Anxiety symptoms without depression are associated with cognitive control network (CNN) dysfunction: An fNIRS study.

Anxiety is a common psychological disorder associated with other mental disorders, with depression being the most common comorbidity. Few studies have examined the neural mechanisms underlying anxiety after controlling for depression. This study aimed to explore whether there are differences in cortical activation in anxiety patients with different severities whose depression are normal. In the current study, depression levels were normal for 366 subjects-139 healthy subjects, 117 with mild anxiety, and 110 with major anxiety. Using the Hospital Anxiety and Depression Scale (HADS) and a verbal fluency task (VFT) to test subjects' anxiety and depression and cognitive function, respectively. A 53-channel guided near-infrared spectroscopic imaging technology (fNIRS) detected the concentration of oxyhemoglobin (oxy-Hb). Correlation analysis between anxiety severity and oxy-Hb concentration in the brain cortex was performed, as well as ANOVA analysis of oxy-Hb concentration among the three anxiety severity groups. The results showed that anxiety severity was significantly and negatively correlated with oxy-Hb concentrations in the left frontal eye field (lFEF) and in the right dorsolateral prefrontal area (rDLPFC). The oxy-Hb concentration in the lFEF and the rDLPFC were significantly lower in the major anxiety disorder group than that in the control group. This suggests that decreased cortical activity of the lFEF and rDLPFC may be neural markers of anxiety symptoms after controlling for depression. Anxiety symptoms without depression may be result from the dysfunction of the cognitive control network (CCN) which includes the lFEF and rDLPFC.

Psychological stress of university students in the hardest-hit areas at different stages of the COVID-19 epidemic.

BACKGROUND: The outbreak of COVID-19 has caused extremely many serious consequences for the country and the world. In fact, it has seriously affected people's mental health. The purpose of this study is to understand the psychological stress among college students in different stages of epidemics in hard-hit areas such as Hubei. Moreover, to highlight the factors that influencing, their psychological conditions with the emphasis of further corresponding suggestions. METHODS: This study includes self-designed questionnaires in order to assess and analyze the psychological state of over 17,000 college students during the outbreak period in January and home quarantine in February. The questionnaire contains three aspects and six dimensions: pressure responses: stress susceptibility (SS), stress adjustment (SA), risk cognition: cognition of danger (CD), cognition of illness (CI) and stress reactions: emotional responses (ER), somatic responses (SR). This survey was done by an online questionnaire (www.wjx.cn) to investigate the psychological stress information of college students, and analyzed the data by SPSS 22.0 for Windows. RESULTS: Regarding the stress susceptibility, participants were more likely stressed in February than in January. Regarding the stress adjustment, the number of participants requiring pressure regulation or release in the February survey was significantly lower than that the effective in the January survey. The mean of the cognition of danger reduced significantly in February than in January, in other words, participants were highly worried about the epidemic in January than in February. Regarding the cognition of illness, participants in January had a more pessimistic attitude towards the epidemic than those in February. The emotional responses of the participants in February were more severe than those in January, while the somatic responses reduced significantly in February compared with January. Furthermore, females have stronger stress reactions than males. However, the SR doesn't have significant differences between females and males. CONCLUSION: After two surveys in January and February, it was found that the psychological stress of college students in Hubei was significantly different at different stages of the epidemic, where the epidemic developed, the psychological stress of college students become more severe. The psychological stress of the college students in Hubei Province, as a severely affected area, should be paid more attention.

Psychological stress of medical staffs during outbreak of COVID-19 and adjustment strategy.

COVID-19 has a significant impact on public health and poses a challenge to medical staffs, especially to front-line medical staffs who are exposed to and in direct contact with patients. To understand the psychological stress status of medical staffs during the outbreak of COVID-19, random sample questionnaire survey was conducted among 2110 medical staffs and 2158 college students in all provinces of China through a questionnaire, which was compiled and completed through the Questionnaire Star platform relying on Wechat, QQ, and other social software. The differences in psychological stress status of different groups were compared through the analysis of the questionnaire. Results revealed that in all provinces of China, medical staffs scored significantly higher on all items of psychological stress than college students (P < .001). In Wuhan, medical staffs scored significantly higher than college students in all items of psychological stress (P < .001). While among medical staffs, the group in Wuhan area scored significantly higher than the group outside Wuhan on the following items: "Thought of being in danger," "The possibility of self-illness," "Worrying about family infection" (P < .05), "Poor sleep quality," "Needing psychological guidance," and "Worrying about being infected" (P < .01) in the Psychological Stress Questionnaire, but on the item "Confidence in the victory of the epidemic," the group in Wuhan area scored significantly lower than the group outside Wuhan (P < .05). The emotion, cognition, physical, and mental response of front-line medical staff showed obvious "exposure effect", which calls for a psychological crisis intervention strategy that can be helpful.

Psychological factors and oral health during initial outbreak of COVID-19 in China: A cross-sectional study.

OBJECTIVES: To investigate associations between oral health and psychological factors (i.e., depression, anxiety, and resilience) in a group of Chinese individuals who had sought an intervention online during the COVID-19 pandemic. METHODS: For this cross-sectional study, online questionnaires were created using online survey software from set items of instruments commonly used to assess depression, anxiety, and resilience combined with an oral health survey. The study was conducted from March 13 to 16, 2020. RESULTS: 568 participants (188 men and 380 women) with a mean ± SD age of 41.7 ± 10.2 years were included in the analyses. In total, 152 (27%) participants were from Beijing, 149 (26%) from Wuhan, 110 (19%) from Shenyang, and 157 (28%) from other Chinese cities. Halitosis and bleeding gums were the most common reasons for individuals to seek an intervention. Compared with other cities, participants from Wuhan showed higher anxiety and depression and worse previous oral health. Resilience mediated the relationship between depression and oral health, but not between anxiety and oral health. CONCLUSION: We hope that the data from this study will inform clinical practitioners and demonstrate that mental health awareness and resilience training are important strategies that may mitigate the negative impact of lockdown and isolation on oral health.

Theta-burst stimulation of TMS treatment for anxiety and depression: A FNIRS study.

BACKGROUND: This study aimed to evaluate the intervention effect of intermittent Theta burst stimulation (iTBS) on anxiety and depression by using Functional Near-Infrared Spectroscopy technology for confirming the effect of iTBS on anxiety and depression and providing new parameter basis for the treatment and development of rTMS. METHOD: 37 patients with anxiety and depression were treated with rTMS intervention in iTBS mode, and the symptoms of depression and anxiety were assessed by Hospital Anxiety and Depression Scale at baseline and after 10 times of treatments. The brain activation was assessed by verbal fluency task. The scores of anxiety and depression were analyzed by paired sample t-test. RESULTS: After 10 times of rTMS treatment in iTBS mode, the symptoms of anxiety and depression in patients were relieved. The anxiety scores before and after treatment were significantly different, and the post-test scores were significantly lower than the pre-test scores. Significant differences in depression scores were observed before and after treatment, and the post-test score was significantly lower than the pre-test score. In the brain functional connection, the connection of various brain regions was strengthened, and the strength of functional connection between all ROIs before the intervention was significantly lower than that after the intervention. Statistical significance was observed. CONCLUSION: The intervention of iTBS model has a positive effect on improving symptoms and strengthening brain functional connection of patients with anxiety and depression. This performance supports the effectiveness of iTBS model in treating anxiety and depression.

Dorsolateral prefrontal activation in depressed young adults with and without suicidal ideation during an emotional autobiographical memory task: A fNIRS study.

OBJECTIVE: Previous studies have proved that there is a strong association between dorsolateral prefrontal cortex and mood symptoms. This study aimed at using functional near-infrared spectroscopy technology to invest brain activity in dlPFC of depressed individuals with and without suicidal ideation during emotional autobiographical memory test, and to understand their differences in brain cognitive mechanisms. It is helpful to improve our ability to predict and subsequently to prevent suicide. METHODS: 85 young adults participated in the study by a simple random sampling method, with health control (34participants), depression with suicidal ideation (17participants), and depression without suicidal ideation (34participants). The average oxyhemoglobin in dlPFC of subjects during EAMT was collected by a 53-channel fNIRS imaging device. RESULTS: A marginal significant difference was found between three groups in left dlPFC and right dlPFC. Post hoc analysis revealed that: (1) under negative emotion, depression without suicidal ideation group had higher activation than healthy control group in left dlPFC. (2) under positive emotion, depression with suicidal ideation group had lower activation than healthy control in right dlPFC. CONCLUSIONS: Results indicated that the depressed individuals with suicidal ideation had some deficits in executive function in right dlPFC, while the depressed adults without suicidal ideation may have mechanism of resource compensatory recruitment in left dlPFC and the dlPFC abnormality involved in the pathophysiology, may localize within left hemisphere. The depressed individuals with and without suicidal ideation had the different mechanisms in dlPFC and fNIRS can be a neuroimaging biomarker characterizing or predicting suicidality in depressed individuals.

Stress Response on Behavioral Response of University Students During the Peak Period of COVID-19.

Background: This study aimed to explore the underlying mechanisms of the relationship between stress response and behavioral response and to develop a moderated mediation model with stress management and risk cognition. Methods: We developed 4 novel questionnaires, namely, stress response questionnaire, behavioral response questionnaire, stress management questionnaire, and risk cognition questionnaire. A total of 5896 university students in China were investigated during the peak period of the coronavirus disease 2019. Results: The results showed that stress response had a significant negative predictive effect on behavioral response (r = -0.489, P < .001). Moreover, stress management had a partial mediating effect between stress response and behavioral response. Risk cognition plays a moderating effect on the mediation model (ß = -0.109, P = .030), and the effect of high-risk cognition is more significant. Conclusion: During the coronavirus disease 2019 period, improving the risk awareness of university students will help to enhance the buffering effect of stress management on behavioral response and indirectly reduce their behavioral response.

The right prefrontal cortex (PFC) can distinguish anxious depression from non-anxious depression: A promising functional near infrared spectroscopy study (fNIRS).

BACKGROUND: Anxious depression is a serious mental disorder characterized by comorbidity of anxiety and depression, and its symptoms are similar to those of non-anxious depression. This study aimed to use functional near-infrared spectroscopy (fNIRS) as a tool to distinguish between patients with anxious and non-anxious depression based on differences in hemodynamic changes in the right prefrontal cortex during the verbal fluency task. It is helpful to improve the diagnostic accuracy of the two disorders to further promote their therapeutic effect and prognosis. METHODS: A total of 105 subjects, comprising 39 patients with anxious depression, 32 patients with non-anxious depression, and 32 healthy controls, were evaluated using 53-channel fNIRS and the Depression and Anxiety Clinical Scale. RESULTS: Hemodynamic activation was significantly enhanced in the right dorsolateral prefrontal cortex (DLPFC) and right frontopole cortex (FPC) in the anxious depressed group compared with the non-anxious depressed and healthy groups. LIMITATIONS: First, Hospital Anxiety and Depression Scale (HADS) was used to evaluate the scores of anxiety and depression among the three groups in our study. Different scales may result in different research results. Therefore, other scales (HAM, the Montgomery Asberg Depression Rating Scale, or the Beck Depression Inventory) should be used for further verification. Second, although all the samples we have chosen were patients with the diagnosis of anxious depression or no-anxious depression, we did not distinguish between different severity of anxious depression or no-anxious depression. Third, pure anxiety was not included as the control condition in our study. CONCLUSIONS: There are significant differences in activation patterns of the right DLPFC and right FPC areas between patients with and without anxious depression. Moreover, the right FPC area is promising as a brain region to assess the severity of anxious depression. fNIRS may be a potential tool to improve diagnostic accuracy for both disorders.

Factors Influencing Mental Health of Medical Workers During the COVID-19 Outbreak.

Background: Since the outbreak of COVID-19, physical and psychological harm has been spreading across the global population alongside the spread of the virus. Currently, the novel coronavirus has spread to most countries in the world, and its impact on the public is also increasing. As a high-risk group in direct contact with the virus, medical workers should be monitored, and their mental health deserves extensive attention. The aim of this study was to explore the mental health of medical workers facing the novel coronavirus and the main factors affecting it. Methods: The present cross-sectional study including 2,100 eligible individuals from 1,050 hospitals in China was conducted through the network platform powered by www.wjx.cn, a platform providing functions equivalent to Amazon Mechanical Turk. We used a self-designed questionnaire to collect demographic information and data on mental states, including gender, age (years), educational level, job rank, body and mind reaction, cognition of risk, and the judgment of the epidemic situation. Independent samples t-tests and one-way (ANOVA) analysis were carried out to compare the differences in the mental reactions according to the demographic and psychological states of the participants. Results: There were 502 males (23.9%) and 1,598 females (76.1%). The participants reported feeling calm (39.1%), tense (63.0%), scared (31.4%), angry (18.8%), sad (49.0%), afraid (34.7%), optimistic (5.1%), impressed (65.0%), and confident (31.1%) during the epidemic. At the same time, the psychological stress responses of medical staff were significantly different according to the levels of exposure in their environments, duration and personal experience. Conclusions: Prolonged exposure to the virus and intense work are detrimental to the mental health of medical care personnel. It is necessary to adjust work conditions and intensity according to workers' mental state flexibly and systematically.

Psychological Typhoon Eye Effect During the COVID-19 Outbreak.

Background: The COVID-19 outbreak in Wuhan, Hubei, has brought serious consequences to the lives and mental health of people and has induced psychological stress and affected behavior. Methods: This study used self-designed questionnaires and SPSS to analyze the psychological and behavioral responses of people in different regions during the COVID-19 pandemic and to check for the presence of "psychological typhoon eye" (PTE) effects. The questionnaires adopted three measurement subscales, namely, the risk cognitive subscale, stress response subscale, and behavioral response subscale, and these were administered online (www.wjx.cn) to investigate the psychological and behavioral conduct of respondents from three areas that have been affected by COVID-19 to varying degrees. Exploratory factor analysis and principal component analysis were conducted to explore the factorial structure of these subscales, and confirmatory factor analysis was conducted to explore the structural validity of the questionnaires. The analysis results were used to build a revised 18-item questionnaire which validity was evaluated via ANOVA and LSD. Results: Results confirm the presence of PTE in the research areas during the onset of the COVID-19 outbreak and highlight some significant differences in the cognition and emotions of the residents in these areas. PTE affected the cognition, emotions, and cognitive and emotional responses of the respondents but did not affect their behavioral responses. Conclusion: The findings underscore the urgency of providing sustainable mental health care services across different areas during the COVID-19 outbreak. The residents of those areas worst hit by the pandemic, who may not have taken the situation seriously, require emotional guidance the most. Meanwhile, the residents of other areas, who showed the most negative psychological reactions to the pandemic, require a sense of security, a timely "disconnection" from negative information, an accurate cognition of stress, and an acceptance of self-responses.

Emotional "inflection point" in public health emergencies with the 2019 new coronavirus pneumonia (NCP) in China.

BACKGROUND: The outbreak of the new coronavirus pneumonia (NCP) in Wuhan, Hubei, has caused very serious consequences and severely affected people's lives and mental health. The outbreak will cause bad emotions such as tension, anxiety, fear, and so on. College students who have returned home from school face infection, isolation, and delay in starting school, and thus, their emotional stress should be observed. METHODS: This study used self-designed questionnaires and artificial intelligence (AI) to assess and analyze the emotional state of over 30,000 college students during the outbreak period in January (T1) and home quarantine in February (T2). This survey used online questionnaire (www.wjx.cn) to investigate the emotion information of college students. RESULTS: In the T1 survey, the "Typhoon Eye Effect" appeared. College students in Hubei are calmer than those outside Hubei in T1. However, in T2, an emotional "infection point" appeared, there was an "Exposure Effect", the negative emotions of students in Hubei largely increased and became higher than students outside Hubei. CONCLUSION: This survey found that there is an emotional "infection point" in February among college students, especially in the Hubei area. College students in Hubei are calmer than those outside Hubei in T1. In contrast, college students in Hubei were more nervous and scared than those outside Hubei in T2. This epidemic has caused the students to experience significant pressure and negative emotions. Therefore, universities and society should pay attention to their emotional adjustment, there are some suggestions such as establish the mental health organizations, test students' emotion status regularly.