The Association between Problematic Smartphone Use and Mental Health in Austrian Adolescents and Young Adults.

Although problematic smartphone use (PSU) is prevalent and associated with mental health and physical activity, there are no studies on its prevalence and associations in Austria. The aim of this study was to evaluate the prevalence of PSU and its associations with mental health in adolescents and young adults. A cross-sectional online survey was performed from 19 April to 27 July 2023, and the data of N = 913 respondents (14.1% male, 82.4% female, 3.5% diverse; median age: 17 [IQR: 15-18]; range: 14-20 years) were included in the analyses. Overall, 38.1% (females: 39.0%, males: 33.3%) of those surveyed were above the cut-off for PSU measured with the Smartphone Addiction Scale (SAS-SV). In addition to screen time, PSU is also associated with depressive symptoms (aOR = 1.46), anxiety symptoms (aOR = 1.86), disordered eating (aOR = 1.55), and alcohol abuse (aOR = 1.71), but not physical inactivity. On the other hand, physical inactivity was associated with depressive symptoms (aOR = 2.48), anxiety symptoms (aOR = 1.74), distress (aOR = 2.02), and low well-being (aOR = 3.25). A total of 37.7% respondents reported being strongly lonely, as measured with the De Jong Gierveld Loneliness Scale. The amount of screen time, but not PSU, was associated with loneliness. In sum, PSU affects more than one-third of adolescents and young adults in Austria and is associated with increased mental health symptoms. However, intensive screen time seems to be more strongly associated with increased mental health symptoms than PSU itself. The study confirms once again that smartphone use is associated with negative effects and that they should be used responsibly.

Moderation effects of health behaviors on stress and suicidal ideation in adolescents: a cross-sectional survey during COVID-19.

This cross-sectional online survey study investigated whether certain health behaviors moderated the relationship between perceived stress and suicidal ideation in Austrian adolescents during the COVID-19 pandemic. A total of 1505 14-20-year-old (median age = 16) high school students (77.9% female) filled out an online survey from September to November 2021. Perceived stress was measured with the PSS10, suicidal ideation with item 9 of the PHQ-9. The following health behaviors were assessed: Physical activity (days/week), phone use (hours/day), problematic drinking behavior (CAGE). All three health behaviors significantly moderated the relationship between perceived stress and suicidal ideation (all p < .05), but effects were small. The moderation analyses revealed that higher physical activity and less time spent on the phone were associated with less suicidal ideation at higher stress levels. Showing signs of problematic drinking behavior was associated with higher suicidal ideation at higher stress levels. In conclusion, these results suggest that some health behaviors may be able to act as a buffer between perceived stress and suicidal ideation. However, more research is needed to confirm these potentially buffering effects.

Mental health burden of high school students, and suggestions for psychosocial support, 1.5 years into the COVID-19 pandemic in Austria.

The COVID-19 pandemic and containment efforts seem to be particularly challenging for adolescents. This study assessed mental health in high school students 1.5 years after the pandemic began in Austria. A cross-sectional survey was carried out from September to November 2021. Well-being (WHO-5), depressive symptoms, anxiety symptoms and sleep quality were assessed. A total of 1505 adolescents participated (78% girls). The cut-offs for clinically relevant symptoms were exceeded by 62% girls and 38.1% boys for depression (PHQ-9 score ≥ 11), 49% girls and 29% boys for anxiety (GAD-7 score ≥ 11) and 28% girls and 17% boys for insomnia (ISI score ≥ 15). The prevalence of suicidal ideation (item 9 of the PHQ-9) within the last 2 weeks was 47% in girls and 32% in boys. These data collected in autumn 2021 (the start of the second semester of reopened schools; t2) were compared to data collected in February 2021 (one semester after remote schooling; t1). A matched pairs analysis according to age, gender, region, school type and migration background resulted in a total sample size of N = 2514 adolescents. Results showed small deteriorations in mental health (i.e., well-being, depression, insomnia, suicidal ideation) in girls at t2 compared to t1, and an increase in suicidal thoughts in boys (all p-values < 0.05). Qualitative data show that young people have a need for more psychological support, both professional and informal, as well as increased mental health literacy. Results suggest that mental health burden in adolescents remains high 1.5 years into the pandemic and highlight the need to implement timely psychological support.

The Impact of Coping Styles and Gender on Situational Coping: An Ecological Momentary Assessment Study With the mHealth Application TrackYourStress.

The aim of this study was to investigate the impact of different coping styles on situational coping in everyday life situations and gender differences. An ecological momentary assessment study with the mobile health app TrackYourStress was conducted with 113 participants. The coping styles Positive Thinking, Active Stress Coping, Social Support, Support in Faith, and Alcohol and Cigarette Consumption of the Stress and Coping Inventory were measured at baseline. Situational coping was assessed by the question "How well can you cope with your momentary stress level" over 4 weeks. Multilevel models were conducted to test the effects of the coping styles on situational coping. Additionally, gender differences were evaluated. Positive Thinking (p = 0.03) and Active Stress Coping (p = 0.04) had significant positive impacts on situational coping in the total sample. For women, Social Support had a significant positive effect on situational coping (p = 0.046). For men, Active Stress Coping had a significant positive effect on situational coping (p = 0.001). Women had higher scores on the SCI scale Social Support than men (p = 0.007). These results suggest that different coping styles could be more effective in daily life for women than for men. Taking this into account, interventions tailored to users' coping styles might lead to better coping outcomes than generalized interventions.

Problematic alcohol use in Austrian apprentices during the COVID-19 pandemic.

This study assessed problematic alcohol use in Austrian apprentices during the COVID-19 pandemic. An online survey was performed via REDCap with a sample of 1442 apprentices (53.3% female, 45.4% male, 1.1% non-binary, 28.4% migration background) from 29th March to 18th May 2021. The CAGE questionnaire was used to measure problematic alcohol use. Chi-square tests revealed that problematic alcohol use was more likely in apprentices with depressive symptoms (OR: 2.1), anxiety (OR: 2.1) or insomnia (OR: 1.4) and those over 18 (OR: 1.6). There were no differences in problematic alcohol use according to gender, migration background, or lockdown status.

Health Behaviors in Austrian Apprentices and School Students during the COVID-19 Pandemic.

BACKGROUND: The COVID-19 pandemic has disrupted our daily lives, which in turn has impacted health behaviors. Young people have been particularly affected. This study aimed to assess health behaviors in Austrian apprentices and high school students during the COVID-19 pandemic and whether vaccination willingness is affected by health behaviors. METHODS: Two online surveys were conducted via REDCap with 1442 apprentices (female: 53.5%, male: 45.4%) from 29 March to 18 May 2021 and 563 school students (female: 79.6%, male: 18.6%) from 19 June to 2 July 2021. The two samples were matched to account for sociodemographic differences and analyses were run on the matched sample. Besides the health behaviors, namely, smoking, alcohol consumption, cannabis consumption, and exercise, health status and vaccination willingness were also assessed. RESULTS: Health behaviors were affected by both education group and gender. Apprentices reported significantly more smoking than high school students and this difference was more pronounced in women (all p < 0.01). Alcohol consumption was higher in apprentices than school students, but only in women (p < 0.01). There was a trend for the two education groups to differ in their cannabis use as well (p = 0.05). Apprentices took part in more weekly exercise (p < 0.0001), but high school students reported better average health status (p < 0.001). When included in the same model, health behaviors did not affect vaccine willingness, but education group did, with high school students showing a higher willingness to receive the COVD-19 vaccine than apprentices. CONCLUSIONS: These findings support the argument that education type is an important factor for health behaviors, but this is also mediated by gender. Appropriate interventions for adolescents are needed to prevent adverse health behavior changes following the COVID-19 pandemic.

Mental Health of Apprentices during the COVID-19 Pandemic in Austria and the Effect of Gender, Migration Background, and Work Situation.

This study assessed the mental health of apprentices during the COVID-19 pandemic in Austria and the effect of gender, migration background, work situation, and work sector. An online survey via REDCap was performed with a sample of 1442 apprentices (female: 53.5%, male: 45.4%, diverse: 1.1%, migration background: 28.4%) from 29 March to 18 May 2021. Indicators of mental health were depression (PHQ-9), anxiety (GAD-7), well-being (WHO-5), disordered eating (EAT-8), and insomnia (ISI-7). There was a high prevalence of clinically relevant depression (cut-offs ≥11 for adolescents, ≥10 for adults: 48.3%), anxiety (cut-offs ≥11 for adolescents, ≥10 for adults: 35.4%), insomnia (cut-off ≥15: 27%), and disordered eating (cut-offs ≥2 for men, ≥3 for women: 50.6%). Linear models revealed that apprentices with female and diverse gender, migration background, and unemployed status showed the poorest scores on all mental health measures (all p-values < 0.05) except disordered eating. These findings emphasize the need for intersectional strategies to reduce and prevent adverse mental health consequences of the COVID-19 pandemic for apprentices.

Correction: Relationship quality and mental health during COVID-19 lockdown.

[This corrects the article DOI: 10.1371/journal.pone.0238906.].

Psychometric qualities of the English Coping Scales of the Stress and Coping Inventory in a representative UK sample.

BACKGROUND: The Coping Scales of the Stress and Coping Inventory (SCI; Satow in Stress- und Coping-Inventar (SCI): Test- und Skalendokumentation. Stress and coping inventory. http://www.drsatow.de , 2012) are well-established German self-report scales measuring five coping styles: Positive Thinking, Active Coping, Social Support, Support in Faith, and Alcohol and Cigarette Consumption. The purpose of this study was to translate the scales into English and to psychometrically evaluate this English version of the SCI coping scales with a representative sample of the UK population. METHODS: The coping scales of the SCI were forward-backward translated into English and administered to a representative sample according to age, gender, education, and region for the UK (N = 1006). Internal consistencies, factorial validity, and construct validity were assessed for both the original factor structure of the SCI, as well as a newly identified factor structure. RESULTS: The results for the original factor structure indicated good internal consistency and construct validity. The adaptive coping styles of this version were positively correlated with resilience and negatively with perceived stress. The maladaptive coping strategy, alcohol and cigarette consumption, showed the opposite correlations. The exploratory factor analysis (EFA) of the English version resulted in a five-factor structure, but some items loaded on different factors than in the German version. These new factors were Religious Coping, Social Support, Various Coping, Alcohol and Cigarette Consumption, and Reflective Coping. The novel factors showed similar correlations to resilience and perceived stress as the original factor structure. Only religious coping did not significantly correlate to perceived stress. Confirmatory factor analysis with the original factor structure of the German SCI coping scales revealed poor model fit for the English SCI coping scales. CONCLUSION: The English SCI coping scales consistently and accurately measure five different coping styles. Nevertheless, the original factor structure of the SCI coping scales, when applied to an English-speaking sample, did not fit the data well. The new factor structure established by EFA is only preliminary and needs further validation in future large samples using the English version of the SCI coping scales.

Relationship quality and mental health during COVID-19 lockdown.

Catastrophes are known to have an impact on relationships as well as on mental health. This study evaluated differences in several mental health and well-being measures according to relationship quality during the Coronavirus Disease (COVID-19) pandemic and related lockdown measures. A cross-sectional online survey was launched four weeks after lockdown measures were implemented in Austria. Relationship quality was measured with the Quality of Marriage Index (QMI), and mental health measures included quality of life (WHO-QOL BREF psychological domain), well-being (WHO-5), depression (PHQ-9), anxiety (GAD-7), stress (PSS-10), and sleep quality (ISI). ANOVAs with Bonferroni-corrected post-hoc tests and Chisquared tests were applied. In all mental health scales, individuals with good relationship quality (n = 543) scored better than individuals with poor relationship quality (n = 190) or without relationship (n = 272). The odds ratios (OR) between the poor and good relationship quality groups were 3.5 for the PHQ-9, 3.4 for the GAD-7, and 2.0 for the ISI. Additionally, individuals without no relationship scored better on all scales than individuals with poor relationship quality (all p-values < .05). Relationship quality was related to mental health during COVID-19. The prevalence of depressive symptoms increased according to relationship quality from 13% up to 35%. Relationship per se was not associated with better mental health, but the quality of the relationship was essential. Compared to no relationship, a good relationship quality was a protective factor whereas a poor relationship quality was a risk factor.

Exploring the Time Trend of Stress Levels While Using the Crowdsensing Mobile Health Platform, TrackYourStress, and the Influence of Perceived Stress Reactivity: Ecological Momentary Assessment Pilot Study.

BACKGROUND: The mobile phone app, TrackYourStress (TYS), is a new crowdsensing mobile health platform for ecological momentary assessments of perceived stress levels. OBJECTIVE: In this pilot study, we aimed to investigate the time trend of stress levels while using TYS for the entire population being studied and whether the individuals' perceived stress reactivity moderates stress level changes while using TYS. METHODS: Using TYS, stress levels were measured repeatedly with the 4-item version of the Perceived Stress Scale (PSS-4), and perceived stress reactivity was measured once with the Perceived Stress Reactivity Scale (PSRS). A total of 78 nonclinical participants, who provided 1 PSRS assessment and at least 4 repeated PSS-4 measurements, were included in this pilot study. Linear multilevel models were used to analyze the time trend of stress levels and interactions with perceived stress reactivity. RESULTS: Across the whole sample, stress levels did not change while using TYS (P=.83). Except for one subscale of the PSRS, interindividual differences in perceived stress reactivity did not influence the trajectories of stress levels. However, participants with higher scores on the PSRS subscale reactivity to failure showed a stronger increase of stress levels while using TYS than participants with lower scores (P=.04). CONCLUSIONS: TYS tracks the stress levels in daily life, and most of the results showed that stress levels do not change while using TYS. Controlled trials are necessary to evaluate whether it is specifically TYS or any other influence that worsens the stress levels of participants with higher reactivity to failure.

Depression According to ICD-10 Clinical Interview vs. Depression According to the Epidemiologic Studies Depression Scale to Predict Pain Therapy Outcomes.

PURPOSE: Pain and depression have been shown to have a bidirectional interaction. Although several outcome studies have been conducted, it is still unclear if and how depression influences pain outcome. The current study aims to further clarify this relationship by comparing the predicting value of an interview- and a questionnaire-based assessment of depression. PATIENTS AND METHODS: This retrospective study analyzed data of N = 496 chronic pain patients who received a multimodal pain management program. Multilevel models were performed with depression as predictor, pain measures as dependent variables, and the respective pain score at baseline as covariate. Depression was measured at baseline with (1) a semi-structured psychiatric interview corresponding to the ICD-10 and (2) the Center for Epidemiologic Studies Depression Scale (CES-D). Pain outcomes were pain intensity assessed with the Numeric Rating Scale (NRS), pain disability measured with the pain disability index (PDI), and affective as well as sensory pain perception assessed with the Pain Perception Scale (PPS-A/PPS-S). RESULTS: At post-treatment, pain intensity (NRS) was higher in patients with depression. This result emerged for interview- (ICD-10) and questionnaire- (CES-D) based depression. These results were significant after correction for multiple testing as well. Moreover, affective pain perception (PSS-A) at post-treatment was higher in patients with depression. Again, this result emerged for interview- (ICD-10) and questionnaire- (CES-D) based depression but it was not significant anymore after correction for multiple testing. Furthermore, pain disability (PDI) was higher at post-treatment in patients with depression according to the CES-D than in those without CES-D depression and this difference in the PDI did not emerge for interview-based depression. Yet, this difference on the PDI between the CES-D depression group and the CES-D no depression group was not significant anymore after correction for multiple testing. CONCLUSION: The hypothesis that how depression is assessed - interview-based corresponding to the ICD-10 or with the CES-D - contributes to the association between depression and pain treatment outcome could not be confirmed. Future research should use more than one interview and questionnaire to assess depression, since our results are limited to the clinical ICD-10 interview and the CES-D.

Effectiveness of a 5-Week Inpatient Dialectical Behavior Therapy for Borderline Personality Disorder.

OBJECTIVE: The goal of this study was to evaluate whether symptoms are reduced and emotion regulation improves when patients with borderline personality disorder (BPD) receive a 5-week course of inpatient dialectical behavioral therapy (DBT) and if changes in emotion regulation are associated with changes in symptoms. METHODS: Forty-four patients with BPD receiving a 5-week course of DBT in a German psychiatry clinic participated. The short version of the "Borderline Symptom List" (BSL-23) was the patient-reported outcome. To measure emotion regulation, the "Self-Report Measure for the Assessment of Emotion Regulation Skills" (SEK-27) was administered. Wilcoxon tests were performed to evaluate whether pre-post changes in the BSL-23 and SEK-27 reached statistical significance. Effect sizes (d) were calculated and correlations between the pre-post differences for both measures were computed to test associations between changes in emotion regulation and changes in symptoms. Completer (n=33) and intention-to-treat (n=43) analyses were performed. RESULTS: Symptoms (BSL-23) were reduced and emotion regulation (SEK-27) improved during the 5-week inpatient DBT treatment (completer and intention-to-treat analysis: P<0.001). Effect sizes reached d=0.47 for the BSL-23 and d=0.84 for the SEK-27 in the completer analysis, and d=0.38 for the BSL-23 and d=0.68 for the SEK-27 in the intention-to-treat analysis. Improvements in emotion regulation (SEK-27) were correlated with reductions in symptoms (BSL-23) in both the completer (r=0.54; P=0.001) and the intention-to-treat (r=0.59; P<0.001) analyses. CONCLUSIONS: These findings indicate that a 5-week course of inpatient DBT can effectively reduce symptoms in patients with BPD and that the more patients' emotion regulation improves, the more the patients benefit from the therapy.