Generalized anxiety disorder and resilience during the COVID-19 pandemic: evidence from China during the early rapid outbreak

Abstract Background Generalized Anxiety Disorder (GAD) is a common but urgent mental health problem during disease outbreaks. Resilience buffers against the negative impacts of life stressors on common internalizing psychopathology such as GAD. This study assesses the prevalence of GAD and examines the protective or compensatory effect of resilience against worry factors during the COVID-19 outbreak. Methods A cross-sectional online survey was conducted among Chinese citizens aged ≥18 years from January 31 to February 2, 2020. A total of 4827 participants across 31 provinces and autonomous regions of the mainland of China participated in this study. The Generalized Anxiety Disorder scale (GAD-7), the Connor-Davidson Resilience Scale (CD-RISC), and a self-designed worry questionnaire were used to asses anxiety disorder prevalence, resilience level, and anxiety risk factors. Multivariable logistic regression was used to identify the associations of resilience and worry factors with GAD prevalence after controlling for other covariates. Results The prevalence of anxiety disorder was 22.6% across the 31 areas, and the highest prevalence was 35.4% in Hubei province. After controlling for covariates, the results suggested a higher GAD prevalence among participants who were worried about themselves or family members being infected with COVID-19 (adjusted odds ratio, AOR 3.40, 95%CI 2.43–4.75), worried about difficulty obtaining masks (AOR 1.92, 95%CI 1.47–2.50), worried about difficulty of distinguishing true information (AOR 1.65, 95%CI 1.36–2.02), worried about the prognosis of COVID-19 (AOR 2.41, 95%CI 1.75–3.33), worried about delays in working (AOR 1.71, 95%CI 1.27–.31), or worried about decreased income (AOR 1.45, 95%CI 1.14–1.85) compared with those without such worries. Additionally, those with a higher resilience level had a lower prevalence of GAD (AOR 0.59, 95%CI 0.51–0.70). Resilience also showed a mediating effect, with a negative influence on worry factors and thereby a negative association with GAD prevalence. Conclusion It may be beneficial to promote public mental health during the COVID-19 outbreak through enhancing resilience, which may buffer against adverse psychological effects from worry factors.

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THE EFFECTS OF THE COVID-19 PANDEMIC ON THE MENTAL HEALTH OF UNIVERSITY STUDENTS IN THE FIELD OF HEALTH AND RELATED FACTORS: A WEB-BASED CROSS-SECTIONAL STUDY HEALTH STUDENT IN THE PANDEMIC

EJONS International Journal of Mathematic, Engineering and Natural Sciences ◽

10.38063/ejons.480 ◽

2021 ◽

Vol 5 (20) ◽

pp. 723-737

Author(s):

Ayfer BAYINDIR ÇEVİK ◽

Elçin Sebahat KASAPOĞLU

Keyword(s):

Mental Health ◽

Anxiety Disorder ◽

University Students ◽

Generalized Anxiety Disorder ◽

Cross Sectional Study ◽

Generalized Anxiety ◽

Sectional Study ◽

Cross Sectional ◽

Previous Diagnosis ◽

Level Of Knowledge

Aim: The aim of the study is to evaluate the knowledge, attitudes, behaviors and anxiety of university students about the Covid-19 epidemic at the beginning of the Covid-19 pandemic. Material and Methods: The study is a cross-sectional study. The sample consists of 1243 health students. The data were collected through an online questionnaire consisting of three parts. The questionnaire included questions to assess the socio-demographic characteristics of students, their level of knowledge, awareness and behavior about the Covid-19 pandemic, and the impact of the epidemic on their psychological health. The GAD-7 scale was used to assess students' anxiety levels. Results: In this study; 79.60% of the Health Care Students (HCSs) did not attend any training on COVID-19. Their sources of information were internet/social media (97.18%) and TV (97.18%). In the COVID-19 knowledge assessment test, it was found that 65.7% of them had a high level of knowledge. Most of HCSs thought that their knowledge about COVID-19 was very good (55%). The correct answer means of the 31 questions on the COVID-19 knowledge questionnaire were 22.07±1.70. In this questionnaire, it stated that the most effective methods of protection were the use of a mask in crowded environments (99.1%). Most of the HCSs stated that outbreak was affected their mental health negatively (73.1%) and some of them named this state as "Coronaphobia" (33.2%). In this study was found that some HCSs have a generalized anxiety disorder (22.6%) and anxiety experienced due to COVID "completely affected" their lives (19.5%). The average knowledge score of the students who received applied training in the hospital at the beginning of the pandemic (22.29±1.58) and anxiety level of students (6.77±5.85) was higher than those who did not receive applied training in the hospital (5.84±5.47, p<0.05). The GAD-7 scores for those with a previous diagnosis of psychological disease were 2 times higher than those without a previous diagnosis (p<0.05)Conclusion: At the beginning of the pandemic, students who received hands-on training at the hospital had higher knowledge and awareness levels. Generalized Anxiety Disorder was observed more frequently in those with a previous psychological disorder than in other students. Keywords: Anxiety; coronavirus disease 2019 (covid-19); knowledge; health students; pandemic and mental health

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Impact of Changed Use of Greenspace during COVID-19 Pandemic on Depression and Anxiety

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18115842 ◽

2021 ◽

Vol 18 (11) ◽

pp. 5842

Author(s):

Seulkee Heo ◽

Miraj U. Desai ◽

Sarah R. Lowe ◽

Michelle L. Bell

Keyword(s):

Mental Health ◽

Anxiety Disorder ◽

Generalized Anxiety Disorder ◽

Low Income ◽

Online Survey ◽

Psychological Symptoms ◽

Poor Mental Health ◽

Generalized Anxiety ◽

Patient Health ◽

Financial Issues

The COVID-19 pandemic has had devastating consequences for health, social, and economic domains, but what has received far less focus is the effect on people’s relationship to vital ecological supports, including access to greenspace. We assessed patterns of greenspace use in relation to individual and environmental factors and their relationship with experiencing psychological symptoms under the pandemic. We conducted an online survey recruiting participants from social media for adults in Korea for September–December 2020. The survey collected data on demographics, patterns of using greenspace during the pandemic, and major depression (MD) and generalized anxiety disorder (GAD) symptoms. The Patient Health Questionnaire (PHQ-9) and the Generalized Anxiety Disorder 2-item (GAD-2) were applied to identify probable cases of MD and GAD. A logistic regression model assessed the association decreased visits to greenspace after the outbreak compared to 2019 and probable MD and GAD. Among the 322 survey participants, prevalence of probable MD and GAD were 19.3% and 14.9%, respectively. High rates of probable MD (23.3%) and GAD (19.4%) were found among persons currently having job-related and financial issues. Of the total participants, 64.9% reported decreased visits to greenspace after the COVID-19 outbreak. Persons with decreased visits to greenspace had 2.06 higher odds (95% CI: 0.91, 4.67, significant at p < 0.10) of probable MD at the time of the survey than persons whose visits to greenspace increased or did not change. Decreased visits to greenspace were not significantly associated with GAD (OR = 1.45, 95% CI: 0.63, 3.34). Findings suggest that barriers to greenspace use could deprive people of mental health benefits and affect mental health during pandemic; an alternative explanation is that those experiencing poor mental health may be less likely to visit greenspaces during pandemic. This implies the need of adequate interventions on greenspace uses under an outbreak especially focusing on how low-income populations may be more adversely affected by a pandemic and its policy responses.

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Mental health impact of COVID-19 pandemic among physicians, nurses, and other healthcare providers, in the province of Alberta (Preprint)

10.2196/preprints.27469 ◽

2021 ◽

Author(s):

Hany ElGindi ◽

Reham Shalaby ◽

April Gusnowski ◽

Wesley Vuong ◽

Shireen Surood ◽

...

Keyword(s):

Mental Health ◽

Depressive Symptoms ◽

Anxiety Disorder ◽

Generalized Anxiety Disorder ◽

High Stress ◽

Well Being ◽

Self Report ◽

Generalized Anxiety ◽

Cross Sectional Survey ◽

Cross Sectional

BACKGROUND During the COVID-19 pandemic, threats to mental health, psychological safety, and well-being are evident, particularly among the first responders and the healthcare staff. OBJECTIVE This study aimed to examine the prevalence and the potential predictors of the likely stress, generalized anxiety disorder, and major depressive disorder among healthcare workers (HCW). METHODS A cross-sectional survey was used through a survey link sent to gather demographic information and responses on several self-report scales, including the Perceived Stress Scale (PSS), Generalized Anxiety Disorder 7-item (GAD-7) scale, and Patient Health Questionnaire-9 (PHQ-9) among the various HCW groupings who subscribed to the Text4Hope program. RESULTS This study revealed that the HCW expressed an estimated high prevalence of moderate/high stress rates 840 (81.2%), while the likelihood of moderate/severe anxiety and depressive symptoms were 369 (38.6%), and 317 (32.7%), respectively, during COVID-19 pandemic. Nurses and other HCW were significantly more likely to report depressive symptoms, compared to physicians, (F (2, 159.47) =15.89, 95% CI= (-5.05) -(-2.04). Younger age groups of HCW (≤30 y) were more prone to report likely stress, anxiety, and depressive symptoms, compared to HCW 41-50y and >50y (Odd’s ratio range: 1.82- 3.03). Similarly, females and those who reported a lack of social support (separated/divorced and single) among HCW, had a higher likelihood to report likely stress and depressive symptoms, respectively (OR=1.8 and 1.6). CONCLUSIONS This cross-sectional study revealed the significant impact of COVID-19 pandemic on mental health and indicated significant vulnerability among groups of HCW in Alberta. CLINICALTRIAL Ethical approval for this research was obtained through the University of Alberta Health Research Ethics Board (Pro00086163).

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Impact of Changed Use of Greenspace during COVID-19 Pandemic on Depression and Anxiety

10.20944/preprints202105.0319.v1 ◽

2021 ◽

Author(s):

Seulkee Heo ◽

Miraj Desai ◽

Sarah R. Lowe ◽

Michelle L. Bell

Keyword(s):

Mental Health ◽

Anxiety Disorder ◽

Generalized Anxiety Disorder ◽

Low Income ◽

Online Survey ◽

Psychological Symptoms ◽

Poor Mental Health ◽

Generalized Anxiety ◽

Patient Health ◽

Financial Issues

The COVID-19 pandemic has had devastating consequences for health, social, and economic domains, but what has received far less focus is the effect on people’s relationship to vital ecological supports, including access to greenspace. We assessed patterns of greenspace use in relation to individual and environmental factors and their relationship with experiencing psychological symptoms under the pandemic. We conducted an online survey recruiting participants from social media for adults in Korea for September–December 2020. The survey collected data on demographics, patterns of using greenspace during the pandemic, and major depression (MD) and generalized anxiety disorder (GAD) symptoms. The Patient Health Questionnaire (PHQ-9) and the Generalized Anxiety Disorder 2-item (GAD-2) were applied to identify probable cases of MD and GAD. A logistic regression model assessed the association decreased visits to greenspace after the outbreak compared to 2019 and probable MD and GAD. Among the 322 survey participants, prevalence of probable MD and GAD were 19.3% and 14.9%, respectively. High rates of probable MD (23.3%) and GAD (19.4%) were found among persons currently having job-related and financial issues. Of the total participants, 64.9% reported decreased visits to greenspace after the COVID-19 outbreak. Persons with decreased visits to greenspace had 2.06 higher odds (95% CI: 0.91, 4.67) of probable MD at the time of the survey than persons whose visits to greenspace increased or did not change. Findings suggest that barriers to greenspace use could deprive people of mental health benefits and affect mental health during pandemic; an alternative explanation is that those experiencing poor mental health may be less likely to visit greenspaces during pandemic. This implies the need of adequate interventions on greenspace uses under an outbreak especially focusing on how low-income populations may be more adversely affected by a pandemic and its policy responses.

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Generalized Anxiety Disorder and Associated Factors among Indian Pediatricians during the Coronavirus Disease 2019 Outbreak: A Web- based Cross-sectional Survey

Journal of Medical Sciences and Health ◽

10.46347/jmsh.2021.v07i01.002 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Srivastava Geetika ◽

Nanda Chhavi ◽

Shamsi Sumaiya ◽

Goel Amit ◽

Bhatnagar Shrish

Keyword(s):

Mental Health ◽

At Risk ◽

Anxiety Disorder ◽

Generalized Anxiety Disorder ◽

Categorical Variables ◽

Generalized Anxiety ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Web Based ◽

Survey Tool

Background: Healthcare workers (HCW) are at risk of developing anxiety and other mental health symptoms while rendering health services during Coronavirus Disease 2019 (COVID 19) pandemic. Current study is probably first of its kind to quantify the anxiety levels among pediatricians along with its potential risk factors. Aim : The aim of the study was to find the prevalence of anxiety using the generalized anxiety disorder (GAD-7) score among pediatricians during COVID-19 pandemic. Design This was a cross-sectional web-based survey. Materials and Methods: Data were collected from 702 pediatricians over a period of 10 days using online Electronic “Survey Monkey” questionnaire as the survey tool. Statistical Analysis Categorical variables are expressed as ratios and proportions. Numerical variables are expressed as median (range). Analysis was performed using non-parametric tests as applicable. Results: 702 pediatricians responded to the survey. Mean GAD score was 8.48 ± 5.64 and prevalence of anxiety was 72.65%. Significant anxiety was seen in 281 (40.03%). Mean GAD score was significantly high in female gender, age between 25 and 40 years, married pediatricians and among front line workers. Conclusions: This study is first of its kind from India assessing anxiety among pediatricians reflecting mental health among HCW. Female pediatricians and pediatricians who are married are at risk of having significant anxiety. We recommend formation of social support circles to maintain optimal mental health of all HCW.

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The network structure of stress-related states, depression, and anxiety symptoms during the COVID-19 lockdown

10.31234/osf.io/xa8qk ◽

2020 ◽

Author(s):

Asle Hoffart ◽

Sverre Urnes Johnson ◽

Omid V. Ebrahimi

Keyword(s):

Major Depressive Disorder ◽

Anxiety Disorder ◽

Depressive Disorder ◽

Generalized Anxiety Disorder ◽

Online Survey ◽

Sleep Problems ◽

Generalized Anxiety ◽

Major Depressive ◽

Cross Sectional ◽

Social Distancing

Background. The coronavirus (COVID-19) pandemic and the social distancing protocols used to impede the spread of the virus may have severe mental health consequences. The purpose of this study was to investigate the network of components of pandemic-related negative psychological states (i.e., fear of infection, financial worries, loneliness) and symptoms of major depressive disorder (MDD) and generalized anxiety disorder (GAD).Methods. Data from 10,061 Norwegian adults recruited through an online survey during a period of strict social distancing protocols were analyzed employing a cross-sectional Gaussian Graphical Model.Results. Of the infection fears, fear of being infected, fear of dying from the coronavirus and fear of significant others dying from it had notable connections to the GAD symptoms anxiety and/or fear of awful events. The financial worry component worry about personal economy was connected to the MDD symptom sleep problems and to the GAD symptom generalized worry. Each of the loneliness components was connected to a specific MDD symptom. Anhedonia, depressed mood and worthlessness had the highest strength centrality among the MDD symptoms; generalized worry, uncontrollability of worry, and trouble relaxing among the GAD symptoms; fear of dying from the virus among the fear of infection components; and feeling isolated among the loneliness components. A community analysis identified separate clusters for MDD and GAD as well as a cluster cutting across the two disorders. Conclusions. Particular components of the pandemic-related distressing states of fear of infection and loneliness seem to be associated with specific symptoms of MDD and GAD.Key words: COVID-19; fear of infection; financial worry; loneliness; major depressive disorder symptoms; generalized anxiety disorder symptoms; cross-sectional network analysis

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Exploring the Association Between Physical Activity and Risk of Mental Health Disorders in Saudi Arabian Adults: Cross-sectional Study (Preprint)

10.2196/preprints.25438 ◽

2020 ◽

Author(s):

Nora A Althumiri ◽

Mada H Basyouni ◽

Nasser F BinDhim

Keyword(s):

Mental Health ◽

Physical Activity ◽

Depressive Symptoms ◽

Anxiety Disorder ◽

Generalized Anxiety Disorder ◽

Anxiety Symptoms ◽

World Health ◽

Moderate Intensity ◽

Generalized Anxiety ◽

Cross Sectional

BACKGROUND The relationship between physical activity and mental health, especially the symptoms of major depressive disorder (MDD) and generalized anxiety disorder (GAD), has received increasing attention in recent years. OBJECTIVE The aim of this study was to explore the association between fulfilling the World Health Organization (WHO) global recommendations on physical activity and the risk and symptoms of MDD and GAD in the Saudi population. METHODS This study was a secondary analysis of data from a large nationwide cross-sectional survey conducted via phone interviews in June and July 2020. In this study, a proportional quota sampling technique was used to obtain an equal distribution of participants, stratified by age and gender, across the 13 regions of Saudi Arabia. The main mental health screening tool used for the risk of MDD was the Patient Health Questionnaire-9 (PHQ-9). Risk of GAD was measured using the Generalized Anxiety Disorder-7 (GAD-7) scale. Participants self-reported whether they fulfill the WHO global recommendations on (1) moderate-intensity aerobic physical activity (MIPA) and (2) vigorous-intensity aerobic physical activity (VIPA). The results were then analyzed based on the following two categories: fulfilling the WHO global recommendations or not. RESULTS The data analysis included 8333 participants recruited in the main study between June and July 2020. The response rate was 81.45% (8333/10,231). Of them, 50.3% (4192/8333) were female, and the mean age was 36.5 years, with a median age of 36 years and a range from 18 to 90 years. The average total PHQ-9 score was 5.61, and the average total GAD-7 score was 4.18. For men, the average total PHQ-9 and GAD-7 scores were associated with fulfilling recommendations for MIPA; however, there were no associations for VIPA in both sexes. Fulfilling the WHO’s recommendations for MIPA was associated with considerably fewer depressive symptoms in six of the nine items in the PHQ-9. Moreover, fulfilling recommendations for MIPA was associated with considerably fewer anxiety symptoms in six of the seven items in the GAD-7. However, fulfilling recommendations for VIPA was significantly associated with more depressive symptoms in one of the PHQ-9 items (“Thoughts that you would be better off dead or thoughts of hurting yourself in some way;” <i>P</i><.001). CONCLUSIONS This study has shown that fulfilling guidelines on MIPA is associated with less overall risk of MDD and GAD in males and fewer depressive and anxiety symptoms generally in a nonclinical population. In the general population, an increase in MIPA may improve well-being and general mental health.

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Effects of SARS-CoV-2 Pandemic on the Mental Health of Spanish Ob-Gyn Specialists—A Nationwide Study

Journal of Clinical Medicine ◽

10.3390/jcm10245899 ◽

2021 ◽

Vol 10 (24) ◽

pp. 5899

Author(s):

Ernesto González-Mesa ◽

Jesus Salvador Jiménez-López ◽

Marta Blasco-Alonso ◽

Jose Ramon Anderica-Herrero ◽

Daniel Lubián-López

Keyword(s):

Mental Health ◽

Anxiety Disorder ◽

Generalized Anxiety Disorder ◽

Online Survey ◽

Work And Family ◽

Obstetrics And Gynecology ◽

Generalized Anxiety ◽

Post Traumatic Stress ◽

General Anxiety Disorder ◽

The Impact

It has been reported that frontline health professionals have suffered from an increased rate of mental disorders as a consequence of the SARS-CoV-2 pandemic. Objective: This study aims to evaluate the impact of the pandemic on the mental health of Spanish specialists in the obstetrics and gynecology fields after the fifth Spanish COVID-19 wave. Methods: Psychometric screening of the professionals was performed using a nationwide online survey designed by the Psychosocial Obstetrics and Gynecology taskforce. Post-traumatic stress disorder (PTSD), depression, and general anxiety disorder were screened. Results: We found high scores for PTSD, depression, and generalized anxiety disorder. Up to 12.4% of specialists met the PTSD criteria, 12.8% showed complex PTSD, 37% showed depression, and up to 37% had a positive screening for generalized anxiety disorder. Our results showed that the pandemic has particularly affected the group of female Ob-Gyn specialists, with significant higher scores in depression and anxiety scales. Conclusions: As a lesson learned for the future in case of new health emergencies, it would be very important to provide professionals with adequate psychological support, ensuring enough human and material resources, flexible work shifts, and facilities to reconcile work and family-life, especially in the case of female specialists.

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COVID-19 Pandemic and Mental Health: Prevalence and Correlates of New-Onset Obsessive-Compulsive Symptoms in a Canadian Province

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17196986 ◽

2020 ◽

Vol 17 (19) ◽

pp. 6986

Author(s):

Adam Abba-Aji ◽

Daniel Li ◽

Marianne Hrabok ◽

Reham Shalaby ◽

April Gusnowski ◽

...

Keyword(s):

Anxiety Disorder ◽

Generalized Anxiety Disorder ◽

Online Survey ◽

Early Stage ◽

High Stress ◽

Generalized Anxiety ◽

Sample Population ◽

Obsessive Compulsive ◽

Cross Sectional ◽

Compulsive Disorder

Background: This cross-sectional online survey investigates the prevalence of obsessive-compulsive disorder (OCD) symptoms at an early stage of the COVID-19 pandemic in Canada. Methods: OCD symptoms, moderate/high stress, likely generalized anxiety disorder (GAD) and likely major depressive disorder (MDD) were assessed with the Brief Obsessive-Compulsive Scale (BOCS), Perceived Stress Scale (PSS), Generalized Anxiety Disorder 7-item (GAD-7) scale, and Patient Health Questionnaire-9 (PHQ-9) scale, respectively. Results: Out of 32,805 individuals subscribed to Text4Hope, 6041 completed an online survey; the response rate was 18.4%. Overall, 60.3% of respondents reported onset of OCD symptoms and 53.8% had compulsions to wash hands during the COVID-19 pandemic. Respondents who showed OCD symptoms only since the start of COVID-19 were significantly more likely to have moderate/high stress (z = 6.4, p < 0.001), likely GAD (z = 6.0, p < 0.001), and likely MDD (z = 2.7, p < 0.01). Similarly, respondents who engaged in compulsive hand washing were significantly more likely to have moderate/high stress (z = 4.6, p < 0.001) and likely GAD (z = 4.6 p < 0.001), but not likely MDD (z = 1.4, p = 0.16). Conclusion: The prevalence of OCD symptoms increased during the COVID-19 pandemic, at a rate significantly higher than pre-pandemic rates reported for the sample population. Presenting with OCD symptoms increased the likelihood of presenting with elevated stress, likely GAD, and likely MDD.

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Exploring the Association Between Physical Activity and Risk of Mental Health Disorders in Saudi Arabian Adults: Cross-sectional Study

JMIR Public Health and Surveillance ◽

10.2196/25438 ◽

2021 ◽

Vol 7 (4) ◽

pp. e25438

Author(s):

Nora A Althumiri ◽

Mada H Basyouni ◽

Nasser F BinDhim

Keyword(s):

Mental Health ◽

Physical Activity ◽

Depressive Symptoms ◽

Anxiety Disorder ◽

Generalized Anxiety Disorder ◽

Anxiety Symptoms ◽

World Health ◽

Moderate Intensity ◽

Generalized Anxiety ◽

Cross Sectional

Background The relationship between physical activity and mental health, especially the symptoms of major depressive disorder (MDD) and generalized anxiety disorder (GAD), has received increasing attention in recent years. Objective The aim of this study was to explore the association between fulfilling the World Health Organization (WHO) global recommendations on physical activity and the risk and symptoms of MDD and GAD in the Saudi population. Methods This study was a secondary analysis of data from a large nationwide cross-sectional survey conducted via phone interviews in June and July 2020. In this study, a proportional quota sampling technique was used to obtain an equal distribution of participants, stratified by age and gender, across the 13 regions of Saudi Arabia. The main mental health screening tool used for the risk of MDD was the Patient Health Questionnaire-9 (PHQ-9). Risk of GAD was measured using the Generalized Anxiety Disorder-7 (GAD-7) scale. Participants self-reported whether they fulfill the WHO global recommendations on (1) moderate-intensity aerobic physical activity (MIPA) and (2) vigorous-intensity aerobic physical activity (VIPA). The results were then analyzed based on the following two categories: fulfilling the WHO global recommendations or not. Results The data analysis included 8333 participants recruited in the main study between June and July 2020. The response rate was 81.45% (8333/10,231). Of them, 50.3% (4192/8333) were female, and the mean age was 36.5 years, with a median age of 36 years and a range from 18 to 90 years. The average total PHQ-9 score was 5.61, and the average total GAD-7 score was 4.18. For men, the average total PHQ-9 and GAD-7 scores were associated with fulfilling recommendations for MIPA; however, there were no associations for VIPA in both sexes. Fulfilling the WHO’s recommendations for MIPA was associated with considerably fewer depressive symptoms in six of the nine items in the PHQ-9. Moreover, fulfilling recommendations for MIPA was associated with considerably fewer anxiety symptoms in six of the seven items in the GAD-7. However, fulfilling recommendations for VIPA was significantly associated with more depressive symptoms in one of the PHQ-9 items (“Thoughts that you would be better off dead or thoughts of hurting yourself in some way;” P<.001). Conclusions This study has shown that fulfilling guidelines on MIPA is associated with less overall risk of MDD and GAD in males and fewer depressive and anxiety symptoms generally in a nonclinical population. In the general population, an increase in MIPA may improve well-being and general mental health.

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