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The purpose of this study was a qualitative analysis of how elementary general music teachers adapt their instruction to meet the needs of elementary students with anxiety disorder in Virginia public schools. The phenomenological research design described the meaning of the shared experiences by students with performance anxiety. The participants for this research consist of elementary music teachers in central Virginia. Through a survey, phenomenological information was collected about how elementary music teachers teach students with anxiety disorder. Data was collected through a survey of elementary school music teachers in central Virginia. This qualitative study employed thematic coding to look for the relationship between past data and current survey results. The study results directly correlated with prior research and the participants' survey answers. Conclusions that were drawn from this research are that music performance anxiety is a mental health phenomenon that many music teachers in Virginia lack proper training to handle the symptoms resulting from students who experience music performance anxiety. Recommendations for future research include utilizing follow-up surveys or interviews to explain why the participants chose the answers that they did and analyzing music performance anxiety research with other areas of the United States to look for correlations between music performance anxiety resources in Virginia compared with the rest of the United States of America.

(1) Background: Infantile colic (IC) is a functional gastrointestinal disorder that affects around 20% of infants, and postpartum (PPD) depression is a common disorder that affects between 15 and 22% of mothers. In this study, our objective was to evaluate the relationship between the maternal psychological state in the first postpartum year and IC, with the aim of assessing the importance of feeding type in infants and maternal well-being. (2) Methods: A cross-sectional study was conducted in women in their first year postpartum. Demographic, medical, and obstetric data of the mothers and infants were collected, and the type of feeding was identified. The emotional status of the mother was evaluated using the Edinburgh Postnatal Depression Scale (EPDS), and the Infant Colic Severity Questionnaire (ICSQ) was used for IC diagnosis. (3) Results: A total of 528 women were analyzed, of which 170 (32%) were diagnosed with possible PPD. Two-thirds of the women without depression breastfed their babies on demand; therefore, we report that exclusive breastfeeding (EBF) appears to reduce the risk of possible PPD (p < 0.001; OR = 2.353). IC was present in 39% of babies, and around 70% of babies without colic were breastfed on demand. Infants who were not exclusively breastfed showed almost double the risk of developing colic (p = 0.016; OR = 1.577). There was a significant association between the EPDS and ICSQ scores (p < 0.001). More than half of the women with PPD had babies with colic. However, our results show that 75% of babies without colic had mothers who reported optimal postpartum emotional well-being (p < 0.001; OR = 2.105). (4) Conclusions: The results of this study suggest that postpartum maternal psychological well-being reduces the risk of IC. Therefore, we report that EBF on demand, together with a healthy emotional state in new mothers, may be a protective factor against colic in infants.

Background: Persons with acute low back pain (LBP) have a good prognosis for regaining function, while pain often persists. Neurobiological and psychosocial factors are recognized to amplify pain responses, as reported for central sensitization. This study investigated the combination of mechanical temporal summation (TS) chosen to characterize central sensitization and state anxiety representing a psychological factor and their association with persistent pain. Methods: A longitudinal prospective cohort study including 176 participants aged between 18 and 65 with acute LBP was performed. The following independent variables were analyzed at baseline: The mechanical TS at the lower back, of whom the Wind-up ratio (WUR) was calculated, and the state anxiety level measured with the State and Trait Anxiety Inventory (STAI-S). The outcome pain intensity was assessed at baseline and 2,3,6 and 12 months after the onset of acute LBP with the Numeric Rating Scale 0–10 (NRS). Linear mixed models (LMM) were used to analyze the association of the independent variables with pain intensity over time. Results: The mean baseline WUR was 1.3 (SD 0.6) for the right and 1.5 (SD 1.0) for the left side. STAI-S revealed a mean score of 43.1 (SD 5.2). Pain intensity was, on average, 5.4 points (SD 1.6) on the NRS and decreased over one year to a mean of 2.2 (SD 2.4). After one year, 56% of the participants still experienced pain. The LMM revealed a considerable variation, as seen in large confidence intervals. Therefore, associations of the independent variables (WUR and STAI-S) with the course of the outcome pain intensity over one year were not established. Conclusion: This investigation did not reveal an association of mechanical TS and state anxiety at baseline with pain intensity during the one year measurement period. Pain persistence, mediated by central sensitization, is a complex mechanism that single mechanical TS and state anxiety cannot capture.

Objective: The effects of panic-specific psychotherapy on occupational functioning remain under-researched. This study tests whether two brief psychotherapies for Panic Disorder with or without Agoraphobia (PD/A) may generate improvement in work ability. Methods: Adults (N = 221) with a primary diagnosis of PD/A were randomised to wait-list, panic-focused psychodynamic psychotherapy (PFPP), panic control treatment (PCT), or to the choice between the two treatments. Participants completed the Work Ability Inventory (WAI) at baseline, post-treatment, and during 24-month follow-ups. Change in WAI scores were assessed using segmented multilevel linear growth models, and mediation was explored through path analysis. Results: WAI scores changed from the moderate to good range between baseline and post-treatment (SMD = 0.45; 95% CI [0.33, 0.57]) and continued to increase throughout the follow-up (SMD = 0.16; 95% CI [0.03, 0.28]) with no differences between treatments or allocation forms. In PFPP (but not in PCT) pre- to post-treatment change in WAI was mediated by reduction in panic symptoms and WAI predicted employment status and absences. Conclusions: Two brief panic specific psychotherapies, one cognitive behavioural and one psychodynamic, produced short and long-term increases in work ability.

Background: Long-acting injectable depot buprenorphine may increase access to opioid agonist treatment (OAT) for patients with opioid use disorder in different treatment phases. The aim of this study was to explore the experiences of depot buprenorphine among Swedish patients with ongoing substance use and multiple psychiatric comorbidities. Method: Semi-structured qualitative interviews were conducted with OAT patients with experience of depot buprenorphine. Recruitment took place at two OAT clinics with a harm reduction focus, specializing in the treatment of patients with ongoing substance use and multiple comorbidities. Nineteen participants were included, 12 men and seven women, with a mean age of 41 years (range 24–56 years), and a mean of 21 years (5–35 years) of experience with illicit substance use. All participants had ongoing substance use and psychiatric comorbidities such as ADHD, anxiety, mood, psychotic and eating disorders. Interviews were transcribed verbatim. Thematic content analysis was conducted both manually and using qualitative data analysis software. Results: Participants reported social benefits and positive changes in self-perception and identity. In particular, depot buprenorphine contributed to a realization that it was possible to make life changes and engage in activities not related to substance use. Another positive aspect that emerged from the interviews was a noticeable relief from perceived pressure to divert OAT medication, while some expressed the lack of income from diverted oral/sublingual OAT medication as a negative, but still acceptable, consequence of the depot buprenorphine. Many participants considered that the information provided prior to starting depot buprenorphine was insufficient. Also, not all patients found depot buprenorphine suitable, and those who experienced coercion exhibited particularly negative attitudes towards the medication. Conclusions: OAT patients with ongoing substance use and multiple psychiatric

The following research aims to determine the association of depressive disorder and anxiety with poor glycemic control in patients with DM2 between 18 and 59 years of age in the Family Medicine Unit 57.A study was carried out with an analytical, observational, ambispective, longitudinal approach, probabilistic convenience sampling in the Family Medicine Unit No. 57 in Irapuato, Guanajuato during the period from December 2022 to July 2023, which has 2547 patients with DM2 between 18 and 59 years of age who met the inclusion criteria, of which only 242 patients were studied, which were divided into 2 groups; one with 121 patients with uncontrolled DM 2 and another with 121 patients with DM 2 in control. According to the Beck test of depression and anxiety, it was observed that patients with lack of control presented a greater number of cases of moderate and severe depression with 40.5% compared to those with good control with 5.8%, and similarly it was observed than patients with moderate anxiety with 28.1% in patients in poor control compared to those with good control with 1.7%, thus giving an important degree of significance for the association of depressive disorder and anxiety with glycemic lack of control., La siguiente investigación pretende determinar la asociación del trastorno depresivo y ansiedad con el descontrol glucémico en pacientes con DM2 de 18 a 59 años de edad en la Unidad de Medicina Familiar 57. Se realizó un estudio con enfoque analítico, observacional, ambispectivo, longitudinal, muestreo probabilístico por conveniencia en la Unidad de Medicina Familiar No. 57 en Irapuato, Guanajuato durante el periodo de diciembre del año 2022 a julio del año 2023, la cual cuenta con 2547 pacientes con DM2 entre los 18 a 59 años de edad que cumplieron con los criterios de inclusión, de los cuales solo se estudiaron 242 pacientes, los cuales se dividieron en 2 grupos; uno con 121 pacientes con DM 2 descontrolados y otro de 121 pacientes con DM 2 en control. De acuerdo con el test de Beck de depresión y ansiedad, se observó que los pacientes con descontrol presentaron un número mayor de casos de depresión moderada y grave con 40.5% en comparación con los de buen control con 5.8%, y de igual forma se observó que los pacientes con ansiedad moderada con un 28.1% en pacientes en descontrol en comparación con los de buen control con 1.7%, dando así un grado de significancia importante para la asociación de trastorno depresivo y ansiedad con descontrol glucémico.

Diese Arbeit beschäftigt sich mit der Geschichte des Alpinismus mit besonderem Augenmerk auf die geschichtliche Entwicklung des Kletterns, geht dann über zur Theorie des Therapeutischen Kletterns, dessen bestehende Datenlage und zu angeführten Wirkfaktoren, die sich auf den psychotherapeutischen und pädagogischen Bereich beziehen. Weiters werden Angststörungen und Posttraumatische Belastungsstörung (PTBS) beschrieben und die dazugehörige Datenlage im Therapeutischen Klettern aufbereitet. Dem Klettern als Kulturtechnik verschuldet, in der es vor allem um Materialität und Körperlichkeit geht, wird das innovative Konzept des Körperwissens (implizites Wissen) miteingebracht. Weiters wird die ausgewählte Methodik der Teilnehmenden Beobachtung beschrieben und abschließend die Feldforschung dargestellt, die das Herzstück dieser Arbeit ausmacht. Die Feldforschung begreift sich als qualitative Sozialforschung, in der anhand einer interdisziplinären Studie ein klettertherapeutisches Bewegungsprogramm angeboten wurde. Dieses versteht sich als Gesundheitsprojekt zur Bewältigung von Angst, gedacht für Angststörungs- und PTBS-Patient*innen. Das Ergebnis ist die Beantwortung der Forschungsfrage „Was Vertrauen beim Therapeutischen Klettern schafft“. Es braucht dazu ein sicherheitgebendes und wohlwollendes Setting, welches sich nur im wechselseitigen Miteinander ergeben kann, das eine positive und verlässliche Haltung gegenüber Partner*in, Material, sich selbst und in das Können des eigenen Körpers abverlangt und sich durch das wiederholende, gemeinsame Klettern verstärkt und festigt. Ebenfalls konnten die folgenden aus der Literatur eingebrachten sozialen Wirkfaktoren des Therapeutischen Kletterns durch die Forschung bestätigt werden: Förderung der sozialen Kompetenzen, Förderung tragfähiger sozialer Netzwerke und Ermöglichung von Solidaritätserfahrungen, Entwicklung von Vertrauen, Übernahme von Verantwortung und Förderung der Mentalisierungsfähigkeit. In weiterer Folge sollte vor, This work focuses on the history of mountaineering, with particular attention to the historical development of climbing, then transitions to the theory of therapeutic climbing, its existing data, and cited effectiveness factors, which relate to the psychotherapeutic and pedagogical domains. Additionally, anxiety disorders and posttraumatic stress disorder (PTSD) are described, along with the corresponding data in therapeutic climbing. Due to climbing being a cultural technique primarily concerned with materiality and corporeality, the innovative concept of body knowledge (tacit knowledge) is introduced. Furthermore, the selected methodology of participating observation is described, and finally, field research is presented, which constitutes the heart of this work. The field research is understood as qualitative social research, in which a climbing therapeutic exercise program was offered as part of an interdisciplinary study, conceived as a health project for coping with anxiety, aimed at patients with anxiety disorders and PTSD. The result is the answering of the research question "What creates trust in therapeutic climbing." This requires a reassuring and benevolent setting, which can only arise through mutual interaction, demanding a positive and reliable attitude towards partners, materials, oneself, and one's own body's abilities, and is reinforced and solidified through repeated, shared climbing experiences. Furthermore, the following social factors of therapeutic climbing introduced from the literature were confirmed by the research: promotion of social skills, promotion of sustainable social networks, enabling experiences of solidarity, development of trust, assumption of responsibility, and promotion of mentalization ability. Furthermore, sustainability, and consequently the transferability of therapeutic climbing, should be investigated. The question arises of whether the therapy can have long-term effects or is only successful in the short term. The adva, eingereicht von Julian Smekal, BA, in englischer Sprache, Masterarbeit Universität Innsbruck 2024

The following research aims to determine the association of depressive disorder and anxiety with poor glycemic control in patients with DM2 between 18 and 59 years of age in the Family Medicine Unit 57.A study was carried out with an analytical, observational, ambispective, longitudinal approach, probabilistic convenience sampling in the Family Medicine Unit No. 57 in Irapuato, Guanajuato during the period from December 2022 to July 2023, which has 2547 patients with DM2 between 18 and 59 years of age who met the inclusion criteria, of which only 242 patients were studied, which were divided into 2 groups; one with 121 patients with uncontrolled DM 2 and another with 121 patients with DM 2 in control. According to the Beck test of depression and anxiety, it was observed that patients with lack of control presented a greater number of cases of moderate and severe depression with 40.5% compared to those with good control with 5.8%, and similarly it was observed than patients with moderate anxiety with 28.1% in patients in poor control compared to those with good control with 1.7%, thus giving an important degree of significance for the association of depressive disorder and anxiety with glycemic lack of control., La siguiente investigación pretende determinar la asociación del trastorno depresivo y ansiedad con el descontrol glucémico en pacientes con DM2 de 18 a 59 años de edad en la Unidad de Medicina Familiar 57. Se realizó un estudio con enfoque analítico, observacional, ambispectivo, longitudinal, muestreo probabilístico por conveniencia en la Unidad de Medicina Familiar No. 57 en Irapuato, Guanajuato durante el periodo de diciembre del año 2022 a julio del año 2023, la cual cuenta con 2547 pacientes con DM2 entre los 18 a 59 años de edad que cumplieron con los criterios de inclusión, de los cuales solo se estudiaron 242 pacientes, los cuales se dividieron en 2 grupos; uno con 121 pacientes con DM 2 descontrolados y otro de 121 pacientes con DM 2 en control. De acuerdo con el test de Beck de depresión y ansiedad, se observó que los pacientes con descontrol presentaron un número mayor de casos de depresión moderada y grave con 40.5% en comparación con los de buen control con 5.8%, y de igual forma se observó que los pacientes con ansiedad moderada con un 28.1% en pacientes en descontrol en comparación con los de buen control con 1.7%, dando así un grado de significancia importante para la asociación de trastorno depresivo y ansiedad con descontrol glucémico.

This quantitative correlational study aims to examine the challenges secondary students encounter in sustaining positive mental health and how the benefits of music performance anxiety in secondary school students can aid in the accelerated recovery of social anxiety. There is a present gap in the research exploring the benefits of situational anxiety on clinically diagnosed anxiety disorders and noting that this situational anxiety is a standard expectation and volunteered for when participating in performing arts environments. The objective is to understand the therapeutic benefits of micro-dosing the brain with music performance anxiety in a controlled environment and its potential uses in aiding students' mental resilience development. This quantitative study uses a correlational approach guided by the theoretical framework of Edward Thorndike’s learning theory of connectionism. This research aims to gain a comparative understanding of individuals that have consistent music performance anxiety within a controlled environment and how that can assist the brain in its ability to process the symptoms of an anxiety disorder efficiently. The study focuses on the research obtained from data collected in a survey administered to secondary school-aged students. The questions in the survey center on music performance anxiety and how that affects the students. Findings revealed by the research lead to rejecting the null hypothesis as there is evidence for instrumental music experience’s predictive nature and improvement in musical performance anxiety on general anxiety disorder.

Background Although clinical guidelines prioritize the treatment of depression and anxiety in young persons, there is accumulating evidence that the presence of symptoms of borderline personality disorder (BPD) is associated with the limited effectiveness of these standard treatments. These findings stress the need for interventions addressing early-stage BPD in young people with presenting symptoms of anxiety and depressive disorders. The aim of this study is to investigate the (cost-)effectiveness of an early intervention programme for BPD (MBT-early) compared to first-choice psychological treatment for depression and anxiety according to Dutch treatment guidelines (CBT), in adolescents with either depression, anxiety, or both, in combination with early-stage BPD. Methods This study is a multi-centre randomized controlled trial. A total of 132 adolescents, presenting with either depression, anxiety, or both and significant BPD features will be randomized to either MBT-early or CBT. The severity of BPD, symptoms of depression and anxiety, personality, social and academic functioning, and quality of life will be assessed at baseline, end of treatment, and at 12-, 18-, and 24-month follow-up, along with medical costs and costs of productivity losses for cost-effectiveness analyses. Discussion This study will provide an empirical evaluation of the potential surplus value of early intervention in young people for whom treatment oriented at common mental disorders like anxiety and depression may be insufficient given their underlying personality problems. Trial registration Netherlands Trial Register, NL9569. Registered on June 15, 2021.

Background: Exposure-based therapy is the treatment of choice for anxiety disorders, but many patients do not benefit sufficiently from it. Distressing images of threat related to the future or past may maintain the anxiety symptomatology or impede exposure therapy. An intervention that targets threat-related imagery is eye movement desensitization and reprocessing (EMDR) therapy. The main goal of this multicenter randomized controlled trial is to investigate whether EMDR therapy plus exposure therapy, relative to supportive counseling plus exposure therapy, improves treatment efficacy, tolerability, and adherence in patients with panic disorder. In addition, we will examine potential predictors of optimal treatment allocation, mechanisms of change as well as the long term effects of treatment. Finally, we will assess cost-effectiveness. Methods: A multicenter randomized controlled trial mixed design will be conducted. Participants will be 50 patients, aged ≥ 18, diagnosed with a panic disorder. They will be randomly assigned to one of two conditions: EMDR therapy (i.e., flashforward strategy) or supportive counseling (each consisting of four weekly sessions of 90 min each) prior to exposure therapy (consisting of eight weekly sessions of 90 min each). Assessments will be made pre-treatment (T1), between-treatments (T2), post-treatment (T3), one month post-treatment (FU1) and six months post-treatment (FU2) by an assessor blind to treatment condition. The primary outcome measure is severity of panic-related symptoms. Secondary outcome measures are: tolerability of exposure therapy (initial avoidance, willingness to start exposure therapy, considered drop-out; no-show and drop-out), related symptomatology (generalized anxiety, depression), and functional impairment. Discussion: The primary goals of this research are to compare the efficacy, tolerability, and adherence of EMDR therapy plus exposure therapy and supportive counseling plus expo

Background: Across a range of age, educational and clinical characteristics, adults experiencing depression and anxiety already use digital technology to manage their symptoms. Although several reviews and meta-analyses indicated feasibility and efficacy for adults with depression and anxiety, digital treatments are poorly accessed and disseminated. This review illustrates potentials and limitations of interventions that specifically leveraged unique features of digital technology and were grounded in the principles of Cognitive Behavioral Therapy (CBT). Methods: This systematic review followed the PRISMA guidelines. An electronic database search was conducted in October 2021. Peer-reviewed, English-language studies were included if i) they reported data from RCTs for adults aged 18+ who engaged with CBT-informed digital interventions targeting primarily depression and anxiety; ii) they used at least PHQ-9 or GAD-7 as standardized and validated assessment self-report measures for depression and anxiety. Results: Findings from 35 RCTs examining 33 interventions (25 internet-based, 6 mobile-based, a2 mobile/web) are discussed. The quality of the evidence differed widely as many small-scale RCTs reported only short-term feasibility and preliminary efficacy. Effects of CBT-informed digital interventions were substantially larger when compared to waitlist than active control conditions. Greater therapeutic benefits were observed for interventions that offered clinical assistance or were used in combination with other treatments. Conclusions: CBT-informed digital interventions have accumulated enough scientific evidence to be positioned today as: i) a low-intensity tool for those with subclinical levels of symptoms; ii) a first step in a stepped-care approach to service delivery iii) a low-cost, easily accessible option for targeted preventive programs.

BACKGROUND: Reduced Environmental Stimulation Therapy (REST) is a behavioral intervention that systematically attenuates external sensory input to the nervous system. Previous studies have demonstrated acute anxiolytic and antidepressant effects of single sessions of REST in anxious individuals, however the duration and time course of these effects is unknown. In the current study, we used experience sampling and multiple sessions of REST to explore the time course of the anxiolytic and antidepressant effects over a 48-hour time period. METHODS: 75 adults with anxiety and/or depression were randomized to complete 6 sessions of REST (either pool-REST, pool-REST preferred, or chair-REST). Post-REST effects were tracked using experience sampling on a smartphone with a ten-item survey administered at 6 time points for each session (i.e., immediately before and after REST and then 4, 8, 24, and 48 hours later). Using principal component analysis, responses to survey items at baseline were reduced to broad symptom clusters of anxiety, depression, and serenity and were utilized in linear mixed effects models to determine the magnitude and time course of post-REST effects. RESULTS: REST was associated with significant decreases in anxiety and depression, and significant increases in serenity, with effects lasting for 48 hours. Repeated exposure to REST was associated with lower baseline levels of anxiety at later sessions. CONCLUSION: These initial findings suggest that the anxiolytic and antidepressant effects of REST persist for at least two days, and that repeated REST sessions may have additive effects on lowering anxiety-related symptoms. These findings could help to determine the optimal intervention frequency of REST and facilitate future investigations focused on the combination of REST with standard treatments for anxiety and depression.

Ziel dieser Studie war es, die Effekte des Videospielens auf die psychischen Befindlichkeiten Depressivität, Stress, Ängstlichkeit und Einsamkeit zu erforschen. Es wurde vermutet, dass Videospielen einen positiven Effekt auf jene Folgen besitzt. Diese Studie benutzt einen Mixed Methods Ansatz mit N = 209 Teilnehmer*Innen im quantitativen Teil der Arbeit und N = 5 Teilnehmer*Innen im qualitativen Teil. Der Fragebogen bestand aus fünf Teilen: Soziodemografischen Daten, Videospielverhalten, PHQ-9, GAD-7, PSS-10 und der UCLA-LS. Die qualitative Analyse wurde auf Basis eines semi-strukturierten Interviews, mit einem Leitfaden und narrativen Elemente durchgeführt. Es wurde ein signifikanter positiver Zusammenhang zwischen den Singleplayerspielstunden und den Testwerten des UCLA-LS (p = .01, r = .36) gefunden. Frauen wiesen allerdings einen signifikanten positiven Zusammenhang zwischen den wöchentlichen Spielstunden und den Einsamkeits- (p = .01, r = .40) sowie Depressionswerten (p = .03, r = .33) auf. In der Altersgruppe 18-25 wies das Genre Strategie einen negativen signifikanten Zusammenhang zu den Depressions- (p = .01, r = -.31), und Angstwerten (p = .01, r = -.30) auf. Die Ergebnisse der Interviews weisen auf einen positiven Effekt des Videospielens auf das Wohlbefinden hin. Es konnte gezeigt werden, dass die Präferenz für das Genre Strategie mit niedrigeren Depressivitäts- und Angstwerten zusammenhängt. Allerdings zeigen Frauen eine erhöhte Einsamkeit und Depressivität, umso mehr sie spielen und umgekehrt. Dies könnte, wie im qualitativen Teil beschrieben, daran liegen, dass Frauen in Videospielen häufiger mit toxischem Verhalten konfrontiert werden. Die Studie zeigt auf, dass Videospielen einen positiven Effekt auf die untersuchten Konstrukte haben könnte, es jedoch wichtig ist, das Genre, Geschlecht und Alter in ähnlichen Arbeiten zu inkludieren, da diese die Ergebnisse stark beeinflussen., The purpose of this study was to explore the effects of video gaming on wellbeing and distress - depressiveness, stress, anxiety, and loneliness. It was hypothesized that video gaming has a positive effect on those consequences. This study used a mixed methods approach with N = 209 participants in the quantitative part of the work and N = 5 participants in the qualitative part. The questionnaire consisted of five parts: Sociodemographic Data, Video Game Behavior, PHQ-9, GAD-7, PSS-10, and the UCLA-LS. The Qualitative Analysis was based on a semistructured interview, with narrative elements. A significant positive relationship was found between single-player game hours and test scores on the UCLA-LS (p = .01, r = .36). Against our expectations, females showed a significant positive association between weekly gaming hours and loneliness (p = .01, r = .40) and depression (p = .03, r = .33) scores. In the 18-25 age group, the strategy genre showed the expected negative significant relationship to depression (p = .01, r = -.31), and anxiety scores (p = .01, r = -.30). The results of the interviews indicate a positive effect of video gaming on well-being. It was shown that preference for the genre strategy decreased depressiveness and anxiety scores. Women showed increased loneliness and depressiveness the more they play and vice versa. This could be due to the fact that women are more likely to encounter toxic behavior in video games or that for women video games do not have the same calming effects as for men. The study indicates that video games can have a positive effect on the constructs studied, but it is important to include genre, gender, and age in similar studies as these strongly influence the results., Abweichender Titel laut Übersetzung der Verfasserin/des Verfassers, Masterarbeit Universität Innsbruck 2023

Bakgrund: Depressions- och ångestsyndrom är de vanligaste förekommande psykiska sjukdomarna och leder i stor utsträckning till sjukskrivningar. Patientgruppen utgör en stor del av samhället, samt är en vårdsökande grupp som kommer påträffas inom alla instanser av vården. Det finns en stark korrelation mellan ångest och depression samt fysisk sjukdom, vilket innebär att patientgruppen blir allt vanligare förekommande inom vården. För att kunna förbättra vården blir det därför av stor vikt att förstå vård-upplevelsen utifrån patientens perspektiv. Syfte: att beskriva patienters erfarenheter av faktorer som påverkar vården vid depressions och/eller ångestsyndrom. Metod: En litteraturöversikt över elva artiklar med kvalitativ ansats genomfördes. Resultat: Sex huvudkategorier identifierades: copingstrategier som bidragande faktorer, faktorer som patienten upplever främjar vården, faktorer som patienten upplever försvårar vården, stigmatiseringens konsekvenser för vården, attityder till läkemedelsbehandling av depressions- och ångestsyndrom samt hur patientens självbild påverkar vården. Resultatet redovisar att patienters erfarenheter av försvårande faktorer förekom i större utsträckning än främjande. Erfarenheter som framträdde var bristande bemötande, brister i organisationen, okunskap kring sjukdomsbild samt hur stigmatiseringen påverkar patienten och dennes självbild. Erfarenheter av främjande aspekter var familj och anhöriga som stödjande samt deras eller den egna individens tidigare positiva erfarenheter av vården. Slutsats: Personcentrerad vård kan både underlätta vård och öka följsamheten för denna patientgrupp. För att uppnå en god omvårdnad behöver det etableras en förtroendefull och fördomsfri relation mellan sjuksköterska och patient. Med en personcentrerad omvårdnad stärks patientsäkerheten och sjuksköterskan skapar lättare en förtroendefull relation med patienten., Background: Depressive and anxiety disorder are the most common mental illnesses and largely contribute to sick leave. The patient group constitutes a large part of society and is a care-seeking group that will be encountered in all instances of healthcare. There is a strong correlation between anxiety and depression as well as physical illness, this means that the patient group is becoming increasingly common in healthcare. To improve care, it is therefore of great importance to understand the care-experience from the patient's perspective. Aim: Where to describe patients' experiences of factors that influence care for depressive and/or anxiety disorders. Method: A literature review of eleven articles with a qualitative approach was carried out. Results: Six main categories were identified: coping strategies as contributing factors, factors that the patient perceives as promoting care, factors that the patient perceives as making care more difficult, the consequences of stigma for care, attitudes to drug treatment of depressive and anxiety disorder, and how the patient's self-image affects care. The results report overall on patients' experiences of care where inhibiting factors occur to a greater extent than promoting factors. Experiences that emerged were deficient treatment in healthcare, shortcomings in the organization, unenlightenment about the clinical characteristics of the disease and how the stigma affects the patient and their self-image. Experiences of enablers were family and relatives as motivators as well as their or the individual's own previous positive experiences of care. Conclusion: Person-centred care can both facilitate care and increase adherence for this patient group. To achieve good nursing care a trustful and unprejudiced relationship between the nurse and patient needs to be established. With person-centred nursing care, patient safety is strengthened, and the nurse creates a trusting relationship with the patient more easily.

Background The objective of this population-based register study was (1) to investigate the association between young adults diagnosed with attention-deficit/hyperactivity disorder (ADHD) and subsequent labour market marginalisation (LMM) in two comparison groups, i.e. matched young adults from the general population without ADHD and unaffected siblings to persons with ADHD and (2) to assess the role of comorbid disorders. Methods This study included all young adults in Sweden, aged 19-29 years, with an incident diagnosis of ADHD 2006-2011 (n = 9718). Crude and multivariate sex-stratified hazard ratios (HRs) with 95% confidence intervals (CIs) were measured 5 years after the diagnosis of ADHD for the risk of disability pension, long-term sickness absence (SA) (>90 days), long-term unemployment (>180 days) and a combined measure of all three in young adults with ADHD compared to their siblings without ADHD and a matched comparison group. Results In the adjusted analyses young adults with ADHD had a 10-fold higher risk of disability pension (HR = 10.2; CI 9.3-11.2), a nearly three-fold higher risk of long-term SA (HR = 2.7; CI 2.5-2.8) and a 70% higher risk of long-term unemployment (HR = 1.7; CI 1.6-1.8) compared to the matched comparison group. The risk estimates were lower compared to siblings for disability pension (HR = 9.0; CI 6.6-12.3) and long-term SA (HR = 2.5; CI 2.1-3.1) but higher in the long-term unemployed (HR = 1.9; CI 1.6-2.1). Comorbid disorders explained about one-third of the association between ADHD and disability pension, but less regarding SA and long-term unemployment. Conclusions Young adults with ADHD have a high risk for different measures of LMM and comorbidities explain only a small proportion of this relationship.

Bakgrund: Depressions- och ångestsyndrom är de vanligaste förekommande psykiska sjukdomarna och leder i stor utsträckning till sjukskrivningar. Patientgruppen utgör en stor del av samhället, samt är en vårdsökande grupp som kommer påträffas inom alla instanser av vården. Det finns en stark korrelation mellan ångest och depression samt fysisk sjukdom, vilket innebär att patientgruppen blir allt vanligare förekommande inom vården. För att kunna förbättra vården blir det därför av stor vikt att förstå vård-upplevelsen utifrån patientens perspektiv. Syfte: att beskriva patienters erfarenheter av faktorer som påverkar vården vid depressions och/eller ångestsyndrom. Metod: En litteraturöversikt över elva artiklar med kvalitativ ansats genomfördes. Resultat: Sex huvudkategorier identifierades: copingstrategier som bidragande faktorer, faktorer som patienten upplever främjar vården, faktorer som patienten upplever försvårar vården, stigmatiseringens konsekvenser för vården, attityder till läkemedelsbehandling av depressions- och ångestsyndrom samt hur patientens självbild påverkar vården. Resultatet redovisar att patienters erfarenheter av försvårande faktorer förekom i större utsträckning än främjande. Erfarenheter som framträdde var bristande bemötande, brister i organisationen, okunskap kring sjukdomsbild samt hur stigmatiseringen påverkar patienten och dennes självbild. Erfarenheter av främjande aspekter var familj och anhöriga som stödjande samt deras eller den egna individens tidigare positiva erfarenheter av vården. Slutsats: Personcentrerad vård kan både underlätta vård och öka följsamheten för denna patientgrupp. För att uppnå en god omvårdnad behöver det etableras en förtroendefull och fördomsfri relation mellan sjuksköterska och patient. Med en personcentrerad omvårdnad stärks patientsäkerheten och sjuksköterskan skapar lättare en förtroendefull relation med patienten., Background: Depressive and anxiety disorder are the most common mental illnesses and largely contribute to sick leave. The patient group constitutes a large part of society and is a care-seeking group that will be encountered in all instances of healthcare. There is a strong correlation between anxiety and depression as well as physical illness, this means that the patient group is becoming increasingly common in healthcare. To improve care, it is therefore of great importance to understand the care-experience from the patient's perspective. Aim: Where to describe patients' experiences of factors that influence care for depressive and/or anxiety disorders. Method: A literature review of eleven articles with a qualitative approach was carried out. Results: Six main categories were identified: coping strategies as contributing factors, factors that the patient perceives as promoting care, factors that the patient perceives as making care more difficult, the consequences of stigma for care, attitudes to drug treatment of depressive and anxiety disorder, and how the patient's self-image affects care. The results report overall on patients' experiences of care where inhibiting factors occur to a greater extent than promoting factors. Experiences that emerged were deficient treatment in healthcare, shortcomings in the organization, unenlightenment about the clinical characteristics of the disease and how the stigma affects the patient and their self-image. Experiences of enablers were family and relatives as motivators as well as their or the individual's own previous positive experiences of care. Conclusion: Person-centred care can both facilitate care and increase adherence for this patient group. To achieve good nursing care a trustful and unprejudiced relationship between the nurse and patient needs to be established. With person-centred nursing care, patient safety is strengthened, and the nurse creates a trusting relationship with the patient more easily.

Background The objective of this population-based register study was (1) to investigate the association between young adults diagnosed with attention-deficit/hyperactivity disorder (ADHD) and subsequent labour market marginalisation (LMM) in two comparison groups, i.e. matched young adults from the general population without ADHD and unaffected siblings to persons with ADHD and (2) to assess the role of comorbid disorders. Methods This study included all young adults in Sweden, aged 19-29 years, with an incident diagnosis of ADHD 2006-2011 (n = 9718). Crude and multivariate sex-stratified hazard ratios (HRs) with 95% confidence intervals (CIs) were measured 5 years after the diagnosis of ADHD for the risk of disability pension, long-term sickness absence (SA) (>90 days), long-term unemployment (>180 days) and a combined measure of all three in young adults with ADHD compared to their siblings without ADHD and a matched comparison group. Results In the adjusted analyses young adults with ADHD had a 10-fold higher risk of disability pension (HR = 10.2; CI 9.3-11.2), a nearly three-fold higher risk of long-term SA (HR = 2.7; CI 2.5-2.8) and a 70% higher risk of long-term unemployment (HR = 1.7; CI 1.6-1.8) compared to the matched comparison group. The risk estimates were lower compared to siblings for disability pension (HR = 9.0; CI 6.6-12.3) and long-term SA (HR = 2.5; CI 2.1-3.1) but higher in the long-term unemployed (HR = 1.9; CI 1.6-2.1). Comorbid disorders explained about one-third of the association between ADHD and disability pension, but less regarding SA and long-term unemployment. Conclusions Young adults with ADHD have a high risk for different measures of LMM and comorbidities explain only a small proportion of this relationship.

A considerable number of pregnant women experience fear of childbirth (FOC), characterized by worries and fear of the unpredictable. Despite this, the psychological processes in FOC have received notably little attention. The aim of this study was to advance the understanding by exploring the applicability of the Intolerance of Uncertainty (IU) model on FOC. Anonymous data was collected in a sample of pregnant women (N = 357) with varying levels of FOC. Analyses supported the associations between FOC and all proposed psychological processes: IU, negative problem orientation, positive beliefs about worry and avoidance of inner experiences. The exploration of potential mediators of the relation between IU and FOC revealed that, of the three processes from the model, only positive beliefs about worry were a mediator, and more specifically, a partial mediator between IU and FOC. These findings add to the theoretical understanding of FOC, by indicating that the role of IU may be similar to other conditions inflicted by worry and anxiety, which may inform treatment development. © 2023 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

OBJECTIVE: Many people are struggling to get back to their lives after severe COVID-19. To facilitate their reintegration into everyday life, we need to understand how the process is experienced. We aimed to gain deeper knowledge about this process by interviewing persons one year after hospitalisation due to COVID-19. METHODS: The study is based on a qualitative design, with eleven in-depth interviews conducted one year after discharge for COVID-19. Participants were recruited to form a heterogeneous sample with respect to age, gender and socioeconomic background. All interviews were analysed utilising inductive thematic analysis. RESULTS: From the participants' narratives four themes were identified: 'Concerns and worries in everyday life', 'Supportive and concerned relatives', 'A new way of life-sorrows and advantages' and 'Seize the day-a greater awareness of one´s mortality'. Participants described how they tried to create a functioning everyday life. They were generally afraid of getting COVID-19 again and concerned about future life, where their lack of energy played a major role. Narratives were diverse regarding to what extent the struggle to cope was experienced as emotionally challenging or not. CONCLUSIONS: Participants described an unpredictable recovery after COVID-19, characterised by ups and downs, which created worries concerning their future. In some cases, the worry of getting COVID-19 again was strong enough to keep participants in their homes, as a self-imposed lockdown guarded by anxiety. However, the narratives also revealed gratitude towards being alive and having coped so well. This led to a more positive outlook on life with a greater focus on intrinsic values, close social relations and the deeper meaning of life. Copyright: © 2023 Törnbom et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the o

Background The objective of this population-based register study was (1) to investigate the association between young adults diagnosed with attention-deficit/hyperactivity disorder (ADHD) and subsequent labour market marginalisation (LMM) in two comparison groups, i.e. matched young adults from the general population without ADHD and unaffected siblings to persons with ADHD and (2) to assess the role of comorbid disorders. Methods This study included all young adults in Sweden, aged 19-29 years, with an incident diagnosis of ADHD 2006-2011 (n = 9718). Crude and multivariate sex-stratified hazard ratios (HRs) with 95% confidence intervals (CIs) were measured 5 years after the diagnosis of ADHD for the risk of disability pension, long-term sickness absence (SA) (>90 days), long-term unemployment (>180 days) and a combined measure of all three in young adults with ADHD compared to their siblings without ADHD and a matched comparison group. Results In the adjusted analyses young adults with ADHD had a 10-fold higher risk of disability pension (HR = 10.2; CI 9.3-11.2), a nearly three-fold higher risk of long-term SA (HR = 2.7; CI 2.5-2.8) and a 70% higher risk of long-term unemployment (HR = 1.7; CI 1.6-1.8) compared to the matched comparison group. The risk estimates were lower compared to siblings for disability pension (HR = 9.0; CI 6.6-12.3) and long-term SA (HR = 2.5; CI 2.1-3.1) but higher in the long-term unemployed (HR = 1.9; CI 1.6-2.1). Comorbid disorders explained about one-third of the association between ADHD and disability pension, but less regarding SA and long-term unemployment. Conclusions Young adults with ADHD have a high risk for different measures of LMM and comorbidities explain only a small proportion of this relationship.

Aim: We aimed to develop a decision aid (DA) for individuals with anxiety disorders who consider tapering benzodiazepine (BZD) anxiolytics, and if tapering, tapering BZD anxiolytics with or without cognitive behavioral therapy (CBT) for anxiety. We also assessed its acceptability among stakeholders. Methods: First, we conducted a literature review regarding anxiety disorders to determine treatment options. We cited the results of the systematic review and meta-analysis, which we conducted previously, to describe the related outcomes of two options: tapering BZD anxiolytics with CBT and tapering BZD anxiolytics without CBT. Second, we developed a DA prototype in accordance with the International Patient Decision Aid Standards. We carried out a mixed methods survey to assess the acceptability among stakeholders including those with anxiety disorders and healthcare providers. Results: Our DA provided information such as explanation of anxiety disorders, options of tapering or not tapering BZD anxiolytics (if tapering, the options of tapering BZD anxiolytics with or without CBT) for anxiety disorder, benefits and risks of each option, and a worksheet for value clarification. For patients (n = 21), the DA appeared to be acceptable language (86%), adequate information (81%), and well-balanced presentation (86%). The developed DA was also acceptable for healthcare providers (n = 10). Conclusion: We successfully created a DA for individuals with anxiety disorders who consider tapering BZD anxiolytics, which was acceptable for both patients and healthcare providers. Our DA was designed to assist patients and healthcare providers to involve decision-making about whether to taper BZD anxiolytics or not.

A considerable number of pregnant women experience fear of childbirth (FOC), characterized by worries and fear of the unpredictable. Despite this, the psychological processes in FOC have received notably little attention. The aim of this study was to advance the understanding by exploring the applicability of the Intolerance of Uncertainty (IU) model on FOC. Anonymous data was collected in a sample of pregnant women (N = 357) with varying levels of FOC. Analyses supported the associations between FOC and all proposed psychological processes: IU, negative problem orientation, positive beliefs about worry and avoidance of inner experiences. The exploration of potential mediators of the relation between IU and FOC revealed that, of the three processes from the model, only positive beliefs about worry were a mediator, and more specifically, a partial mediator between IU and FOC. These findings add to the theoretical understanding of FOC, by indicating that the role of IU may be similar to other conditions inflicted by worry and anxiety, which may inform treatment development. © 2023 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

Background The objective of this population-based register study was (1) to investigate the association between young adults diagnosed with attention-deficit/hyperactivity disorder (ADHD) and subsequent labour market marginalisation (LMM) in two comparison groups, i.e. matched young adults from the general population without ADHD and unaffected siblings to persons with ADHD and (2) to assess the role of comorbid disorders. Methods This study included all young adults in Sweden, aged 19-29 years, with an incident diagnosis of ADHD 2006-2011 (n = 9718). Crude and multivariate sex-stratified hazard ratios (HRs) with 95% confidence intervals (CIs) were measured 5 years after the diagnosis of ADHD for the risk of disability pension, long-term sickness absence (SA) (>90 days), long-term unemployment (>180 days) and a combined measure of all three in young adults with ADHD compared to their siblings without ADHD and a matched comparison group. Results In the adjusted analyses young adults with ADHD had a 10-fold higher risk of disability pension (HR = 10.2; CI 9.3-11.2), a nearly three-fold higher risk of long-term SA (HR = 2.7; CI 2.5-2.8) and a 70% higher risk of long-term unemployment (HR = 1.7; CI 1.6-1.8) compared to the matched comparison group. The risk estimates were lower compared to siblings for disability pension (HR = 9.0; CI 6.6-12.3) and long-term SA (HR = 2.5; CI 2.1-3.1) but higher in the long-term unemployed (HR = 1.9; CI 1.6-2.1). Comorbid disorders explained about one-third of the association between ADHD and disability pension, but less regarding SA and long-term unemployment. Conclusions Young adults with ADHD have a high risk for different measures of LMM and comorbidities explain only a small proportion of this relationship.

OBJECTIVE: Many people are struggling to get back to their lives after severe COVID-19. To facilitate their reintegration into everyday life, we need to understand how the process is experienced. We aimed to gain deeper knowledge about this process by interviewing persons one year after hospitalisation due to COVID-19. METHODS: The study is based on a qualitative design, with eleven in-depth interviews conducted one year after discharge for COVID-19. Participants were recruited to form a heterogeneous sample with respect to age, gender and socioeconomic background. All interviews were analysed utilising inductive thematic analysis. RESULTS: From the participants' narratives four themes were identified: 'Concerns and worries in everyday life', 'Supportive and concerned relatives', 'A new way of life-sorrows and advantages' and 'Seize the day-a greater awareness of one´s mortality'. Participants described how they tried to create a functioning everyday life. They were generally afraid of getting COVID-19 again and concerned about future life, where their lack of energy played a major role. Narratives were diverse regarding to what extent the struggle to cope was experienced as emotionally challenging or not. CONCLUSIONS: Participants described an unpredictable recovery after COVID-19, characterised by ups and downs, which created worries concerning their future. In some cases, the worry of getting COVID-19 again was strong enough to keep participants in their homes, as a self-imposed lockdown guarded by anxiety. However, the narratives also revealed gratitude towards being alive and having coped so well. This led to a more positive outlook on life with a greater focus on intrinsic values, close social relations and the deeper meaning of life. Copyright: © 2023 Törnbom et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the o

Background: Multiple or persistent crying, sleeping, or feeding problems in early childhood (regulatory problems) are associated with increased internalizing symptoms in adulthood. Unknown is whether early regulatory problems are associated with emotional disorders in adulthood, and what psychosocial factors may provide protection. We tested whether early childhood multiple or persistent regulatory problems are associated with a higher risk of (a) any mood and anxiety disorder in adulthood; (b) perceiving no social support in adulthood; and (c) whether social support provides protection from mood and anxiety disorders among participants who had multiple/persistent regulatory problems and those who never had regulatory problems. Methods: Data from two prospective longitudinal studies in Germany (n = 297) and Finland (n = 342) was included (N = 639). Regulatory problems were assessed at 5, 20, and 56 months with the same standardized parental interviews and neurological examinations. In adulthood (24–30 years), emotional disorders were assessed with diagnostic interviews and social support with questionnaires. Results: Children with multiple/persistent regulatory problems (n = 132) had a higher risk of any mood disorder (odds ratio (OR) = 1.81 [95% confidence interval = 1.01–3.23]) and of not having any social support from peers and friends (OR = 1.67 [1.07–2.58]) in adulthood than children who never had regulatory problems. Social support from peers and friends provided protection from mood disorders, but only among adults who never had regulatory problems (OR = 4.03 [2.16–7.94]; p = .039 for regulatory problems x social support interaction). Conclusions: Children with multiple/persistent regulatory problems are at increased risk of mood disorders in young adulthood. Social support from peers and friends may, however, only provide protection from mood disorders in individuals who never had regulatory problems.

Aim: We aimed to develop a decision aid (DA) for individuals with anxiety disorders who consider tapering benzodiazepine (BZD) anxiolytics, and if tapering, tapering BZD anxiolytics with or without cognitive behavioral therapy (CBT) for anxiety. We also assessed its acceptability among stakeholders. Methods: First, we conducted a literature review regarding anxiety disorders to determine treatment options. We cited the results of the systematic review and meta-analysis, which we conducted previously, to describe the related outcomes of two options: tapering BZD anxiolytics with CBT and tapering BZD anxiolytics without CBT. Second, we developed a DA prototype in accordance with the International Patient Decision Aid Standards. We carried out a mixed methods survey to assess the acceptability among stakeholders including those with anxiety disorders and healthcare providers. Results: Our DA provided information such as explanation of anxiety disorders, options of tapering or not tapering BZD anxiolytics (if tapering, the options of tapering BZD anxiolytics with or without CBT) for anxiety disorder, benefits and risks of each option, and a worksheet for value clarification. For patients (n = 21), the DA appeared to be acceptable language (86%), adequate information (81%), and well-balanced presentation (86%). The developed DA was also acceptable for healthcare providers (n = 10). Conclusion: We successfully created a DA for individuals with anxiety disorders who consider tapering BZD anxiolytics, which was acceptable for both patients and healthcare providers. Our DA was designed to assist patients and healthcare providers to involve decision-making about whether to taper BZD anxiolytics or not.

Ziel dieser Studie war es, die Effekte des Videospielens auf die psychischen Befindlichkeiten Depressivität, Stress, Ängstlichkeit und Einsamkeit zu erforschen. Es wurde vermutet, dass Videospielen einen positiven Effekt auf jene Folgen besitzt. Diese Studie benutzt einen Mixed Methods Ansatz mit N = 209 Teilnehmer*Innen im quantitativen Teil der Arbeit und N = 5 Teilnehmer*Innen im qualitativen Teil. Der Fragebogen bestand aus fünf Teilen: Soziodemografischen Daten, Videospielverhalten, PHQ-9, GAD-7, PSS-10 und der UCLA-LS. Die qualitative Analyse wurde auf Basis eines semi-strukturierten Interviews, mit einem Leitfaden und narrativen Elemente durchgeführt. Es wurde ein signifikanter positiver Zusammenhang zwischen den Singleplayerspielstunden und den Testwerten des UCLA-LS (p = .01, r = .36) gefunden. Frauen wiesen allerdings einen signifikanten positiven Zusammenhang zwischen den wöchentlichen Spielstunden und den Einsamkeits- (p = .01, r = .40) sowie Depressionswerten (p = .03, r = .33) auf. In der Altersgruppe 18-25 wies das Genre Strategie einen negativen signifikanten Zusammenhang zu den Depressions- (p = .01, r = -.31), und Angstwerten (p = .01, r = -.30) auf. Die Ergebnisse der Interviews weisen auf einen positiven Effekt des Videospielens auf das Wohlbefinden hin. Es konnte gezeigt werden, dass die Präferenz für das Genre Strategie mit niedrigeren Depressivitäts- und Angstwerten zusammenhängt. Allerdings zeigen Frauen eine erhöhte Einsamkeit und Depressivität, umso mehr sie spielen und umgekehrt. Dies könnte, wie im qualitativen Teil beschrieben, daran liegen, dass Frauen in Videospielen häufiger mit toxischem Verhalten konfrontiert werden. Die Studie zeigt auf, dass Videospielen einen positiven Effekt auf die untersuchten Konstrukte haben könnte, es jedoch wichtig ist, das Genre, Geschlecht und Alter in ähnlichen Arbeiten zu inkludieren, da diese die Ergebnisse stark beeinflussen., The purpose of this study was to explore the effects of video gaming on wellbeing and distress - depressiveness, stress, anxiety, and loneliness. It was hypothesized that video gaming has a positive effect on those consequences. This study used a mixed methods approach with N = 209 participants in the quantitative part of the work and N = 5 participants in the qualitative part. The questionnaire consisted of five parts: Sociodemographic Data, Video Game Behavior, PHQ-9, GAD-7, PSS-10, and the UCLA-LS. The Qualitative Analysis was based on a semistructured interview, with narrative elements. A significant positive relationship was found between single-player game hours and test scores on the UCLA-LS (p = .01, r = .36). Against our expectations, females showed a significant positive association between weekly gaming hours and loneliness (p = .01, r = .40) and depression (p = .03, r = .33) scores. In the 18-25 age group, the strategy genre showed the expected negative significant relationship to depression (p = .01, r = -.31), and anxiety scores (p = .01, r = -.30). The results of the interviews indicate a positive effect of video gaming on well-being. It was shown that preference for the genre strategy decreased depressiveness and anxiety scores. Women showed increased loneliness and depressiveness the more they play and vice versa. This could be due to the fact that women are more likely to encounter toxic behavior in video games or that for women video games do not have the same calming effects as for men. The study indicates that video games can have a positive effect on the constructs studied, but it is important to include genre, gender, and age in similar studies as these strongly influence the results., eingereicht von: Elias Augustin Nocker, in englischer Sprache, Masterarbeit Universität Innsbruck 2023

For several decades, the treatment of anxiety disorders and obsessive-compulsive disorder (OCD) has consisted of cognitive behaviour therapy (CBT). Although this is an evidence-based treatment, many patients do not recover with it. The research presented in this thesis aimed to improve the outcome of anxiety disorders and OCD. The initial section focuses on identifying patients with a poor course, while the second part of this dissertation examines a number of novel treatments. Predictors of course Using data gathered in the context of the Nemesis-2 study in the Dutch general population, we explored predictors of long-term outcome in anxiety and depressive disorders to identify clues for influencing their course. With the cohort data of the Netherlands Obsessive-Compulsive Disorder Association (NOCDA) study, we identified patient characteristics that contributed to a poor quality of life and relationship satisfaction. Furthermore, we investigated the relationship between severity of OCD and quality of life and how improving the severity of OCD influences quality of life of the participants in NOCDA. Last, we used NOCDA data to identify predictors of patients who would start with an intensive treatment – such as day-treatment or inpatient treatment – in the following two years. Innovative treatments We conducted several uncontrolled pilot studies and a meta-analysis to explore innovative treatments. The first innovation pertains to the involvement of family members in the treatment of OCD. Since it has been demonstrated that certain responses of family members have the effect of maintaining the OCD, treatments have been developed to improve family interaction on obsessive-compulsive symptoms. A second innovation is to change the planning of the sessions in such a way that sessions are concentrated. A brief, intensive schedule might be superior to a regular schedule because patients have less opportunity to avoid feared situations in between sessions. A third innovati

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OBJECTIVE: Many people are struggling to get back to their lives after severe COVID-19. To facilitate their reintegration into everyday life, we need to understand how the process is experienced. We aimed to gain deeper knowledge about this process by interviewing persons one year after hospitalisation due to COVID-19. METHODS: The study is based on a qualitative design, with eleven in-depth interviews conducted one year after discharge for COVID-19. Participants were recruited to form a heterogeneous sample with respect to age, gender and socioeconomic background. All interviews were analysed utilising inductive thematic analysis. RESULTS: From the participants' narratives four themes were identified: 'Concerns and worries in everyday life', 'Supportive and concerned relatives', 'A new way of life-sorrows and advantages' and 'Seize the day-a greater awareness of one´s mortality'. Participants described how they tried to create a functioning everyday life. They were generally afraid of getting COVID-19 again and concerned about future life, where their lack of energy played a major role. Narratives were diverse regarding to what extent the struggle to cope was experienced as emotionally challenging or not. CONCLUSIONS: Participants described an unpredictable recovery after COVID-19, characterised by ups and downs, which created worries concerning their future. In some cases, the worry of getting COVID-19 again was strong enough to keep participants in their homes, as a self-imposed lockdown guarded by anxiety. However, the narratives also revealed gratitude towards being alive and having coped so well. This led to a more positive outlook on life with a greater focus on intrinsic values, close social relations and the deeper meaning of life. Copyright: © 2023 Törnbom et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the o

Mental health is an important thing for everyone to have. Because with a healthy mentality, individuals can do their days productively and can also maximize the abilities that exist in themselves. However, since the pandemic came, all activities have stopped and people also need to follow the changes caused by the pandemic. Because of this, people also feel lost and are also worried about what will happen in the future, which eventually leads to excessive worry. At that time the mental health of some people finally felled and along with this, several communities related to mental health issues emerged on social media to help everyone who had mental disorders. One of these communities is      OmahJiwa which provides free counseling for everyone who has mental problems, one of which is anxiety disorders. The purpose of this study was to see       the pattern of communication and also the effectiveness of interpersonal communication between a counselor and a counselee who has an anxiety disorder. This research uses a post positivist paradigm with a qualitative approach. The concepts used are Communication Patterns and Interpersonal Communication. The results obtained from this study are the OmahJiwa Community Counselors use 4 Communication Patterns (primary, secondary, linear, circular) and use Two-Way Communication Patterns. 5 directions for the effectiveness of Interpersonal Communication that occurs between counselors and counselees, but the most prominent are empathy, support, and positiveness

Generalized Anxiety Disorder (GAD) and Panic Disorder (PD) share underlying neurobiological mechanisms and several clinical features which, with medical comorbidities, may increase misdiagnosis and delay proper treatment. The aim of the study was to evaluate the association between clinical/socio-demographic markers and GAD/PD diagnosis. Outpatients (N = 290) with PD or GAD were identified in mental health services in Monza and Milan (Italy). Descriptive analyses and a binary logistic regression model were performed. Post-onset psychiatric (p = 0.05) and medical (p = 0.02) multiple co-morbidities were associated with GAD; treatment with selective serotonin reuptake inhibitors (SSRIs) was associated with PD, while GAD diagnosis was associated with treatment with atypical antipsychotics or GABAergic drugs (p = 0.03), as well as psychodynamic psychotherapy (p < 0.01). Discontinuation of the last pharmacological treatment was associated with GAD diagnosis rather than the PD one (p = 0.02). GAD patients may have a worse prognosis than PD patients because of more frequent multiple co-morbidities, relapses and poorer treatment compliance. The different treatment approaches were consistent with the available literature, while the association between GAD and psychodynamic psychotherapy is an original finding of our study. Further studies on larger samples are necessary to better characterize clinical factors associated with GAD or PD.

A considerable number of pregnant women experience fear of childbirth (FOC), characterized by worries and fear of the unpredictable. Despite this, the psychological processes in FOC have received notably little attention. The aim of this study was to advance the understanding by exploring the applicability of the Intolerance of Uncertainty (IU) model on FOC. Anonymous data was collected in a sample of pregnant women (N = 357) with varying levels of FOC. Analyses supported the associations between FOC and all proposed psychological processes: IU, negative problem orientation, positive beliefs about worry and avoidance of inner experiences. The exploration of potential mediators of the relation between IU and FOC revealed that, of the three processes from the model, only positive beliefs about worry were a mediator, and more specifically, a partial mediator between IU and FOC. These findings add to the theoretical understanding of FOC, by indicating that the role of IU may be similar to other conditions inflicted by worry and anxiety, which may inform treatment development. © 2023 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

Background The objective of this population-based register study was (1) to investigate the association between young adults diagnosed with attention-deficit/hyperactivity disorder (ADHD) and subsequent labour market marginalisation (LMM) in two comparison groups, i.e. matched young adults from the general population without ADHD and unaffected siblings to persons with ADHD and (2) to assess the role of comorbid disorders. Methods This study included all young adults in Sweden, aged 19-29 years, with an incident diagnosis of ADHD 2006-2011 (n = 9718). Crude and multivariate sex-stratified hazard ratios (HRs) with 95% confidence intervals (CIs) were measured 5 years after the diagnosis of ADHD for the risk of disability pension, long-term sickness absence (SA) (>90 days), long-term unemployment (>180 days) and a combined measure of all three in young adults with ADHD compared to their siblings without ADHD and a matched comparison group. Results In the adjusted analyses young adults with ADHD had a 10-fold higher risk of disability pension (HR = 10.2; CI 9.3-11.2), a nearly three-fold higher risk of long-term SA (HR = 2.7; CI 2.5-2.8) and a 70% higher risk of long-term unemployment (HR = 1.7; CI 1.6-1.8) compared to the matched comparison group. The risk estimates were lower compared to siblings for disability pension (HR = 9.0; CI 6.6-12.3) and long-term SA (HR = 2.5; CI 2.1-3.1) but higher in the long-term unemployed (HR = 1.9; CI 1.6-2.1). Comorbid disorders explained about one-third of the association between ADHD and disability pension, but less regarding SA and long-term unemployment. Conclusions Young adults with ADHD have a high risk for different measures of LMM and comorbidities explain only a small proportion of this relationship.

Highlights: Anxiety is an important morbidity among visually impaired older adults. There is potential for stakeholders to specifically channel their interventions towards particular IVI domains in order to reduce anxiety prevalence. Abstract: Visual impairment is a significant morbidity among adults globally. It has negative impacts on work force participation and productivity, as and well as higher depression and anxiety disorder rates. In the case of older adults, vision impairment can contribute to social isolation and a greater likelihood of early entry into nursing or care homes. This hospital-based, cross-sectional study was designed to determine anxiety disorder's prevalence among the study population and which Impact of Visual Impairment (IVI) domain is most correlated with anxiety disorder. The study was carried out at the Ophthalmology Clinic of the Ekiti State University Teaching Hospital, Ado Ekiti, Nigera. Questionnaires were used to collect information from 115 respondents. Information sought included sociodemographic information, anxiety status, and visual impairment's impact on daily functions. The Hospital Anxiety and Depression Scale (HADS) was used to assess anxiety disorder, while the IVI scale was used to assess the impact of visual impairment. The IVI scale is an instrument used for determining the impact of visual impairment under three domains: (reading and accessing information, mobility and independence, and emotional well-being). Anxiety disorder was detected in 10.4% of all the respondents, and the IVI's mobility and independence domain of IVI was most strongly correlated with anxiety disorder.

Background: The goal of this study is to validate the psychometric properties of the Hamilton Rating Scales for anxiety and depression. These two scales will be used to analyze anxiety and depression, seven days before, after and seven days after screening of a video showing ex-traction of a lower third molar in four different strata of the sample: mixed disorder, anxiety dis-order, adaptive disorder, and no mental disorder. Material and Methods: A prospective study was performed of 240 Caucasian subjects ages 18-70 in a psychiatry outpatient clinic in Malaga. The study was ap-proved by the Research Ethics Committee of the University of Seville. Following interviews with a psychiatrist and completion of the Hamilton scales, the participants were divided into four levels, with 60 participants per group. The influence of sex and place of residence were analysed. Results: The scales showed good psychometric properties. At the three video screenings, the means were higher for women, persons from rural environments and persons with mixed disorder in the first instance and then anxiety disorder. Conclusions: Patients with mixed disorder experience a higher level of anxiety and depression than do patients free of mental pathologies.

[Background:] Computer-assisted treatment may reduce therapist contact and costs and promote client participation. This meta-analysis examined the efficacy and acceptability of an unguided computer-assisted therapy in patients with obsessive-compulsive disorder (OCD) compared with a waiting list or attention placebo. [Objective:] This study aimed to evaluate the effectiveness and adherence of computer-assisted self-help treatment without human contact in patients with OCD using a systematic review and meta-analysis approach. [Methods:] Randomized controlled trials with participants primarily diagnosed with OCD by health professionals with clinically significant OCD symptoms as measured with validated scales were included. The interventions included self-help treatment through the internet, computers, and smartphones. We excluded interventions that used human contact. We conducted a search on PubMed, Cochrane Central Register of Controlled Trials, EMBASE, World Health Organization International Clinical Trials Registry Platform, and ClinicalTrials.gov, as well as the reference lists of the included studies. The risk of bias was evaluated using version 2 of the Cochrane risk-of-bias tool for randomized trials. We calculated the standardized mean differences for continuous outcomes and risk ratios for dichotomous outcomes. The primary outcomes were short-term improvement of OCD symptoms measured by validated scales and dropout for any reason. [Results:] We included 11 randomized controlled trials with a total of 983 participants. The results indicated that unguided computer-assisted self-help therapy was significantly more effective than a waiting list or psychological placebo (standard mean difference −0.47, 95% CI −0.73 to −0.22). Unguided computer-assisted self-help therapy had more dropouts for any reason than waiting list or psychological placebo (risk ratio 1.98, 95% CI 1.21 to 3.23). However, the quality of evidence was very low because of the risk of bias and i

IMPORTANCE Children who are placed in out-of-home care may have poorer outcomes in adulthood, on average, compared with their peers, but the direction and magnitude of these associations need clarification. OBJECTIVE To estimate associations between being placed in out-of-home care in childhood and adolescence and subsequent risks of experiencing a wide range of social and health outcomes in adulthood following comprehensive adjustments for preplacement factors. DESIGN, SETTING, PARTICIPANTS This cohort and cosibling study of all children born in Finland between 1986 and 2000 (N = 855622) monitored each person from their 15th birthday either until the end of the study period (December 2018) or until they migrated, died, or experienced the outcome of interest. Cox and Poisson regression models were used to estimate associations with adjustment for measured confounders (from linked population registers) and unmeasured familial confounders (using sibling comparisons). Data were analyzed from October 2020 to August 2021. EXPOSURES Placement in out-of-home care up to age 15 years. MAIN OUTCOMES AND MEASURES Through national population, patient, prescription drug, cause of death, and crime registers, 16 specific outcomes were identified across the following categories: psychiatric disorders; low socioeconomic status; injuries and experiencing violence; and antisocial behaviors, suicidality, and premature mortality. RESULTS A total of 30127 individuals (3.4%) were identified who had been placed in out-of-home care for a median (interquartile range) period of 1.3 (0.2-5.1) years and 2 (1-3) placement episodes before age 15 years. Compared with their siblings, individuals who had been placed in out-of-home care were 1.4 to 5 times more likely to experience adverse outcomes in adulthood (adjusted hazard ratio [aHR] for those with a fall-related injury, 1.40; 95% CI, 1.25-1.57 and aHR for those with an unintentional poisoning injury, 4.79; 95% CI, 3.56-6.43, respectively). The

Background: Currently, in addition to the undeniable impact of cultural factors on mental health problems’ diagnosis and treatment methods, the use of rapid, short, and intervention-based instruments can be effective in the accurate diagnosis of mental health problems, especially in the health system of developing countries. Objectives: This study aimed to validate an instrument developed for screening patients with common mental health problems using item response theory (IRT). Methods: The study was conducted in Semnan province (with Persian ethnicity), Iran, from August 2017 to February 2018. A 101-item tool consisted of district common mental health problems (i.e., depression, anxiety, and obsession), along with a functional checklist. The development of the instrument involved a pilot study and psychometric testing. The IRT-based analysis was used as the item-reduction method to evaluate the shortened tool as an appropriate screening tool. The participants were healthy individuals and patients with depression, anxiety, and obsessive-compulsive disorder (OCD). The data were analyzed using Stata software (version 15.1). Results: The study participants were 160 individuals (58.2% male) with a mean age of 36.3 ± 11.2 years. All item impact factors were within the range of 1.8-5. The mean values of clarity, simplicity, relevance, and scale-level content validity index/averaging calcu-lation method of the instrument were 96.73 ± 0.70, 97.64 ± 0.61, 98.2 ± 1.9, and 97.09 ± 0.63, respectively. Cronbach’s alpha and internal consistency coefficient were 0.88 and 0.7. Moreover, 13, 5, and 12 items were excluded using IRT from depression, anxiety, and OCD dimensions based on the threshold criteria, respectively. Conclusions: Iranian screening tools for mental health problems can provide qualified information with the least error and the most precision in appropriate early diagnosis and decrease the burden of mental health problems in the national healthcare system.

Background: Currently, in addition to the undeniable impact of cultural factors on mental health problems’ diagnosis and treatment methods, the use of rapid, short, and intervention-based instruments can be effective in the accurate diagnosis of mental health problems, especially in the health system of developing countries. Objectives: This study aimed to validate an instrument developed for screening patients with common mental health problems using item response theory (IRT). Methods: The study was conducted in Semnan province (with Persian ethnicity), Iran, from August 2017 to February 2018. A 101-item tool consisted of district common mental health problems (i.e., depression, anxiety, and obsession), along with a functional checklist. The development of the instrument involved a pilot study and psychometric testing. The IRT-based analysis was used as the item-reduction method to evaluate the shortened tool as an appropriate screening tool. The participants were healthy individuals and patients with depression, anxiety, and obsessive-compulsive disorder (OCD). The data were analyzed using Stata software (version 15.1). Results: The study participants were 160 individuals (58.2% male) with a mean age of 36.3 ± 11.2 years. All item impact factors were within the range of 1.8-5. The mean values of clarity, simplicity, relevance, and scale-level content validity index/averaging calcu-lation method of the instrument were 96.73 ± 0.70, 97.64 ± 0.61, 98.2 ± 1.9, and 97.09 ± 0.63, respectively. Cronbach’s alpha and internal consistency coefficient were 0.88 and 0.7. Moreover, 13, 5, and 12 items were excluded using IRT from depression, anxiety, and OCD dimensions based on the threshold criteria, respectively. Conclusions: Iranian screening tools for mental health problems can provide qualified information with the least error and the most precision in appropriate early diagnosis and decrease the burden of mental health problems in the national healthcare system.

Traumatic brain injury (TBI) is a major public health problem. Here, we developed a novel model of non-invasive TBI induced by laser irradiation in the telencephalon of adult zebrafish (Danio rerio) and assessed their behavior and neuromorphology to validate the model and evaluate potential targets for neuroreparative treatment. Overall, TBI induced hypolocomotion and anxiety-like behavior in the novel tank test, strikingly recapitulating responses in mammalian TBI models, hence supporting the face validity of our model. NeuN-positive cell staining was markedly reduced one day, but not seven days, after TBI, suggesting increased neuronal damage immediately after the injury, and its fast recovery. The brain-derived neurotrophic factor (Bdnf) level in the brain dropped immediately after the trauma, but fully recovered seven days later. A marker of microglial activation, Iba1, was elevated in the TBI brain, albeit decreasing from Day 3. The levels of hypoxia-inducible factor 1-alpha (Hif1a) increased 30 min after the injury, and recovered by Day 7, further supporting the construct validity of the model. Collectively, these findings suggest that our model of laser-induced brain injury in zebrafish reproduces mild TBI and can be a useful tool for TBI research and preclinical neuroprotective drug screening. © 2022 by the authors.

Background: Currently, in addition to the undeniable impact of cultural factors on mental health problems’ diagnosis and treatment methods, the use of rapid, short, and intervention-based instruments can be effective in the accurate diagnosis of mental health problems, especially in the health system of developing countries. Objectives: This study aimed to validate an instrument developed for screening patients with common mental health problems using item response theory (IRT). Methods: The study was conducted in Semnan province (with Persian ethnicity), Iran, from August 2017 to February 2018. A 101-item tool consisted of district common mental health problems (i.e., depression, anxiety, and obsession), along with a functional checklist. The development of the instrument involved a pilot study and psychometric testing. The IRT-based analysis was used as the item-reduction method to evaluate the shortened tool as an appropriate screening tool. The participants were healthy individuals and patients with depression, anxiety, and obsessive-compulsive disorder (OCD). The data were analyzed using Stata software (version 15.1). Results: The study participants were 160 individuals (58.2% male) with a mean age of 36.3 ± 11.2 years. All item impact factors were within the range of 1.8-5. The mean values of clarity, simplicity, relevance, and scale-level content validity index/averaging calcu-lation method of the instrument were 96.73 ± 0.70, 97.64 ± 0.61, 98.2 ± 1.9, and 97.09 ± 0.63, respectively. Cronbach’s alpha and internal consistency coefficient were 0.88 and 0.7. Moreover, 13, 5, and 12 items were excluded using IRT from depression, anxiety, and OCD dimensions based on the threshold criteria, respectively. Conclusions: Iranian screening tools for mental health problems can provide qualified information with the least error and the most precision in appropriate early diagnosis and decrease the burden of mental health problems in the national healthcare system.

Background: A majority of psychiatric patients suffer from insomnia or insomnia-like problems. In addition to impairing quality of life, sleep problems can worsen psychiatric conditions, such as depression and anxiety, and can make treatment of various psychiatric conditions less successful. Several international guidelines recommend cognitive behavioural therapy for insomnia (CBT-I) as first line treatment. However, patients in psychiatric care are rarely offered this treatment, and there is a lack of studies evaluating the treatment in regular psychiatric settings. In this pilot study, we aimed to determine the clinical feasibility of a group-based CBT-I intervention in an outpatient clinical setting for patients with depression, bipolar disorder, anxiety disorders and PTSD. We also aimed to investigate if symptoms of insomnia, depression and anxiety changed after CBT-I. Methods: Seventeen patients at an out-patient psychiatric clinic for mixed psychiatric problems of anxiety, affective disorders and PTSD, were enrolled in a six-week long group-based CBT-I intervention. Primary outcomes were pre-defined aspects of treatment feasibility. Secondary outcomes were changes in self-reported symptoms of insomnia severity, depression, and anxiety between pre - and post intervention. Assessment of insomnia severity was also performed 3 months after treatment. Feasibility data is reported descriptively, changes in continuous data from preto post-treatment were analysed with dependent t-tests. Results: All feasibility criteria were met; there were enough patients to sustain at least one group per semester (e.g., minimum 8), 88% of included patients attended the first session, mean of attended sessions was 4.9 of 6, and dropout rate was 5.9%. Therapists, recruited from clinical staff, found the treatment manual credible, and possible to use at the clinic. Symptoms of insomnia decreased after treatment, as well as symptoms of depression and anxiety. Conclusion: CBT-I could pro

Background: Generalised anxiety disorder (GAD) is a common anxiety disorder associated with social and occupational impairment. Recently, a theory was postulated that dysfunctional gamma aminobutyric acid type A receptors (GABAA) are implicated in anxiety symptomology, which could be corrected by flumazenil, an antagonist at the benzodiazepine binding site on the GABAA receptor. Method: Participants had a primary diagnosis of GAD and were treated initially with an eight-day continuous low-dose flumazenil infusion (total 32 mg at a rate of 4 mg/24 h). Some participants were re-treated with a further four- or eight-day infusion. Treatment response was measured as a 50 % reduction in anxiety or stress scores on the Depression Anxiety Stress Scale — 21 (DASS-21). Remission was measured as scores ≤ 3 or ≤ 7 on the anxiety and stress subscales of the DASS-21, respectively. Results: Eight cases are reported. All cases met the criteria for treatment response on the anxiety and stress subscale of the DASS-21. Remission was achieved in seven participants on the anxiety subscale and in five on the stress subscale. No changes in hepatic, renal, or haematological function were likely attributed to flumazenil. Conclusion: Data suggest that low-dose continuous flumazenil infusion manages GAD symptoms and is safe. Although these results are promising, future randomised control trials are required to confirm these results.

Despite its rewards, parenting is a challenging role, frequently associated with heightened stress. Parents of children with mental health conditions, such as childhood anxiety disorders (ADs), commonly report even higher levels of parenting stress and increased problems with their own mental health. These parents may also experience greater emotion dysregulation (ED) and may engage in more “negative” parenting behaviours (e.g., criticism, rejection); all of which are in turn associated with greater child anxiety symptoms and poorer child anxiety-focused therapy outcomes. In contrast, several “positive” parenting behaviours (e.g., warmth, responsiveness) have been shown to be associated with better long-term outcomes for clinically anxious children and appear to play an important protective role among families. Recently, it has been suggested that parent’s capacity for mindfulness and mindful parenting is related to parents adopting more positive parenting practices that may result in more favourable parent and child outcomes. This may be particularly relevant for parents of young children with ADs given the important role parents play for their emotional and behavioural adjustment during early childhood years. Yet, there is a paucity of research examining these parent factors (including ED, parenting stress, parenting behaviours, and mindful parenting) among parents of young clinically anxious children. Given the challenges that many parents face in parenting a clinically anxious child, there is a need for interventions that aim to provide greater support to parents in hopes to improve therapeutic outcomes for both parents and children with ADs. Indeed, mindful parenting interventions (MPIs) have been proposed as one such support for parents. A key aim of MPIs is to address parenting stress through teaching mindfulness and mindful parenting techniques. Although the evidence-base has increased, much is yet to be learned about the theoretical assumptions underlying m, Thesis (Professional Doctorate), Doctor of Philosophy (PhD), School of Applied Psychology, Griffith Health, Full Text

Objective: To determine the prevalence of depression, anxiety, and posttraumatic stress disorder (PTSD) years after hyperemesis gravidarum (HG) and its association with HG severity. Material and methods: This prospective cohort study consisted of a follow-up of 215 women admitted for HG, who were eligible to participate in a randomized controlled trial and either declined or agreed to be randomized between 2013 and 2016 in 19 hospitals in the Netherlands. Participants completed the Hospital Anxiety and Depression Scale (HADS) six weeks postpartum and during follow-up and the PTSD checklist for DSM-5 (PCL-5) during follow-up. An anxiety or depression score ≥8 is indicative of an anxiety or depression disorder and a PCL-5 ≥ 31 indicative of PTSD. Measures of HG severity were symptom severity (PUQE-24: Pregnancy Unique Quantification of Emesis), weight change, duration of admissions, readmissions, and admissions after the first trimester. Results: About 54/215 participants completed the HADS six weeks postpartum and 73/215 participants completed the follow-up questionnaire, on average 4.5 years later. Six weeks postpartum, 13 participants (24.1%) had an anxiety score ≥8 and 11 participants (20.4%) a depression score ≥8. During follow-up, 29 participants (39.7%) had an anxiety score ≥8, 20 participants (27.4%) a depression score ≥8, and 16 participants (21.9%) a PCL-5 ≥ 31. Multivariable logistic regression analysis showed that for every additional point of the mean PUQE-24 three weeks after inclusion, the likelihood of having an anxiety score ≥8 and PCL-5 ≥ 31 at follow-up increased with OR 1.41 (95% CI: 1.10;1.79) and OR 1.49 (95% CI: 1.06;2.10) respectively. Conclusion: Depression, anxiety, and PTSD symptoms are common years after HG occurred.

Background: Currently, in addition to the undeniable impact of cultural factors on mental health problems’ diagnosis and treatment methods, the use of rapid, short, and intervention-based instruments can be effective in the accurate diagnosis of mental health problems, especially in the health system of developing countries. Objectives: This study aimed to validate an instrument developed for screening patients with common mental health problems using item response theory (IRT). Methods: The study was conducted in Semnan province (with Persian ethnicity), Iran, from August 2017 to February 2018. A 101-item tool consisted of district common mental health problems (i.e., depression, anxiety, and obsession), along with a functional checklist. The development of the instrument involved a pilot study and psychometric testing. The IRT-based analysis was used as the item-reduction method to evaluate the shortened tool as an appropriate screening tool. The participants were healthy individuals and patients with depression, anxiety, and obsessive-compulsive disorder (OCD). The data were analyzed using Stata software (version 15.1). Results: The study participants were 160 individuals (58.2% male) with a mean age of 36.3 ± 11.2 years. All item impact factors were within the range of 1.8-5. The mean values of clarity, simplicity, relevance, and scale-level content validity index/averaging calcu-lation method of the instrument were 96.73 ± 0.70, 97.64 ± 0.61, 98.2 ± 1.9, and 97.09 ± 0.63, respectively. Cronbach’s alpha and internal consistency coefficient were 0.88 and 0.7. Moreover, 13, 5, and 12 items were excluded using IRT from depression, anxiety, and OCD dimensions based on the threshold criteria, respectively. Conclusions: Iranian screening tools for mental health problems can provide qualified information with the least error and the most precision in appropriate early diagnosis and decrease the burden of mental health problems in the national healthcare system.