The network analysis of anxiety, depression and academic burnout symptom relationships throughout early, middle, and late adolescence.

BACKGROUND: Previous research has explored the associations between anxiety, depression, and academic burnout primarily from a variable-level perspective. However, there is limited understanding of which symptoms might play a significant role in anxiety, depression, and academic burnout among adolescents at different stages. METHODS: This study included 7,286 adolescents aged 10 to 18. Questionnaires assessed participants' anxiety, depression, and academic burnout. Network analysis was conducted on the overall sample and segmented by early, middle, and late adolescence to explore relationships between symptoms and variations in symptom expression across these stages, aiming to propose effective interventions targeting anxiety, depression, and academic burnout symptoms in early, middle, and late adolescence. RESULTS: The study found that "feeling that studying is meaningless" emerged as a core symptom in the overall sample. Additionally, "acting or speaking slowly" emerged as a core symptom in early adolescence, while "the thought of dying or hurting" and "feeling bad about yourself, letting your family down" were prominent in middle adolescence, and "easily annoyed or irritable" and "feeling tired" may be prioritized in late adolescence. The varying central symptoms across different adolescent stages suggest the need for targeted interventions. CONCLUSION: These findings underscore the importance of interventions tailored to specific symptoms to meet the unique needs of adolescents at different developmental stages.

Association between parental phubbing and short-form video addiction: A moderated mediation analysis among Chinese adolescents.

BACKGROUND: Short-form video applications have spread rapidly and gained popularity among adolescents for their interactivity, sociality, and personalization. However, excessive and uncontrolled use has also caused some adolescents to develop short-form video addiction (SFVA). Although parental phubbing has been shown to be a risk factor for SFVA in adolescents, its intermediate mechanisms, particularly the emotional mediation mechanisms, remain unclear. Therefore, this study aims to explore the relationships among parental phubbing, SFVA, symptoms of depression and anxiety, and neuroticism in adolescents. METHODS: Adolescents aged 13-19 (N = 5785) were recruited from Shandong Province, China, as participants in 2023. Participants were asked to complete five self-report questionnaires, including the Parental Phubbing Behavior Questionnaire (PPBQ), Short-Form Video Addiction (SFVA) Scale, The Center for Epidemiological Studies Depression Scale (CESD20), Generalized Anxiety Disorder 7-item (GAD-7) Scale, and Chinese Big Five Personality Inventory (Brief Version) (CBF-PI-B). RESULTS: The results indicate that the influence of parental phubbing on short-form video addiction among adolescents is mediated by symptoms of depression and anxiety. Additionally, neuroticism moderates the association between parental phubbing and symptoms of depression and anxiety. LIMITATIONS: Cross-sectional design limits causal inferences. Reliance on self-report scales. CONCLUSIONS: These findings contribute to a better understanding of the systemic impact mechanisms of negative family interactions on SFVA. Moreover, prevention and intervention strategies targeting high neuroticism and symptoms of depression and anxiety may help prevent the developmental pathway from parental phubbing to SFVA.

Investigating the interplay of chronotypes, neuropsychiatric dimensions, demographic and clinical characteristics and disability in migraine patients: A cross-sectional assessment.

The study investigated associations between chronotypes (Morning [M], Neither [N], Evening [E]), sociodemographic characteristics, body mass index (BMI), smoking habits, years with migraines, sleep quality (PSQI), anxiety (HADS-A), depression (HADS-D), migraine disability (MIDAS), headache frequency, and pain intensity (VAS) in 80 individuals with migraine. Significant age differences emerged (p < 0.001), with M-types being the oldest. BMI also varied, with M-types presenting the highest median BMI (p = 0.005). While migraine duration and headache frequency showed no significant variance, sleep quality did, with E-types reporting the poorest sleep (p = 0.030). Anxiety and depression were significantly worse in E-types (HADS-A: p = 0.002; HADS-D: p = 0.010). Differences in MIDAS levels were notable (p = 0.038); however, differences in MIDAS scores were not significant (p = 0.115). Pain intensity varied, with E-types experiencing the most severe pain (p = 0.009). Post-hoc analysis showed higher MIDAS scores in E-types compared to N-types (χ2 = 6.56, p = 0.038, ε2 = 0.0831). The findings highlight the need for thorough patient evaluations and tailored care, considering the complex interplay of factors affecting migraine severity, particularly among different chronotypes.

Dynamic links between daily anxiety symptoms and young adults' daily well-being.

BACKGROUND: Anxiety disorders are prevalent among youth and adults. Increasing studies examined the dynamic associations between momentary fluctuations of anxiety and well-being, primarily focusing on the severity of general anxiety. Scant research has explored the co-fluctuations between different anxiety symptoms and mental health outcomes. METHOD: The current study evaluated the multi-level factor structure and assessed the subclinical symptoms of generalized anxiety disorder (GAD), social phobia (SP), and panic disorder (PD) in a sample of non-clinical young adults (N = 271, Mage = 18 years, 72% female, 68% non-White) who participated in a 30-day daily diary study. RESULTS: Between persons, GAD, SP, and PD were positively correlated with depressive symptoms, stress, as well as emotional and peer problems. Within persons, both SP and PD were positively associated with stress, peer and emotional problems on the same day. Across days, there was positive reciprocal relation between PD and stress, whereas negative reciprocal link was observed between SP and emotional problems. CONCLUSIONS: Current findings showed dynamic and distinct patterns in the associations between different anxiety symptoms and several mental health outcomes, which emphasizes the need to disentangle between- and within-person variation of anxiety symptoms with intensive longitudinal designs.

The impact of mold exposure on anxiety symptoms in the older adults: A moderated mediation model based on CLHLS.

BACKGROUND: Mold exposure is a common environmental issue that can adversely affect health, particularly among older adults. The impact of mold exposure on anxiety symptoms in this population has not been extensively studied. OBJECTIVE: This study aims to examine the relationship between mold exposure and anxiety symptoms in older adults, considering the mediating role of cognitive function and the moderating effects of open window ventilation and multivitamin supplementation. METHODS: Data from the eighth wave of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) was utilized, including 11,021 participants aged 65 and older. Logistic regression models and moderated mediation analysis were employed to explore these relationships. RESULTS: Mold exposure was significantly associated with increased anxiety symptoms (OR=1.831, 95 % CI=1.588-2.110). Cognitive impairment partially mediated this relationship. Open window ventilation (B=-0.040, P<0.001) and multivitamin supplementation (B=-0.197, P<0.001) served as protective factors. Subgroup analysis indicated higher vulnerability among females (OR=1.72, P<0.001), those aged 65-79 (OR=1.86, P<0.001), urban residents (OR=2.50, P<0.001), individuals not living with family members (OR=1.89, P<0.001), those with higher education (OR=2.01, P<0.001), married individuals (OR=1.80, P<0.001), and those in very good health (OR=2.11, P=0.026). CONCLUSION: Mold exposure contributes to anxiety symptoms in older adults, with cognitive decline playing a mediating role. Effective interventions, including improved ventilation and multivitamin supplementation, can mitigate these effects. These findings highlight the need for targeted public health strategies to enhance the well-being of older adults.

Anxiety in Patients with Post-COVID Syndrome: Associated Factors.

Introduction: The term "post-COVID-19 syndrome" describes a range of symptoms persisting beyond the acute phase of the disease. These symptoms predominantly include fatigue, muscle pain, shortness of breath, and psychological issues. Research additionally suggests the possibility of long-term neurological and psychiatric impairment associated with COVID-19. Methodology: The study included patients who visited the post-COVID outpatient clinic between April 2020 and June 2022. The examination included the detailed history taking, including the COVID-19 course, posteroanterior chest X-ray and pulmonary function tests. Anxiety level was assessed using the Beck Anxiety Inventory (BAI). The relationship between anxiety, demographic data, and course of the disease, need for hospital admission during the acute phase, oxygen therapy, post-inflammatory changes on the chest X-ray and lung function parameters was investigated. Results: This study included 1756 patients who experienced COVID-19 and visited a post-COVID outpatient clinic. The majority of individuals experienced a mild form of the infection. The results showed that younger age and female gender were associated with significantly higher anxiety scores. Inpatients had lower BAI values than those who were not hospitalized during acute phase. Patients with post-inflammatory changes on chest X-ray had surprisingly lower BAI values. Lower values of FEV1 (forced expiratory volume in 1 second), DLCO (diffusing capacity of the lungs for carbon monoxide), and KCO (carbon monoxide transfer coefficient) were associated with significantly higher BAI values. Female gender was associated with higher levels of anxiety. In contrast, higher FEV1 values reduced the risk of a pathological level of anxiety. Conclusion: In our study, the influence of age, gender, inpatient care during the acute phase of infection, the presence of post-inflammatory changes on the chest diagram and selected parameters of lung function (FEV1, DLCO, and KCO) were shown to be important factors in the assessment of anxiety symptoms in post-COVID patients.

Leptin, ghrelin and high-molecular-weight adiponectin in relation to anxiety in older adults.

BACKGROUND: Leptin and ghrelin have been linked to depressive symptoms in older adults. There is a large overlap between depression and anxiety in this group. It is unclear whether the same associations exist with anxiety. Adiponectin has an inverse association with anxiety in older adults. However, the association between the most biologically active isoform - high-molecular-weight (HMW) adiponectin - and anxiety has not been previously reported. METHODS: We analyzed the association between leptin, ghrelin and HMW adiponectin and general symptoms of anxiety (HADS-A score ≥ 7) at baseline and after three years of follow-up in a population based cohort of older adults in the Netherlands (n = 898) using multivariable logistic regression analyses. RESULTS: For leptin there was significant effect modification by sex. We found a positive association between leptin and general symptoms of anxiety in men at baseline and after three years of follow-up after adjusting for depressive symptoms, when comparing the third to the first leptin tertile (T3 vs T1 OR 3.40, 95 % CI 1.08 - 10.78). We found no significant associations for ghrelin. HMW adiponectin was associated with general symptoms of anxiety at follow up. We found a positive association both before and after adjustment for depressive symptoms (T3 vs T1 OR 3.26, 95 % CI 1.36 - 7.83). CONCLUSIONS: Our results showed significant associations in men only between leptin and HMW adiponectin and general symptoms of anxiety after three years of follow up. Our findings contribute to further insight into the pathophysiology of anxiety in older adults. However, further research is necessary as we show associations.

Analysis of the effect of BMI on depression and anxiety among older adults in China: the mediating role of ADL and IADL.

Background: Anxiety and depression are serious psychological and public health issues among the older adults. Currently, there is a lack of understanding of the relationship between Body Mass Index (BMI) and anxiety or depression symptoms in the older adult population in China. Therefore, the purpose of this study is to investigate the impact of BMI on anxiety and depression through correlation analysis in different subgroups and to examine the potential chain mediating effects of Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) between BMI and symptoms of anxiety and depression. Methods: From the CLHLS database conducted in 2017-2018, data regarding height, weight, anxiety symptoms, depression symptoms, as well as demographic, socioeconomic, behavioral, and health-related characteristics were collected. Multivariate logistic regression analysis was used to explore the impact of BMI on anxiety and depression symptoms. Finally, the SPSS macro process was utilized to test the multiple mediating effects of ADL and IADL between BMI and anxiety or depression symptoms. Results: After screening, a final sample of 9,098 Chinese older adult individuals aged 65 and above was selected. Among them, 1,074 cases (11.8%) exhibited anxiety symptoms, 1,458 cases (16.0%) exhibited depressive symptoms. Compared to normal BMI, the adjusted analysis showed that underweight in Chinese older adult individuals was significantly associated with anxiety (OR = 1.316, p = 0.004) and depression (OR = 1.232, p = 0.013). This relationship was found to be more significant in males, individuals aged 80 and above, unmarried individuals, and those residing in town. ADL and IADL played a chain-mediated role between BMI and anxiety symptoms in the older adult. BMI not only had a direct effect on anxiety symptoms in the older adult (effect = -0.0159; SE = 0.0066; 95%CI: LL = -0.0288, UL = -0.0031), but also influenced them indirectly through two pathways: the independent mediating role of IADL (effect = -0.0010; SE = 0.0005; 95%CI: LL = -0.0018, UL = -0.0003) and the chain-mediated role of ADL and IADL (effect = -0.0012; SE = 0.0004; 95%CI: LL = -0.0020, UL = -0.0006). Conclusion: In the older adult individuals in China, underweight is associated with an increased risk of anxiety and depression symptoms. Improving the underweight condition of Chinese older adult individuals can reduce their ADL and IADL limitations, thereby benefiting their mental health.

Perceived control ameliorates the impact of adverse childhood experiences on downstream mental health.

BACKGROUND: Previous scholarship has illustrated the pernicious role of adverse childhood experiences (ACEs) in self-reported mental health, namely depressive and anxiety-related symptoms. Given these insights, highlighting protective factors that may diminish the magnitude of this relationship is important. The present study explored the moderating role of perceived control on the relationship between ACEs and depressive and anxiety symptoms, respectively. METHODS: Participants consisted of a US-based non-clinical sample of 567 undergraduate students who completed a battery of surveys related to psychological wellbeing and individual differences. A series of hierarchical linear regression analyses were utilized for hypothesis testing. RESULTS: Consistent with our main hypotheses, perceived control moderated the relationship between ACEs and both anxiety and depressive symptoms, respectively. Namely, at low levels of perceived control, ACEs were associated with significantly greater levels of anxiety and depressive symptoms, respectively. However, for those reporting high levels of perceived control, we found no association between ACEs and self-reported symptoms. CONCLUSION: We offer evidence that perceived control may serve as a protective factor for mental health and wellbeing against the influence of adverse childhood experiences.

Relationship between Perceived Family Resilience, Emotional Flexibility, and Anxiety Symptoms: a Parent-Adolescent Dyadic Perspective.

Family resilience is crucial for individual's psychological health. Previous studies explored the protective factors of anxiety at the individual level, with less attention paid to the impact of family interaction from a dyadic perspective. This study utilized the Actor-Partner Interdependence Mediation Model to investigate the relationship between family resilience, emotional flexibility, and anxiety symptoms. A sample of 2144 Chinese parent-adolescent dyads (36% upper grades of primary school, 64% secondary school, 49.39% girls; 70.38% mothers) was recruited. Perceived family resilience was inversely related to anxiety symptoms, directly or indirectly, through the mediation of emotional flexibility at the individual level. At the dyadic level, adolescents' perceived family resilience was significantly associated with parents' anxiety symptoms through their own or parents' emotional flexibility. Parents' perceived family resilience was inversely link to adolescents' anxiety symptoms through parents' emotional flexibility. Parents emotional flexibility also mediated the association between adolescents' perceived family resilience and their anxiety symptoms. These findings contribute to understanding the intricate dynamics of family resilience and psychological outcomes in parent-child relationships under adversity, emphasizing the need for child-centered interventions to improve family members' mental health.

The impact of the COVID-19 pandemic on individuals with pre-existing diabetes mellitus.

OBJECTIVES: To examine the psychosocial impact of the COVID-19 pandemic on patients with a diagnosis of diabetes mellitus (DM). METHODS: Semi-structured interviews were conducted with 31 individuals with DM attending a diabetes clinic to determine the impact of the COVID-19 restrictions on anxiety and depressive symptoms, social and occupational functioning and quality of life. Anxiety symptoms were correlated with functioning, quality of life and diabetes self-management. RESULTS: Likert data demonstrated that social functioning (mean = 5.5, SD = 3.7) and quality of life (mean = 4.1, SD = 3.1) were most impacted by the COVID-19 pandemic. Anxiety symptoms were prevalent with 13 individuals (41.9%) scoring above cut-off scores for the presence of anxiety symptoms based on the Beck Anxiety Inventory. Diabetes self-management was significantly correlated with functioning (r = 0.51, p = 0.006) and inversely correlated with anxiety symptoms (r = -0.51, p = 0.007). A prior history of a depressive or anxiety disorder was associated with significantly increased anxiety symptoms, as well as impaired global functioning (p < 0.01), poorer self-care of diabetes (p = 0.014) and satisfaction with diabetes treatment (p = 0.03). CONCLUSIONS: The psychological and social impact of COVID-19 restrictions on individuals with DM was significant, with poorer management of diabetes correlated with anxiety symptom severity.

A rapid assessment of depressive and anxious symptoms among university students during the COVID-19 public health emergency: A repeated cross-sectional analysis.

OBJECTIVES: To identify potential associations between student characteristics and mental health symptoms during the early parts of the pandemic. PARTICIPANTS: 3,883 students at a large public university on the West Coast of the United States. METHODS: We conducted a repeated cross-sectional survey to assess health-protective behaviors, mental health, social support, and stigma resistance. The survey was administered in April 2020 and again in November/December 2020. Odds of mental health symptoms were estimated using multinomial logistic regression. RESULTS: 39% of respondents reported anxious symptoms, 9% reported depressive symptoms, and 27% reported both anxious and depressive symptoms. AAPI had lower odds of reporting both anxious/depressive symptoms compared to whites (OR = 0.59; 95% CI:0.43-0.81). CONCLUSION: Students reported elevated levels of psychological stress during the pandemic, yet our results may underestimate the actual odds due to stress brought on by COVID-19.

Process of change and efficacy of acceptance and commitment therapy (ACT) for anxiety and depression symptoms in adolescents: A meta-analysis of randomized controlled trials.

INTRODUCTION: Recent literature suggests that acceptance and commitment therapy (ACT) may be an effective approach for treating symptoms of depression and anxiety symptoms in adolescents. This review meta-analyzes the efficacy of ACT on adolescent depression and anxiety, emphasizing the role of process variables (i.e., psychological flexibility). METHODS: We systematically searched MedLine, PsycInfo and Scopus for randomized controlled trials (RCT) investigating the effect of ACT on anxiety/depression in adolescents. Studies were combined using the inverse variance method in a random effects model. Additional subgroup and meta-regression analyses were performed, and risk of bias was assessed. The review was pre-registered (PROSPERO registration number: CRD42023483300). RESULTS: Our review included 27 RCTs with a total of 2860 participants. ACT did not outperform CBT but was significantly more effective than other active controls (e.g., treatment as usual) for depression symptoms and inactive controls for all outcomes. ACT was more effective than inactive controls for all outcomes. Improvements in psychological flexibility significantly predicted reductions in between-group depression and anxiety. Younger age and a higher percentage of women predicted better outcomes for some outcomes. LIMITATIONS: It should be noted that this results may be limited by the fact that all included studies were rated as having a high risk of bias. This is mainly due to the self-reported nature of the measures and the lack of crucial methodological information (e.g., process of randomization and allocation, treatment fidelity assessment). CONCLUSION: Our findings support ACT's efficacy for adolescents, particularly in treating depression symptoms. The proposed mechanism of change (psychological flexibility) plays a significant role in the improvements. ACT is comparable in efficacy to CBT, suggesting its potential as an alternative to traditional cognitive-behavioral approaches.

Incidence of anxiety after traumatic brain injury: a systematic review and meta-analysis.

BACKGROUND: Traumatic brain injury (TBI) is defined as acquired cerebral damage caused by an external mechanical impact, which has the potential to lead to transient or enduring debilitation. TBI is associated with many forms of long-lasting psychiatric conditions, including anxiety disorders. As anxiety is highly debilitating by causing impaired social functioning and decreased quality of life for the afflicted, especially in the form of anxiety disorders such as generalized anxiety disorder, certain efforts have been made to explore the factors associated with it, and one such factor is TBI. METHODS: We searched PubMed, Scopus, and Web of Science on January 26th, 2024 for observational case-control or cohort or cross-sectional studies assessing the incidence of anxiety symptoms or disorders in patients with TBI compared to healthy individuals or the same individuals if pre-TBI information regarding anxiety was available. We calculated the pooled incidence and relative risk (RR) and 95% confidence interval (95CI) using the inverse variance method. Publication bias was assessed using Eggers's regression test. Quality assessment was performed using the Newcastle-Ottawa scale. Sub-group analyses were conducted for the type of anxiety (anxiety disorder vs anxiety symptoms), TBI severity, and type of anxiety disorders. RESULTS: The incidence rate of anxiety after traumatic brain injury was 17.45% (95CI: 12.59%, 22.31%) in a total of 705,024 individuals. Moreover, TBI patients were found to be 1.9 times as likely to have anxiety compared to their non-TBI counterparts [Random effects model RR = 1.90 [1.62; 2.23], p-value < 0.0001] using a population of 569,875 TBI cases and 1,640,312 non-TBI controls. Sub-group analysis revealed TBI severity was not associated with anxiety and generalized anxiety disorder was the most common type of anxiety disorder reported post-TBI. CONCLUSION: Patients who have experienced a TBI exhibit a significantly greater incidence of anxiety symptoms and anxiety disorders in the aftermath when compared to healthy individuals.

Premenstrual dysphoric disorder-an undervalued diagnosis? A cross-sectional study in Hungarian women.

Background: Premenstrual dysphoric disorder (PMDD) is a common but underdiagnosed mental health problem among women of reproductive age, which complicates women's daily lives with the presence of severe psychological symptoms altering everyday functioning. This study aimed to assess the prevalence of probable PMDD, the anxio-depressive symptom severity, and well-being in women affected by PMDD across the menstrual cycle. Methods: 112 women with regular menstrual periods, without hormonal contraceptives were included. The study assessed the presence of probable PMDD using a DSM-5-based screening tool, a retrospective questionnaire assessment, for the detection of premenstrual symptoms. Anxio-depressive symptoms and well-being were assessed using the Beck Depression Inventory, the state subscale of the State-Trait Anxiety Inventory, and the WHO Well-Being Scale. Results: Based on a DSM-5-based screening Tool, the sample was divided into women with probable PMDD diagnosis (PMDD group, n = 68) and women without probable PMDD diagnosis (nonPMDD group, n = 45). The PMDD group reported significantly more severe depressive (F(1; 56.2) = 19.394, p ≤ 0.001) and anxiety (F(1; 35.6) = 17.714, p ≤ 0.001) symptoms and lower well-being (F(1; 44.3) = 4.288, p = 0.04) compared to the non-PMDD group. A binomial logistic regression model was used to examine which factors predict PMDD: the model was significant (χ2(2) = 27.287, p ≤ 0.001), it explained 29.2 % of the variance in PMDD, and classified 71.4 % of the cases correctly. Anxiety (B = 0.058, S.E. = 0.022, Waldχ2(1) = 7.142, p = 0.01, OR = 1.060) and depressive (B = 0.085, S.E. = 0.031, Waldχ2(1) = 7.480, p = 0.01, OR = 1.089) symptoms predicted the likelihood of probable PMDD. Conclusion: Women even with probable PMDD experience significant affective difficulties and lower well-being, which underscore the need for attention towards psychological symptoms even in the case of probable PMDD, and consequently highlights the importance of appropriate assessment and treatment of the clinical appearance of PMDD.

Longitudinal patterns of alcohol and cannabis use among US young adults: Correlates and implications for problematic health outcomes.

INTRODUCTION: Alcohol and cannabis use are common during young adulthood. Less is known regarding correlates of alcohol-cannabis use patterns and related problematic health outcomes. METHODS: Using longitudinal survey data (Fall 2018, 2019, 2020) from 2,194 young adults (YAs; ages 18-34), bivariate analyses and multivariable logistic regressions examined: (1) Wave 1 (W1) sociodemographics and psychosocial factors (i.e., adverse childhood experiences [ACEs], depressive symptoms, personality traits, parent and peer alcohol and cannabis use) in relation to W3 past-month use group (i.e., use of neither, alcohol only, cannabis only, both/co-use); and (2) W3 use group in relation to W5 problematic alcohol use (Alcohol Use Disorder Identification Test), problematic cannabis use (Cannabis Use Disorder Identification Test), and depressive/anxiety symptoms (Patient Health Questionnaire - 4 item). RESULTS: Overall, 42.3% reported W3 alcohol-only use, 34.9% co-use, 17.8% no use, and 5.0% cannabis-only use. Those reporting W3 co-use reported greater W1 extraversion, openness, friend alcohol/cannabis use, and were more likely to report parent cannabis use (vs. no use); reported less conscientiousness, greater friend cannabis use, and were more likely to report depressive symptoms and parent cannabis use (vs. alcohol-only use); and reported greater friend alcohol use, and were more likely to report parent alcohol use (vs. cannabis-only use). W3 co-use was associated with higher odds of W5 problematic alcohol use (vs. alcohol-only use) and problematic cannabis use (vs. cannabis-only use). CONCLUSIONS: Substance use messaging and interventions should consider YAs' alcohol-cannabis co-use and the unique correlates of such use.

Virtual reality exposure therapy for social anxiety disorders: a meta-analysis and meta-regression of randomized controlled trials.

BACKGROUND AND OBJECTIVES: Virtual reality exposure therapy offers a unique opportunity to treat social anxiety disorder. This meta-analysis aims to evaluate the effectiveness of virtual reality exposure therapy compared to waitlist comparators or other interventions for individuals with social anxiety disorder in alleviating anxiety symptoms. METHODS: A three-step comprehensive search for the randomized controlled trials of virtual reality exposure therapy was conducted from inception to 7 December 2023. The overall effect was measured using Hedges' g and determined using t-statistics at a significance level of p < 0.05. Sensitivity, subgroup, and meta-regression analyses were carried out. RESULTS: A total of 17 randomized control trials were retrieved from nine electronic databases. Virtual reality exposure therapy has greater efficacy than waitlist comparators in reducing anxiety symptoms at post-intervention and follow-up assessment. Virtual reality exposure therapy demonstrates a similar effect to other interventions at post-intervention and follow-up assessment. We observed a greater effect for participants with symptomatic social anxiety when we combined the intervention with cognitive behavioral therapy compared to its counterpart. Meta-regression analyses found no significant covariate. CONCLUSIONS: Overall, virtual reality exposure therapy can provide supplementary therapy for improving anxiety symptoms. Additional high-quality and large-scale trials with long-term follow-up are needed.

Social Anxiety among Middle-Aged Teachers in Secondary Education Schools.

BACKGROUND: This study aimed to investigate the prevalence of social anxiety symptoms (SASs) and its associated factors among middle-aged teachers in secondary education schools. METHODS: A cross-sectional survey was conducted from December 2023 to March 2024 among 341 secondary education schoolteachers aged 45-59 in Chiang Mai, Thailand, involving an online survey. Effects of psychosocial variables on SASs were investigated, including attachment anxiety, attachment avoidance, neuroticism and extraversion personality traits, loneliness, perceived social stress, job burnout, and anxiety and depression. Multiple linear regression was used to identify predictors of SASs. RESULTS: This study found that 98 out of 341 (28.7%) teachers presented SASs. Multiple linear regression analysis showed that marital status (ß = 0.103, 95% CI [0.437, 3.404]), income (ß = 0.087, 95% CI [0.049, 3.758]), extraversion (ß = -0.179, 95% CI [-0.573, -0.198]), attachment anxiety (ß = 0.165, 95% CI [0.106, 0.359]), attachment avoidance (ß = 0.145, 95% CI [0.066, 0.243]), depression (ß = 0.242, 95% CI [0.248, 0.862]), loneliness (ß = 0.182, 95% CI [0.099, 0.580]), and perceived social stress (ß = 0.235, 95% CI [0.131, 0.373]) were significant predictors of SASs, explaining 51.1% of the variance. CONCLUSION: This study discovered a relatively high prevalence of SASs among middle-aged secondary schoolteachers.

Caregiver burden, mental health, quality of life and self-efficacy of family caregivers of persons with dementia in Malaysia: baseline results of a psychoeducational intervention study.

BACKGROUND: The majority of persons with dementia (PWD) are mainly cared for by their family members in the home. Evidence is however scarce on family caregivers' psychosocial burden and quality of life in Asian countries including Malaysia. This study describes the baseline data of a telephone-delivered psychoeducational intervention study and examines the determinants of outcome measures (caregiver burden, depressive and anxiety symptoms, quality of life and caregiving self-efficacy) among Malaysian family caregivers to PWD. METHODS: This was a cross-sectional study originated from the baseline survey of a randomized control trial of 121 family caregivers recruited from lists of PWD who were registered at memory and psychiatry clinics in three tertiary care hospitals in Malaysia. The participants were assessed for caregiver burden by the Zarit Burden Interview, depressive and anxiety symptoms by the Hospital Anxiety and Depression Scale, quality of life by the Control, Autonomy, Self-Realization, and Pleasure Scale, and caregiving self-efficacy by the Revised Scale for Caregiving Self-Efficacy. RESULTS: Prevalence of caregiver burden was 69.4%, depressive symptoms 32.2% and anxiety symptoms 32.2%. Family caregivers to PWD having perceived peer support e.g., social/family/friend/significant other supports were less likely to report caregiver burden, depressive and anxiety symptoms, and more likely to report higher levels of quality of life and caregiving self-efficacy. Being married and PWD's ability to self-care were associated with lesser likelihood of experiencing caregiver burden, depressive and anxiety symptoms. The other determinants of greater probability of reporting better quality of life were caregivers' employment and having Islamic faith. Marital status (married), PWD's ability to self-care, spousal relationship with PWD and shared caregiving process were associated with higher likelihood of reporting caregiving self-efficacy. CONCLUSION: Caregiver burden, depressive and anxiety symptoms are prevalent in family caregivers to PWD in Malaysia. Social support and caregiving related factors influence family caregivers' quality of life and caregiving self-efficacy. Implementing psychoeducational intervention and support in the psychiatry and memory clinics may help improve the psychosocial burden, quality of life and caregiving self-efficacy in family caregivers of PWD. TRIAL REGISTRATION: ISRCTN14565552 (retrospectively registered).

Cross-sectional study on university students' mental health during the COVID-19 pandemic: Exploring the influence of adverse and positive childhood experiences.

Aim: This study examined the psychological impact of the COVID-19 pandemic on university students, focusing on how adverse childhood experiences (ACEs) and positive childhood experiences (PCEs) influence mental health. Methods: A web-based survey was administered to 3000 university students from October 26 to 31, 2022, following the peak of the COVID-19 pandemic. Mental health assessments included the Japanese version of the Kessler Psychological Distress 6-Item Scale (K6) for depressive/anxiety symptoms, the Impact of Event Scale-Revised (IES-R-J) for distress, fear of COVID-19, and a three-item loneliness scale. Results: Of the respondents, 46.9% reported depressive/anxiety symptoms, 55.4% reported distress, and 37.3% reported fear of COVID-19. Factors such as current psychiatric treatment history and reduced income (either parental or personal) were predictive of worsening depressive/anxiety symptoms, distress, and loneliness. ACEs were found to exacerbate depressive/anxiety symptoms and distress, while PCEs mitigated these symptoms, and vice versa. Conclusion: This study underscores the importance of considering both ACEs and PCEs in supporting the mental health of university students. PCEs were found to independently prevent mental health deterioration, including depressive/anxiety symptoms and distress, which may include post-traumatic stress disorder symptoms, even in the presence of ACEs. Recognizing and fostering PCEs emerged as an effective strategy for mitigating mental health issues.