Investigation of anxiety and depression in patients with chronic diseases

The health of an individual depends on both his/her physical and psychological condition. In recent years it has been observed that chronic patients have frequently an affected psycho-emotional state. The purpose of this study is to investigate anxiety and depression in patients with chronic diseases and the correlation of the results with daily physical activity levels and individual health levels, as well comorbidity. This study included patients with chronic diseases that were treated in a local general hospital or were visiting often outpatient clinics of the same hospital due to their condition. The sample in this particular study included 204 patients; 118 of them were women and 86 men. From the total sample that participated in our research, 118 (57.8%) were females and the majority of the participants were secondary/basic education graduates (67%), married (71%), living in urban areas (53%). Hypertension was the most frequent chronic disease in our sample, followed by hypercholesterolemia and diabetes mellitus. Comparing the occurrence of depression and anxiety symptoms in both questionnaires in relation to the expected frequency in the general population, significant levels of depression and anxiety symptoms were recorded. Taking into consideration the findings of this research, anxiety and depression symptoms can have profound effects regarding the control of chronic diseases, the patients’ quality of life and their general health.

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Outcomes of a Blended Care Coaching Program for Clients Presenting With Moderate Levels of Anxiety and Depression: Pragmatic Retrospective Study

JMIR Mental Health ◽

10.2196/32100 ◽

2021 ◽

Vol 8 (10) ◽

pp. e32100

Author(s):

Monica S Wu ◽

Shih-Yin Chen ◽

Robert E Wickham ◽

Shane O’Neil-Hart ◽

Connie Chen ◽

...

Keyword(s):

Mental Health ◽

Health Care ◽

Mental Health Care ◽

Total Sample ◽

Anxiety And Depression ◽

Depression Symptoms ◽

Depression And Anxiety ◽

Care Needs ◽

Effective Manner ◽

Blended Care

Background Depression and anxiety are leading causes of disability worldwide, but access to quality mental health care is limited by myriad factors. Cognitive-behavioral coaching is rooted in evidence-based principles and has the potential to address some of these unmet care needs. Harnessing technology to facilitate broader dissemination within a blended care model shows additional promise for overcoming barriers to care. Objective The aim of this study is to evaluate the outcomes of a blended care coaching (BCC) program for clients presenting with moderate levels of anxiety and depression in real-world settings. Methods This study examined retrospective data from US-based individuals (N=1496) who presented with moderate levels of depression and anxiety symptoms and who received blended care coaching services. Using a short-term framework, clients met with coaches via a secure video conference platform and also received digital video lessons and exercises. To evaluate the effectiveness of the BCC program, mixed effects modeling was used to examine growth trajectories of anxiety and depression scores over the course of care. Results Out of the total sample of 1496 clients, 75.9% (n=1136) demonstrated reliable improvement, and 88.6% (n=1326) recovered based on either the Generalized Anxiety Disorder-7 scale (anxiety) or Patient Health Questionnaire-9 (depression). On average, clients exhibited a significant decline in anxiety and depression symptoms during the initial weeks of coaching, with a continued decline over subsequent weeks at a lower rate. Engaging in a coaching session was associated with lower anxiety (b=–1.04) and depression (b=–0.79) symptoms in the same week, as well as lower anxiety (b=–0.74) and depression (b=–0.91) symptoms the following week (P<.001). Conclusions The BCC program demonstrated strong outcomes in decreasing symptomology for clients presenting with moderate levels of anxiety and depression. When clients received coaching sessions, significant decreases in symptoms were observed, reflecting the importance of session attendance. Additionally, the steepest declines in symptoms tended to occur during the initial weeks of coaching, emphasizing the importance of client buy-in and early engagement. Collectively, these findings have implications for addressing unmet mental health care needs in a more accessible, cost-effective manner.

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Self-reported symptoms of depression and anxiety among informal caregivers of persons with dementia: a cross-sectional comparative study between Sweden and Italy

BMC Health Services Research ◽

10.1186/s12913-020-05964-2 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Joseba Wulff ◽

Agneta Malmgren Fänge ◽

Connie Lethin ◽

Carlos Chiatti

Keyword(s):

Informal Caregivers ◽

Depression Scale ◽

Well Being ◽

Anxiety Symptoms ◽

Anxiety And Depression ◽

Depression Symptoms ◽

Depression And Anxiety ◽

Cross Sectional ◽

Symptoms Of Depression ◽

People With Dementia

Abstract Background Around 50 million people worldwide are diagnosed with dementia and this number is due to triple by 2050. The majority of persons with dementia receive care and support from their family, friends or neighbours, who are generally known as informal caregivers. These might experience symptoms of depression and anxiety as a consequence of caregiving activities. Due to the different welfare system across European countries, this study aimed to investigate factors associated with self-reported depression and anxiety among informal dementia caregivers both in Sweden and Italy, to ultimately improve their health and well-being. Methods This comparative cross-sectional study used baseline data from the Italian UP-TECH (n = 317) and the Swedish TECH@HOME (n = 89) studies. Main outcome variables were the severity of self-reported anxiety and depression symptoms, as measured by the Hospital Anxiety and Depression Scale (HADS). HADS scores were investigated using descriptive and bivariate statistics to compare means and standard deviations. Linear regressions were used to test for associations between potential factors and self-reported symptoms of depression and anxiety. Results Italian informal caregivers reported more severe symptoms of depression and anxiety than Swedish caregivers. In Italy, a higher number of hours of caregiving was associated with anxiety symptoms (β = − 1.205; p = 0.029), being 40–54 years-old with depression symptoms (β = − 1.739; p = 0.003), and being female with symptoms of both depression (β = − 1.793; p < 0.001) and anxiety (β = 1.474; p = 0.005). In Sweden, a higher number of hours of caregiving and being < 39 years-old were associated with depression symptoms (β = 0.286; p < 0.000; β = 3.945; p = 0.014) and a higher number of hours of caregiving, the lack of additional informal caregivers and dementia severity were associated with anxiety symptoms (β = 0.164; p = 0.010; β = − 1.133; p = 0.033; β = − 1.181; p = 0.031). Conclusion Multiple factors are associated with self-reported symptoms of depression and anxiety among informal caregivers in Sweden and Italy. Factors found in this study partly differ between the two countries, suggesting the important role of cultural and social factors affecting the experience of caregiving. A deeper knowledge of these factors may increase the knowledge on potential protective and risk factors, provide information to policymakers and ultimately improve the psychological well-being of informal caregivers to people with dementia across Europe.

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Determinants of increased frequency of depressive and anxiety symptoms in exercise professionals during the COVID-19 pandemic

Work ◽

10.3233/wor-210648 ◽

2021 ◽

pp. 1-11

Author(s):

Natan Feter ◽

Eduardo L. Caputo ◽

Igor R. Doring ◽

Marcelo C. da Silva ◽

Felipe F. Reichert ◽

...

Keyword(s):

Physical Activity ◽

Depressive Symptoms ◽

Depression Scale ◽

Exercise Program ◽

Anxiety Symptoms ◽

Anxiety And Depression ◽

Depression Symptoms ◽

Depression And Anxiety ◽

Cross Sectional ◽

Social Distancing

BACKGROUND: The coronavirus disease (COVID-19) pandemic has affected workers in different health services including exercise professionals (EP). The urgent need to adapt in-person to online activities might have led to increased frequency of anxiety and depressive symptoms. OBJECTIVE: We aimed to identify the determinants of aggravated depressive and anxiety symptoms in EP in southern Brazil during social distancing from the COVID-19. METHODS: A cross-sectional study was conducted with EP who worked at fitness centers, sports clubs, private schools, or at a public exercise program offered by the municipal council. We used an online-based, self-administered, adapted version of the Hospital Anxiety and Depression scale to compare symptoms of depression and anxiety pre- and during social distancing. RESULTS: Participants (n = 201) had a mean age of 32.7±8.0 years, with more than half being male, white, and having an university degree. We observed that 81%and 71%of respondents reported higher frequency in anxiety and depression symptoms, respectively, during social distancing than in the period before it. Physical education teachers, women, non-white professionals, and those with chronic disease were more likely to worsen anxiety symptoms. Women had higher odds to increased frequency in depressive symptoms. Physical activity and previous experience with internet-based tools for working activities reduced the risk of increased depressive symptoms. CONCLUSIONS: Sex, ethnicity, chronic diseases, educational level, physical activity, and experience with online tools were determinants for increased frequency of depression and anxiety symptoms in EP.

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Staff SARS-CoV-2 Seroprevalence and Mental Health as Key Factors in University Response to COVID-19 Pandemic

Frontiers in Public Health ◽

10.3389/fpubh.2021.689919 ◽

2021 ◽

Vol 9 ◽

Author(s):

David G. Lopes ◽

Ana Rita Henriques ◽

Margarida Santos-Dias ◽

Catarina Nunes-da-Silva ◽

Juliana Gonçalves ◽

...

Keyword(s):

Mental Health ◽

Medical School ◽

Urban Areas ◽

Academic Community ◽

Anxiety Symptoms ◽

Anxiety And Depression ◽

Blood Collection ◽

Depression Symptoms ◽

Blood Draw ◽

Negatively Associated

Background: In response to rapid global spread of the newly emerged coronavirus disease 2019 (COVID-19), universities transitioned to online learning and telework to decrease risks of inter-person contact. To help administrators respond to the COVID-19 pandemic and better understand its impacts, we surveyed SARS-CoV-2 seroprevalence among NOVA University employees and assessed community mental health.Methods: Data were collected from voluntary participants at six NOVA University locations, in the Lisbon metropolitan area, from June 15–30, 2020. All subjects provided written informed consent. Of 1,627 recruited participants (mean age 42.0 ± 12.3 years), 1,624 were tested. Prior to blood collection, participants completed a questionnaire that assessed: COVID-19 symptoms during the previous 14 days, chronic non-communicable diseases, chronic medication, anxiety, and depression symptoms. SARS-CoV-2 serology tests were then performed, and results communicated approximately 4 days after blood draw. Participants with positive serology tests were contacted to assess COVID-19 symptoms since February.Results: Estimated prevalence of SARS-CoV-2 IgG antibodies was 3.1% (n = 50), of which 43.5% reported symptoms in the previous 4 months. The Medical School had the highest seroprevalence (6.2%). Participants reported having at least one chronic disease (63.7%), depression-like symptoms (2.1%), and anxiety symptoms (8.1%). Rates of depression and anxiety symptoms were significantly higher in women, with sleep hours and occasional alcohol consumption negatively associated with depression. Male gender, older age, and sleep hours negatively associated with anxiety symptoms. School of employment and presence of comorbidities positively associated with anxiety.Conclusion: By measuring seroprevalence of SARS-CoV-2 antibodies among NOVA employees and assessing subjects' mental health, we aim to help administrators at European public universities in urban areas, such as Lisbon, Portugal, better understand the needs of their communities. This study resulted in implementation of a stricter contingency plan in the Medical School, while other schools continued to follow Government mitigation guidelines. These findings may also guide the development of tailored strategies to ensure physical and mental health of the academic community during this pandemic crisis. We conclude that, together with COVID-19 contingency plans, psychological support services and facilities to help people effectively face pandemic-associated challenges and minimise anxiety and depression should be implemented.

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Outcomes of a Blended Care Coaching Program for Clients Presenting With Moderate Levels of Anxiety and Depression: Pragmatic Retrospective Study (Preprint)

10.2196/preprints.32100 ◽

2021 ◽

Author(s):

Monica S Wu ◽

Shih-Yin Chen ◽

Robert E Wickham ◽

Shane O’Neil-Hart ◽

Connie Chen ◽

...

Keyword(s):

Mental Health ◽

Health Care ◽

Mental Health Care ◽

Total Sample ◽

Anxiety And Depression ◽

Depression Symptoms ◽

Depression And Anxiety ◽

Care Needs ◽

Effective Manner ◽

Blended Care

BACKGROUND Depression and anxiety are leading causes of disability worldwide, but access to quality mental health care is limited by myriad factors. Cognitive-behavioral coaching is rooted in evidence-based principles and has the potential to address some of these unmet care needs. Harnessing technology to facilitate broader dissemination within a blended care model shows additional promise for overcoming barriers to care. OBJECTIVE The aim of this study is to evaluate the outcomes of a blended care coaching (BCC) program for clients presenting with moderate levels of anxiety and depression in real-world settings. METHODS This study examined retrospective data from US-based individuals (N=1496) who presented with moderate levels of depression and anxiety symptoms and who received blended care coaching services. Using a short-term framework, clients met with coaches via a secure video conference platform and also received digital video lessons and exercises. To evaluate the effectiveness of the BCC program, mixed effects modeling was used to examine growth trajectories of anxiety and depression scores over the course of care. RESULTS Out of the total sample of 1496 clients, 75.9% (n=1136) demonstrated reliable improvement, and 88.6% (n=1326) recovered based on either the Generalized Anxiety Disorder-7 scale (anxiety) or Patient Health Questionnaire-9 (depression). On average, clients exhibited a significant decline in anxiety and depression symptoms during the initial weeks of coaching, with a continued decline over subsequent weeks at a lower rate. Engaging in a coaching session was associated with lower anxiety (b=–1.04) and depression (b=–0.79) symptoms in the same week, as well as lower anxiety (b=–0.74) and depression (b=–0.91) symptoms the following week (P<.001). CONCLUSIONS The BCC program demonstrated strong outcomes in decreasing symptomology for clients presenting with moderate levels of anxiety and depression. When clients received coaching sessions, significant decreases in symptoms were observed, reflecting the importance of session attendance. Additionally, the steepest declines in symptoms tended to occur during the initial weeks of coaching, emphasizing the importance of client buy-in and early engagement. Collectively, these findings have implications for addressing unmet mental health care needs in a more accessible, cost-effective manner.

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Symptoms of mood disorders in family carers of older people with dementia who experience caregiver burden: a network approach

Age and Ageing ◽

10.1093/ageing/afaa008 ◽

2020 ◽

Vol 49 (4) ◽

pp. 628-633

Author(s):

Alex Bacadini França ◽

Adam Lee Gordon ◽

Rajvinder Samra ◽

Evelise Saia Rodolpho Duarte ◽

Alessandro Ferrari Jacinto

Keyword(s):

Network Analysis ◽

Older People ◽

Depression Scale ◽

Anxiety Symptoms ◽

Warning Signs ◽

Anxiety And Depression ◽

Depression Symptoms ◽

Depression And Anxiety ◽

Family Carers ◽

People With Dementia

Abstract Background informal carers of people with dementia are at greater risk of anxiety and depressive disorders if they find caregiving to be a burden. The aim of this study was to use a network analysis of cross-sectional data to investigate the relationships between anxiety and depressive symptoms in family carers of older people with dementia who experience burden. Methods sixty family carers exhibiting high levels of burden using the Zarit Burden Interview were included in the study. Participants completed the Hospital Anxiety and Depression Scale. The network analysis identified the depression and anxiety symptom network using features including a topological graph, network centrality metrics and community analysis. The network was estimated through the graphical LASSO technique in combination with a walktrap algorithm to obtain the clusters within the network and the connections between the nodes (symptoms). A directed acyclic graph was generated to model symptom interactions. Results the resulting network architecture shows important bridges between depression and anxiety symptoms. Lack of pleasure and loss of enjoyment were identified as potential gateway symptoms to other anxiety and depression symptoms and represent possible therapeutic targets for psychosocial interventions. Fear and loss of optimism were highly central symptoms, indicating their importance as warning signs of more generalised anxiety and depression. Conclusions this network analysis of depressive and anxiety symptoms in overburdened family carers provides important insights as to what symptoms may be the most important targets for behavioural interventions.

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Effectiveness of a Mobile App Intervention for Anxiety and Depression Symptoms in University Students: Randomized Controlled Trial (Preprint)

10.2196/preprints.15418 ◽

2019 ◽

Author(s):

Tayla McCloud ◽

Rebecca Jones ◽

Gemma Lewis ◽

Vaughan Bell ◽

Elias Tsakanikos

Keyword(s):

Randomized Controlled Trial ◽

University Students ◽

Controlled Trial ◽

Mobile App ◽

Anxiety Symptoms ◽

Mean Difference ◽

Anxiety And Depression ◽

Depression Symptoms ◽

Depression And Anxiety ◽

Randomized Controlled

BACKGROUND Depression and anxiety symptoms are common among university students, but many do not receive treatment. This is often because of lack of availability, reluctance to seek help, and not meeting the diagnostic criteria required to access services. Internet-based interventions, including smartphone apps, can overcome these issues. However, a large number of apps are available, each with little evidence of their effectiveness. OBJECTIVE This study aims to evaluate for the first time the effectiveness of a self-guided mobile app, Feel Stress Free, for the treatment of depression and anxiety symptoms in students. METHODS A web-based randomized controlled trial compared a cognitive behavioral therapy (CBT)–based mobile app Feel Stress Free with a wait-list control. University students self-identified as experiencing symptoms of anxiety or depression and were randomized to 6 weeks of intervention (n=84) or control (n=84), unblinded. The app is self-guided and incorporates behavioral relaxation activities, mood tracking and thought challenging, and minigames. Participants completed the Hospital Anxiety and Depression Scale online at baseline and every fortnight. RESULTS At week 6, the primary end point, there was evidence that the Feel Stress Free app reduced depression symptoms (mean difference −1.56; 95% CI −2.67 to −0.44; P=.006) but only very weak evidence that it reduced anxiety symptoms (mean difference −1.36; 95% CI −2.93 to 0.21; P=.09). At week 4, there was evidence to support the effectiveness of the intervention for anxiety symptoms (mean difference −1.94; 95% CI −3.11 to −0.77; P=.001) and, though weaker, depression symptoms (mean difference −1.08; 95% CI −2.12 to −0.04; P=.04). At week 6, 83% (34/41) of participants indicated that they were using the app weekly or more frequently. CONCLUSIONS The Feel Stress Free app is a promising mobile intervention for treating symptoms of anxiety and depression in students and overcomes many of the barriers to traditional CBT. Further research is needed to establish its effectiveness at and beyond 6 weeks. CLINICALTRIAL ClinicalTrials.gov NCT03032952; https://clinicaltrials.gov/ct2/show/NCT03032952

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Relationships between depression and anxiety symptoms and adipocyte-derived proteins in postmenopausal women

PLoS ONE ◽

10.1371/journal.pone.0248314 ◽

2021 ◽

Vol 16 (3) ◽

pp. e0248314

Author(s):

Yu-Ting Wu ◽

Wan-Yu Huang ◽

Chew-Teng Kor ◽

Ko-Hung Liu ◽

Ting-Yu Chen ◽

...

Keyword(s):

Postmenopausal Women ◽

Rating Scale ◽

Linear Regression Analysis ◽

Depression Scale ◽

Anxiety Symptoms ◽

Population Heterogeneity ◽

Anxiety And Depression ◽

Future Research ◽

Depression Symptoms ◽

Depression And Anxiety

Introduction Studies on the association between adiponectin and leptin and anxiety and depression among postmenopausal women are limited. Therefore, the present study specifically evaluates the mutual relationships between adiponectin and leptin and anxiety and depression in postmenopausal women. Participants and design In this cross-sectional study, a total of 190 women aged 40–65 years were enrolled. Depression symptoms were assessed using the Center for Epidemiologic Studies Depression Scale (CES-D), and anxiety symptoms were evaluated using the Hamilton Anxiety Rating Scale (HAM-A). Fasting specimens were collected to measure sex hormone, glucose, insulin, and adipokine levels. Multiple linear regression analysis was performed to evaluate the associations between depression and anxiety and adipocyte-derived hormones. Settings The study was performed in a hospital medical center. Results Among 190 enrolled postmenopausal women, Spearman’s rank correlation analysis revealed significant correlations between CES-D and HAM-A (r = 0.715, P < 0.0001), between CES-D and adiponectin (p = 0.009) and leptin (p = 0.015), and between HAM-A and adiponectin (p = 0.01) and leptin (p = 0.001). The subjects with CES-D ≥ 16 and with HAM-A ≥ 18 had higher adiponectin levels than those with CES-D < 16 and HAM-A < 18, respectively. After adjusting for age, body mass index, exercise, alanine amino transferase and parameters of lipid profiles, Log adiponectin levels were found to be significantly associated with both CES-D and HAM-A, and Log leptin levels were only significantly associated with HAM-A. Conclusions The data show that adiponectin and leptin levels are significantly associated with depression and anxiety symptoms. These results suggest that higher adiponectin and lower leptin levels may serve as potential markers related to anxiety and mood in postmenopausal women. More future research that is designed to deal with the important confounders (e.g., population heterogeneity) is needed to investigate comprehensively on these associations.

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Effectiveness of a Mobile App Intervention for Anxiety and Depression Symptoms in University Students: Randomized Controlled Trial

JMIR mhealth and uhealth ◽

10.2196/15418 ◽

2020 ◽

Vol 8 (7) ◽

pp. e15418

Author(s):

Tayla McCloud ◽

Rebecca Jones ◽

Gemma Lewis ◽

Vaughan Bell ◽

Elias Tsakanikos

Keyword(s):

Randomized Controlled Trial ◽

University Students ◽

Controlled Trial ◽

Mobile App ◽

Anxiety Symptoms ◽

Mean Difference ◽

Anxiety And Depression ◽

Depression Symptoms ◽

Depression And Anxiety ◽

Randomized Controlled

Background Depression and anxiety symptoms are common among university students, but many do not receive treatment. This is often because of lack of availability, reluctance to seek help, and not meeting the diagnostic criteria required to access services. Internet-based interventions, including smartphone apps, can overcome these issues. However, a large number of apps are available, each with little evidence of their effectiveness. Objective This study aims to evaluate for the first time the effectiveness of a self-guided mobile app, Feel Stress Free, for the treatment of depression and anxiety symptoms in students. Methods A web-based randomized controlled trial compared a cognitive behavioral therapy (CBT)–based mobile app Feel Stress Free with a wait-list control. University students self-identified as experiencing symptoms of anxiety or depression and were randomized to 6 weeks of intervention (n=84) or control (n=84), unblinded. The app is self-guided and incorporates behavioral relaxation activities, mood tracking and thought challenging, and minigames. Participants completed the Hospital Anxiety and Depression Scale online at baseline and every fortnight. Results At week 6, the primary end point, there was evidence that the Feel Stress Free app reduced depression symptoms (mean difference −1.56; 95% CI −2.67 to −0.44; P=.006) but only very weak evidence that it reduced anxiety symptoms (mean difference −1.36; 95% CI −2.93 to 0.21; P=.09). At week 4, there was evidence to support the effectiveness of the intervention for anxiety symptoms (mean difference −1.94; 95% CI −3.11 to −0.77; P=.001) and, though weaker, depression symptoms (mean difference −1.08; 95% CI −2.12 to −0.04; P=.04). At week 6, 83% (34/41) of participants indicated that they were using the app weekly or more frequently. Conclusions The Feel Stress Free app is a promising mobile intervention for treating symptoms of anxiety and depression in students and overcomes many of the barriers to traditional CBT. Further research is needed to establish its effectiveness at and beyond 6 weeks. Trial Registration ClinicalTrials.gov NCT03032952; https://clinicaltrials.gov/ct2/show/NCT03032952

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Graduating from Medical School amid a Pandemic: A Study of Graduates’ Mental Health and Concerns

Education Research International ◽

10.1155/2021/8854587 ◽

2021 ◽

Vol 2021 ◽

pp. 1-5

Author(s):

Hend M. Alkwai

Keyword(s):

Medical Students ◽

Online Survey ◽

Virus Disease ◽

Demographic Data ◽

Anxiety Symptoms ◽

Anxiety And Depression ◽

Depression Symptoms ◽

Depression And Anxiety ◽

Cross Sectional ◽

The Impact

The corona virus disease of 2019 (COVID-19) pandemic has vastly impacted individuals worldwide. Millions have contracted the disease thus far; however, the ramifications of containment measures such as quarantine and lockdown have affected many more. This study aimed to explore the prevalence of self-reported anxiety and depression among a cohort of Saudi medical students, as well as graduating medical students’ concerns, during this pandemic. This cross-sectional study utilized an online survey that collected demographic data, scores on validated anxiety, and depression scales, as well as the graduates’ concerns. The Generalized Anxiety Disorder 7-item (GAD-7) and the Public Health Questionnaire 9-item (PHQ-9) scales were used. Cutoff scores for anxiety symptoms were (GAD-7 ≥ 8) and for depression (PHQ-9 ≥ 10). Out of 83 graduates, 55 completed the online survey. Anxiety symptoms were present in 34%, depression was present in 26%, and 19% had both depression and anxiety symptoms. Female graduates experienced higher anxiety symptoms (54 vs. 15%, p = 0.004 ). The highest-ranked concerns were the possible effect of the pandemic on the forthcoming internship year and on the impact on the current academic course. We found high levels of anxiety and depression symptoms during the pandemic among our cohort of medical students in their final year of study. Our findings suggest that medical students in their final years may be negatively affected by the pandemic, where high levels of depression and anxiety coincide with concerns about the effect of the pandemic on the next phase of their vocation.

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