Search Results (879)

Patients undergoing hemodialysis often experience reduced quality of life, with psychological symptoms and nutritional risk representing important determinants of patient functioning. This study aimed to examine the relationships between depression, anxiety, stress, nutritional risk, mental health, and physical functioning in patients undergoing hemodialysis, with particular emphasis on the mediating role of mental health. A cross-sectional study was conducted among 199 patients receiving hemodialysis in five Croatian hospitals. Depression, anxiety, and stress were assessed using the DASS-42, quality of life using the SF-36, and nutritional risk using the NRS-2002. Associations between variables were examined using Spearman’s correlation coefficient, while structural equation modeling was used to analyze direct and indirect relationships among psychological symptoms, nutritional risk, mental health, and physical functioning. Depression and stress showed significant negative effects on mental health, while mental health showed a significant positive effect on physical functioning. Nutritional risk had a significant direct negative effect on physical functioning. Mental health significantly mediated the relationship between depression and stress and physical functioning. These findings indicate that psychological symptoms and nutritional risk are important determinants of functioning and quality of life in hemodialysis patients and support the need for an integrated care approach that includes regular psychological and nutritional screening. Full article

Background/Objectives: The COVID-19 pandemic posed significant challenges to quality of life, particularly for individuals living with chronic physical and/or mental conditions. Psychological factors such as fear of COVID-19, psychological distress, and resilience may be associated with quality-of-life outcomes during prolonged public health crises. This study aimed to examine quality of life and its psychological correlates among individuals with chronic conditions during the later phases and aftermath of the COVID-19 pandemic crisis. Methods: A cross-sectional study was conducted among 293 adults with chronic physical and/or mental conditions attending the General Hospital of Argolida, Greece. Participants completed validated self-report measures assessing quality of life (MVQOLI), fear of COVID-19 (FCV-19S), depression, anxiety, and stress (DASS-21), and psychological resilience (CD-RISC-25). Descriptive statistics, Spearman correlation analyses, and multivariable regression models were used to examine associations and identify factors associated with quality-of-life domains. Results: Higher levels of fear of COVID-19 and depressive symptoms were significantly associated with poorer quality of life across multiple domains. Depressive symptoms showed consistent negative associations with functional, interpersonal, transcendent, and overall quality-of-life scores. In contrast, psychological resilience was positively associated with interpersonal, transcendent, and overall quality of life. Regression analyses showed that depressive symptoms were negatively associated with overall quality of life, while resilience was independently associated with better quality-of-life outcomes. Conclusions: Psychological distress, particularly depressive symptoms and fear related to COVID-19, was associated with lower quality of life among individuals with chronic conditions during the later phases and aftermath of the COVID-19 crisis. Psychological resilience was positively associated with better quality-of-life outcomes, underscoring its relevance for supporting well-being during and after public health crises. Full article

This study investigated neural oscillatory dynamics underlying visual word recognition in university students with dyslexia using a portable brain–computer interface (BCI) EEG system. The sample included university students with dyslexia (N = 12) and matched controls (N = 14) who completed auditory discrimination and visual word recognition tasks, with and without musical accompaniment. Through these experimental conditions, the researchers assessed (a) the cortical activation across frequency bands, (b) the modulatory effect of background music, and (c) the relationship between emotional states and brain activity. Results revealed significant group differences in oscillatory patterns, with reduced β- and γ-band activity in the left occipito-temporal cortex among participants with dyslexia, confirming disrupted temporal coordination in posterior reading networks. Compensatory right-hemisphere activation was observed, particularly under musical conditions, accompanied by increased α-band power and reduced δ activity, indicating enhanced attentional engagement and reduced cognitive fatigue. Emotional assessment using the DASS-21 revealed higher stress and anxiety scores in the dyslexic group, suggesting that affective factors may modulate oscillatory dynamics. The presence of background music appeared to attenuate these effects, supporting improved emotional regulation and cognitive focus. These findings demonstrate that dyslexia reflects a distributed disruption in neural synchrony and cross-frequency coupling, influenced by both cognitive and affective mechanisms. The integration of portable EEG technology with rhythmic auditory stimulation offers new insights into the neurophysiological and emotional aspects of dyslexia, highlighting the potential of rhythm- and music-based approaches for both diagnostic and therapeutic applications. Full article

Introduction: The aim of this study was to examine the prevalence of scores indicating depression, anxiety and stress (<95th percentile of the score on each of the domains) among students at the University of Pristina-Kosovska Mitrovica and social and lifestyle characteristics associated with scores indicative of depression, anxiety and stress in this population studying in a post-conflict area. Methods: The cross-sectional study applying the non-probabilistic convenience sampling that included a total of 656 students of nine faculties who were present in the classes during the day of this study at the University of Pristina-Kosovska Mitrovica was conducted during the 2024/2025 school year. Results: A total of 9.3% had a score on the DASS-D scale, indicating severe or extremely severe depression, 19.6% had a score indicating severe or extremely severe anxiety, and 13.9% had a score indicative of severe or extremely severe stress. Our study showed the association of scores indicating depression with living in rural areas, average self-rated health, use of anti-anxiety medications, and mobile phone addiction. Our study showed the association of scores indicating anxiety and average self-rated health, use of anti-anxiety medications, score on social support scale, and score on state impulsivity scale. Our study showed the association of scores indicating stress with female sex, age in years, poor self-rated financial status, average self-rated health, use of anti-anxiety medications, and score on the state impulsivity scale. Conclusions: This study has shown a significant burden of psychological distress among students at the University of Pristina-Kosovska Mitrovica. Full article

Background/Objectives: Social development in children is a significant aspect that supports appropriate behavior in the community, and parents, as the main caregivers, play a central role in developing social skills in children. However, caregivers experiencing mental health problems—such as depression, anxiety, and stress—may find it challenging to provide a nurturing rearing environment. This one-year follow-up study examined whether the baseline mental health of caregivers was associated with social skills in children 1 year later in an urban Indonesian context. Methods: A one-year follow-up study was conducted in an urban area of Indonesia in 2023–2024, inviting all nine kindergartens in the area to participate. Caregivers completed the demographic questionnaire and the Depression, Anxiety, Stress Scale (DASS-21), while teachers assessed social skills in children using the Social Skills Scale (SSS). Linear mixed-effects models with random intercepts for kindergarten were estimated to account for clustering. Results: Finally, a total of 270 parent–child dyads were included. After adjusting for baseline social skills and covariates, higher levels of baseline caregiver depression (B = −0.15, p < 0.001), anxiety (B = −0.22, p < 0.001), and stress (B = −0.27, p < 0.001) were associated with lower social skills in children in the follow-up. Conclusions: Even subclinical variations in caregiver mental health problems may be meaningfully associated with social development in children over time. The findings highlight mental health in caregivers as a potentially important factor associated with early social development in an urban setting of Indonesia. Full article

Background and Objectives: Chronic kidney disease (CKD) is an increasingly important global health challenge and is frequently accompanied by psychiatric symptoms, including anxiety. A multidimensional assessment of anxiety in hemodialysis (HD) using the Endler Multidimensional Anxiety Scales (EMAS) has not, to our knowledge, been previously reported. We aim to evaluate the reliability, convergent validity, and exploratory domain-level structure of EMAS in HD patients treated at a dialysis center in Craiova, Romania. Materials and Methods: A total of 103 HD patients underwent clinical and sociodemographic/socioeconomic profiling, cognitive screening using the Mini-Mental State Examination (MMSE), and EMAS administration at two time points (4-week interval) for test–retest evaluation. The anxiety subscale of the Depression, Anxiety, and Stress Scale-21R (DASS-21R) was administered to assess convergent validity. Internal consistency (Cronbach’s α), temporal stability (test–retest correlations and intraclass correlation coefficients), and convergent validity (Pearson correlations) were computed. Exploratory factor analyses were conducted on EMAS domain scores (state, trait, and perceived anxiety domains) as an exploratory structural check. Results: EMAS state and trait anxiety scores were higher in women than in men, while perceived anxiety showed a more heterogeneous pattern across dimensions. Total state anxiety increased with age, particularly after 50 years. Domain-level internal consistency was good for state and acceptable for trait components (standardized α ≈ 0.84 and 0.78 across administrations), whereas perceived anxiety domains showed low cross-domain coherence, consistent with context-specific appraisal. The DASS-21R anxiety subscale showed good internal consistency (α = 0.863). Convergent validity analyses indicated small, domain-specific associations between EMAS scores and DASS-21R anxiety. Domain-level EFA supported a theoretically coherent pattern in which state and trait domains clustered distinctly, while perceived anxiety domains formed a partially separable factor; this pattern was broadly consistent across both administrations. Conclusions: In this HD cohort, EMAS demonstrated good reliability and limited but domain-specific evidence of convergent validity, and exploratory domain-level analyses supported its multidimensional organization. Further studies with larger samples are warranted for item-level structural testing and to inform feasibility-oriented shortening for potential clinical use. Full article

Background and Objectives: The relationship between mental health and sports injuries has become increasingly important in youth soccer, due to developmental changes in this population, the high demands of training, and the competitive pressures of sport. This cross-sectional study examined the association between injury history (no injuries, 1–2, >2 injuries), mental health indicators (anxiety, stress, depression), and differences by sex, competitive category, and playing position. Materials and Methods: 146 soccer players (79 males, 67 females; ages 12–30; mean age = 16.65, SD = 2.34 years) from youth and senior categories of a professional club in Spain completed the STAI-T (trait anxiety), DASS-21 (state anxiety, stress, depression), sociodemographic and sports-related variables (gender, sports category, playing position), and self-reported injury history: no injuries (n = 39), 1–2 injuries (n = 80), >2 injuries (n = 27). The statistical analyses performed were one-way ANOVA (ηp²), χ² tests, and Games-Howell post hoc tests. Results: 73.3% of the players reported ≥1 injury (54.8% 1–2 injuries; 18.5% >2), with no differences by gender, position, or category (χ² range: p > 0.05). The ANOVA revealed significant differences for trait anxiety (F(2, 143) = 3.68, p = 0.029, ηp² = 0.049; small-to-moderate), and state anxiety (F(2, 143) = 4.63, p = 0.014, ηp² = 0.061; moderate). No effects were found for stress/depression (p > 0.12). The post hoc test (Games-Howell) indicates that the group with no injuries showed significantly lower trait anxiety (p = 0.038, d = 0.33) vs. 1–2 injuries, and state anxiety (p = 0.012, d = 0.70) vs. >2 injuries. Stress and depression showed a non-significant upward trend. Conclusions: A greater history of injuries is associated with higher levels of anxiety in youth soccer players. The findings suggest routine assessment of anxiety and training in emotional self-regulation for injury prevention and rehabilitation. Longitudinal studies are needed to clarify the bidirectional relationship. Full article

Objectives: This study aims to examine Internet addiction profiles, their associations with comorbid anxiety and depression, and characterize network architectures of anxiety and depression across profiles. Methods: From November 2022 to November 2023, we conducted a short-term cohort study including 2503 students. Latent profile analysis (LPA) and multinomial logistic regression analysis were employed to investigate the association between Internet addiction and comorbidity of anxiety and depression, and network analysis was used to characterize anxiety–depression network structure within each profile. Results: LPA identified three profiles of Internet addiction, which were labeled: “regular” (66.60%) profile, “risk” profile (23.09%), and “addiction” profile (10.31%). The incidence of comorbid anxiety and depression was 10.67%. Both the “risk” (adjusted OR = 1.76, 95% CI: 1.27–2.44) and “addiction” (adjusted OR = 2.12, 95% CI: 1.39–3.24) profiles were significantly associated with increased comorbidity risk. The “dass13” (“Downhearted and blue”) emerged as a core symptom, and “dass15” (“Close to panic”) was identified as a key bridge symptom across three network models. The edge weight for the dass05–dass21 (Lack of motivation–Meaninglessness of life) was higher in the “risk” profile than in the “addiction” profile. Conclusions: Children and adolescents in the “risk” and “addiction” profiles were significantly more likely to experience comorbid anxiety and depression. “dass13” (“Downhearted and blue”) and “dass15” (“Close to panic”) can be used as the key target during intervention. Targeted interventions can be implemented for children and adolescents in the “risk” and “addiction” profiles. Full article

Background: Psychological distress is a common comorbidity in chronic obstructive pulmonary disease (COPD), yet its relationship with disease severity remains incompletely understood. This study aimed to assess depression, anxiety, and stress using the Depression Anxiety Stress Scales–21 (DASS-21) and to examine their distribution across COPD severity stages. Methods: This multicenter, cross-sectional observational study included 285 clinically stable COPD patients enrolled between 2023 and 2025. COPD severity was classified according to Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria. Multinomial and binary logistic regression models were constructed to identify independent predictors of COPD severity and clinically significant psychological distress, adjusting for demographic and clinical covariates. Bayesian independent sample analyses and ANOVA effect size estimates were additionally performed. Results: Smoking exposure was independently associated with advanced COPD stages (GOLD 4 vs. GOLD 1–3: aOR 1.05, p < 0.001), as was dyspnea severity (mMRC: aOR 14.66, p < 0.001). In multivariable models examining psychological outcomes, COPD severity was not independently associated with clinically significant depression (p = 0.899), anxiety (p = 0.460), or stress (p = 0.843). In contrast, symptom burden measured using the COPD Assessment Test (CAT) score was consistently associated with depression (aOR 1.133, p < 0.001), anxiety (aOR 1.179, p < 0.001), and stress (aOR 1.144, p < 0.001). ANOVA effect sizes across GOLD stages were small (η² ≤ 0.047), and Bayesian analyses provided moderate to strong evidence supporting minimal differences in DASS-21-R scores between severity groups. Conclusions: Psychological distress is prevalent across all COPD severity stages and is not independently determined by airflow limitation. Symptom burden rather than spirometric severity appears to be more closely associated with emotional outcomes. Full article

Depression and obesity are a public health crisis in the United States. A plethora of research has established an association between obesity and depression. Research on the relationship between normal weight, non-normal weight (underweight, overweight, and obesity), academic level, and depression among college students is limited. This study aims fills an important gap in the literature by analyzing the association between Body Mass Index (BMI) and depression by academic level. In addition, the interaction between BMI and depression by academic level was also evaluated. Data for this cross-sectional study were collected using a subscale (depression) of the Depression, Anxiety and Stress Scale (DASS-21) from 987 undergraduate and graduate students from two colleges in the Bronx, NY. BMI was calculated using participant’s self-reported height and weight. Data were analyzed using chi-square and logistic regression analyses. Results indicate that students in the normal weight category were less likely to be depressed compared to underweight, overweight, and obese students (Model 1: Adjusted Exp(B) = 0.641, C.I. = 0.416–0.989, and p = 0.044). Those who were in the freshman year were twice as likely to be depressed compared to graduate students (Model 1: Adjusted Exp(B) = 2.236, C.I. = 1.158–4.318, and p = 0.017). A significant interaction between BMI and academic level was found (Model 2: Adjusted Ex(B) = 5.404, C.I. = 1.114–26.221, and p = 0.036). This implies that the association between BMI and depression varies by academic level (sophomore). In conclusion institutions should develop programs that address risk factors for underweight, overweight, obesity, and depression simultaneously, with the goal of improving overall well-being and academic outcomes, especially among lower level (freshmen and sophomore) students. Full article

Background/Objectives: Endoscopic Ultrasound with Fine Needle Biopsy (EUS-FNB) of pancreatic lesions often induces patient anxiety. Graphic medicine, an emerging health communication tool, could potentially mitigate this. This pilot study aimed to explore the feasibility of a graphic novel in reducing anxiety in adult patients awaiting EUS-FNB. Methods: This prospective, single-center, randomized pilot study was conducted from June 2024 to March 2025 in patients aged 18–89 years. The intervention group received a comic panel detailing the EUS-FNB routine, while controls had standard care. Anxiety was measured using the Beck Anxiety Inventory (BAI) and modified DASS-21 (mASS-14). Results: Overall, 65 patients (33 “Graphic Novel”, 32 “Control”) were included. Mean BAI was 4.88 (graphic novel) vs. 7.25 (controls, p = 0.092), and mASS-14 was 4.97 vs. 6.22 (p = 0.261). Anxiety prevalence was low (4.6% BAI, 13.8% mASS-14). Controls were more symptomatic (69.2%) and had a higher rate of pancreatic cancer (n = 20) compared to the graphic novel group (n = 6). Subgroup analyses showed that BAI was slightly lower for patients with children and no prior surgical experience when using graphic novels. Trends for lower anxiety appeared in those on chronic medication, under surveillance, or with solid/suspected metastatic lesions. Conclusions: This pilot study suggests that a graphic novel may help to reduce anxiety and stress scores in patients undergoing diagnostic procedures for pancreatic lesions. However, it needs confirmation in larger, adequately powered trials. Full article

Background: Attention-Deficit/Hyperactivity Disorder (ADHD) has been less frequently and extensively investigated in university students than in children, despite substantial evidence demonstrating its significant impact on academic performance and negative affect, such as anxiety. We conducted two studies to address this gap. Methods: The objective of our first study (n = 233) was to assess the prevalence of subclinical ADHD among medical students and examine its associations with comorbid mental health conditions, such as Depression, Anxiety and Stress (DASS-21). In the second pilot intervention study (n = 16), we compared the ratio of negative and positive emotions (PANAS) and anxiety (STAI-S-5) before and after neurofeedback-based relaxation training in two groups of students: one with high scores and another with low scores on the Adult ADHD Self-Report Scale (ASRS). Results: According to our results, more than 50% of students showed risk for ADHD symptoms, and linear regression analyses revealed a strong association between ADHD symptoms and the prevalence of negative affect. Interestingly, no significant differences were found in ADHD and DASS scale scores between students who were falling behind and those progressing in line with the curriculum. Further results of the second study were inconclusive in several areas. In the examined group, a significant increase was observed in one of the core symptoms of ADHD—mind wandering—by the end of the intervention, compared to the baseline. Additionally, frustration levels were significantly higher at the second measurement point among participants with higher ASRS scores. Conclusions: Compared to the literature, it can be concluded that while longer interventions tend to be effective, two sessions are insufficient to reduce symptom. Full article

Background/Objectives: Mood disorders like depression, anxiety, and stress have increased steadily among adults, with growing interest in non-pharmaceutical treatments to improve symptomology. Epigallocatechin-3-gallate (EGCG) and curcumin are polyphenols with evidence to support their positive impacts on mood disorder symptomology and potential mood-associated biomarkers like brain-derived neurotrophic factor (BDNF). This study examined the effects of combined EGCG and curcumin supplementation on mood disturbance symptomology and serum brain-derived neurotrophic factor in adults. Methods: An 8-week randomized double-blinded placebo-controlled trial was conducted in adults (n = 64, 18–50 years old). Participants were randomized to a supplement group (n = 32; 350 mg EGCG and 1330 mg curcumin daily) or a matched placebo group (n = 32). Mood disturbance (DASS-21, GAD-7), sleep disturbance (GSAQ), and physical activity (IPAQ) were assessed at baseline, Week 4, and Week 8. Anthropometric measures, 24 h diet recalls, and fasted blood samples for serum BDNF were collected at baseline and Week 8. A multivariate ANOVA evaluated primary outcomes (DASS-21 composite score and BDNF), followed by repeated measures ANOVA for secondary outcomes (p < 0.05). Results: Significant improvements were observed across all participants for mood (DASS-21 composite and subscales, GAD-7, p < 0.001 for all), sleep (p < 0.001), and physical activity (p < 0.01), with no significant difference between supplement and placebo groups. Mean serum BDNF increased in both groups, but neither were statistically significant with no group-by-time interactions. Sugar intake (g/kg body weight) was positively correlated with mood symptoms at Week 8 in the supplement group. Baseline fruit and vegetable intake was associated with mood symptom severity at select time points; however, dietary changes during the intervention were not significantly related to changes in mood outcomes. Conclusions: Combined EGCG and curcumin supplementation did not show additional benefits beyond placebo for mood disturbance or serum BDNF over eight weeks. Observed improvements across both groups suggest that behavioral or lifestyle factors may play a larger role in short-term mood improvements than supplementation alone. Full article

Background/Objectives: Inflammatory bowel disease (IBD), mainly encompassing Crohn’s disease (CD) and ulcerative colitis (UC), is strongly linked to psychological comorbidities such as depression, anxiety, and stress. These mental health factors negatively impact disease progression, healthcare utilization, and quality of life (QoL). Methods: Participants completed the Depression–Anxiety–Stress Scale 21 (DASS-21) and EuroQol (EQ-5D-5L) questionnaires. Statistical analyses included multivariate linear regressions to identify predictors of psychological distress. Results: We conducted a cross-sectional case–control study involving 355 participants: 55 with CD, 90 with UC, and 210 healthy controls. Patients with IBD reported significantly higher levels of stress (p < 0.01), anxiety (p = 0.016), and depression (p < 0.01) compared to controls. Severe or very severe symptoms were more prevalent in those with CD and UC. The relative risk for stress was high (RR = 2.1), and the risk for depression was significantly elevated (RR = 1.54) in the IBD population. Quality-of-life analysis revealed lower EQ visual analog scale scores and increased difficulties across all domains, particularly in emotional well-being and pain. Multivariate analysis showed UC diagnosis, female sex, and corticosteroid use as predictors of higher stress and depression scores, while self-reported rest was consistently protective. Conclusions: This study confirms the psychological burden of IBD and underscores the importance of regular screening for stress, anxiety, and depression in clinical care. Self-reported rest emerged as a key protective factor, suggesting potential benefits from interventions targeting sleep quality and emotional support. Future research should explore longitudinal outcomes and personalized psychological interventions in IBD populations. Full article

This study investigated an integrative mediation model examining whether anxiety and depression mediate the relationship between the Big Five personality traits and the severity of alcohol and nicotine dependence among psychiatric patients with neurotic disorders (ICD-10 codes F40–F48). A cross-sectional design was conducted on a clinical sample of 232 patients (57.3 female; mean age = 48.58, SD = 10.77) using standardized instruments: Big Five Inventory (BFI-44), Fagerström Test for Nicotine Dependence (FTND), Michigan Alcoholism Screening Test (MAST), and Depression, Anxiety, and Stress Scale (DASS-21). Data were analyzed using MLR mediation modeling. The model explained 32.6 of the variance in nicotine dependence and 27.1 in alcohol dependence. Results revealed a pattern of complete mediation: neuroticism had no direct effect on addiction but influenced alcohol dependence exclusively through anxiety (p = 0.001) and nicotine dependence through depressive symptoms (p = 0.012). Extraversion and agreeableness showed a dual role, exerting significant direct positive paths toward addiction severity (p = 0.005) while simultaneously reducing it through negative indirect effects on affective distress. Overall, neuroticism was confirmed as a universal risk factor for mental health issues. These findings suggest that personality-driven addiction in neurotic patients is operationalized through specific clinical symptoms, highlighting the necessity for therapeutic interventions focused on targeted affect regulation and social assertiveness to mitigate substance use in this population. Full article