The Association between Social Integration, Coping Mechanisms and Anxiety in Patients with Non-Communicable Diseases

Recently, mental health issue and chronic physical condition are substantially linked and this comorbidity is likely to increase.Patient focusing in the self-care activities is an important component in the mechanism of coping with chronic disease with a significant impact on clinical and psychological outcomes. In this context, the current study is conducted to assess the impact of self-care and social integration mechanisms on anxiety levels among patients with chronic non-communicable diseases.This observational study of cross-sectional design was performed in the pathology service of Fier city hospital, in Albania during August-September 2020. To assess the level of anxiety, we used the scale of 7 items of General Anxiety Disorder (GAD-7) with a score of ≥10 indicating GAD. Subscales of the Health Education Impact Questionnaire (heiQ) were used in order to evaluate social integration and self-care mechanism. The data were entered into the statistical program SPSS, version 23. The regression analysis is performedto examine the relationship between variables. The findings revealed that 56% of participants had GAD, 47% of participants were unable to self-monitor the disease, while 89% of them didnot performe any type of physical activity. The scale of anxiety was significantly associated with variables of Self–monitoring (p=0.000<0.05; OR=0.10) and Social integration (p=0.000<0.05; OR=21.4). These findings address the need to support peoplewho struggle with chronic non-communicable diseases developing adaptive ways to deal with their chronic condition and improve their lifestyle for better overall health.

General Anxiety Disorder-7 Questionnaire as a marker of low socioeconomic status and inequity

Background: The General Anxiety Disorder-7 (GAD-7) questionnaire is a standard tool used for screening and follow-up of patients with Generalized Anxiety Disorder (GAD). Although it is generally accepted that anxiety correlates with clinical and psychosocial stressors, precise quantitative data is limited on the relations among GAD-7, traditional biomarkers, and other measures of health. Even less is known about how GAD-7 relates to race, ethnicity, and socioeconomic status (SES).We determined how multiple demographic and socioeconomic data correlate with the participant's GAD-7 results when compared with laboratory, physical function, clinical, and other biological markers. Methods: The Project Baseline Health Study (BHS) is a prospective cohort of adults representing several populations in the USA. We analyzed a deeply phenotyped group of 2502 participants from that study. Measures of interest included: clinical markers or history of medical diagnoses; physical function markers including gait, grip strength, balance time, daily steps, and echocardiographic parameters; psychometric measurements; activities of daily living; socioeconomic characteristics; and laboratory results. Results: Higher GAD-7 scores were associated with female sex, younger age, and Hispanic ethnicity. Measures of low SES were also associated with higher scores, including unemployment, income ≤$25,000, and ≤12 years of education. After adjustment for 166 demographic, clinical, laboratory, and symptom characteristics, unemployment and overall higher SES risk scores were highly correlated with anxiety scores. Protective factors included Black race and older age. Limitations: Correlations identified in this cross-sectional study cannot be used to infer causal relationships; further, we were not able to account for possible use of anxiety treatments by study participants. Conclusions: These findings highlight the importance of understanding anxiety as a biopsychosocial entity. Clinicians and provider organizations need to consider both the physical manifestations of the disorder and their patients' social determinants of health when considering treatment pathways and designing interventions.

A History of Mild Traumatic Brain Injury Is Associated With a a More Severe Long-term Migraine Phenotype

ObjectiveThis study aimed to investigate the effect of prior mTBI on the clinical features and disability in patients presenting with migraine.BackgroundHead injury is a risk factor for chronic migraine (CM) and migraine is a risk factor for persistent headache after mild traumatic brain injury (mTBI).Design/MethodsOf 2,161 migraine patients without a diagnosis of post-traumatic headache (PTH) who participated in the American Registry for Migraine Research (ARMR) between February 2016 and March 2020, 1,120 answered questions about a history of mTBI. After controlling for age, gender, and having CM, demographics, headache characteristics, Patient Health Questionnaire-2 (PHQ-2) score, General Anxiety Disorder-7 (GAD-7) grade, and Migraine Disability Assessment Scale (MIDAS) scores were compared between those with a history of mTBI to those without.ResultsAmong 1,098 migraine patients, 37.6% (n = 413) had a history of mTBI. The patients with mTBI were more likely to have CM (p = 0.004), dizziness (p = 0.003), vertigo (p = 0.009), and difficulty finding words (p < 0.001). Patients with mTBI had significantly greater scores on the MIDAS (58.6 ± 52.6 vs 50.0 ± 47.8, p = 0.034) and PHQ-2 (1.6 ± 1.8 vs 1.3 ± 1.6, p = 0.012), and had significantly higher proportion of moderate to severe GAD-7 grade (21.7% vs 17.1%, p = 0.017) compared to those without mTBI.ConclusionsIn patients presenting with migraine, a prior history of mTBI was associated with a diagnosis of chronic migraine, disability, anxiety and depression severity, as well as dizziness, vertigo, and word finding difficulty. A history of mTBI should be assessed in patients presenting with migraine, and people with migraine who have a high exposure risk to mTBI, should be aware of the potential for migraine progression and psychiatric symptoms after mTBI.

UTILIZAÇÃO DE PSICOFÁRMACOS E SINTOMAS DE ANSIEDADE E DEPRESSÃO EM ESTUDANTES UNIVERSITÁRIOS DE LAGARTO/SE DURANTE A PANDEMIA DA COVID-19

Introdução: A pandemia causada pela COVID-19 pode provocar impactos na saúde mental dos universitários, devido a fatores como suspensão das aulas presenciais e a sobrecargas do ensino online, assim objetivou-se quantificar o número de estudantes universitários com ansiedade e depressão provável relacionando com o uso de psicofármacos durante a pandemia. Métodos: Estudo transversal, descritivo e quantitativo aprovado pelo CEP (CAAE: 37453920.0.0000.5546). Foi aplicado um questionário online para verificação dos sintomas de depressão (Questionário Sobre Saúde do Paciente; PHQ-2) e ansiedade (Escala de Transtorno geral de Ansiedade; GAD-2), e sobre o uso de psicofármacos e perfil sociodemográfico de estudantes de graduação da Universidade Federal de Sergipe (UFS) de Lagarto-SE. Resultados: Dos 99 participantes, 48,5% foram classificados com ansiedade provável (GAD-2 ≥ 3) e 37,4% com depressão provável (PHQ-2 ≥ 3), enquanto que 33,3% (n=33) apresentaram depressão e ansiedade provável, simultaneamente. Destes 10,1% (n=10) faziam uso de psicofármacos. Uma quantidade significativa de pessoas que não fazem uso de psicofármacos apresentou sintomas de ansiedade (47,2%, n=42) e de depressão (33,7%, n=30). Conclusão: A grande maioria dos estudantes foi avaliada com depressão ou ansiedade provável, entretanto, uma pequena porcentagem faz uso de psicofármacos, podendo sugerir outras formas de tratamentos ou a falta de tratamento. Assim é sugerido que os mesmos procurem por apoio psicológico para avaliações adicionais. ABSTRACT Introduction: The pandemic caused by COVID-19 can cause impacts on the mental health of university students, due to factors such as suspension of in-person classes and overload of online teaching, so the objective was to quantify the number of university students with anxiety and depression likely related to the use of psychotropic drugs during the pandemic. Methods: Cross-sectional, descriptive, and quantitative study approved by CEP (CAAE: 37453920.0.0000.5546). An online questionnaire was applied to check the symptoms of depression (Questionnaire on Health of the Patient; PHQ-2) and anxiety (General Anxiety Disorder Scale; GAD-2), and on the use of psychotropic drugs and the sociodemographic profile of undergraduate students of the Federal University of Sergipe (UFS) in Lagarto-SE. Results: Of the 99 participants, 48.5% were classified with probable anxiety (GAD-2 ≥ 3) and 37.4% with probable depression (PHQ-2 ≥ 3), while 33.3% (n=33) presented depression and likely anxiety. Of these 10.1% (n=10) were using psychotropic drugs. A significant number of people who do not use psychotropic drugs had symptoms of anxiety (47.2%, n=42) and 33.7% (n=30) of depression. Conclusion: The vast majority of students were assessed with probable depression and anxiety, however, a small percentage uses psychotropic drugs, which may suggest other forms of treatment or lack of treatment. Thus, it is suggested that they look for psychological support for further evaluations.

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

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.

Pharmaceutical Management of General Anxiety Disorder

Generalized anxiety disorder (GAD) is a mental disorder defined as excessive worrying over little things. It is a one of the most common types of anxiety disorders. A study stated that 1-5% of the general population suffers from GAD. The condition affects the quality of life of a patient negatively and activities in their everyday life. In this review article, we highlighted several studies that compared combined therapy of psychotherapy and pharmacotherapy to either therapy alone, results were conflicting and differ from one study to another. Provide a thorough and comprehensive review of the different approaches of GAD management, several database websites were searched for articles discussing the pharmacological management of general anxiety disorder. Clinical trials, clinical guidelines, systematic reviews, meta-analyses and review articles were all reviewed and considered for inclusion. The review emphasizes the importance of taking the decision of therapy after counseling the patient, taking into account, the cost effectiveness of the treatment, patient’s symptomatology, comorbidity, medical conditions, concomitant using medications, previous trials and preference. Accordingly, thorough assessment should be done before moving to management plan, and a trial of other group or other therapies should be taken if there is no response seen. However, generalized anxiety disorder is one of the most common types of anxiety disorders. It has a lifetime prevalence around 5%, it can include intolerable cognitive, emotional and physical symptoms. Thus, GAD can adversely affect the patient’s life aspects, including personal, functional, social or educational. There are options to be taken among psychotherapy, pharmacotherapy or combined therapy.

An Assessment of the Level of COVID-19 Anxiety among Pregnant Women in Poland: A Cross-Sectional Study

Introduction: The COVID-19 pandemic has caused general anxiety worldwide. Pregnant women are at a much higher risk of developing the infection due to multiple changes that occur in the body during this period. The consequences of the disease can be dramatic not only for the expectant mothers, but also for their unborn children. SARS-CoV-2 infection is generally known to cause serious concerns about future health and life. The data on the severity of COVID-19 pandemic-related anxiety in pregnant women are insufficient. The aim of the study was to assess the level of COVID-19-related anxiety among pregnant women in Poland. Materials and Methods: The study included 173 pregnant women who volunteered for the research. The research was conducted by means of an online diagnostic survey containing an original questionnaire and the following standardized tools: State-Trait Anxiety Inventory (STAI), Short Health Anxiety Inventory (SHAI), and General Anxiety Disorder-7 (GAD-7). Results: Women hospitalised during pregnancy differed statistically significantly in terms of STAI-X1 scores. Primiparas obtained statistically significantly higher SHAI scores than multiparas. Women with higher education had higher SHAI scores. In the GAD-7 scale, 13.3% of respondents obtained a score suggesting a suspected generalised anxiety disorder. Conclusions: Pregnant women are concerned about both developing COVID-19 and the consequences of infection for themselves and their unborn children. The study demonstrated anxiety of varying severity (depending on the tool used). Hospital stay during pregnancy is an additional stressor in expectant women. Further studies are needed to assess the level of COVID-19-related anxiety to assess this phenomenon in Poland in more detail.

Anxiety disorders in clinical practice - a modern view on the problem of therapy

Clinically significant anxiety occurs in 5-7% of the general population and in 25% or more of patients seen by general practitioners. The lifetime incidence of anxiety disorders can be over 30%. Anxiety in adolescence and young adulthood often later develops into depression. The line between a “normal” response to a threat and a pathological anxiety disorder is often very blurred and there may be a continuum from personal distress to mental disorder. The real clinical situation is that most people with anxiety do not have their diagnosis. Only about a quarter (27.6%) of people who meet DSM-V, criteria for anxiety disorder receive treatment. The aim of the study was to optimize the treatment of anxiety disorders using the drug Mexidol®, taking into account modern data of epidemiology and neurobiology. Material and methods. This review is based on relevant publications obtained through selective searches in PubMed from 2010 to 2020 (58 references). The search was conducted for the following words: anxiety disorders, terminology, Mexidol®. The presence of at least one of these keywords served as a criterion for inclusion in this review. Results and discussion. Recently, there have been changes in the classification of anxiety disorders terminology. In ICD-10, disorders that were previously defined as neuroses are now located systemically in the headings F40 - F42: panic disorder, agoraphobia, social phobia; specific isolated phobias; general anxiety disorder, obsessive thoughts, compulsive actions and others. Estimates are widely spread across countries, with the highest prevalence in low-income countries (5.0%), lower in middle-income countries (2.8%), and lowest in high-income countries (1.6%). Mixed anxiety-depressive disorders are also one of the manifestations of chronic cerebral ischemia (CCI). In order to optimize treatment and to consider development of psychosomatic pathology in patients with anxiety disorders, Mexidol® is widely used. It has a vegetotropic, anti-stress, anxiolytic and other effects. Mexidol® creates a mechanism for biological desensitization of recurring neurotic, anxious experiences, stabilizes the parameters of the neuropsychiatric status. Conclusions. Our clinical and research experience shows that the management of patients with anxiety disorders can be optimized with the use of Mexidol®. Against the background of sequential drug therapy in most studies, a regression of affective disorders was noted (a decrease in the severity of anxiety, depressive manifestations, and asthenic syndrome). Keywords: anxiety disorders, terminology features, Mexidol®.

Community Workforce Differences in Mental Health Across Gender and Job Description in Southwest Indiana

Background and Hypothesis: In May 2020, a community partnership was built in Southwest Indiana to determine the local prevalence of COVID-19 to guide reopening in the region. One year later, a follow-up survey study was launched to address new, pressing questions related to mental health in the community workforce. We hypothesized that adverse mental health symptoms would be disproportionately experienced by specific worker groups based on degree of in-person contact over the past year and demographic characteristics such as age and gender. Methods: For the 2021 survey, participants were invited through their place of employment or via phone to participate in a short online survey consisting of questions related to demographics, general work roles, company policies over the past year, and wellness. When examining mental health, the Patient Health Questionnaire-2 (PHQ-2) and General Anxiety Disorder-2 (GAD-2) were used to determine feelings of depression and anxiety, respectively. Results: 480 participants filled out the 2021 online survey (73% of which were returning). 442 of these responses were complete and eligible for analysis of mental health and degree of in-person contact. 345 responses were complete and eligible for information regarding age. No correlation was found between age and mental health. However, differences were observed based on gender and job description. Women (n=244) and customer-facing employees (n=99) reported more frequent symptoms of anxiety and depression, with customer-facing women reporting the most. Comparing only employees that did not work remotely during the pandemic, customer-facing employees still reported more frequent symptoms of anxiety and depression. Conclusion and Potential Impact: The impacts of COVID-19 on the workforce are still being studied, but the pandemic continues to take its toll. These mental health trends will help guide future policies to support and improve employee wellbeing, both within participating companies and the workforce at large.