Nurses’ Attitudes Towards Death and Its Relationship With Anxiety Levels

This study examined nurses’ attitudes towards death, anxiety levels, and socio-demographic characteristics affecting their attitudes towards death. Three hundred and eighty-four nurses participated in the study. A questionnaire form, the Death Attitude Profile-Revised (DAP-R), and the Penn State Worry Questionnaire were applied to the nurses. Nurses’ attitudes towards death were positive and their level of fear of death was low. Approach acceptance was high in younger ones; the escape acceptance score was higher in single ones. The neutral acceptance score was higher in those who received training on death. A statistically significant positive correlation was found between nurses' anxiety level and escape acceptance score. There was a statistically significant positive correlation between the length of working years of nurses and the escape acceptance and approach acceptance. Nurses should be prepared for and supported on death with in-service training. It will be useful to provide these training programs to nursing students during their education process.

Care Recipient Diagnosis Moderates the Relationship Between Caregiver Worry and Vigilance

Family members of persons diagnosed with dementia or a traumatic brain injury (TBI) are often relied upon to provide daily support to their care recipients. However, research on the differing experiences of caregivers based on care recipient diagnosis is limited. The aim of this study was to examine the impact of worry and feelings of vigilance among caregivers of people with cognitive impairment due to either TBI or dementia. This sample included 61 caregivers (88.5% female, mean age 57.3±15.5) of persons with either a TBI (n = 32) or dementia (n = 29). Worry was assessed with the Penn State Worry Questionnaire and Vigilance was assessed with the Caregiver Vigilance Scale. Linear regressions revealed that after controlling for age, care recipient diagnosis moderated the relationship between worry and caregiver vigilance. Specifically, worry was significantly associated with caregiver vigilance in those caring for someone with dementia; however, a similar relationship was not seen in those caring for someone with a TBI. This suggests caregivers of people with TBIs have a different experience of worry and vigilance than caregivers of people with dementia. These findings demonstrate the need for more research on the unique needs of caregivers of people with TBIs. Additionally, this research suggests interventions targeting worry may be particularly effective in supporting caregivers of people with TBIs.

Psychometric Properties of the Persian Version of General Emotion Questionnaire-Contrast Avoidance Model

Background: According to Contrast Avoidance Model, those suffering from generalized anxiety disorder (GAD) are afraid of severe emotional changes such as the transition from a good or neutral position to sudden unhappiness following a negative event. Also, the model shows that persistent worrying can be used to maintain negative emotions as a means of preventing a sudden change to negative in people with GAD. Objectives: This study aimed to evaluate the psychometric properties of the Persian version of the General Emotion Questionnaire-Contrast Avoidance Model (GEQ-CAM). Methods: Early, the GEQ was translated into Persian according to the translation instructions and using multistage cluster sampling. Initially, five universities located in Tehran were randomly selected, then from each of them, three different colleges were selected for the academic year of 2020. Afterward, 50 cases with GAD were selected using the convenience sampling method, yielding a total sample size of 576 (526 students and 50 cases with GAD). Results: General Emotion Questionnaire has an excellent level of internal consistency (α = 0.973) and test-retest reliability (0.986). This questionnaire indicated a positive and significant correlation with Penn State Worry Questionnaire (r = 0.804) and GAD-7 (r = 0.727), which indicates its appropriate convergent validity. Also, confirmatory factor analysis supported its 2-factor structure. Conclusions: In accordance with previous studies, the findings suggested that psychometric properties of the Persian version of the General Emotion Questionnaire-Contrast Avoidance Model are acceptable; hence, this questionnaire can be used for research, diagnostic, and therapeutic purposes.

What’s Worrying Our Students? Increasing Worry Levels over Two Decades and a New Measure of Student Worry Frequency and Domains

Background The frequency and severity of mental health problems in student populations have been a growing cause for concern worldwide, and studies have identified measures of a number of mental health symptoms that have been steadily increasing in frequency and intensity over the past 20–25 years. Methods In two studies we investigate the levels and domains of pathological worrying in university student participants. Study 1 is a retrospective study of Penn State Worry Questionnaire (PSWQ) data collected between 2001 and 2019. Study 2 describes the development of the Student Worry Questionnaire, a short and easily delivered measure of student worrying that identifies both frequency of worry as well as the student-relevant domains across which worrying occurs. Results Study 1 revealed a steady increase in student worry scores of around 20% between 2001 and 2019, with a significant positive correlation between year of data collection and mean PSWQ score. The domain scores in Study 2 indicated that academic work was a significantly higher worry than any of the other domains, and worries about intimate relationships and ‘what people think of me’ were also worries that scored higher than either financial or health worries. Conclusions The present studies indicate that pathological worrying can be added to the list of anxiety- and stress-related symptoms that have been shown to be on the increase in student populations in recent decades, and we discuss whether these increases represent a greater willingness to report symptoms or a genuine increase in experienced symptoms over time.

The Impacts of Propensity to Worry and Fear of COVID-19 on Mental Health of University Students

Epidemics and pandemics are difficult periods for the affected community, specifically in the proliferation of mental health issues. In such adverse times, factors of psychological vulnerability such as propensity to worry and low emotional stability might have a detrimental effect on the mental health of the individuals. To investigate the impact of such factors on mental health, this study examined the impacts of propensity to worry and fear of COVID-19 on anxiety depending on the individuals’ levels of emotional stability. As a means of such investigation, this study was conducted based on quantitative data, and the research sample was selected using a convenient sampling method. Participants included 304 university students (71.6% were women and 28.4% were men; MAge = 22.37 ± 3.04) and responded to the Penn State Worry Questionnaire, Fear of COVID-19 Scale, Symptom Checklist-90 Revised, and 10-Item Personality Inventory. The moderated mediation analysis using PROCESS macro (Model 14) was performed to examine the study hypotheses. Results revealed that propensity to worry was associated with anxiety symptoms. Fear of COVID-19 mediated this link and emotional stability moderated the relationship between propensity to worry and anxiety. The findings showed that trait worry, trait emotional stability, and fear of COVID-19 are determinants of anxiety symptoms, suggesting that such factors are important in understanding these issues.

Depression and Intolerance of Uncertainty: Association with Decisional Conflict in Otolaryngology Patients

Objective: To determine if anxiety, stress, depression, worry, and intolerance of uncertainty were related to pre-operative decisional conflict (DC), shared decision making (SDM), or demographic variables in adult otolaryngology surgical patients. Methods: Consecutive adult patients meeting criteria for otolaryngological surgery were recruited and completed DC and SDM scales, Penn State Worry Questionnaire (PSWQ), Intolerance of Uncertainty Scale (IUS-12), and Depression, Anxiety and Stress Scale-21 (DASS-21). Results: The cohort included 118 patients, 61 (51.7%) males and 57 (48.3%) females. Surgery was planned for a benign process in 90 (76.3%) and 46 (39.3%) had previous otolaryngologic surgery. SDM and DC scores did not significantly differ across gender, age, education level, previous otolaryngologic surgery or whether or not surgery was for malignancy. Patients with no malignancy had significantly higher DASS-21 Stress scores (mean 12.94 vs 8.15, P < .05) and total IUS-12 scores (mean 28.63 vs 25.56, P = .004). Women had lower PSWQ scores (41.56 vs 50.87 for men, P = .006). IUS-12 and PSWQ declined with age. DC scores correlated positively with DASS-21 Depression ( r = .256, P = .008) and IUS-12 scores ( r = .214, P = .024). SDM correlated negatively with DASS-21 Depression ( r = −.208, P = .030). Linear regression model for DC scores revealed a significant relationship with DASS depression ( B = 0.674, P = .048). Conclusion: Preoperative decisional conflict is associated with increased depression and intolerance of uncertainty in adults undergoing otolaryngologic surgery. Screening for and management of depression, anxiety, and related concerns may improve surgical outcomes in this group.

Effect of a Music Therapy Intervention Using Gerdner and Colleagues’ Protocol for Caregivers and Elderly Patients with Dementia: A Single-Blind Randomized Controlled Study

Music therapy (MT) is considered one of the complementary strategies to pharmacological treatment for behavioral and psychological symptoms (BPSD) of dementia. However, studies adopting MT protocols tailored for institutionalized people with dementia are limited and their usefulness for supporting caregivers is under investigated to date. Our study aimed at evaluating the effects of an MT intervention according to Gerdner and colleagues’ protocol in a sample of 60 elderly people with moderate-to-severe dementia of the Auxologico Institute (Milan, Italy) and associated caregivers, randomly assigned to an Experimental Group (EG) (n = 30) undergoing 30 min of MT two times a week for 8 weeks and to a Control Group (n = 30) (CG) receiving standard care. Before and after the intervention, residents-associated caregivers were administered the Caregiver Burden Inventory (CBI) and the Neuropsychiatric Inventory (NPI). Depression and worry were also assessed in caregivers prior to the intervention, by the Beck Depression Inventory-II and the Penn State Worry Questionnaire, respectively. A mixed model ANCOVA revealed a Time*Group effect (p = 0.006) with regard to CBI decreasing after the intervention for the EG and Time*Group effects (p = 0.001) with regard to NPI_frequencyXseverity and NPI_distress, with a greater effect for the EG than the CG. Implications for MT protocols implementations are discussed.

Efficacy of Virtual Reality Based Worry Exposure Therapy on the Anxiety Severity and Worry in Generalized Anxiety Disorder

Background: Generalized anxiety disorder is one of the most common anxiety disorders observed in clinical centers and the general population. This study aimed to evaluate the efficacy of virtual reality-based worry exposure therapy on the Anxiety Severity and worry in patients with symptoms of generalized anxiety disorder. Materials and Methods: This study was conducted in the framework of a single-subject experimental design using Multiple baselines with a 6-week follow-up. Three women with GAD were selected through a structured clinical interview based on the criteria of Diagnostic and Statistical Manual of Mental Disorders 5 by Convenience Sampling among those who referred to the Counseling centers in Tabriz. The protocol of this study followed the manual by Becker and Margraf which describes imaginal exposure for GAD applied in 15 sessions. The only difference was that in this research exposure to virtual reality replaced with imagination. In this study, three 360-degree films were made by the researcher used for exposure. The content made in the form of 360-degree videos and displayed to patients through virtual reality tools. The scales to assess changes in Anxiety Severity and worry include The Penn State Worry Questionnaire and The Overall Anxiety Severity and Impairment Scale. Data analyzed with visuals inspection, improvement percentage, and reliable change index strategies. Results: Results showed that virtual reality-based worry exposure therapy has significant efficiency on the reduction of Anxiety Severity and worry clinically and statistically (p<0.05). Conclusion: Virtual reality-based worry exposure therapy has appropriate efficacy in reducing GAD symptom severity.

Evidence-based assessment of treatment outcomes for late-life generalized anxiety disorder using the Penn State Worry Questionnaire (PSWQ) and Penn State Worry Questionnaire – Abbreviated (PSWQ-A)

ABSTRACT Objective: The Penn State Worry Questionnaire (PSWQ) is a commonly used measure of treatment outcome for late-life generalized anxiety disorder (GAD). However, there is considerable variability in the definitions used to define treatment response and remission. This study aimed to provide empirically derived guidelines for assessing treatment response and remission among older adults with GAD using the PSWQ and the abbreviated PSWQ (PSWQ-A). Design: Longitudinal assessment of GAD symptoms pre- and posttreatment. Participants: Participants were 259 older adults aged 60–86 years with a diagnosis of GAD who were assessed before and after treatment. Intervention: Participants were randomly assigned to cognitive behavioral therapy or control (waitlist, discussion group, or supportive therapy) conditions. Measurements: Signal-detection analyses using receiver operating characteristic (ROC) methods were used to determine optimal agreement between structured diagnostic interviews and scores on the PSWQ and PSWQ-A. Results: Results suggest that a score of ≤51 was optimal for defining diagnostic remission status on the PSWQ, and a score of ≤24 was optimal on the PSWQ-A. A 9% reduction or ≥4-point reduction was optimal for assessing treatment response on the PSWQ. The PSWQ-A was poor at identifying treatment response status. Conclusions: Findings suggest that most of the previously used definitions have underestimated the treatment effects for late-life GAD. However overall, the PSWQ and PSWQ-A are suboptimal for assessing treatment outcome for late-life GAD. The standardization of response and remission criteria has implications for comparison between treatment trials, and for the benchmarking of outcomes in clinical practice.