions were conducted in 5 sessions and with occasional follow-ups during the following year. The primary dependent variable was an objective measure of chess performance (ELO Performance). Data analysis was conducted using the JZS+AR Bayesian hypothesis testing for single-case designs and the nonparametric Tau-U statistic. Control participants did not significantly improve their chess performance during the follow-up, but chess players who received the intervention showed significant increases in their performance. Both treated participants experienced clinically significant reductions in symptomatology and improved valued living after the intervention. This study provides empirical evidence regarding the potential benefit of applying ACT to improve chess performance in players with clinical problems (AU)

Impacto psicológico de la pandemia de COVID-19 y el confinamiento en una muestra española con trastorno de ansiedad: diferencias entre sexos / Psychological impact of the covid-19 pandemic and lockdown in a spanish sample with anxiety disorder: sex differences

Introducción. El impacto psicológico en las etapas iniciales de la pandemia por COVID-19 y el confinamiento fue mayor en personas con trastornos mentales. En este estudio se exploraron las diferencias en el impacto psicológico según el sexo en personas con trastorno de ansiedad en España. Metodología. Estudio transversal, descriptivo y comparativo de los datos aportados por los participantes en una encuesta online anónima realizada entre el 19 y el 26 de marzo de 2020. El cuestionario ad hoc incluyó datos sociodemográficos, clínicos y variables relacionadas con COVID-19,junto con preguntas sobre estrategias de afrontamiento y las versiones en español de la Escala de Escalas de Depresión Ansiedad Estrés (DASS-21) y la Escala de Impacto del Estresor(IES). Se utilizaron análisis descriptivos bivariados y modelos de regresión logística. Resultados. De los 21.207 participantes, se analizaron1617 (7,6%) personas con trastorno de ansiedad autoinformado [1347 (83,3%) mujeres; 270 (16,7%) varones]. El impacto psicológico fue mayor en las mujeres que en los hombres con diferencias estadísticamente significativas en cada subescala del DASS-21 y subescalas del IES. Después de ajustar por posibles variables de confusión, se observó que ser mujer se asoció con puntuaciones más altas en las subescalas de pensamientos intrusivos y evitativos. Conclusiones. Nuestro estudio sugiere que las mujeres con trastorno de ansiedad son un grupo vulnerable a un mayor impacto negativo en la salud mental y, especialmente, en los síntomas relacionados con el trastorno de estrés postraumático. (AU)

Background. The early psychological impact of the COVID-19 pandemic and lockdown is greater in peoplewith mental disorders. This study explored the differences in the psychological impact on people with an anxiety disorder by sex in Spain. Methods. Cross-sectional, descriptive, comparative study of the data provided by participants in an anonymous online survey between March 19 and 26, 2020. Thead hoc questionnaire included sociodemographic, clinical,and variable data related to COVID-19, along with questions about coping strategies, and the Spanish versions ofthe Depression, Anxiety, and Stress Scale (DASS-21) andImpact of Event Scale (IES). Descriptive bivariate analyses and logistic regression models were used. Results. Of the 21,207 participants, 1617 (7.6%) people with self-reported anxiety disorder were analyzed [1347(83.3%) females; 270 (16.7%) males]. The psychological impact was greater on women than men with statistically significant differences in each subscale of the DASS-21and subscales of the IES. After adjusting for potential confounding variables, it was observed that being awoman was associated with higher scores on the intrusiveand avoidant thoughts subscales. Conclusions. Our study suggests that women with ananxiety disorder are a group vulnerable to a greater negative impact on mental health and, especially, symptomsr elated to post-traumatic stress disorder. (AU)

Effects of transcranial direct current stimulation on neural activity and functional connectivity during fear extinction

Background/Objective: Anxiety disorders are highly prevalent and negatively impact daily functioning and quality of life. Transcranial direct current stimulation (tDCS) targeting the dorsolateral prefrontal cortex (dlPFC), especially in the right hemisphere impacts extinction learning; however, the underlying neural mechanisms are elusive. Therefore, we aimed to investigate the effects of cathodal tDCS stimulation to the right dlPFC on neural activity and connectivity patterns during delayed fear extinction in healthy participants. Methods: We conducted a two-day fear conditioning and extinction procedure. On the first day, we collected fear-related self-reports, clinical questionnaires, and skin conductance responses during fear acquisition. On the second day, participants in the tDCS group (n = 16) received 20-min offline tDCS before fMRI and then completed the fear extinction session during fMRI. Participants in the control group (n = 18) skipped tDCS and directly underwent fMRI to complete the fear extinction procedure. Whole-brain searchlight classification and resting-state functional connectivity analyses were performed. Results: Whole-brain searchlight classification during fear extinction showed higher classification accuracy of threat and safe cues in the left anterior dorsal and ventral insulae and hippocampus in the tDCS group than in the control group. Functional connectivity derived from the insula with the dlPFC, ventromedial prefrontal cortex, and inferior parietal lobule was increased after tDCS. Conclusion: tDCS over the right dlPFC may function as a primer for information exchange among distally connected areas, thereby increasing stimulus discrimination. The current study did not include a sham group, and one participant of the control group was not randomized. Therefore, to address potential allocation bias, findings should be confirmed in the future with a fully randomized and sham controlled study. (AU)

Effectiveness of psychological interventions for child and adolescent specific anxiety disorders: A systematic review of systematic reviews and meta-analyses / Eficacia de las intervenciones psicológicas para el tratamiento de los trastornos específicos de ansiedad en niños y adolescentes: una revisión derevisiones sistemáticas y meta-análisis

Anxiety disorders are highly prevalent in children and adolescents. The associated functional limitations and the negative psychological consequences have led to increased research into effective psychological interventions. What is missing, however, is a comprehensive review of the literatureaddressing the effectiveness of these treatments for specific disorders. A systematic review of systematic reviews and meta-analyses evaluating theeffectiveness of psychological treatments for specific anxiety disorders in children and adolescents was performed. The study followed PRISMAguidelines. Four bibliographic databases were searched: MEDLINE (PubMed), PsycINFO, Web of Science (Core Collection), and The CochraneLibrary. Two authors independently screened the articles by title, abstract, and full-text, according to established inclusion and exclusion criteria.Two independent authors evaluated the methodological quality of the included reviews using AMSTAR-2. Five records were included in this systematic review. Four studies included children and adolescents with specific phobias, generalized anxiety disorder, and separation anxiety disorderand one focused solely on nocturnal fears. Cognitive behavioral therapy-based interventions have been shown to be effective for the treatment ofthese diagnoses in both short and long term. The methodological quality of the included studies was classified as critically low. Cognitive behavioralinterventions are effective in treating specific phobias, generalized anxiety disorder, and separation anxiety disorder and nighttime fears in childrenand adolescents. The improvement of the methodological quality and the need for further studies focusing on the effectiveness of treatments forspecific disorders are discussed. (AU)

Los trastornos de ansiedad son muy comunes en la infancia y adolescencia y repercuten negativamente enla vida del niño y la familia. Pese al aumento en el número de investigaciones centradas en estudiar la eficacia de las intervenciones psicológicas,hasta la fecha no se ha llevado a cabo una síntesis que haya dado cuenta de la eficacia de estas intervenciones para cada uno de los trastornosde ansiedad de manera específica. Se realizó una revisión sistemática de revisiones sistemáticas y metaanálisis. Se realizaron búsquedas en cuatrobases de datos: MEDLINE (PubMed), PsycINFO, Web of Science (colección principal) y The Cochrane Library. Dos autores examinaron de formaindependiente los artículos por título, resumen y texto completo, según unos criterios de inclusión y exclusión previamente establecidos. Dos autoresevaluaron de forma independiente la calidad metodológica de las revisiones incluidas mediante AMSTAR-2. Se incluyeron cinco estudios. Cuatroincluyeron participantes con fobias específicas, ansiedad generalizada y ansiedad por separación y uno se centró en miedos nocturnos. Las intervenciones basadas en la terapia cognitivo conductual demostraron ser efectivas para el tratamiento de estos trastornos a corto y a largo plazo. Lacalidad metodológica de los estudios incluidos se clasificó como críticamente baja. Las intervenciones basadas en la terapia cognitivo conductualson eficaces para los trastornos de ansiedad en niños y adolescentes. Se discute la necesidad de mejorar la calidad metodológica y de aumentarlos estudios centrados en la eficacia de los tratamientos para trastornos específicos. (AU)

The influence of music education combined with sports psychology on students' anxiety / La influencia de la educación musical combinada con la psicología del deporte en la ansiedad de los estudiantes

The mental health of college students has become a topic of public discourse and is one of the most pressing issues confronting colleges and universities on the path to survival and development. This study aims to determine the effect of music education and sports psychology on student anxiety. This eight-week study examined the students of a college of physical education using SAS and a questionnaire. Free recovery, sports prescription recovery, group psychological counseling recovery, and sports prescription plus group psychological counseling recovery were implemented as intervention measures. 37% had anxiety symptoms, with most students in social athletics classes suffering from anxiety disorders. There is a significant difference between the proportion of male and female anxiety sufferers. Before and after the intervention, the contents of serum 5-hydroxytryptamine (5-HT), brain-derived neurotrophic factor (BNDF), and plasma cortisol (COR) were measured; after the intervention, the contents of 5-HT, BNDF, and COR were significantly increased (P0.05 or P0.01) in all groups except the free recovery group. The anxiety level of apprehensive college students can be reduced using the intervention. These findings are novel and contribute significantly to the existing body of knowledge. The study suggests some prospective research directions for scholars to consider.(AU)

Análisis de redes de síntomas del trastorno de agorafobia en personas mayores de 65 años / Analysis of symptom networks of agoraphobia disorder in people over 65 years of age

El objetivo es realizar un análisis de redes de síntomas del trastorno de agorafobia (con o sin pánico) según la edad y el sexo, en una muestra representativa de 555 personas mayores de 65 años de la Comunidad de Madrid. La red se estimó utilizando el paquete InsingFit que implementa un procedimiento llamado eLasso. Los resultados revelan redes diferenciadas para hombres y mujeres, y para los grupos de edad de 65-74 y 75-84 años, encontrando un mayor porcentaje de ocurrencia en las mujeres tanto en las situaciones como en los síntomas de ansiedad y en las razones para sentir miedo. Las mujeres temen un mayor número de situaciones, mientras que los hombres parecen tener sus miedos más localizados y centralizados en situaciones relacionadas con el transporte y los viajes cuando los hacen solos. Estos resultados pueden ser interesantes para diseñar intervenciones que aborden los síntomas y sus relaciones mutuas más importantes, diferentes y características en función de la edad y el sexo. (AU)

The aim of this study is to conduct a network analysis of agoraphobia disorder symptoms (with or without panic) according to age and gender, in a representative sample of 555 people over 65 years of age in the Community of Madrid. The network was estimated using the InsingFit package that implements a procedure called eLasso. The results reveal differentiated networks for men and women, and for the age groups 65-74 and 75-84 years, finding a higher percentage of occurrence in women in both situations and symptoms of anxiety and reasons for fear. Women fear a greater number of situations, while men seem to have their fears more localized and centralized in situations related to transport and travel when travelling alone. These results may be of interest for designing interventions that address the symptoms and the most important, different and characteristic relationships among them according to age and gender. (AU)

Mental health impact by COVID-19 in hospitalized patients sample in Mexico City / Impacto en la salud mental en una muestra de pacientes hospitalizados por COVID-19 en la Ciudad de México

Una de las consecuencias de la pandemia es el aumento de la prevalencia de alteraciones mentales como la ansiedad, la depresión y el estrés. En este estudio transversal y observacional se evaluó la prevalencia de estrés, ansiedad y depresión en pacientes hospitalizados por COVID-19 así como la probable asociación con el impacto emocional recibido por familiares de pacientes hospitalizados por COVID-19. Cuarenta y cinco pacientes hospitalizados por COVID-19 con una edad promedio de 54.4 ± 9.6 años y cincuenta y cinco familiares de pacientes hospitalizados con una edad promedio de 43.2 ± 11.8 años respondieron una batería de preguntas y la encuesta DASS-21. Nuestros resultados revelaron una alta prevalencia de depresión, ansiedad y estrés identificados por DASS-21. En este estudio identificamos factores de riesgo asociados a la salud emocional como la edad (< 50 años: depresión RM = 2.99 [1.31, 6.80] p < .05 y ansiedad RM = 2.83 [1.15, 6.93], p < .05), el género (mujeres: ansiedad RM = 4.13 [1.57, 10.89], p < .05 y estrés RM = 5.38 [2.27, 12.8], p < .05) y el grupo de estudio (familiares: depresión RM = 3.83 [1.63, 8.96]; p < .05 , ansiedad RM = 3.60 [1.46, 8.88]; p < .05 y estrés RM = 3.30 [1.41, 7.70]; p < .05). Además, el género femenino y el nivel socioeconómico bajo de los pacientes (β = 3.23; 1.96) y familiares (β = 1.86; 2.31) se asociaron con puntuaciones más altas en ansiedad (p < .05) y estrés (p < .05). Concluimos que la muestra de pacientes con COVID-19 mantiene una alta prevalencia de alteraciones mentales y que algunos factores sociodemográficos se asocian con la magnitud de estos trastornos.(AU)

One of the consequences of pandemic is the increase in the prevalence of mental alterations such as anxiety, depression and stress. Since here, we aimed to determinate through a transversal and observa-tional studyprevalence of stress, anxiety and depression within hospital-ized patients by COVID-19 as well as their likely association with the emo-tional impact received by relatives with hospitalized patients by COVID-19. Forty-five COVID-19 hospitalized patients with mean age of 54.4 ± 9.6 yearsand fifty-five relatives with mean age of 43.2 ± 11.8 yearsan-swered a questions battery and DASS-21 survey. Our resultsrevealed high prevalence of depression, anxiety and stress assessed by DASS-21 sub-scales. We also identified risk factors associated with the emotional health such as age (<50 years: depression OR=2.99 [1.31, 6.80], p< .05 and anxiety OR=2.83 [1.15,6.93], p< .05), by gender (female: anxiety OR = 4.13 [1.57, 10.89], p< .05 and stress OR = 5.38 [2.27, 12.8], p< .05), by group of study (relatives: depression OR = 3.83 [1.63, 8.96]; p< .05, anxie-ty OR = 3.60 [1.46, 8.88]; p< .05 and stress OR = 3.30 [1.41, 7.70]; p< .05). Additionally, female gender and low socioeconomic status in patients (β= 3.23; 1.96) and relatives (β= 1.86; 2.31) were associated with higher scores in anxiety (p< .05) and stress (p <.05). We concluded that our sample of COVID-19 patients maintain a high prevalence of mental altera-tions and age, gender and socioeconomic status modify the magnitude of these disorders.(AU)

Factorial analysis and gender invariance of GPIUS2 scale and evaluation ofCaplan’s cognitive-behavioral model of problematic Internet use in adolescents / Análisis factorial e invarianza de género de la escala GPIUS2 y evaluación del modelo cognitivo-conductual de Caplan del uso problemático de Internet en adolescentes

Caplan's (2010) revised cognitive-behavioral model of Problem-atic Internet Use (PIU) has become one of the most promising theoretical frameworks on such behavior in the last decade. The Generalized Prob-lematic Internet Use Scale (GPIUS2) (Caplan, 2010) has been adapted and validated for use with Spanish adolescents, but gender invariance has not been tested yet in this country. The present study focuses on three objec-tives: to confirm the factorial structure of GPIUS2, to analyze gender in-variance, and to test Caplan’s theoretical model, in a sample of Spanish ad-olescents. A cross-sectional study was carried out. The sample was com-posed of 909 participants from Spain, agedbetween 12 and 18 years (Mean age= 14.2, SD= 1.6). The results indicated a good fit of the GPIUS2 fac-tor structure and gender factorial invariance. Moreover, the cognitive-behavioral model fit the data. GPIUS2 has a very good structure and pre-sents gender factorial invariance, which favors its application in Spanish adolescent population. This study supports the cognitive-behavioral model of PIU.(AU)

El modelo cognitivo-conductual revisado de Caplan (2010) so-bre el Uso Problemático de Internet (UPI) es uno de los marcos teóricos más prometedores sobre dicho comportamiento en la última década. La Escala Uso Problemático de Internet Generalizado(GPIUS2) (Caplan, 2010) ha sido adaptada y validada para su uso con adolescentes españoles, pero aún no se ha comprobado su invarianza de género en España. El pre-sente estudio se centra en tres objetivos: confirmar la estructura factorial de la escala GPIUS2, analizar la invarianza de género de dicha escala y poner a prueba el modelo teórico de Caplan en una muestra de adolescentes espa-ñoles. Se realizó un estudio transversal. La muestra estuvo compuesta por 909 participantes de España, con edades comprendidas entre los 12 y los 18 años (Edad media= 14.2, DT= 1.6). Los resultados indicaron un buen ajuste de la estructura factorial del GPIUS2 e invarianza factorial en fun-ción del género. Además, el modelo cognitivo-conductual mostró un buen ajuste de los datos. La GPIUS2 tiene una muy buena estructura y presenta invarianza factorial para el género, lo que favorece su aplicación en la po-blación adolescente española. Este estudio apoya el modelo cognitivo-conductual en el UPI.(AU)

Perceived stigma and discrimination among persons with mood and anxiety disorders: Results from the WHO World Mental Health Survey Portugal

Background and objectives: The stigma attached to mental disorders remains a public health challenge, represents an important barrier to healthcare and widens existing social inequalities.This study aimed to characterize the association between perceived stigma and mental disorders. The two main objectives were to estimate the association between perceived stigma and 12-month anxiety and mood disorders, and to assess the factors associated with perceived stigma among persons with these mental disorders.MethodsA nationally representative sample of the Portuguese population was used. Participants were Portuguese-speaking adults, aged 18 or above and residing in permanent dwellings in the country's mainland. The survey was administered by trained lay interviewers using a computer assisted personal interview (CAPI) on a face-to-face setting.ResultsThe results showed a two-fold increase in the likelihood of experiencing stigma among individuals with 12-month anxiety and mood disorders, slightly higher in the latter, when compared with individuals without. Among the sub-sample with these mental disorders, participants retired (or others), with psychiatric comorbidity and with co-occurrence of psychiatric and physical disorders had higher odds of reporting perceived stigma.ConclusionsThe findings of this study highlight the need to consider stigma as a public health priority in Portugal and to develop policies to create awareness and promote the social inclusion of persons with mental disorders. (AU)