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Validation of the Generalized Anxiety Disorder-7 (GAD-7) among Chinese people with epilepsy
Abstract
Objective:
To validate the Chinese version of the Generalized Anxiety Disorder-7 (GAD-7) in Chinese people with epilepsy (PWE).
Methods:
A consecutive cohort of PWE from the West China Hospital was recruited. Each patient received a psychiatric evaluation comprising the Mini International Neuropsychiatric Interview (MINI) and the GAD-7. Demographic and clinical characteristics were collected. Cronbach's α coefficient was calculated and receiver operating curve (ROC) analysis was conducted.
Results:
A total of 213 PWE completed the psychiatric evaluation. The GAD-7 was easily understood and quickly completed by all participants. Fifty patients (23.5%) had GAD according to the MINI criteria. Cronbach's α coefficient for the GAD-7 was 0.888. ROC analysis showed an area under the curve of 0.974 (95% CI=0.956-0.993). At a cut-off score of >6, the GAD-7 achieved the largest Youden index of 0.854 with a sensitivity of 94%, a specificity of 91.4%, a positive predictive value of 77% and a negative predictive value of 98%.
Significance:
The Chinese version of the GAD-7 is a valuable tool for screening for GAD in Chinese PWE.
... The total score ranges from 0 to 21, With the higher score, the severity of anxiety symptoms. In line with previous research, anxiety symptoms are defined as GAD-7 scores ≥ 5 [32,33]. ...
Background
The joint association of dietary diversity (DD) and physical activity (PA) on anxiety, depressive symptoms, and their comorbidity have not been extensively explored. Hence, this study focused on examining this association.
Methods
Data in this cross-sectional study was derived from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Based on self-reported dietary diversity score (DDS) questions were used to assess DD, ranging from 0 to 8. DDS < 5 was defined as insufficient DD and DDS ≥ 5 was defined as sufficient DD. PA was based on a self-reported binary question. Anxiety was assessed using the Generalized Anxiety Disorder Scale-7 (GAD-7), and depressive symptoms were evaluated by the Center for Epidemiologic Studies Depression Scale-10 (CESD-10). The independent and joint associations of DD and PA on anxiety, depressive symptoms, and their comorbidity were examined by multivariable-adjusted binary logistic regression models.
Results
In this cross-sectional study, sufficient DD was independently associated with a decreased risk of anxiety (adjusted OR = 0.57, 95% CI = 0.50–0.65), depressive symptoms (adjusted OR = 0.69, 95% CI = 0.63–0.77), and their comorbidity (adjusted OR = 0.58, 95% CI = 0.49–0.68). Similarly, exposure to current exercise was also a significant protective factor for mental health. Importantly, co-exposure to sufficient DD and current exercise may amplify the protective effects on mental health (adjusted OR = 0.47, 95% CI = 0.38–0.57 for anxiety; adjusted OR = 0.36, 95% CI = 0.31–0.42 for depressive symptoms; adjusted OR = 0.37, 95% CI = 0.29–0.48 for their comorbidity). The robustness of these associations was demonstrated in four sensitivity analyses.
Conclusions
Our study found that sufficient DD and current exercise were associated with a decreased risk of mental health disorders. Importantly, the combination of both appeared to enhance this protective effect. Our findings promote the joint assessment of DD and PA to provide new insights into health-related behaviors for prevention strategies for mental health disorders in older adults.
... (2) Anxiety symptoms over the past 2 weeks were assessed by the Generalized Anxiety Disorder-7 (GAD-7) (Spitzer et al. 2006). The GAD-7 is widely utilized for assessing anxiety symptoms, which has been translated into Chinese (Tong et al. 2016) and validated in Chinese adolescents (Sun et al. 2021). It consists of 7 items with a total score range of 0 to 21 (e.g., "Feeling nervous, anxious, or on edge"). ...
Introduction
Existing research indicates high prevalence of emotional problems among adolescents with excessive academic burden, yet the underlying reasons are not well understood. This study aimed to explore loneliness, physical activity, and sleep as potential mediating pathways between academic burden and emotional problems in adolescents.
Methods
A longitudinal cohort study was conducted among middle and high school students in Taizhou City, Zhejiang Province, China, with data collected at three time points. The study included 2965 adolescents, with a mean age of 15.2 years (SD = 1.7), of whom 48.0% were female. Most participants came from families with middle to high economic status (94.8%). Structural equation modeling was employed to analyze the direct associations between academic burden (measured by study time and academic stress) and depressive and anxiety symptoms. Additionally, the indirect associations were explored through three mediators: loneliness, physical activity, and sleep.
Results
Higher academic stress at T1 was directly associated with more severe depressive symptoms at T3. Sleep (indirect effect 0.11, 95% CI 0.09–0.13), loneliness (0.10, 0.08–0.11) and physical activity (0.01, 0.002–0.012) at T2 mediated the relationship, accounting for 31.0%, 26.8%, and 1.8% of the total association of academic stress, respectively. For anxiety symptoms, sleep (0.11, 0.09–0.14) and loneliness (0.07, 0.05–0.08) mediated the association of academic stress with longitudinal mediation effect sizes of 34.1% and 20.6%, respectively. Study time was only associated with the outcomes indirectly via academic stress.
Conclusions
Our results highlight the importance of behavioral and psychosocial differences related to academic burden in understanding the severity of mental health problems in adolescents.
... The 7-item Generalized Anxiety Disorder Questionnaire (GAD-7) was used to assess participants' anxiety in the past two weeks. This instrument was developed and validated by Spitzer, et al. in 2006 and was validated among pregnant women and people with epilepsy in China [40][41][42]. This instrument contains 7 items which are 4-point Likert scaled ranging from 0 to 3. The scores of the instrument range from 0 to 21. ...
China witnessed an Omicron COVID-19 outbreak at the end of 2022. During this period, medical crowding and enormous pressure on the healthcare systems occurred, which might result in the occurrence of occupational burnout among healthcare workers (HCWs). This study aims to investigate the prevalence of occupational burnout and associated mental conditions, such as depressive symptoms, anxiety, PTSD symptoms, perceived social support, resilience, and mindfulness among HCWs of the Chinese mainland during the Omicron COVID-19 outbreak, and to explore the potential risk and protective factors influencing occupational burnout of HCWs. A multicenter cross-sectional study was conducted among HCWs working in the Chinese mainland from January 5 to February 9, 2023. A total of 6552 participants were recruited by convenience sampling. Data were collected on demographic characteristics, occupational burnout, depressive symptoms, anxiety, PTSD, perceived social support, resilience, and mindfulness by online questionnaires. Descriptive analyses were performed to describe the participants’ demographic characteristics. Univariate-Multivariate analyses were used to determine the influencing factors of occupational burnout. The results showed that the prevalence of occupational burnout and associated mental disorders, such as depressive symptoms, anxiety, and PTSD in HCWs were 44.56%, and 70.75%, 47.87%, and 37.49%, respectively. Older age, female gender, higher income, more doses of COVID-19 vaccine, a higher level of mindfulness, resilience, and perceived social support were protective factors of occupational burnout. Working as nurses, in a department currently taking charge of the treatment of COVID-19 patients, perceived high risk of contracting COVID-19 due to work, perceived high work intensity, and a higher level of anxiety and depressive symptoms were risk factors of occupational burnout. Tailored interventions on perceived social support, resilience, and mindfulness should be implemented to alleviate occupational burnout and associated mental disorders among HCWs.
... Depressive symptoms were assessed with the validated Chinese version of the nine-item Patient Health Questionnaire (PHQ-9) (Yeung et al. 2008). Anxiety was assessed by the seven-item Generalized Anxiety Disorder Scale (GAD-7), which is validated among Chinese people (Kroenke et al. 2007;Spitzer et al. 2006;Tong et al. 2016). Each scale measured the frequency of symptom severity in the previous 2 weeks on a 4-point scale (not at all, several days, more than half the days, nearly every day). ...
The COVID-19 pandemic profoundly impacted population mental health worldwide. Few studies examined how the neighborhood environment and online social connections might influence the social gradient in mental health during the pandemic lockdown. We aim to examine the moderating and mediating role of neighborhood environment and online social connections in the association between socioeconomic status (SES) and mental health outcomes. We conducted a cross-sectional online survey of 3763 Shanghai residents during the COVID-19 lockdown between April 29 and June 1, 2022. Employing OLS linear regression analyses, our findings reveal that SES was negatively associated with depressive symptoms (B = 0.173, p < 0.001) and anxiety (B = 0.147, p < 0.001). The findings supported our hypotheses that this disparity in mental health was partially mediated by neighborhood social capital, community management, and the extent of online social connections measured by the frequency of social connection through the social media WeChat (all p < 0.05). Additionally, neighborhood social capital, community management, and online social connections also mitigated SES-driven mental health inequalities (all p < 0.05). The study underscores the significance of the neighborhood environment and online social interactions in amplifying SES-related mental health effects, offering valuable insights for urban planning and health equity strategies.
... Convergent validity was demonstrated through significant correlations with the Hamilton Anxiety Rating Scale (r = 0.71, p < 0.001; Spitzer et al. [24]). The scale has shown good discriminant validity, with significantly different scores between clinical and non-clinical groups (t = 15.6, p < 0.001; Tong et al. [25]). These psychometric properties align with international validation studies that have consistently supported the GAD-7's reliability and validity in assessing anxiety symptoms across diverse populations [20,26]. ...
Background
The functional aspects of non-suicidal self-injury (NSSI) among adolescents represent a complex phenomenon requiring deeper understanding. While research has identified various NSSI functions, including emotional regulation, attention-seeking, and social avoidance, the field lacks comprehensive analysis of how these functions cluster into distinct profiles. Understanding these functional profiles is crucial for developing targeted interventions.
Method
A cross-sectional study of 1,783 adolescents (1,464 girls, 318 boys) aged 12–18 years was conducted across 14 psychiatric or general hospitals in nine Chinese provinces. Participants completed the Functional Assessment of Self-Mutilation (FASM), which assesses 22 distinct NSSI functions across three primary dimensions: emotional regulation, attention-seeking, and social avoidance. Additional measures included the Patient Health Questionnaire (PHQ-9) for depression and Generalized Anxiety Disorder Scale (GAD-7) for anxiety symptoms. Latent profile analysis was employed to identify distinct patterns in NSSI functions, with model selection based on fit indices including AIC, BIC, entropy, and LMRT.
Results
Latent profile analysis revealed four distinct functional profiles: low attention-seeking-high social avoidance (LA-HS, 19.7%), high attention-seeking-high social avoidance (HA-HS, 9.5%), low attention-seeking and social avoidance (LA-LS, 57.8%), and high attention-seeking-low social avoidance (HA-LS, 13.0%). The HA-HS profile demonstrated the most severe clinical presentation, showing significantly elevated scores in NSSI frequency (M = 26.160, SD = 9.771), anxiety (GAD-7: M = 16.265, SD = 4.951), and depression (PHQ-9: M = 20.612, SD = 6.003). The LA-HS profile showed the second-highest severity (NSSI: M = 25.800, SD = 10.058; GAD-7: M = 14.775, SD = 5.376; PHQ-9: M = 19.966, SD = 5.938). Both profiles also demonstrated significantly higher rates of suicidal ideation (HA-HS: 77.6%; LA-HS: 79.2%) compared to other profiles.
Conclusions
Our findings reveal distinct patterns in how adolescents utilize NSSI functionally, particularly regarding attention-seeking and social avoidance dimensions. These functional profiles show meaningful associations with psychological outcomes, suggesting that understanding NSSI functions, rather than just behaviors, may be crucial for assessment and intervention. The identification of these distinct functional profiles among Chinese adolescents highlights the importance of function-specific approaches in clinical assessment and treatment planning.
... The anxiety levels of the participants were measured using the Generalized Anxiety Disorder Scale (GAD-7) in Chinese, a seven-item scale with a Cronbach's alpha coefficient of .89 (Tong et al., 2016), tested on a sample of 213 adults (aged ≥18) diagnosed with epilepsy from the epilepsy outpatient clinic of West China Hospital. Items are rated on a scale from 0 (not at all) to 3 (nearly every day), with total scores categorizing anxiety severity as minimal (0-4), mild (5-9), moderate (10-14), and severe (≥15) (Spitzer et al., 2006). ...
Background
Depression is a growing concern among university students. Chatbots provide flexible, accessible, personalized psychosocial support. Delivering Mindfulness-Based Stress Reduction (MBSR) sessions via chatbots may reduce depressive symptoms in university students.
Aim
This study aims to evaluate the feasibility, acceptability, safety, and preliminary efficacy of a chatbot-based MBSR intervention for university students with depressive symptoms.
Methods
A rule-based MBSR chatbot was developed and evaluated with a single-group pretest–posttest study for university students in Hong Kong ( N = 30) reporting depressive symptoms, followed by the collection of their subjective feedback. The intervention lasted eight weeks. The primary clinical outcome was depression levels, with a range of secondary outcomes.
Results
The chatbot-based MBSR program demonstrated satisfying recruitment, retention, and adherence rates. The safety of the program was confirmed by the absence of any adverse events directly related to the intervention, tracked from the onset of the intervention to the completion of data assessment. Significant improvements were observed in both primary and secondary outcomes. Participant feedback highlighted the benefits of the program and its effects on depressive symptoms.
Conclusions
The program has shown feasibility, acceptability, safety, and preliminary efficacy in reducing depressive symptoms among 30 university students in Hong Kong. The intervention should now be evaluated in a randomized controlled trial with follow-up. This study highlights the potential role of chatbot-based interventions in mental health promotion, nursing, and clinical practice and will inform the subsequent development of innovative digital interventions to address mental health challenges faced by university students.
... In the present study, its Cronbach's alpha was 0.913 at T1 and 0.924 at T2. Anxiety symptoms were evaluated by the Chinese version of the Generalized Anxiety Disorder Questionnaire (GAD-7) (Tong et al., 2016) at T1 and T2. Each item was rated on a four-point Likert scale, ranging from 0-not at all, 1-several days, 2-more than half the days, to 3-nearly every day. ...
The reciprocal relationships between sleep disturbance and internalizing symptoms (e.g., anxiety and depression symptoms) have been widely explored in both cross-sectional and longitudinal studies. Although intolerance of uncertainty (IU) is recognized as a risk factor for both sleep disturbance and internalizing symptoms, its role in their longitudinal reciprocal associations remains unclear. To address this gap, a two-wave longitudinal study was conducted with 54,240 Chinese adolescents, who provided self-reported data on sleep disturbance, internalizing symptoms, and IU. Results revealed significant longitudinal reciprocal associations between sleep disturbance and internalizing symptoms, with IU exacerbating these relationships. Notably, the moderating effect of IU was asymmetric, exerting a stronger influence on the prediction of internalizing symptoms through sleep disturbance than vice versa. Beyond its direct impact on sleep disturbance and internalizing symptoms, IU was shown to intensify their longitudinal reciprocal relationship for the first time. These findings underscore the need for early screening and timely intervention for IU in adolescents. Moreover, the asymmetric moderating effect also suggests that sleep disturbance and IU may have synergistic effects on internalizing symptoms, highlighting the importance of prioritizing IU-based assessments and interventions for adolescents experiencing sleep disturbance.
... The total score ranged from 5 to 9 for mild anxiety, 10 to 14 for medium anxiety, 15 to 21 for high anxiety. Like the PHQ-9, the GAD-7 has also been validated in the Chinese population, with studies supporting its reliability and validity for assessing anxiety symptoms among Chinese individuals [16][17][18][19] . According to Teymoori's study, the total score of GAD-7 ≥ 5 indicates the presence of anxiety symptoms 20 . ...
This study aimed to explore psychological problems and related factors among frontline primary healthcare workers who belongs to community health service centers and directly provides medical security services to community residents during the COVID-19 in Shanghai. We used a cross-sectional data analysis design to investigate the anxiety and depression levels of 929 frontline healthcare staff (primary healthcare providers, nurses, village doctors, and public health workers) during the Shanghai epidemic.The prevalence of depression among frontline primary healthcare workers was 39.7% (369 cases) and that of anxiety was 30%(279 cases). There was a significant correlation between the depression symptoms and anxiety symptoms. And factors associated with depression were being female, advanced education, expecting psychological interventions, expecting vacations as a reward, and expecting financial rewards. Factors strongly associated with anxiety were being female, expecting psychological interventions, and expecting vacations as a reward. Psychological problems among frontline primary healthcare workers merit more attention during the COVID-19 outbreak, especially those who are vulnerable (e.g., females and those with an advanced education).
... Anxiety symptoms were assessed by the Generalized Anxiety Disorder Scale-7 (GAD-7) in Chinese, which has been validated and extensively utilized in Chinese studies [30,31], and the Cronbach's alpha was 0.89 in this study. The respondents were asked to rate the frequency of seven anxiety symptoms during the last two weeks, with the response options given on a 4-point scale from 0 to 4. The seven items' total scores range from 0 to 21, with higher scores indicating more severe anxious symptoms [32]. ...
Background
While the association between screen time (ST) and psychosocial well-being has been extensively examined, limited studies have investigated the dynamic patterns of ST, and their impact on subsequent psychosocial well-being among adolescents. Therefore, this longitudinal study aimed to examine the association between ST trajectories and the subsequent psychosocial well-being among Chinese adolescents.
Methods
Data were drawn from the Longitudinal Study of Adolescents’ Mental and Behavioral Well-being Research (Registration No. ChiCTR1900022032). The final analysis included 1480 participants who completed baseline and two follow-up surveys. Standardized measures were employed to assess ST and multiple psychosocial well-being, including depressive symptoms, anxiety, externalizing problems, and coping style. Group-based trajectory modeling and generalized linear mixed models were performed.
Results
Over the two-year follow-up period, two distinct ST trajectories emerged: continued high (298 [20.1%]) and continued low (1182 [79.9%]). Compared with those in the continued low ST group, adolescents in the continued high group exhibited a higher likelihood of presenting depressive symptoms (β = 0.97, 95% CI = 0.43 ~ 1.50), anxiety symptoms (β = 0.29, 95% CI = 0.05 ~ 0.53), and emotional problems (β = 0.35, 95% CI = 0.22 ~ 0.48), and were less likely to demonstrate prosocial behavior or employ positive coping style. The stratified analysis demonstrated that the aforementioned associations only existed among female adolescents.
Conclusions
Persistent high exposure to ST was associated with an increased odds of emotional problems and a decreased probability of engaging in prosocial behavior and positive coping style, with particularly noteworthy effects observed among female adolescents. These findings underscore the importance of reducing ST exposure to improve the psychological well-being of adolescents.
... Anxiety symptoms were assessed using the 7-item Generalized Anxiety Disorder Scale (GAD-7) (80), a self-reporting screening scale that has been validated in China (81). Participants reported on their anxiety symptoms over the past 2 weeks using a 4-point scale (1 = not at all, 2 = several days, 3 = more than half the days, 4 = nearly every day). ...
Background
College students in Western China face unique economic, cultural, and educational environments, yet limited studies have specifically investigated the factors or interventions concerning emotional distress within this population.
Aim
This study aimed to explore whether school belongingness mediates the relationship between expectations regarding school and emotional distress among college students in Western China, and whether physical exercise moderates this mediation.
Methods
Employing a cross-sectional design, 1,063 college students in Xinjiang, China were recruited for this study. A self-administered electronic questionnaire assessed expectations regarding school, school belongingness, physical exercise, anxiety, and depression. Structural equation modeling was utilized to analyze mediating and moderating effects.
Results
Expectations regarding school was negatively associated with emotional distress. School exclusion and school acceptance fully mediated the effect of expectations regarding school on emotional distress. Physical exercise moderated the mediating effect of school exclusion, but not that of school acceptance.
Conclusion
Expectations regarding school and school belongingness, particularly the exclusion component, emerge as pivotal factors influencing emotional distress among college students in Western China. Furthermore, physical exercise presents itself as a promising targeted intervention for alleviating emotional distress within this demographic.
... Anxiety symptoms were measured using the Chinese version of Generalized Anxiety Disorder-7, which has good internal consistency (Cronbach's α .89; Tong et al., 2016). It assesses the occurrence of general anxiety symptoms in the past 2 weeks on a scale of four ranging from 0 (not at all) to 3 (nearly every day). ...
Chronic pain and depression are highly prevalent and correlated in older adults. Acceptance and commitment therapy (ACT) and exercise have been shown to be effective for both conditions, mostly in Western literature. Little is known about integrating two approaches, particularly in Asian cultures and among less well-educated people. This article describes the iterative process of developing a culturally adapted ACT with exercise intervention for older Chinese with chronic pain and depressive symptoms. A multidisciplinary expert panel codesigned a culturally adapted ACT with exercise intervention, comprising a weekly 2-hr ACT and a 1½-hr exercise program for 8 weeks, focusing on six ACT core components and low-to-moderate intensity circuit-based resistance exercise. Its feasibility was tested through a mixed-methods, pretest–posttest design with 22 older Chinese experiencing chronic pain and depressive symptoms (Mage = 71.5 years, SD = 7.5, 86% female). Participants showed significant improvements in pain intensity, pain interference, pain self-efficacy, physical performance, pain acceptance, and committed action (all p < .05). We identified five themes to inform protocol revision: (1) contextualizing values, (2) utilizing experiential learning, (3) using culturally appropriate metaphors, (4) establishing linkage between ACT concepts and pain, and (5) promoting application through repetition and prompts. Incorporating these findings, the final protocol emphasized three core ACT components and one set of physical exercises. This is the first study demonstrating the feasibility of a culturally adapted, person-centered tailoring ACT with exercise intervention for improving pain-related outcomes and mental wellness among older Chinese.
... The Chinese version of 7-item General Anxiety Disorder-7 (GAD-7; [24,47,50]) was employed to measure participants' anxiety. Past research has established that GAD-7 is an efficient and effective tool for screening anxiety disorder. ...
Psychological help-seeking for suicidal ideation is a critical aspect of effective suicide prevention. Past research has documented low help-seeking amongst rural residents in China. This study investigates the patterns and predictors of help-seeking intentions for suicidal ideation versus mental (depression) and physical (heart disease) health conditions among Chinese rural residents using General Help-Seeking Questionnaire Vignette version. A total of 143 rural participants from sixteen villages in Hubei province of China completed the survey via home-visiting interviews. Results revealed a general trend that the help-seeking intentions decreased as the helping sources shifted from close others (spouses, family, etc.) to professional helpers and online sources. Additionally, rural residents with higher educational levels, high self-efficacy, and more severe suicide ideations were more willing to seek help; and suicide literacy was found to be negatively associated with help-seeking intentions. The implications of the research findings are discussed.
... For the psychological assessments, patients were asked to self-administer several standardized questionnaires designed to measure various aspects of their mental health. These questionnaires are widely recognized and validated tools in clinical research and practice [21][22][23][24][25][26][27][28][29][30][31][32][33][34] . These questionnaires included the PHQ-9 (Patient Health Questionnaire-9), which evaluates the severity of depressive symptoms through a 9-item scale with scores ranging from 0 to 27 35 ; the GAD-7 (Generalized Anxiety Disorder-7), a 7-item scale used to assess the severity of anxiety symptoms, with scores ranging from 0 to 21 36 ; the PCL-5 (Posttraumatic Stress Disorder Checklist for DSM-5), a 20-item checklist used to determine the presence and severity of PTSD symptoms, with scores ranging from 0 to 80 26 ; and the PSQI (Pittsburgh Sleep Quality Index), which assesses sleep quality over the past month through 19 self-rated questions that produce a global score ranging from 0 to 21 37 . ...
COVID-19 survivors concerning about the rehabilitation and sustained sequelae of Coronavirus Disease 2019 (COVID-19) infection. We aimed to investigate the sequelae of patients’ psychological and physical condition and its related factors in the early and late stages. This longitudinal study tracked 281 COVID-19 patients discharged from hospitals in Guangdong, China, for one year. Assessments occurred at 2,4,12,24 and 48 weeks post-discharge. We define 2 weeks, 4 weeks, and 12 weeks as early stage, and 24 weeks and 48 weeks as late stage. Psychological health was measured using the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5), and Pittsburgh Sleep Quality Index (PSQI) scales. Physical health was assessed through laboratory tests, chest computed tomography (CT) scans, and pulmonary function tests. Data were analyzed using multivariate regression models to evaluate the influence of demographic and clinical variables on health outcomes. COVID-19 survivors exhibited psychological and physical sequelae in both the early and late stages. Compared to the early stage, the proportions of patients with depression (early stage 14.6%, late stage 4.6%), anxiety (early stage 8.9%, late stage 5.3%), PTSD(early stage 3.6%, late stage 0.7%), abnormal liver function (early stage 24.6%, late stage 11.0%), abnormal cardiac function (early stage 10.0%, late stage 7.8%), abnormal renal function (early stage 20.6%, late stage 11.0%) and abnormal pulmonary function (early stage 40.9%, late stage 13.5%) were significantly reduced in the late stage. Factors such as gender, age, severity of COVID-19, hospitalization duration, and various comorbidities were significantly associated with these sequelae. We noticed that psychological and physical sequelae occurred to COVID-19 survivors in short and long stages, and these would gradually decrease as time went on. Male gender, age > 50 years old, severe clinical condition, longer hospitalization time and comorbidity history were related factors that significantly affected the rehabilitation of COVID-19 patients.
... This investigation employed the version of GAD-7 revised by He et al. The version is suitable for the Chinese context and has demonstrated good reliability and validity among Chinese populations (32,33). The GAD-7 consists of 7 items including excessive worry, difficulty relaxing, feeling restless, irritability, and fear. ...
Introduction
Depression, anxiety, and somatic symptoms are highly comorbid and represent the most prevalent psychosomatic health issues. Few studies have investigated the network structure of psychosomatic symptoms among traditional Chinese medicine (TCM) students. This study aims to investigate the psychosomatic health status of college students in TCM universities, while simultaneously constructing a network structure of common somatic symptoms and psychological symptoms.
Methods
Online investigation was conducted among 665 students from a university of Chinese medicine. Health Status Questionnaire, Generalized Anxiety Disorder-7 (GAD-7), and Patient Health Questionnaire-2 (PHQ-2) were used to assess the mental symptoms and physical status of participants. With the R software processing, a network model of psychosomatic symptoms was constructed. Specifically, we computed the predictability (PRE), expected influence (EI), and bridging expected influence (BEI) of each symptom. Meanwhile, the stability and accuracy of the network were evaluated using the case-deletion bootstrap method.
Results
Among the participants, 277 (41.65%) subjects exhibited depressive symptoms, and 244 (36.69%) subjects showed symptoms of anxiety. Common somatic symptoms included fatigue, forgetfulness, sighing, thirst, and sweating. Within the psychosomatic symptoms network, “ worrying too much about things “, “uncontrollable worries” and “weakness” exhibited the high EI and PRE, suggesting they are central symptoms. “ Little interest or pleasure in doing things,” “ feeling down, depressed, or hopeless,” “ dyssomnia,” and “sighing” with high BEI values demonstrated that they are bridging symptoms in the comorbid network.
Conclusion
The psychosomatic health status of college students in traditional Chinese medicine schools is concerning, showing high tendencies for depression, anxiety, and somatic symptoms. There exists a complex relationship between somatic symptoms and psychological symptoms among students. “ Worrying too much about things “, “uncontrollable worries” and “weakness” enable to serve as comorbid intervention targets for anxiety, depression, and somatic symptoms. Addressing “ little interest or pleasure in doing things,” “ feeling down, depressed, or hopeless,” “ dyssomnia,” and “sighing” may effectively prevent the mutual transmission between psychological and physical symptoms. The network model highlighting the potential targeting symptoms to intervene in the treatment of psychosomatic health.
... Participants' physical health status was categorized as excellent or very good or good versus fair or poor. Mental health status included depression and anxiety assessed using the Chinese version of the 9-item Patient Health Questionnaire (PHQ-9) [40] and the Chinese version of the 7-item Generalized Anxiety Disorder Scale (GAD-7), respectively [41,42]. These were validated instruments assessing symptom severity over the last 2 weeks on a 4-point scale. ...
Background
The implementation of COVID-19 lockdown measures had immediate and delayed psychological effects. From March 27, 2022, to June 1, 2022, the Shanghai government enforced a city-wide lockdown that affected 25 million residents. During this period, mental health services were predominantly provided through digital platforms. However, limited knowledge exists regarding the general population’s intention to use mental health services during this time.
Objective
This study aimed to assess the intention of Shanghai residents to use mental health services during the 2022 Shanghai lockdown and identify factors associated with the intention to use mobile mental health services.
Methods
An online survey was distributed from April 29 to June 1, 2022, using a purposive sampling approach across 16 districts in Shanghai. Eligible participants were adults over 18 years of age who were physically present in Shanghai during the lockdown. Multivariable logistic regression was used to estimate the associations between demographic factors, lockdown-related stressors and experiences, physical and mental health status, and study outcomes–mobile mental health service use intention (mobile applications and WeChat Mini Programs [Tencent Holdings Limited]).
Results
The analytical sample comprised 3230 respondents, among whom 29.7% (weighted percentage; n=1030) screened positive for depression or anxiety based on the 9-item Patient Health Questionnaire or the 7-item Generalized Anxiety Disorder Scale. Less than one-fourth of the respondents (24.4%, n=914) expressed an intention to use any form of mental health services, with mobile mental health service being the most considered option (19.3%, n=728). Only 10.9% (n=440) used digital mental health services during the lockdown. Factors associated with increased odds of mobile mental health service use intention included being female, being employed, being a permanent resident, experiencing COVID-19–related stressors (such as loss of income, food insecurity, and potentially traumatic experiences), and having social and financial support. Individuals with moderate or severe anxiety, as well as those with comorbid anxiety and depression, demonstrated a higher intention to use mobile mental health services. However, individuals with depression alone did not exhibit a significantly higher intention compared with those without common mental disorders.
Conclusions
Despite a high prevalence of common mental disorders among Shanghai residents, less than one-fourth of the study respondents expressed an intention to use any form of mental health services during the lockdown. Mobile apps or WeChat Mini Programs were the most considered mental health service formats. The study provided insights for developing more person-centered mobile mental health services to meet the diverse needs of different populations.
... Responses to each item range from 0 to 3 with total scores of the GAD-7 ranging from 0 to 21; higher scores reflected higher anxiety levels. The Chinese version of GAD-7 has been shown to have good reliability and validity in samples of Chinese (Tong et al., 2016;Zhang et al., 2021). ...
The 33-item Childhood Trauma Questionnaire (CTQ-33) is a recently developed tool expanded from the 28-item Childhood Trauma Questionnaire (CTQ-28) to assess childhood trauma events, which showed good test-retest reliability over 2 weeks. However, little is known regarding the factor structure and long-term test-retest reliability of the CTQ-33. To fill such a gap, this study investigated the factorial validity of the CTQ-33 and test-retest reliability of the scale over a relatively long interval of 1 year. Data on demographics, the CTQ-33 scores, and mental health statuses such as depressive/anxiety symptoms were collected in Chinese adolescents (n = 188) twice across a one-year period. Results of the confirmatory factor analysis (CFA) revealed that the Chinese version of CTQ-33 has close factor validity when compared to the original CTQ-28 in college students. Furthermore, the total and most subscale scores of the CTQ-33 have fair to good test-retest reliability (intra-class correlation coefficients >0.6 for the total score, and > 0.4 for most subscales), except for the physical abuse subscale. Moreover, we replicated previous findings of significant positive relationships between levels of different childhood trauma subtypes using the CTQ-33. These findings provide initial evidence supporting that the CTQ-33 is overall reliable to assess childhood traumatic events in adolescents over relatively long intervals.
... A Cronbach's alpha of 0.89 has been demonstrated in the Chinese population, which suggests an acceptable level of internal consistency. 46 Participants will be asked to rate the frequency on a scale ranging from 1 (not at all) to 5 (daily) and indicate the duration (number of hours) where they engaged in positive and meaningful daily life activities in the past 2 weeks. Positive and meaningful activity is defined as 'involving in various aspects of subjective well-being, such as deriving pleasure and enjoyment, engaging in activities and satisfying basic needs through a wide range of daily living tasks'. ...
Background
Loneliness is a prevalent and alarming issue among older adults that requires effective interventions. While randomised controlled trials have been commonly undertaken to explore reduction in loneliness, there is a growing recognition that a comprehensive treatment strategy involving multiple interventions may yield better outcomes. Therefore, this study aims to develop and identify a two-stage adaptive intervention that combines telephone-delivered behavioural activation (Tele-BA) and mindfulness techniques (Tele-MF) to reduce loneliness in older adults in Hong Kong.
Methods
A Sequential, Multiple Assignment, Randomised Trial (SMART) design will be adopted. 244 lonely older adults will be recruited from the community and randomly assigned to either one of the 4-week two-stage, embedded adaptive interventions involving different sequences and dosages of Tele-BA and Tele-MF (eg, 4 weeks of Tele-BA followed by booster sessions for responders or 4 weeks of Tele-BA followed by 4 weeks of Tele-BA with motivational component or 4 weeks of Tele-MF for non-responders) based on a set of decision rules. The primary outcome will be loneliness measured by the Revised University of California Los Angeles (UCLA) Loneliness Scale. Secondary outcomes, such as De Jong Gierveld Loneliness Scale, perceived stress, sleep quality and depressive and anxiety symptoms, will be assessed. Adhering to the intention-to-treat principles, the data will be analysed using linear mixed models. The findings may have implications for the development of psychosocial adaptive interventions involving BA and MF to reduce loneliness and improve well-being among older adults in Hong Kong using the SMART design.
Ethics and dissemination
Ethical approval was obtained by the Human Research Ethics Committee at The Education University of Hong Kong (reference: 2022-2023-0117). The findings from this study will be presented in academic conferences and submitted for publication.
Trial registration number
ChiCTR2300077472.
... This could be because these studies were conducted during the early stage of the pandemic, when the virus was more toxic and the public knew little about it. Third, there will be inevitable reporting bias as self-report questionnaires were used although we used standardized and validated scales with excellent psychometric properties, and the psychometric properties of self-assessment instruments used in this study have been validated in Chinese population [51,52]. Additionally, community-level determinants, such as supplies provided by communities in the lockdown, might impact mental health but were not included in this study. ...
Background
The mental health inequality between migrants and non-migrants was exacerbated by the COVID-19 pandemic. Identifying key determinants of this inequality is essential in promoting health equity.
Methods
This cross-sectional study recruited Shanghai residents by purposive sampling during the city-wide lockdown (from April 29 to June 1, 2022) using an online questionnaire. Migration statuses (non-migrants, permanent migrants, and temporary migrants) were identified by migration experience and by household registration in Shanghai. Mental health symptoms (depression, anxiety, loneliness, and problematic anger) were assessed by self-report scales. The nonlinear Blinder-Oaxaca decomposition was used to quantify mental health inequality (i.e., differences in predicted probabilities between migration groups) and the contribution of expected correlates (i.e., change in predicted probability associated with variation in the correlate divided by the group difference).
Results
The study included 2738 participants (771 [28.2%] non-migrants; 389 [14.2%] permanent migrants; 1578 [57.6%] temporary migrants). We found inequalities in depression (7.1%) and problematic anger (7.8%) between permanent migrants and non-migrants, and inequalities in anxiety (7.3%) and loneliness (11.3%) between temporary migrants and non-migrants. When comparing permanent migrants and non-migrants, age and social capital explained 12.7% and 17.1% of the inequality in depression, and 13.3% and 21.4% of the inequality in problematic anger. Between temporary migrants and non-migrants, age and social capital also significantly contributed to anxiety inequality (23.0% and 18.2%) and loneliness inequality (26.5% and 16.3%), while monthly household income (20.4%) and loss of monthly household income (34.0%) contributed the most to anxiety inequality.
Conclusions
Significant inequalities in depression and problematic anger among permanent migrants and inequalities in anxiety and loneliness among temporary migrants were observed. Strengthening social capital and economic security can aid in public health emergency preparedness and promote mental health equity among migrant populations.
... The Cronbach's alpha coefficient for this scale in this study was 0.888. The GAD-7 developed by Spitzer et al. (2006) and subsequently revised by Tong et al. (2016), which demonstrates good reliability and validity in screening for symptoms of anxiety. It consists of seven items, each rated on a four-point scale from 0 to 3. The total score is the primary statistical indicator, with higher scores indicating greater anxiety severity. ...
Objective
To explore the relationship among boredom proneness, the behavioral inhibition system, and anxiety among college students based on variable-centered and person-centered analytic approaches.
Methods
A questionnaire survey was conducted on 1,102 college students from a university in Hebei Province using the Boredom Proneness Questionnaire (BPQ) for College Students, the Behavioral Inhibition System Scale (BIS), and the General Anxiety Disorder-7 scale (GAD-7).
Results
The results reveal that boredom proneness was negatively correlated with scores on the behavioral inhibition system (r = −0.100, p < 0.01), and positively correlated with anxiety (r = 0.457, p < 0.001), while the behavioral inhibition system was positively correlated with anxiety (r = 0.086, p < 0.01). In the variable-centered analyses study, it was found that the behavioral inhibition system partially mediated the association between boredom proneness and anxiety. In the person-centered analyses study, three subtypes were identified: the high boredom-low inhibition group (9.35%), the moderate boredom-inhibition group (66.70%), and the low boredom-high inhibition group (23.95%). Individuals in these subtypes showed significant differences in anxiety scores (F = 4.538, p < 0.05), with the low boredom-high inhibition group scoring the highest.
Conclusion
The results showed that the behavioral inhibition system partially mediates the relationship between boredom proneness and anxiety in college students; boredom proneness and the behavioral inhibition system exhibit group heterogeneity, with distinct classification features closely related to anxiety.
... 20,22 The Chinese version of the GAD-7 is a commonly used scale for evaluating generalized anxiety disorders. 23,24 It consists of seven questions that assess the frequency and severity of anxiety symptoms in the past two weeks, with a total score of 0-4 indicating no anxiety, a score of 5-9 indicating mild anxiety, a score of 10-14 indicating moderate anxiety, and a score of 15-21 indicating severe anxiety. 25 The Chinese version of the PHQ-9, derived from the depression module of the Patient Health Questionnaire edited by Spitzer et al, is an internationally recognized depression detection scale. ...
Purpose
This study aimed to evaluate nocturnal sleep structure and anxiety, depression, and fatigue in patients with narcolepsy type 1 (NT1).
Methods
Thirty NT1 patients and thirty-five healthy controls were enrolled and evaluated using the Epworth sleepiness scale (ESS), Generalized Anxiety Disorder-7, Patient Health Questionnaire-9, Fatigue Severity Scale (FSS), polysomnography, multiple sleep latency test, and brain function state monitoring. Statistical analyses were performed using SPSS Statistics for Windows, version 23.0. Benjamini-Hochberg correction was performed to control the false discovery rate.
Results
Apart from typical clinical manifestations, patients with NT1 are prone to comorbidities such as nocturnal sleep disorders, anxiety, depression, and fatigue. Compared with the control group, patients with NT1 exhibited abnormal sleep structure, including increased total sleep time (Padj=0.007), decreased sleep efficiency (Padj=0.002), shortening of sleep onset latency (Padj<0.001), elevated wake after sleep onset (Padj=0.002), increased N1% (Padj=0.006), and reduced N2%, N3%, and REM% (Padj=0.007, Padj<0.001, Padj=0.013). Thirty-seven percent of patients had moderate to severe obstructive sleep apnea-hypopnea syndrome. And sixty percent of patients were complicated with REM sleep without atonia. Patients with NT1 displayed increased anxiety propensity (Padj<0.001), and increased brain fatigue (Padj=0.020) in brain function state monitoring. FSS scores were positively correlated with brain fatigue (Padj<0.001) and mean sleep latency was inversely correlated with FSS scores and brain fatigue (Padj=0.013, Padj=0.029). Additionally, ESS scores and brain fatigue decreased after 3 months of therapy (P=0.012, P=0.030).
Conclusion
NT1 patients had abnormal nocturnal sleep structures, who showed increased anxiety, depression, and fatigue. Excessive daytime sleepiness and fatigue improved after 3 months of treatment with methylphenidate hydrochloride prolonged-release tablets in combination with venlafaxine.
... Illness profile included alcohol/ substance use disorder, and chronic physical disease. Concerning mental health symptoms of both psychiatric patient and control groups, depressive and anxiety symptom severity were assessed by Patient Health Questionnaire-9 (PHQ-9) [24,25] and Generalized Anxiety Disorder-7 scale (GAD-7) [26,27], respectively, with both scales using a 4-point Likert scale ranging from 0 (never) to 3 (nearly every day). The total score for depression was ranging from 0 to 27, whereas that for anxiety was 0 to 21. ...
Background
Psychiatric patients are susceptible to adverse mental health outcome during COVID-19 pandemic, but its associated factors are understudied. This observational cross-sectional study aimed to comprehensively examine prevalence and correlates of psychological distress, in terms of depression, anxiety and post-traumatic-stress-disorder (PTSD)-like symptoms, among Chinese adult psychiatric outpatients amidst the peak of fifth COVID-19 wave in Hong-Kong.
Methods
A total of 415 patients (comprising 246 patients with common-mental-disorders [CMD] and 169 with severe-mental-disorders [SMD]) and 399 demographically-matched controls without mental disorders were assessed with self-rated questionnaires between 28-March and 8-April-2022, encompassing illness profile, mental health symptoms, psychosocial measures (loneliness, resilience, coping styles) and COVID-19 related factors. Univariate and multivariable logistic regression analyses were conducted to determine variables associated with moderate-to-severe depressive, anxiety and PTSD-like symptoms among psychiatric patients.
Results
Our results showed that CMD patients had the greatest psychological distress relative to SMD patients and controls. Approximately 40–55% CMD patients and 25% SMD patients exhibited moderate-to-severe depression, anxiety and PTSD-like symptoms. Multivariable regression analyses revealed that female gender, lower educational attainment, single marital status, being housewife, more severe insomnia, psychotic-like symptoms and cognitive complaints, self-harm behavior, lower resilience, avoidance coping, never contracting COVID-19 infection, greater fear of contagion, and longer exposure to pandemic-related information were independently associated with depression, anxiety and/or PTSD-like symptoms in psychiatric patients.
Conclusions
Our results affirm increased vulnerability of psychiatric patients toward psychological distress during pandemic. An array of identified correlates facilitates early detection of high-risk psychiatric patients for targeted strategies to minimize pandemic-related negative psychological impact.
... The participants also contributed a blood sample at recruitment. The self-rated depressive and anxiety symptoms were collected by established scales [15,16], both at recruitment and during an active follow-up period (i.e., at 1-, 6-, and 12month follow-ups in the CSAC and at 1-, 3-, 6-, and 12-month follow-ups in the CSTC). Until December 31, 2022, the response rate at baseline was 94.4% for questionnaire data collection and 70.6% for blood sample collection in the CSAC; the corresponding rates were 87.1% and 78.5%, respectively, in the CSTC. ...
Pre-existing psychiatric disorders were linked to an increased susceptibility to COVID-19 during the initial outbreak of the pandemic, while evidence during Omicron prevalence is lacking. Leveraging data from two prospective cohorts in China, we identified incident Omicron infections between January 2023 and April 2023. Participants with a self-reported history or self-rated symptoms of depression or anxiety before the Omicron pandemic were considered the exposed group, whereas the others were considered unexposed. We employed multivariate logistic regression models to examine the association of pre-existing depression or anxiety with the risk of any or severe Omicron infection indexed by medical interventions or severe symptoms. Further, we stratified the analyses by polygenic risk scores (PRSs) for COVID-19 and repeated the analyses using the UK Biobank data. We included 10,802 individuals from the Chinese cohorts (mean age = 51.1 years, 45.6% male), among whom 7841 (72.6%) were identified as cases of Omicron infection. No association was found between any pre-existing depression or anxiety and the overall risk of Omicron infection (odds ratio [OR] =1.04, 95% confidence interval [CI] 0.95–1.14). However, positive associations were noted for severe Omicron infection, either as infections requiring medical interventions (1.26, 1.02–1.54) or with severe symptoms (≥3: 1.73, 1.51–1.97). We obtained comparable estimates when stratified by COVID-19 PRS level. Additionally, using clustering method, we identified eight distinct symptom patterns and found associations between pre-existing depression or anxiety and the patterns characterized by multiple or complex severe symptoms including cough and taste and smell decline (ORs = 1.42–2.35). The results of the UK Biobank analyses corroborated findings of the Chinese cohorts. In conclusion, pre-existing depression and anxiety was not associated with the risk of Omicron infection overall but an elevated risk of severe Omicron infection, supporting the continued efforts on monitoring and possible early intervention in this high-risk population during Omicron prevalence.
... Excellent psychometric properties of the measure were found, for example, in representative samples of German adult population (Löwe et al., 2008) and of Finnish adolescents (Tiirikainen et al., 2019), in US and Korean college students (Byrd-Bredbenner et al. 2020;Lee and Kim, 2019), in US first responders (Ahmadi et al., 2023), Chinese pregnant women (Gong et al., 2021), and in samples of Italian patients with coronary heart disease (Bolgeo et al., 2023), British seizure patients (Goldstein et al., 2023), US and British substance abuse patients (Bentley et al., 2021;Delgadillo et al., 2012) and US anxiety and mood disorders patients (Rutter and Brown, 2017). The measure has been translated into more than 20 languages and has consistently shown excellent internal consistency in both US and international samples (Delgadillo et al., 2012;Kertz et al., 2013;Löwe et al., 2008;Seo and Park, 2015;Tong et al., 2016;Wild et al., 2014). Studies of international translations also shown that cultural adaptations to the wording of the items is generally not necessary; however, cultural context might need to be considered during scoring interpretation (Mills et al., 2014). ...
The GAD-7 is a widely used screening tool for the measurement and diagnosis of symptoms of generalized anxiety disorder. It has been translated and validated across more than 20 cultural contexts. However, no study to date examined its psychometric properties in a Slovak sample, despite the fact that a Slovak translation exists. The purpose of the present study was to test psychometric properties and factor structure of GAD-7 in a general sample of Slovak helping professionals. It was hypothesized that a one-dimensional factor structure would be supported by the data, and that construct validity would be demonstrated. A total of 2239 participants (Mage = 42.20, SD = 14.30) from different helping professions (e.g., psychologists, teachers, special educators, medical doctors, nurses, speech-language pathologists) completed an online survey. A confirmatory factor analysis yielded satisfactory factor loadings and acceptable model fit of the tested one-dimensional model. This evidence was invariant by sex. Internal consistency coefficients indicated good reliability. Significant correlations were found between the GAD-7 and both negative and positive adjustment constructs, thus demonstrating convergent and discriminant validity, respectively. The results of this study add to the evidence on the GAD-7 and its applicability across cultures and support the use of a Slovak translation of the instrument.
... The GAD-7 consists of seven items, and response options for each item range from 0 = not at all to 3 = nearly every day. The Chinese version of the GAD-7 has been validated for use in Chinese populations (Sun et al., 2021;Tong et al., 2016). Only Sample 1 completed the GAD-7, and the internal consistency measures in the current study were α = .91, ...
The academic grit scale (AGS) is a new measure developed to assess the level of adolescents’ grit in an academic-specific context. The main purpose of this study was to examine the psychometric properties, factor structure, and measurement invariance of the AGS among Chinese adolescents. A cross-sectional design and convenient sampling were conducted in a sample of Chinese adolescents (N = 619, 50.6% female, Mage = 14.56 years, SD = 1.47 years) using the AGS. Confirmatory factor analysis (CFA) supported the original unidimensional model of the AGS, and multiple-group CFA further verified the AGS scores had strong measurement invariance across gender (i.e., boys and girls) and grade level (i.e., middle school students and high school students). Moreover, the AGS also showed satisfactory internal consistency (using Cronbach’s α, McDonald’s ω, and mean inter-item correlation) and criterion validity, supported by expected relationships with scores on external variables (i.e., general grit, anxiety, and depression). In conclusion, these findings suggest that the AGS has satisfactory psychometric properties and can be a reliable tool to measure the academic grit level of Chinese adolescents.
... The cutoff of this instrument is 10 with sensitivity of 86.2% and a specificity of 95.5% (Kroenke, Spitzer, Williams, Monahan, & Löwe, 2007). The GAD-7 has been validated in Chinese populations through several studies such as those conducted by Sun, Liang, Chi, and Chen (2021) and Tong, An, McGonigal, Park, and Zhou (2016). In the current study, the Cronbach's α was 0.887. ...
Background and aims
Nomophobia (NMP) is a contemporary digital ailment referring to the improper utilization of smartphones which can have significant impacts on the physical and mental health of college students. However, as a result of unclear cutoff points, the proportion of people with NMP may be exaggerated. This study therefore aimed to determine the critical value of NMP and assess the extent to which Chinese college students are impacted by NMP using the Nomophobia Questionnaire (NMP-Q).
Methods
Latent profile analysis (LPA) and the receiver operating characteristic curve (ROC) were combined to determine the critical value based on NMP-Q scores using a large sample of 3,998 college students ( M age = 20.58; SD = 1.87).
Results
Based on latent profile (i.e., at-risk NMP group), ROC revealed an optimal cut-off point of 73 (Sensitivity = 0.965, Specificity = 0.970, Accuracy = 0.968, AUC = 99.60%, Youden's index = 0.935), and the percentage of NMP students being 28.04%, with 1,121 participants identified as positive cases (probable cases). Positive cases were found to exhibit more severe depression and anxiety symptoms, with a higher proportion of females were observed in the positive group ( N = 829; 73.95%).
Conclusions
These findings provide evidence that the proportion of NMP individuals may have been overestimated in the past. Furthermore, this study helps to validate the NMP-Q as a valid tool to identify NMP in college-aged individuals.
... A cutoff score of 10 has been established for this scale, demonstrating a sensitivity of 86.20% and specificity of 95.50% [37]. The Chinese version of the GAD-7 has been used successfully in various Chinese settings [38,39]. The Cronbach's α for the GAD-7 in this study was 0.90. ...
Background
This study aimed to investigate the interplay between anxiety and depressive symptoms in Chinese college freshmen using the causal system perspective (CSP), which differs from the traditional common cause perspective (CCP) by providing an alternative explanation by attributing comorbidity to direct interactions among symptoms.
Methods
A convenience sample of 2,082 Chinese college freshmen (39.51% male, Mage = 18.61) from a normal university completed the Generalized Anxiety Disorder 7-Item Scale (GAD-7) and the Patient Health Questionnaire (PHQ-9). Network analysis was conducted and evaluated as to centrality, stability, node predictability, and bridging features. Moreover, the moderated network model (MNM) was utilized to detect the moderation effects of gender in the comorbidity network.
Results
The network of anxiety and depressive symptoms exhibited stability, characterized by the core symptoms of “restlessness”, “lack of energy”, and “excessive worry about control”, as well as the bridging symptoms of “fearfulness”, “sad mood”, and “irritability”. Notably, the nodes representing “uncontrollable worry” and “difficulty in relaxation” demonstrated the highest predictive power. Gender did not exert any moderating effects on the anxiety and depressive symptom network.
Conclusion
These results reinforce that certain anxiety or depressive symptoms are more central than others, and thus play a more vital role in the comorbid network. These findings highlight underlying potential targeting symptoms to consider in future interventions.
Purpose
This study aims to use solution-focused cognitive group intervention (SCGI), which combines cognitive behavioral therapy with solution-focused brief therapy, to improve the benefit finding of petitioners.
Method
This intervention includes six sessions and two follow-up tests (at three months and six months). Sixty-four petitioners (mean age = 44.31, standard deviation = 4.43) were randomly assigned to the intervention group (32 participants) and the control group (32 participants). The SCGI group aims to enhance benefit finding and reduce anxiety. Solution-focused thinking, strength knowledge, and strength use make up the intervention components.
Results
The intervention effectively improved participants’ benefit finding and reduced their anxiety, with long-term effects. The control group did not change. Network analysis indicates that strength use has the greatest influence in the network.
Discussion
For future research, it is imperative to focus on participants’ strengths to comprehend the efficacy mechanisms and enhance the intervention framework.
Objective
To evaluate the effect of pressing needle therapy on depression, anxiety, and sleep in patients recovering from COVID-19, and to provide a more effective and convenient treatment for the sequelae of COVID-19.
Methods
A total of 136 patients recovering from COVID-19 were randomized into a treatment group (68 cases) and a control group (68 cases, with one case dropping out). The treatment group received pressing needle therapy, while the control group received sham pressing needle therapy, three times a week for 4 weeks. The Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder Scale (GAD-7), and Insomnia Severity Index (ISI) were used to evaluate patients’ emotional states and sleep quality. These scales were assessed before, after, and at a 1-month follow-up.
Results
Compared to before treatment, the treatment group showed a significant decrease in PHQ-9 scores (p < 0.05, Cohen’s d = 1.26), GAD-7 scores (p < 0.05, Cohen’s d = 1.10), and ISI scores (p < 0.05, Cohen’s d = 0.94) after treatment. Similarly, at the 1-month follow-up, significant decreases were observed in PHQ-9 scores (p < 0.05, Cohen’s d = 1.11), GAD-7 scores (p < 0.05, Cohen’s d = 0.88), and ISI scores (p < 0.05, Cohen’s d = 0.94). In contrast, the control group demonstrated no statistically significant differences in PHQ-9, GAD-7, or ISI scores after treatment or at the 1-month follow-up (p > 0.05). Between the two groups, statistically significant improvements (p < 0.05) were observed in PHQ-9 scores (Cohen’s d = 1.47), GAD-7 scores (Cohen’s d = 1.61), and ISI scores (Cohen’s d = 1.06) after treatment. At the 1-month follow-up, statistically significant differences (p < 0.05) between the two groups were also noted in PHQ-9 scores (Cohen’s d = 1.10), GAD-7 scores (Cohen’s d = 0.87), and ISI scores (Cohen’s d = 0.92).
Conclusion
Pressing needle therapy significantly improves the mental health and sleep quality of patients recovering from COVID-19. It enhances their quality of life, promotes early recovery, and is simple and easy to administer, making it a treatment worthy of clinical application.
Clinical trial registration
https://www.chictr.org.cn/.
Acute stress, which is omnipresent in daily life, is associated with executive function, mental disorders, and social cognition. However, the intricate relationships among these variables within a joint framework remain unknown. To address this gap, we performed a network analysis using cross-sectional data including pertinent variables. Data were collected from 1010 Chinese adult participants (mean age = 26.05 ± 5.95) who completed validated self-report scales of acute stress, problematic smartphone use, social media addiction, anxiety, depression, sense of control, intolerance of uncertainty, executive function, theory of mind, perspective taking, and empathic concern. Subsequently, a regularized partial-correlation network was estimated. Community detection analysis was then conducted and centrality and bridge centrality indices were determined. The result of community detection showed four communities in the constructed network, namely technology addiction, stress-induced mental disorders, cognition-behavior regulation, and social cognition. Nine cross-community and nine within-community connections were emphasized. Acute stress had the highest strength and bridge strength, perspective taking had the highest expected influence, and intolerance of uncertainty had the highest bridge expected influence. The findings revealed that connections were present between acute stress and relevant variables, as well as between other pairwise variables, independent of pre-existing knowledge or hypotheses. Our findings elucidate the pathways between these variables after eliminating confounding effects and highlight the important role of acute stress, which is potentially a promising and effective target for prevention and treatment of acute stress and related mental disorders.
Background
This study aims to validate a hypothesized model of the relationships between optimism, resilience, coping, parenting stress, perceived social support, and anxiety, as well as their influencing factors and consequences among caregivers of children diagnosed with cleft lip and/or palate (CL/P).
Methods
A hypothesized model was proposed based on diathesis-stress theoretical model and existing literature. A convenience sample of two CL/P treatment centers in China was collected between April 2019 and July 2020. Various well-validated instruments were used to collect 248 valid data points. Descriptive statistics and correlations were computed to assess model fitness and path analysis was performed to investigate direct and indirect effects.
Results
The results revealed that the average level of anxiety among caregivers of children suffering from CL/P was 3.00 (0.00,6.00). The fitness of the modified path model was evaluated using various measures, including χ2/df = 1.806, GFI = 0.989, RFI = 0.916, IFI = 0.990, CFI = 0.989, TLI = 0.960, RMSEA = 0.0570. Parenting stress had the greatest direct associated with anxiety, followed by perceived social support. Moreover, indirect relations to anxiety were observed for optimism, resilience, and coping, which were mediated through perceived social support and parenting stress.
Conclusion
In summary, this work suggests that both parenting stress and perceived social support in caregivers of children suffering from CL/P are associated with anxiety. Therefore, developing effective intervention approaches targeting key factors might potentially instrumental to alleviate anxiety.
Background
Anxiety and depressive disorders, characterized by high incidence and functional impairments, are emotional disorders with shared etiological and maintenance mechanisms. Dialectical behavior therapy (DBT) is a promising approach for the transdiagnostic treatment of emotional disorders. Developing a brief DBT intervention can facilitate the adoption of evidence-based therapy.
Methods
This protocol is for a 3-year single-blinded, two-arm randomized controlled trial. Individuals with depressive or anxiety disorder will be randomly allocated to a modified DBT–informed transdiagnostic psychotherapy group or a treatment-as-usual group. The intervention group will receive DBT individual therapy for 15 weeks. Power analyses revealed that the cohort should include a minimum of 250 participants. Preintervention, postintervention, and follow-up (after 3 months) assessments will be conducted. Primary outcomes will be severities of depression and anxiety rated by blind assessors. Intent-to-treat and per-protocol analyses will be conducted using the hierarchical linear model. Effect sizes will be estimated using Cohen’s d.
Result
To the best of our knowledge, the proposed study will be the first randomized controlled trial to evaluate the efficacy of a modified DBT intervention in managing transdiagnostic emotional disorders in Chinese individuals.
Conclusion
This intervention is expected to improve clinical outcomes, daily functioning, and quality of life. The trial will enrich the empirical evidence for transdiagnostic interventions, facilitating the implementation of evidence-based therapy and reducing the high prevalence and challenges (e.g., disability) of emotional disorders in the Chinese population.
Trial registration number
NCT05989451
Objective
To investigate the effect of cognitive insight on anxiety in community-dwelling schizophrenia patients and to construct a chain mediating model to determine the underlying mechanisms of the relationship between cognitive insight and anxiety through family cohesion and chronotype.
Methods
The Beck Cognitive Insight Scale, the Chinese version of the Family Adaptability and Cohesion Scale, the Morningness-Eveningness Scale, and the Generalized Anxiety Disorder Scale were used to assess cognitive insight, family cohesion, chronotype, and anxiety in a sample of 785 individuals with schizophrenia living in the community. Spearman correlation analysis, multiple linear regression and Bootstrap methods were employed to analyze the four variables.
Results
Residential region, current employment status, and family economic status impacted anxiety among community-dwelling schizophrenia patients. All variables were associated with each other, but self-certainty was not significantly associated with anxiety. Cognitive insight and self-reflection had direct effects on anxiety, as well as indirect effects on anxiety through the partial mediating effect of chronotype, the suppressing effect of family cohesion, and the chain mediating effect of family cohesion and chronotype.
Conclusions
Family cohesion and chronotype can mediate the relationship between cognitive insight and anxiety. Improving family functioning, promoting emotional relationships within families, and correcting non-circadian sleep patterns can reduce anxiety in community-dwelling schizophrenia patients, with important implications for improving adverse mental health outcomes.
Objectives: To facilitate research on digital hoarding in China, this study evaluated the psychometric properties of the Digital Hoarding Scale (DHS). Methods: A total of 618 participants were recruited through an online survey. The factorial structure, measurement invariance (MI), reliability, and validity of the DHS were tested. Results: The Chinese version of DHS was best represented by a bifactor exploratory structural equation modeling representation, which contains one general factor and three specific factors. The MI of the DHS was established across gender and age groups. Reliabilities of the specific and general factors were demonstrated by high values of omega coefficients. Moreover, the criterion validity was supported by the positive associations between DHS and physical hoarding disorder, obsessive-compulsive disorder, and anxiety. Conclusions: The DHS is a reliable tool for future studies investigating digital hoarding in Chinese.
Background
Nursing students are faced with multiple challenges and have a higher probability of suffering from anxiety. The current study aims to explore the relation between empathy and anxiety, examining the mediation and moderation effects of insomnia and self-compassion, respectively.
Methods
This study employed a convenient sampling method, recruiting 1,161 nursing students (female = 923, male = 238, Meanage = 18.37, SDage = 2.38) from three universities in China. These students completed the questionnaires online, including General Anxiety Disorder -7 (GAD-7), Jefferson Scale of Physician Empathy-Nursing student (JSPE-NS), Youth Self-rating Insomnia Scale -8 (YSIS-8), and Self-Compassion Scale (SCS). The study employed latent variable structural equation models to analyze the relation and mechanisms between empathy and anxiety. Then, the mediated role of insomnia and the moderated role of self-compassion were examined.
Results
The prevalence rates of anxiety and insomnia in the current sample are 18.24% and 26.76%, respectively. The results showed that empathy could negatively predict anxiety, with a significant mediating effect of insomnia between them (B = -0.081, p < 0.05, 95% CI [-0.197, -0.063]). Additionally, it was proven that self-compassion moderated the positive relation between insomnia and anxiety. With a higher level of self-compassion, the indirect effect of empathy on anxiety through insomnia was weaker (B = -0.053, p < 0.01, 95% CI [-0.095, -0.019]). When individuals showed a lower level of self-compassion, the indirect effect of empathy on anxiety through insomnia was stronger (B = -0.144, p < 0.01, 95% CI [-0.255, -0.059]).
Conclusion
The analysis of this research proved that empathy was negatively related to anxiety, and insomnia served as a mediator between empathy and anxiety. Besides, the protective role of self-compassion on individuals’ mental health was identified. The findings of the study suggest that the education of nursing students should highlight the significance of fostering empathy and self-compassion. The intervention on insomnia may be helpful in reducing the levels of anxiety since insomnia is a risky factor for anxiety.
Adverse birth outcomes remain challenging public health problems in China. Increasing evidence indicated that prenatal depression and anxiety are associated with adverse birth outcomes, highlighting the importance and severity of prenatal depression and anxiety in China. The COVID-19 pandemic is likely to further exacerbate prenatal mental health problems and increase the risk of adverse birth outcomes. The aim of this study is to assess and compare the impacts of prenatal mental health issues on birth outcomes before and during the COVID-19 pandemic in Ma’anshan, Anhui, China. Participants in this study were women who visited local maternal and child health hospitals in Ma’anshan, Anhui, China. Two independent sets of individual maternal data (npre-pamdemic = 1148; npandemic = 2249) were collected. Prenatal depression and anxiety were measured online using the Edinburgh Postnatal Depression Scale (EPDS) and the General Anxiety Disorder-7 (GAD-7). Adverse birth outcomes were determined using hospital-recorded infant birth weight and gestational age at delivery. In this study, we found that the pandemic cohort had lower mean EPDS and GAD-7 scores than the pre-pandemic cohort. The prevalence of prenatal depression (14.5%) and anxiety (26.7%) among the pandemic cohort were lower than the pre-pandemic cohort (18.6% and 36.3%). No significant difference was found in the prevalence of adverse birth outcomes comparing the two cohorts. Prenatal depression was associated with small gestational age only in the pandemic cohort (OR = 1.09, 95% CI 1.00–1.19, p = 0.042). Overall, this study highlighted an association between prenatal depression and small for gestational age in Anhui, China. Addressing prenatal depression may thus be key in improving birth outcomes. Future studies could focus on potential causal relationships.
Introduction and aims
In the specialized nursing setting, nurses are susceptible to developing negative mental health issues. Such conditions among nurses can potentially result in unfavorable medical outcomes. Consequently, this study aims to explore the role of social support in regulating between sleep and mental health in nurses.
Methods
A cross-sectional study was carried out in September 2022 on 1219 nurses in Quanzhou. The study comprised general demographic information and utilized various questionnaires, namely the Social Support Rate Scale (SSRS), Pittsburgh Sleep Quality Index Questionnaire (PSQI), Generalized Anxiety Disorder Questionnaire (GAD-7), and Patient Health Questionnaire-9 (PHQ-9). The data analysis was performed using t-tests, ANOVAs, Pearsons correlations and hierarchical regression analyses in SPSS software.
Results
Results show that significant associations of sleep quality and social support with anxiety and depression. Simple slope analysis shows that under low levels of social support, sleep quality has a positive impact on anxiety(β = 0.598) and depression(β = 0.851), and the impact is significant. Under high levels of social support, sleep quality also has a positive impact on anxiety(β = 0.462) and depression(β = 0.578), but the impact is smaller. This indicates that as the level of social support increases, the positive predictive effect of sleep quality on anxiety and depression gradually diminishes.
Conclusions
Social support has the potential to alter the impact of sleep quality on anxiety and depression. Therefore, healthcare policymakers need to focus on enhancing the level of social support and mitigating the impact of poor sleep on anxiety and depression.
Background
Digital cognitive behavioral therapy for insomnia (dCBTi) is an effective intervention for treating insomnia. The findings regarding its efficacy compared to face-to-face cognitive behavioral therapy for insomnia are inconclusive but suggest that dCBTi might be inferior. The lack of human support and low treatment adherence are believed to be barriers to dCBTi achieving its optimal efficacy. However, there has yet to be a direct comparative trial of dCBTi with different types of coaching support.
Objective
This study examines whether adding chatbot-based and human coaching would improve the treatment efficacy of, and adherence to, dCBTi.
Methods
Overall, 129 participants (n=98, 76% women; age: mean 34.09, SD 12.05 y) whose scores on the Insomnia Severity Index [ISI] were greater than 9 were recruited. A randomized controlled comparative trial with 5 arms was conducted: dCBTi with chatbot-based coaching and therapist support (dCBTi-therapist), dCBTi with chatbot-based coaching and research assistant support, dCBTi with chatbot-based coaching only, dCBTi without any coaching, and digital sleep hygiene and self-monitoring control. Participants were blinded to the condition assignment and study hypotheses, and the outcomes were self-assessed using questionnaires administered on the web. The outcomes included measures of insomnia (the ISI and the Sleep Condition Indicator), mood disturbances, fatigue, daytime sleepiness, quality of life, dysfunctional beliefs about sleep, and sleep-related safety behaviors administered at baseline, after treatment, and at 4-week follow-up. Treatment adherence was measured by the completion of video sessions and sleep diaries. An intention-to-treat analysis was conducted.
Results
Significant condition-by-time interaction effects showed that dCBTi recipients, regardless of having any coaching, had greater improvements in insomnia measured by the Sleep Condition Indicator (P=.003; d=0.45) but not the ISI (P=.86; d=–0.28), depressive symptoms (P<.001; d=–0.62), anxiety (P=.01; d=–0.40), fatigue (P=.02; d=–0.35), dysfunctional beliefs about sleep (P<.001; d=–0.53), and safety behaviors related to sleep (P=.001; d=–0.50) than those who received digital sleep hygiene and self-monitoring control. The addition of chatbot-based coaching and human support did not improve treatment efficacy. However, adding human support promoted greater reductions in fatigue (P=.03; d=–0.33) and sleep-related safety behaviors (P=.05; d=–0.30) than dCBTi with chatbot-based coaching only at 4-week follow-up. dCBTi-therapist had the highest video and diary completion rates compared to other conditions (video: 16/25, 60% in dCBTi-therapist vs <3/21, <25% in dCBTi without any coaching), indicating greater treatment adherence.
Conclusions
Our findings support the efficacy of dCBTi in treating insomnia, reducing thoughts and behaviors that perpetuate insomnia, reducing mood disturbances and fatigue, and improving quality of life. Adding chatbot-based coaching and human support did not significantly improve the efficacy of dCBTi after treatment. However, adding human support had incremental benefits on reducing fatigue and behaviors that could perpetuate insomnia, and hence may improve long-term efficacy.
Trial Registration
ClinicalTrials.gov NCT05136638; https://www.clinicaltrials.gov/study/NCT05136638
The clinical literature encourages further exploration of the relationship between anxiety and paranoid ideation with the overall objective of identifying processes that mitigate such relationship, thus establishing targets for cognitive intervention. Empirical studies demonstrate that increased levels of anxiety precede the emergence of paranoid cognitions. Yet, possible mediators are still to be investigated. In all, 273 adults completed a battery of standardized questionnaires, and collated data were analyzed statistically. Generalized anxiety was positively associated with paranoid ideation, for both ideas of reference and persecutory beliefs. Although the relationship was not mediated by cognitive flexibility in its entirety, perceived control over internal experiences and external events, an essential constituent of cognitive flexibility, acted as a significant mediator. The results highlight the importance of increasing adaptive perceptions of control among individuals experiencing generalized anxiety, which would likely reduce the co-occurrence of paranoid ideation and lower the risk of transitioning into clinical levels of paranoia.
Background
Maternal parenting self‐efficacy plays a critical role in facilitating positive parenting practices and successful adaption to motherhood. The Perceived Maternal Parenting Self‐Efficacy Scale (PMPS‐E), as a task‐specific measure, confirms its psychometric properties in cultural contexts. Compared with other tools, the advantages of the PMPS‐E are as follows: (i) specific context or time period during the lifespan of a child, (ii) explicitly assess parenting self‐efficacy across a diverse enough range of parenting tasks or activities during the perinatal/postnatal period and (iii) having robust psychometric properties. The aim of this study was to translate and determine the psychometric properties of the PMPS‐E among Chinese postpartum women (C‐PMPS‐E).
Method
The cross‐cultural adaptation process followed Beaton et al.'s intercultural debugging guidelines. A total of 471 women were included to establish the psychometric properties of the C‐PMPS‐E. Mothers were asked to complete the C‐PMPS‐E, Edinburgh Postnatal Depression Scale (EPDS), the Generalized Anxiety Disorder‐7 (GAD‐7) and several demographic questions. The psychometric testing of the C‐PMPS‐E was established through item analysis, construct validity and internal consistency reliability.
Results
Item analysis showed that the critical ratios of all items were greater than 3 between the low‐score group and high‐score group, and all item–total correlation coefficients were greater than 0.4. The fit indices showed that the original correlated four‐factor model of C‐PMPS‐E was observed to be an excellent fit to the data. The PMPS‐E was negatively correlated with the EPDS and GAD‐7 demonstrating its discriminant validity. As expected, no significant correlation was found between PMPS‐E total or subscale scores and mothers' age. In addition, statistically significant differences for parity were detected for C‐PMPS‐E total and subscale scores with multipara having higher scores. This was taken as further evidence of the scale known‐groups discriminant validity. In terms of internal consistency, the Cronbach's alpha of the C‐PMPS‐E total scale was 0.950, and subscales ranged from 0.76 to 0.89. Furthermore, a ROC curve analysis was conducted to establish the ability of the C‐PMPS‐E to distinguish between symptoms of depression and symptoms of anxiety. A cut‐off value of 55 was identified that resulted in good specificity and fair sensitivity.
Conclusion
The C‐PMPS‐E is a reliable and valid tool to assess maternal parenting self‐efficacy in a Chinese context.
Objective
This survey investigated the prevalence, distribution, and correlative factors of insomnia symptoms among people aged 65 and above in Guangdong Province, China.
Methods
The Guangdong Mental Health Survey was conducted on the elderly in all 21 cities of Guangdong Province from September to December 2021. Multistage stratified cluster sampling was adopted, and 16 377 adult residents were interviewed face-to-face, from which 4001 elderly participants aged 65 and above were included for this study. Complex weighted adjustment methods were applied to weight the data. Multinomial logistic regression was applied to test the independent associations of clinical insomnia symptoms (CIS) and subthreshold insomnia symptoms (SIS) with the factors.
Results
The pooled estimate of insomnia symptoms was 13.44% [95% confidence interval (CI): 12.2 %-14.7%]. The 1-month weighted prevalence of SIS and CIS were 11.15% (95% CI: 10.05%-12.37%) and 2.28% (95%CI: 1.77%-2.94%), respectively. Multinomial logistic regression analysis revealed that urban residence, irregular diet, low body mass index, chronic disease, napping 3-4/week, early changes in dementia, symptoms of subthreshold depression, subthreshold generalized anxiety, and generalized anxiety disorder were positively associated with SIS. Additionally, living in urban areas, having chronic diseases, symptoms of subthreshold depression, major depressive disorder, subthreshold generalized anxiety, generalized anxiety disorder were positively associated with CIS.
Conclusion
Insomnia symptoms, including CIS and SIS, were prevalent among the elderly in Guangdong Province. Given the high burden of CIS and SIS, policymakers and healthcare professionals must explore and treat the related factors accordingly.
Objectives: To test the hypothesis that neuropsychiatric symptomatology is predictive of the success of seizure control in patients newly treated with antiepileptic drugs (AEDs), and that this predictive value adds to that provided by other clinical, imaging, and genomic factors in a multivariate model. Methods: One hundred seventy newly treated patients with epilepsy completed the A-B Neuropsychological Assessment Scale (ABNAS) before commencing AED therapy and were prospectively followed up for 12 months. Patients were classified as nonresponsive if they had at least 1 seizure not explained by medication noncompliance or other significant provoking factors. Results: Of the 138 patients in whom a drug response phenotype at 12 months was able to be determined, nonresponsive patients (n = 45) had a higher pretreatment ABNAS score than patients whose seizures were controlled (n = 93) (p = 0.007). A lesion on MRI was also associated with a higher risk of seizure recurrence (p = 0.003). On multivariate logistic regression, the ABNAS score, the MRI results, and a genomic classifier were all independently predictive of treatment outcome. For AED pharmacoresponse, this multivariate model had diagnostic values of 91% sensitivity, 64% specificity, 84% positive predictive, and 78% negative predictive values. The predictive value of the ABNAS score was validated in a second prospective cohort of 74 newly treated patients with epilepsy (p = 0.005). Conclusions: The ABNAS provides prognostic information regarding successful seizure control in patients newly treated with AEDs. Furthermore, these results demonstrate the multifactorial nature of the determinants of AED response, with neuropsychological, structural, and genomic factors all contributing to the complex response phenotype. Neurology (R) 2010;75:1015-1021
Objective:
Generalized anxiety disorder (GAD) during pregnancy is associated with several adverse maternal and perinatal outcomes. A reliable and valid screening tool for GAD should lead to earlier detection and treatment. Among pregnant Peruvian women, a brief screening tool, the GAD-7, has not been validated. This study aims to evaluate the reliability and validity of the GAD-7.
Methods:
Of 2,978 women who attended their first perinatal care visit and had the GAD-7 screening, 946 had a Composite International Diagnostic Interview (CIDI). The Cronbach's alpha was calculated to examine the reliability. We assessed the criterion validity by calculating operating characteristics. The construct validity was evaluated using factor analysis and association with health status on the CIDI. The cross-cultural validity was explored using the Rasch Rating Scale Model (RSM).
Results:
The reliability of the GAD-7 was good (Cronbach's alpha = 0.89). A cutoff score of 7 or higher, maximizing the Youden Index, yielded a sensitivity of 73.3% and a specificity of 67.3%. One-factor structure of the GAD-7 was confirmed by exploratory and confirmatory factor analysis. Concurrent validity was supported by the evidence that higher GAD-7 scores were associated with poor self-rated physical and mental health. The Rasch RSM further confirmed the cross-cultural validity of the GAD-7.
Conclusion:
The results suggest that the Spanish-language version of the GAD-7 may be used as a screening tool for pregnant Peruvian women. The GAD-7 has good reliability, factorial validity, and concurrent validity. The optimal cutoff score obtained by maximizing the Youden Index should be considered cautiously; women who screened positive may require further investigation to confirm GAD diagnosis.
Generalized anxiety disorder has a strong impact on health-related quality of life. For this reason, it seems relevant to develop strategies allowing early diagnoses in order to promote appropriate treatments. The objective of this study was to culturally adapt and validate the GAD-7 for the Portuguese patients with generalized anxiety disorder.
For the cultural adaptation of the Portuguese version of the GAD-7 scale we started with a previous translation made by Mapi Institute and decided to perform a clinical review followed by a cognitive debriefing with patients. Once piloted, this version was then tested in a larger sample for feasibility and reliability (1-week test-retest). Construct validity was assessed by the relationship between GAD-7 and socio-demographic and clinical variables. Its unidimensionality was tested by principal component factor analysis. Criterion validity was assessed by comparing GAD-7 scores with those obtained by HADS, and EQ-5D. STAI was mainly used as a screening indicator for patient inclusion.
GAD-7 was considered feasible with a mean completion time of 2.3 minutes and no major floor or ceiling effects. We found an excellent Cronbach's alpha internal consistency score (0.880) and the test-retest and interclass correlation coefficients were also very good. Regarding the construct validity, younger patients, those with higher education, employed and without anxiety symptoms revealed lower GAD-7 scores, meaning better health. The unidimensionality of GAD-7 index was also confirmed by principal component factor analysis. At last, GAD-7 was significantly correlated with other health outcome indices and the classification levels created by it and by HADS showed to be dependent.
The excellent metric properties confirmed the cultural adaptation and validity of GAD-7 into Portuguese population, allowing the clinicians an early detection and treatment of these patients.
Many recent epidemiological studies have found the prevalence of depression and anxiety to be higher in people with epilepsy (PWE) than in people without epilepsy. Furthermore, people with depression or anxiety have been more likely to suffer from epilepsy than those without depression or anxiety. Almost one-third of PWE suffer from depression and anxiety, which is similar to the prevalence of drug-refractory epilepsy. Various brain areas, including the frontal, temporal, and limbic regions, are associated with the biological pathogenesis of depression in PWE. It has been suggested that structural abnormalities, monoamine pathways, cerebral glucose metabolism, the hypothalamic-pituitary-adrenal axis, and interleukin-1b are associated with the pathogenesis of depression in PWE. The amygdala and the hippocampus are important anatomical structures related to anxiety, and γ-aminobutyric acid and serotonin are associated with its pathogenesis. Depression and anxiety may lead to suicidal ideation or attempts and feelings of stigmatization. These experiences are also likely to increase the adverse effects associated with antiepileptic drugs and have been related to poor responses to pharmacological and surgical treatments. Ultimately, the quality of life is likely to be worse in PWE with depression and anxiety than in PWE without these disorders, which makes the early detection and appropriate management of depression and anxiety in PWE indispensable. Simple screening instruments may be helpful for in this regard, particularly in busy epilepsy clinics. Although both medical and psychobehavioral therapies may ameliorate these conditions, randomized controlled trials are needed to confirm that.
Purpose:
One fifth of people with established epilepsy attend hospital emergency departments (EDs) and one half are admitted each year. These ED visits are not necessarily required, and unplanned hospitalizations are costly. Reducing avoidable ED visits and admissions is a target in most health services. The development of interventions is, however, challenging. Policymakers lack information about users' characteristics, factors associated with ED use, as well as quality of care. This study provides this information.
Methods:
We prospectively recruited patients attending three London EDs for seizures. They completed questionnaires on service use and psychosocial state.
Key findings:
Eighty-five patients were recruited. The mean age was 41; 53% were male. The average number of ED attendances in the prior year (mean 3.2; median 2) exceeded that of other ED users and those with most chronic conditions. ED use was not homogenous, with some patients attending frequently. Compared to the wider epilepsy population, ED attendees experienced more seizures, anxiety, had lower knowledge of epilepsy and its management and greater perceived epilepsy-related stigma. In the previous 12 months, most patients' epilepsy outpatient care was consistent with standard criteria for quality. In descending order, lower knowledge, higher perceived stigma, poorer self-medication management, and seizure frequency were associated with more emergency visits.
Significance:
People with epilepsy presenting to EDs reattend frequently. Interventions aiming at reduced ED use by this population should address lower knowledge, stigma, suboptimal self-management, and frequent seizures reported by patients.
After reviewing the negative effects of antiepileptic drugs (AEDs) on general health and quality of life, the Commission on Outcome Measurement from the International League Against Epilepsy (ILAE) recommended incorporating reliable and valid tools in clinical essays in order to achieve a more accurate assessment of the subjective adverse effects rate and disease severity when using AEDs.
The aim of this study was to correlate the severity of adverse effects of AEDs, with the presence of anxiety and depression in patients with epilepsy.
The Spanish version of the Liverpool Adverse Events Profile (LAEP) and the hospital anxiety and depression scale (HADS) were applied on 130 consecutive outpatients with epilepsy from the epilepsy clinic at the Mexico's National Institute of Neurology and Neurosurgery. A correlation analysis was carried out to determine if the presence of depression and anxiety was related to the adverse effects of AEDs. The relation between LAEP scores with other epidemiological variables was also assessed.
Our study found a positive correlation between the LAEP and the HADS scores (p < or = 0.01). The most common adverse effects were drowsiness (81.5% [n=106]), difficulty in concentrating (76% [n=99]), and nervousness and/or agitation (75% [n=97]). Female gender, a history of febrile seizures, persistent seizures and polytherapy were associated with a higher toxicity on LAEP. In our study, age at epilepsy onset, duration of epilepsy, type of epilepsy and patients' age were not related to higher LAEP scores.
Adverse effects to AEDs can be related with the presence of psychiatric disorders such as anxiety and depression in patients with epilepsy.
Up to 50 or 60% of patients with chronic epilepsy have various mood disorders including depression and anxiety. Whereas the relationship between epilepsy and depression has received much attention, less is known about anxiety disorders. It is now recognized that anxiety can have a profound influence on the quality of life of patients with epilepsy. The relationship between anxiety disorders and epilepsy is complex. It is necessary to distinguish between different manifestations of anxiety disorder: ictal, postictal, and interictal anxiety. Preexisting vulnerability factors, neurobiological factors, iatrogenic influences (antiepileptic drugs, epilepsy surgery), and psychosocial factors are all likely to play a role, but with considerable individual differences. Despite the high prevalence of anxiety disorders in patients with epilepsy, there are no systematic treatment studies or evidence-based guidelines for best treatment practice. Nevertheless, a practical approach based on the temporal relationship between anxiety and epileptic seizures allows clinicians to consider appropriate treatment strategies to reduce the psychiatric comorbidity in patients with epilepsy.
Generalized anxiety disorder (GAD) is one of the most common mental disorders; however, there is no brief clinical measure for assessing GAD. The objective of this study was to develop a brief self-report scale to identify probable cases of GAD and evaluate its reliability and validity.
A criterion-standard study was performed in 15 primary care clinics in the United States from November 2004 through June 2005. Of a total of 2740 adult patients completing a study questionnaire, 965 patients had a telephone interview with a mental health professional within 1 week. For criterion and construct validity, GAD self-report scale diagnoses were compared with independent diagnoses made by mental health professionals; functional status measures; disability days; and health care use.
A 7-item anxiety scale (GAD-7) had good reliability, as well as criterion, construct, factorial, and procedural validity. A cut point was identified that optimized sensitivity (89%) and specificity (82%). Increasing scores on the scale were strongly associated with multiple domains of functional impairment (all 6 Medical Outcomes Study Short-Form General Health Survey scales and disability days). Although GAD and depression symptoms frequently co-occurred, factor analysis confirmed them as distinct dimensions. Moreover, GAD and depression symptoms had differing but independent effects on functional impairment and disability. There was good agreement between self-report and interviewer-administered versions of the scale.
The GAD-7 is a valid and efficient tool for screening for GAD and assessing its severity in clinical practice and research.
Anxiety, although as common as depression, has received less attention and is often undetected and undertreated.
To determine the current prevalence, impairment, and comorbidity of anxiety disorders in primary care and to evaluate a brief measure for detecting these disorders.
Criterion-standard study performed between November 2004 and June 2005.
15 U.S. primary care clinics.
965 randomly sampled patients from consecutive clinic patients who completed a self-report questionnaire and agreed to a follow-up telephone interview.
7-item anxiety measure (Generalized Anxiety Disorder [GAD]-7 scale) in the clinic, followed by a telephone-administered, structured psychiatric interview by a mental health professional who was blinded to the GAD-7 results. Functional status (Medical Outcomes Study Short Form-20), depressive and somatic symptoms, and self-reported disability days and physician visits were also assessed.
Of the 965 patients, 19.5% (95% CI, 17.0% to 22.1%) had at least 1 anxiety disorder, 8.6% (CI, 6.9% to 10.6%) had posttraumatic stress disorder, 7.6% (CI, 5.9% to 9.4%) had a generalized anxiety disorder, 6.8% (CI, 5.3% to 8.6%) had a panic disorder, and 6.2% (CI, 4.7% to 7.9%) had a social anxiety disorder. Each disorder was associated with substantial impairment that increased significantly (P < 0.001) as the number of anxiety disorders increased. Many patients (41%) with an anxiety disorder reported no current treatment. Receiver-operating characteristic curve analysis showed that both the GAD-7 scale and its 2 core items (GAD-2) performed well (area under the curve, 0.80 to 0.91) as screening tools for all 4 anxiety disorders.
The study included a nonrandom sample of selected primary care practices.
Anxiety disorders are prevalent, disabling, and often untreated in primary care. A 2-item screening test may enhance detection.
We aimed to validate the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) for Chinese people with epilepsy (PWE).
The NDDI-E was translated into a Chinese version. A consecutive cohort of PWE from West China Hospital was recruited to test the reliability and validity of the Chinese version of the NDDI-E (C-NDDI-E). Each patient underwent the Mini International Neuropsychiatric Interview (MINI) and C-NDDI-E.
A total of 202 PWE completed the psychiatric evaluation. The C-NDDI-E was easily comprehended and quickly completed by all participants. Fifty-four patients (26.7%) had current major depressive disorder (MDD) according to the MINI criteria. The Cronbach's α coefficient for the C-NDDI-E was 0.825. Receiver operating characteristic analyses showed an area under the curve of 0.936 (95% CI=0.904-0.968). At a cutoff score of >12, the C-NDDI-E had a sensitivity of 0.926, a specificity of 0.804, a positive predictive value of 0.633, and a negative predictive value of 0.967.
The C-NDDI-E is a valuable instrument for screening MDD in Chinese PWE.
Copyright © 2015 Elsevier Inc. All rights reserved.
Epilepsy was defined conceptually in 2005 as a disorder of the brain characterized by an enduring predisposition to generate epileptic seizures. This definition is usually practically applied as having two unprovoked seizures >24 h apart. The International League Against Epilepsy ( ILAE) accepted recommendations of a task force altering the practical definition for special circumstances that do not meet the two unprovoked seizures criteria. The task force proposed that epilepsy be considered to be a disease of the brain defined by any of the following conditions: (1) At least two unprovoked (or reflex) seizures occurring >24 h apart; (2) one unprovoked (or reflex) seizure and a probability of further seizures similar to the general recurrence risk (at least 60%) after two unprovoked seizures, occurring over the next 10 years; (3) diagnosis of an epilepsy syndrome. Epilepsy is considered to be resolved for individuals who either had an age‐dependent epilepsy syndrome but are now past the applicable age or who have remained seizure‐free for the last 10 years and off antiseizure medicines for at least the last 5 years. “Resolved” is not necessarily identical to the conventional view of “remission or “cure.” Different practical definitions may be formed and used for various specific purposes. This revised definition of epilepsy brings the term in concordance with common use.
A PowerPoint slide summarizing this article is available for download in the Supporting Information section here .
Although there has been increasing recognition of psychiatric comorbidity in epilepsy, most research and attention in this area has focused on depression. However, comorbid anxiety in epilepsy is highly prevalent, affecting more than 40 % of patients in some reports. Many important outcomes are significantly impacted by anxiety in epilepsy, including quality of life, mortality, and seizure status. Recent evidence from epidemiologic studies suggests a bidirectional association of anxiety and epilepsy, and there is mounting evidence for possible common pathophysiology underlying anxiety and epilepsy. Despite this importance, anxiety is under-recognized and undertreated in clinical practice. A variety of anxiety symptoms are seen in epilepsy, including symptoms exclusively before, during or after seizures (peri-ictal anxiety), symptoms resembling primary anxiety disorders, and anxiety directly related to epilepsy or its treatment. Key therapeutic approaches include pharmacotherapy or cognitive behavioral therapy for most forms of interictal anxiety and better seizure control for peri-ictal anxiety.
Purpose:
Epilepsy patients have a significantly higher rate of anxiety and depression than the general population, and psychiatric disease is particularly prevalent among drug resistant epilepsy patients. Symptoms of anxiety and depression might serve as a barrier to appropriate epilepsy care. The aim of this study was to determine if drug resistant epilepsy patients with symptoms of anxiety and/or depression receive different epilepsy management than controls.
Method:
We identified 83 patients with drug resistant focal epilepsy seen at the Penn Epilepsy Center. Upon enrollment, all patients completed 3 self-report scales and a neuropsychiatric inventory and were grouped into those with symptoms of anxiety and/or depression and controls. Each patient's medical records were retrospectively reviewed for 1-2 years, and objective measures of outpatient and inpatient epilepsy management were assessed.
Results:
At baseline, 53% (n=43) of patients screened positive for symptoms of anxiety and/or depression. The remaining 47% (n=38) served as controls. Patients with anxiety and/or depression symptoms had more missed outpatient visits per year compared to controls (median 0.84 vs. 0.48, p=0.02). Patients with symptoms of both anxiety and depression were more likely to undergo an inpatient admission or procedure (56% vs. 24%, p=0.02).
Conclusion:
For most measures of epilepsy management, symptoms of anxiety and/or depression do not alter epilepsy care; however, drug resistant epilepsy patients with anxiety and/or depression symptoms may be more likely to miss outpatient appointments, and those with the highest burden of psychiatric symptoms may be admitted more frequently for inpatient services compared to controls.
We investigated the frequency of affective symptoms in Korean adults with epilepsy who visited epilepsy clinics at two tertiary care hospitals and in healthy adults. We also examined the psychosocial impact of affective symptoms on people with epilepsy (PWE). Participants were asked to complete self-report questionnaires to assess depression and anxiety symptoms, felt stigma, suicidal ideation, and quality of life (QOL). Of 568 PWE, 30.5% exhibited affective symptoms. The frequencies of depression and anxiety symptoms were 27.8% and 15.3%, respectively, significantly higher than those in healthy controls. Those with poor seizure control were more likely to endorse affective symptoms at the time of study. The frequencies of felt stigma and suicidal ideation were higher in PWE with affective symptoms than in those without. Quality of life was impacted by affective symptoms, especially when depression and anxiety coexisted. Reducing affective symptoms by appropriate seizure control may ameliorate psychosocial problems in PWE.
Background: The 7-item Generalized Anxiety Disorder Scale (GAD-7) is a practical self-report anxiety questionnaire that proved valid in primary care. However, the GAD-7 was not yet validated in the general population and thus far, normative data are not available.
Objectives: To investigate reliability, construct validity, and factorial validity of the GAD-7 in the general population and to generate normative data.
Research Design: Nationally representative face-to-face household survey conducted in Germany between May 5 and June 8, 2006.
Subjects: Five thousand thirty subjects (53.6% female) with a mean age (SD) of 48.4 (18.0) years.
Measures: The survey questionnaire included the GAD-7, the 2-item depression module from the Patient Health Questionnaire (PHQ-2), the Rosenberg Self-Esteem Scale, and demographic characteristics.
Results: Confirmatory factor analyses substantiated the 1-dimensional structure of the GAD-7 and its factorial invariance for gender and age. Internal consistency was identical across all subgroups (α = 0.89). Intercorrelations with the PHQ-2 and the Rosenberg Self-Esteem Scale were r = 0.64 (P < 0.001) and r = -0.43 (P < 0.001), respectively. As expected, women had significantly higher mean (SD) GAD-7 anxiety scores compared with men [3.2 (3.5) vs. 2.7 (3.2); P < 0.001]. Normative data for the GAD-7 were generated for both genders and different age levels. Approximately 5% of subjects had GAD-7 scores of 10 or greater, and 1% had GAD-7 scores of 15 or greater.
Conclusions: Evidence supports reliability and validity of the GAD-7 as a measure of anxiety in the general population. The normative data provided in this study can be used to compare a subject's GAD-7 score with those determined from a general population reference group.
Anxiety in epilepsy has recently become a focus of interest for a number of reasons. Epidemiological studies have established that anxiety disorders are twice as common in patients with epilepsy compared to the general population, while in referral centres their prevalence is even higher. In addition, it has been recently appreciated that anxiety exerts a significant negative impact on the quality of life of patients with epilepsy of any age. With regard to the pathogenesis of anxiety in epilepsy, a number of theories have been put forward including those based on psychodynamics, learning-cognition, and neurobiology. From a clinical point of view, anxiety may occur as a comorbid disorder with epilepsy or be directly linked with epilepsy as a preictal, ictal, postictal or interictal phenomenon. The treatment of anxiety in patients with epilepsy requires a comprehensive, multidisciplinary, clinical assessment. Regarding pharmacological therapies, it should be recognised that some drugs prescribed for anxiety disorders are associated with a high risk of seizures, whereas some antiepileptic drugs possess anxiolytic properties that could be of use in the management of epileptic patients with anxiety. The correct diagnosis and successful treatment of anxiety is expected to have significant benefits for the quality of life of epileptic patients.
Consciousness is essential to normal human life. In epileptic seizures consciousness is often transiently lost, which makes it impossible for the individual to experience or respond. These effects have huge consequences for safety, productivity, emotional health, and quality of life. To prevent impaired consciousness in epilepsy, it is necessary to understand the mechanisms that lead to brain dysfunction during seizures. Normally the consciousness system-a specialised set of cortical-subcortical structures-maintains alertness, attention, and awareness. Advances in neuroimaging, electrophysiology, and prospective behavioural testing have shed light on how epileptic seizures disrupt the consciousness system. Diverse seizure types, including absence, generalised tonic-clonic, and complex partial seizures, converge on the same set of anatomical structures through different mechanisms to disrupt consciousness. Understanding of these mechanisms could lead to improved treatment strategies to prevent impairment of consciousness and improve the quality of life of people with epilepsy.
To compare the effect of anxiety disorders, major depressive episodes (MDEs), and subsyndromic depressive episodes (SSDEs) on antiepileptic drug (AED)-related adverse events (AEs) in persons with epilepsy (PWE).
The study included 188 consecutive PWE from five U.S. outpatient epilepsy clinics, all of whom underwent structured interviews (SCID) to identify current and past mood disorders and other current Axis I psychiatric diagnoses according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) criteria. A diagnosis of SSDE was made in patients with total Beck Depression Inventory-II (BDI-II) scores >12 or the Centers of Epidemiologic Studies-Depression (CES-D) > 16 (in the absence of any DSM diagnosis of mood disorder. The presence and severity of AEs was measured with the Adverse Event Profile (AEP).
Compared to asymptomatic patients (n = 103), the AEP scores of patients with SSDE (n = 26), MDE only (n = 10), anxiety disorders only (n = 21), or mixed MDE/anxiety disorders (n = 28) were significantly higher, suggesting more severe AED-related AEs. Univariate analyses revealed that having persistent seizures in the last 6 months and taking antidepressants was associated with more severe AEs. Post hoc analyses, however, showed that these differences were accounted for by the presence of a depressive and/or anxiety disorders.
Depressive and anxiety disorders worsen AED-related AEs even when presenting as a subsyndromic type. These data suggest that the presence of psychiatric comorbidities must be considered in their interpretation, both in clinical practice and AED drug trials.
Anxiety disorders are the most common mental health problems and often co-exist with substance use. Little evidence exists to support the use of brief screening tools for anxiety disorders in routine addictions treatment. This is the first study to test the validity and reliability of GAD-7 and GAD-2 in an outpatient drugs treatment population.
A sample of 103 patients completed brief screening questionnaires and took part in structured diagnostic assessments using CIS-R. A subgroup of 60 patients completed retests after 4 weeks. The results of brief questionnaires were compared to those of gold-standard diagnostic interviews using Receiver Operating Characteristic (ROC) curves. Psychometric properties were also calculated to evaluate the validity and reliability of self-completed questionnaires.
A GAD-7 score ≥ 9 had a sensitivity of 80% and specificity of 86% for any anxiety disorder, also displaying adequate temporal stability at repeated measurements (intra-class correlation=0.85) and high internal consistency (Cronbach's alpha=0.91). A GAD-2 score ≥ 2 had 94% sensitivity and 53% specificity, with adequate internal consistency (0.82).
GAD-7 adequately detected the presence of an anxiety disorder in drug and alcohol users; although this study was limited by sample size to determine its reliability for specific diagnoses. Results in this small sample suggest that GAD-7 may be a useful screening tool in addiction services, although replication in a larger sample is warranted.
People with epilepsy (PWE) have a high chance of experiencing depression and anxiety disorders over their lifetime. However, those most at risk are unknown. Psychosocial variables have been suggested as potentially important risk factors. A systematic review was conducted in order to critically assess available evidence regarding the psychosocial predictors of depression and anxiety in adults with epilepsy.
Electronic databases searched were MEDLINE, PsycINFO and Web of Science. Studies were included if they assessed depressive or anxiety symptoms using a validated questionnaire, and controlled for the role of potentially important epilepsy factors. Eleven studies were identified and assessed for research standards using the Quality Index Scale (QIS).
Ten of the eleven studies found at least one significant predictor of depression and all six studies that assessed anxiety found one or more significant predictors.
Overall QIS score was only 7.5 out of 15, indicating significant design limitations of many included studies. There was also large variability between studies in measures used to assess psychosocial variables.
Studies did not support the importance of attributional theory and stigma in the development of depression in epilepsy. There was inconsistent support for the role of illness representations but likely support for the role of stress and self-efficacy. Consistent support was found for the role of coping strategies and perceived social support. Given that psychosocial factors are potentially modifiable, a better understanding of their role in the development of depression in people with epilepsy is urgently needed to guide effective treatments.
To investigate the association between quality of life (QOL) and sociodemographic factors, clinical seizure factors, depression and anxiety in patients suffering from epilepsy.
We examined 141 consecutive patients with epilepsy (mean age 25.8±9.6, 61.7% male). All patients completed the Self-Rating Depression Scale, Self-Rating Anxiety Scale, WHOQOL-BREF and QOLIE-31(Chinese version). Multiple linear regression analyses were applied to investigate factors impact on QOL.
The results revealed that scores on two domains of the WHOQOL-BREF (i.e., physical and psychological domains, P<0.05) were significantly lower in the epilepsy group compared with the control group. Multiple regression analyses showed that anxiety, depression and course explained approximately 40% of the variance in patients' QOL. Anxiety was consistently the strongest predictor of lower scores on almost all QOL domains. In addition, the severity of depressive symptoms was significantly associated with lower scores across many QOL domains.
Our findings suggest that QOLIE scores might be substantially affected by the presence and severity of anxiety symptoms and, to a lesser degree, of depressive symptoms and prolonged course of illness. In contrast, clinical seizure variables had a weaker association with QOL. Healthcare professionals should be aware of the significance of patients' emotional state and of the role it plays in their QOL.
To test the hypothesis that neuropsychiatric symptomatology is predictive of the success of seizure control in patients newly treated with antiepileptic drugs (AEDs), and that this predictive value adds to that provided by other clinical, imaging, and genomic factors in a multivariate model.
One hundred seventy newly treated patients with epilepsy completed the A-B Neuropsychological Assessment Scale (ABNAS) before commencing AED therapy and were prospectively followed up for 12 months. Patients were classified as nonresponsive if they had at least 1 seizure not explained by medication noncompliance or other significant provoking factors.
Of the 138 patients in whom a drug response phenotype at 12 months was able to be determined, nonresponsive patients (n = 45) had a higher pretreatment ABNAS score than patients whose seizures were controlled (n = 93) (p = 0.007). A lesion on MRI was also associated with a higher risk of seizure recurrence (p = 0.003). On multivariate logistic regression, the ABNAS score, the MRI results, and a genomic classifier were all independently predictive of treatment outcome. For AED pharmacoresponse, this multivariate model had diagnostic values of 91% sensitivity, 64% specificity, 84% positive predictive, and 78% negative predictive values. The predictive value of the ABNAS score was validated in a second prospective cohort of 74 newly treated patients with epilepsy (p = 0.005).
The ABNAS provides prognostic information regarding successful seizure control in patients newly treated with AEDs. Furthermore, these results demonstrate the multifactorial nature of the determinants of AED response, with neuropsychological, structural, and genomic factors all contributing to the complex response phenotype.
To evaluate the frequency and intensity of psychiatric disorders in a group of temporal lobe epilepsy (TLE) patients from a tertiary-care center.
Clinical and sociodemographic data of 73 patients were collected and a neuropsychiatric evaluation was performed with the following instruments: Mini-Mental State Examination (MMSE), structured clinical interview (MINI-PLUS), Hamilton Anxiety Scale (HAM-A), Hamilton Depression Scale (HAM-D), Brief Psychiatric Rating Scale (BPRS).
Patients with TLE showed a high frequency of lifetime psychiatric disorders (70%), the most frequent being mood disorders (49.3%). At assessment, 27.4% of the patients were depressed and 9.6% met criteria for bipolar disorder. Nevertheless, depression had not been properly diagnosed nor treated. Anxiety disorders were also frequent (42.5%), mainly generalized anxiety disorder (GAD) (21.9%). Obsessive compulsive disorder (OCD) was present in 11.0% and psychotic disorders in 5.5% of the sample. Patients with left mesial temporal sclerosis (LMTS) exhibited more psychopathologic features, mainly anxiety disorders (p=0.006), and scored higher on HAM-A and HAM-D (p<0.05 in both).
TLE is related to a high frequency of psychiatric disorders, such as anxiety and depression, which are usually underdiagnosed and undertreated. Damage to the left mesial temporal lobe, seen in LMTS, seems to be an important pathogenic lesion linked to a broad range of psychopathological features in TLE, mainly anxiety disorders. The present study prompts discussion on the recognition of the common psychiatric disorders in TLE, especially on the Brazilian setting.
This study aimed to assess the frequency of generalized anxiety disorder (GAD) among primary care patients in China. We also determined the rate of comorbid major depression (MD) in patients with GAD and explored the differences in sociodemographic and health-related characteristics between patients with and without GAD.
We invited consecutive outpatients who presented to 4 primary care facilities in Shanghai, China to fill out a survey composed of a screening questionnaire based on the Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition (DSM-IV) for GAD (GAD-7), the Zung Self-Rating Depression Scale (SDS), and various sociodemographic and health-related variables. The 4 primary care facilities covered urban and suburban areas of the city. Patients completed the survey in the reception area as they waited for their medical appointment.
The frequency of GAD in Chinese primary care was 4.1% (3.9% for males and 4.3% for females). This estimate was based on 127 positive results among a total of 3073 surveys collected. Of the patients who screened positive for GAD, 72.4% also screened positive for MD. Patients with GAD were more likely to report chronic medical conditions and to attend a university-affiliated primary care clinic.
Our results showed that the frequency of GAD was significantly high in Chinese primary care patients. Compared with the GAD prevalence in Chinese general population from previously published studies, our findings suggest a link between GAD and health-seeking behaviors. Generalized anxiety disorder was also strongly correlated with MD. Integration of a routine GAD screening regime merits serious consideration to screen, diagnose, and treat patients with GAD in the primary care setting.
To compare the impact of anxiety disorders, major depressive episodes (MDEs), and subsyndromic depressive episodes (SSDEs) on the quality of life of patients with epilepsy (PWEs), and to identify the variables predictive of poor quality of life.
A psychiatric diagnosis according to DSM-IV-TR criteria was established in 188 consecutive PWEs with the MINI International Neuropsychiatric Interview. Patients also completed the Beck Depression Inventory-II (BDI-II), the Centers for Epidemiologic Studies-Depression (CES-D), and the Quality of Life in Epilepsy-89 (QOLIE-89). A diagnosis of SSDE was made in any patient with total scores of the BDI-II >12 or CES-D >16 in the absence of any DSM-IV diagnosis of mood disorder according to the MINI.
Patients with SSDEs (n = 26) had a worse quality of life than asymptomatic patients (n = 103). This finding was also observed among patients with MDEs only (n = 10), anxiety disorders only (n = 21), or mixed MDEs/anxiety disorders (n = 28). Furthermore, having mixed SSDEs/anxiety disorders yielded a worse quality of life than having only SSDEs. Independent predictors of poor quality of life included having a psychiatric disorder and persistent epileptic seizures in the last 6 months.
Although isolated mood and anxiety disorders, including SSDE, have a comparable negative impact on the quality of life of PWEs; the comorbid occurrence of mood and anxiety disorders yields a worse impact. In addition, seizure freedom in the previous 6 months predicts a better quality of life.
Comorbid anxiety disorders severely affect daily living and quality of life in patients with epilepsy. We evaluated 97 consecutive outpatients (41.2% male, mean age=42.3+/-13.2 years, mean epilepsy duration=26.9+/-14.2 years) with refractory focal epilepsy using the German version of the anxiety section of the Structured Clinical Interview for DSM-IV Axis I disorders (SCID-I). Nineteen patients (19.6%) were diagnosed with an anxiety disorder (social phobia, 7.2%; specific phobia, 6.2%; panic disorder, 5.1%; generalized anxiety disorder, 3.1%; anxiety disorder not further specified, 2.1%; obsessive-compulsive disorder, 1.0%; posttraumatic stress disorder, 1.0%). Four-week prevalenc