Search Results (647)

Background: In this study, we investigated patients in the early stages of COPD to support the hypothesis that symptoms of anxiety and depression are related to mild and moderate COPD and not only to the chronic complications that accompany severe disease. Methods: A total of 250 mild to moderate COPD patients were randomly selected from a population of 5239 individuals who were part of a study on early COPD detection and smoking cessation that was carried out in Central Macedonia, Greece. An age-matched control group of three hundred current or former smokers was also included. A questionnaire was used for demographic data collection, along with the Hospital Anxiety and Depression Scale (HADS) questionnaire for the evaluation of anxiety (HADS-A) and depressive (HADS-D) symptoms. Results: The COPD and non-COPD groups were similar in age, gender, and socioeconomic background. The majority of COPD patients were classified as Grade 1 or 2 and belonged to Group A or B according to the GOLD classification. Among the COPD patients, 19.6% had a score greater than 7 in the HADS-A subscale, 14% in the HADS-D subscale, and 10.8% in both, compared with 6%, 5%, and 5%, respectively, for the non-COPD individuals (p < 0.01). A regression analysis showed that the presence of at least one comorbidity (β = 0.43, p < 0.001) and the presence of at least one respiratory symptom (β = 0.49, p < 0.001) significantly predicted the total HADS score in the COPD group. Conclusions: The prevalence of depression and anxiety symptoms in early COPD patients was greater in comparison to non-COPD smokers. Implementing routine screening for mood disorders using the HADS in mild to moderate COPD outpatients may improve overall disease management and patients’ quality of life. Full article

Background: The COVID-19 pandemic caused lasting disruption to healthcare systems and the mental health of frontline workers. Though the acute crisis has passed, many healthcare workers (HCWs) continue to experience long-term psychological effects, including anxiety, grief, and burnout. This mixed-methods study investigates the enduring effects of the COVID-19 pandemic on the mental health of physicians in a low-resource country. Methods: Drawing on data from the ear, nose, and throat (ENT) or otolaryngology department at a tertiary care hospital in Pakistan, the study employed an explanatory mixed-methods design, combining structured surveys and semi-structured interviews. The Hospital Anxiety and Depression Scale, the Perceived Stress Scale, and the Brief COPE Inventory were administered to 42 ENT specialists, trainees, and house officers, alongside semi-structured interviews with eight ENT physicians. Results: Survey results revealed moderate to high levels of anxiety, depression, and stress that persisted beyond the acute crisis phase of the pandemic. Interviews provided nuanced insights into the emotional burden experienced by physicians, including persistent concerns about contagion risk, professional isolation, and increased workload. Physicians described maladaptive responses and employed active coping strategies, such as seeking peer support and utilizing adaptive problem solving. Conclusions: The COVID-19 pandemic has had enduring effects on the mental well-being of physicians. Targeted interventions and policy reforms that address the ongoing pressures frontline physicians face in resource-constrained environments may help mitigate these burdens, support healthcare professionals more effectively, and improve their mental health. Full article

Background/Objectives: Patients with heart failure (HF) experience increased morbidity, limited daily activities, and diminished quality of life (QoL), thus relying on a family member, widely known as informal caregiver, for support. The objective of this study was to explore (a) QoL, anxiety, and depression; (b) factors associated with QoL; and (c) the impact of associated factors on QoL among HF caregivers. Materials and methods: Data collection was performed using the 36-Item Short Form Survey (SF-36), the Hospital Anxiety and Depression Scale (HADs), and the European Heart Failure Self-care Behavior Scale (EHFScBS). Also recorded were characteristics of caregivers and patients. Results: In the present study, 110 HF caregivers and the family members they provided care to were enrolled. The majority of caregivers were patients’ spouses (60%) and were female (71.8%). Within a QoL score range of 0–100, caregivers showed moderate to high levels in role-physical, role-emotional, emotional well-being, and pain (median: 75, 66.7, 64, and 67.5, respectively); moderate QoL levels in energy/fatigue, social functioning, and general health (median: 55, 56.3, and 62, respectively); and poor QoL levels in physical functioning (median: 18). Moreover, 64.5% of caregivers had anxiety and 41.8% had depression. Caregivers with HADs scores that indicate anxiety and depression had worse QoL (p = 0.001). No association was detected between caregivers’ QoL and patients’ HADs and self-care. Conclusions: QoL and anxiety/depression merit further research by clinicians, health systems, and policymakers so that evidence-based policies and interventional programs tailored to their needs can be implemented. Full article

Background: The COVID-19 pandemic has had a profound impact on nurses’ mental health and overall wellness, both during and after the crisis. Objectives: This study aims to explore overall wellness during and after the pandemic, and the long-term psychological effects of the relationship between psychological distress and the eight dimensions of well-being among nurses in the post-pandemic era. Methods: A cross-sectional research design was used to conduct the study among 288 nurses from two regional hospitals in Albania. Participants were recruited using purposive sampling, selecting nurses based on availability and relevance to the study criteria. Data were collected through self-administered questionnaires using the DASS-21 scale and the Personal Assessment of the Eight Dimensions of Wellness. Descriptive statistics and Kendall’s Tau-b correlation were used to assess associations, followed by ordinal regression to explore the influence of demographic and professional variables. Results: Findings revealed persistent levels of psychological distress among nurses, especially related to anxiety and stress. Significant negative correlations were found between wellness dimensions particularly emotional and occupational wellness and psychological distress. Age and department assignment emerged as predictors of post-pandemic stress and depression. Conclusions: The study highlights the need for institutional strategies to support mental health and promote comprehensive well-being among nurses in the post-COVID-19 period. Investing in long-term psychological support and wellness training is essential for building a resilient nursing workforce. Full article

Nurse practitioners (NPs) are increasingly integrated into surgical care teams, complementing traditional surgical roles. However, the relationship between their involvement and patient-reported outcome measures (PROMs), such as pain and anxiety, remains understudied. Purpose: To examine the types of care from NPs in surgical units during the perioperative period and evaluate their association with length of stay, pain, and anxiety. Methods: Our prospective comparative study in two surgical units at a tertiary medical center included 315 patients: 156 received care from NPs, and 159 received usual care. Data were collected at three time points: post-operative day one (T0), during hospitalization (T1), and 14 days post-discharge (T2). Measures included the Brief Pain Inventory, the Hospital Anxiety and Depression Scale, and an intervention checklist completed by the NPs. Findings: NPs performed primarily in-hospital interventions including care coordination (40%) and medication management (44%). Patients treated by NPs reported significantly lower in-hospital anxiety compared to usual care (p = 0.001). The length of stay and pain levels were not significantly associated with NP care. Discussion: NPs in surgical settings provide patient-centered care associated with lower in-hospital anxiety. Further research is recommended to validate these findings in diverse settings. Full article

Background/Objectives: Anxiety and depression are common among individuals with coronary heart disease (CHD) and pose significant barriers to lifestyle modifications. Evidence on sex-related differences in anxiety and depression following cardiac rehabilitation (CR) remains inconclusive. This study aims to assesses the prevalence and changes in anxiety and depression symptoms during CR and explores potential sex differences. Methods: A quasi-experimental one-group pretest–post-test design was employed, measuring self-reported anxiety and depression symptoms utilizing the Hospital Anxiety and Depression Scale (HADS). Results: HADS was reported by 175 patients, 122 men and 53 women, at CR admission and discharge between 1 January 2022 and 30 April 2024. The prevalence of anxiety symptoms (HADS-anxiety score ≥ 8) significantly decreased from 28.2% at admission to 16.9% at discharge, while depression prevalence dropped (HADS-depression score ≥ 8) from 16.3% to 6.2%. Statistically significant sex differences were observed in depression prevalence at discharge, with women exhibiting lower symptom prevalence. Both sexes experienced significant HADS-anxiety and HADS-depression score reductions (p < 0.001) in both the overall sample and the sub-analysis of patients presenting with symptoms at admission. Women initially presented higher HADS-anxiety scores and significantly greater HADS-anxiety score reductions (p = 0.014) than men. No significant sex differences were observed in the reduction in HADS-depression scores. Conclusions: The prevalence of anxiety and depression symptoms significantly decreased among both sexes compared to admission, with women experiencing greater symptom reduction at discharge than men. Further research is needed to determine specific CR components contributing to these improvements. Full article

Background/Objectives: Cognitive impairment in older adults has emerged as a growing public health concern, particularly in relation to COVID-19 infection and its associated neuropsychiatric symptoms. The identification of modifiable risk factors may contribute to the development of targeted preventive strategies. This study aimed to assess predictors of cognitive impairment in older adults with and without recent SARS-CoV-2 infection. Methods: A prospective cohort study was conducted from June 2023 to March 2024 at a tertiary hospital in western Mexico. Adults aged 65 years or older with confirmed SARS-CoV-2 infection within the previous six months, along with uninfected controls, were enrolled. Cognitive function (Mini-Mental State Examination), depression (PHQ-9), anxiety (Geriatric Anxiety Inventory), insomnia (Insomnia Severity Index), functional status (Katz Index and Lawton–Brody Scale), and laboratory markers were evaluated at baseline, three months, and six months. The primary outcome was cognitive impairment at six months. Independent predictors were identified using a multivariable generalized linear mixed-effects model. Results: Among the 111 participants, 20 (18.8%) developed cognitive impairment within six months. Low serum magnesium (adjusted risk ratio [aRR] 2.73; 95% CI 1.04–7.17; p = 0.041) and depression (aRR 5.57; 95% CI 1.88–16.48; p = 0.002) were independently associated with a higher risk. A significant synergistic among COVID-19, depression, and hypomagnesemia was observed (RR 44.30; 95% CI 9.52–206.21; p < 0.001), corresponding to the group with simultaneous presence of all three factors compared to the group with none. Conclusions: Depression and hypomagnesemia appear to be independent predictors of cognitive impairment in older adults with recent COVID-19 infection. These findings suggest potential targets for prevention and support the implementation of routine neuropsychiatric and biochemical assessments in this population. Full article

Background and Objectives: Although survival after congenital cardiac malformations (CCM) has improved, little is known about Romanian children’s own perceptions of health-related quality of life (HRQoL) or their emotional burden. We compared HRQoL, depressive symptoms, and anxiety across lesion severity strata and explored clinical predictors of impaired HRQoL. Methods: In this cross-sectional study (1 May 2023–30 April 2025), 72 children (mean age 7.9 ± 3.0 years, 52.8% male) attending a tertiary cardiology clinic completed the Romanian-validated Pediatric Quality of Life Inventory (PedsQL), Children’s Depression Inventory (CDI) and the Screen for Child Anxiety-Related Emotional Disorders questionnaire (SCARED-C, child version). Lesions were classified as mild (n = 22), moderate (n = 34), or severe (n = 16). Left-ventricular ejection fraction (LVEF) and unplanned cardiac hospitalisations over the preceding 12 months were extracted from electronic records. Results: Mean PedsQL total scores declined stepwise by severity (mild 80.9 ± 7.3; moderate 71.2 ± 8.4; severe 63.1 ± 5.4; p < 0.001). CDI and SCARED-C scores rose correspondingly (CDI: 9.5 ± 3.0, 13.6 ± 4.0, 18.0 ± 2.7; anxiety: 15.2 ± 3.3, 17.2 ± 3.8, 24.0 ± 3.4; both p < 0.001). PedsQL correlated positively with LVEF (r = 0.51, p < 0.001) and negatively with hospitalisations (r = −0.39, p = 0.001), depression (r = −0.44, p < 0.001), and anxiety (r = −0.47, p < 0.001). In multivariable analysis, anatomical severity remained the sole independent predictor of lower HRQoL (β = −8.4 points per severity tier, p < 0.001; model R² = 0.45). Children with ≥ 1 hospitalisation (n = 42) reported poorer HRQoL (69.6 ± 8.0 vs. 76.1 ± 11.1; p = 0.005) and higher depressive scores (p < 0.001). Conclusions: HRQoL and internalising symptoms in Romanian children with CCM worsen with increasing anatomical complexity and recent hospital utilisation. The severity tier outweighed functional markers as the main determinant of HRQoL, suggesting that psychosocial screening and support should be scaled to lesion complexity. Integrating the routine use of the Romanian-validated PedsQL, CDI, and SCARED-C questionnaire into cardiology follow-up may help identify vulnerable patients early and guide targeted interventions. Full article

Background/Objectives: Despite the importance of parent mental health for child health, there are no global prevalence data on parental mental health symptoms when children are hospitalized. We aimed to describe depression and anxiety symptom prevalence and associated factors among parents of hospitalized children. Methods: We conducted this 14-country prospective cohort survey with parents/primary caregivers staying at a nearby Ronald McDonald House^® during their child’s hospital treatment. We used the Hospital Anxiety and Depression Scale to measure depression and anxiety symptoms and validated scales and theory-based questions to measure parent, family, and child covariates. We calculated the prevalence of clinically significant or concerning symptoms of depression and anxiety, and used multivariable regression analyses to examine associations between covariates and outcomes. Results: Among 3350 participants, 1789 (49.7%) reported depression symptoms and 2286 (69.0%) reported anxiety symptoms. Worry about housing and poorer ratings of their child’s health were associated with increased risk of depression symptoms. Poorer rating of the child’s health, living with a partner, and discrimination in daily life were associated with increased risk of anxiety symptoms. Higher levels of self-care, hospital family-centered care, and social support were associated with reduced risk of depression symptoms. Higher levels of self-care and social support were associated with reduced risk of anxiety symptoms. Conclusions: Clinically significant or concerning depression and anxiety symptoms are common among parents of hospitalized children globally. Hospitals should consider offering routine mental health symptom screening and preventative mental health and support services to all parents. Full article

Background and Objectives: Caring for an individual with dementia encompasses many challenges. This can lead to increased burden, anxiety, and mental health issues among those taking care of them. Limited research exists investigating the care of people with dementia in Kuwait, particularly regarding the mental health of caregivers. There is a need to understand the impact of caregiver burden in this population. This study aimed to assess the level of burden of care, depression, anxiety, and well-being among caregivers of the elderly with dementia in Kuwait. Methods: This study used a descriptive and cross-sectional design. To measure the burden of care, depression, anxiety, and well-being of the caregivers, we utilized the Zarit Burden Interview, the Hospital Anxiety and Depression Scale, and the World Health Organization-Five Well-Being Index. A sensitivity analysis was conducted to compare the results of the parametric and non-parametric methods. Results: This study included 180 (65%) caregivers for the elderly with dementia and 98 (35%) without dementia. The descriptive statistics showed that caregivers for the elderly with dementia and caregivers for the elderly without dementia experienced moderate burden (17.21 ± 9.09 and 14.51 ± 8.08, respectively), borderline abnormal anxiety (9.92 ± 5.15 and 8.61 ± 4.79, respectively), borderline abnormal depression (8.69 ± 4.35 and 8.06 ± 4.24, respectively), and low mental health well-being (54.40 ± 25.10 and 58.90 ± 23.42, respectively). The t-test of independent samples and Mann–Whitney U test results showed that the burden and anxiety in the caregivers for the elderly with dementia group were statistically significantly higher than those in the caregivers for the elderly without dementia group (p = 0.015 and p = 0.039; p = 0.026 and p = 0.027, respectively). The ANOVA test and Kruskal–Wallis test revealed that the caregivers for the elderly with dementia group had statistically significant differences in burden (p < 0.001; p < 0.001), anxiety (p = 0.048; p = 0.043), depression (p = 0.017; p = 0.009), and mental health well-being (p = 0.001; p = 0.002) scores across various durations of care. The multiple linear regression showed that caregiving was a significant predictor of burden of care and anxiety, indicating that caregivers of the elderly with dementia experienced a higher burden of care than those caring for the elderly without dementia. In addition, confounders with significant influence were duration of care (p < 0.001), education level (p = 0.002), employment status (p = 0.008), and gender (p = 0.02). Conclusions: Family caregivers experienced significant levels of burden of care and anxiety when caring for the elderly with dementia. A multidimensional holistic approach is needed to provide family caregivers of the elderly with dementia with valuable interventions. Full article

Background/Objectives: Despite the psychological benefits of breast reconstruction (BR) after mastectomy, uptake remains limited among women with breast cancer. This study explores psychosocial and personality predictors of BR intentions in the pre-mastectomy phase, aiming to inform strategies for mental health promotion in oncology care. Methods: This cross-sectional analysis used preoperative data from a longitudinal study at a university hospital in Greece. Women with primary breast cancer scheduled for mastectomy completed a battery of validated self-report measures, including the International Personality Item Big-Five Factor Markers (IPIP-BFFM), the Hospital Anxiety and Depression Scale (HADS), and the Short Form-36 Health Survey (SF-36). Demographic, clinical, and psychosocial data were also collected. Binary logistic regression was used to examine predictors of (a) BR information-seeking and (b) BR intention. Results: Seventy-four women participated (mean age = 61.1 years). Older age predicted lower BR intention (Exp(b) = 0.897, 95% CI: 0.829–0.970) and information-seeking (Exp(b) = 0.925, 95% CI: 0.859–0.997). Single/divorced status was associated with reduced BR information-seeking (Exp(b) = 0.053, 95% CI: 0.005–0.549). Openness to experience significantly predicted both outcomes (BR information-seeking: Exp(b) = 1.115, 95% CI: 1.028–1.209); BR intention: Exp(b) = 1.095, 95% CI: 1.016–1.181). Higher physical health-related QoL scores were associated with increased BR intention (Exp(b) = 1.039, 95% CI: 1.007–1.072), whereas higher mental health-related QoL (Exp(b) = 0.952, 95% CI: 0.912–0.994) and higher depression scores (Exp(b) = 0.797, 95% CI: 0.638–0.996) were linked to decreased BR intent. No psychological factor significantly predicted information-seeking. Conclusions: These findings underscore the value of psychosocial screening and personality-informed counseling prior to surgery. By identifying individuals less likely to seek information or consider BR, pre-mastectomy assessments can contribute to tailored, mental health-promoting interventions and support informed, patient-centered surgical decision-making. Full article

This study explored psychological distress and gender differences among couples diagnosed with unexplained infertility (UI) and undergoing evaluation for assisted reproductive treatment at the AOUP Santa Chiara Hospital in Pisa, Italy. A total of 21 heterosexual couples (N = 42) completed the Perceived Stress Scale (PSS), Depression Anxiety Stress Scale (DASS-21), Defeat Scale (DS), and Core-Fertility Quality of Life questionnaire (Core-FertiQol). Women reported significantly higher levels of anxiety and stress compared to men, as confirmed both by DASS-21 and PSS scores. No significant gender differences emerged either in depressive symptoms or defeat. In the Core-FertiQol, women scored higher in the Mind–Body component. Within-couple comparisons mirrored between-gender findings, with women showing higher distress. Despite elevated distress levels, women also demonstrated relatively preserved quality of life, possibly reflecting more adaptive coping strategies. The study provides preliminary support for the development of mindfulness-based interventions tailored to couples coping with UI. Further research with larger samples is needed to clarify gender-specific mechanisms and inform integrated psychological care in fertility settings. Full article

Objective: This study aims to investigate the feasibility of an online music therapy protocol for individuals previously diagnosed with COVID-19, focusing on their perceptions of their respiratory symptoms and the intervention’s impact on psychosocial measures. Methods: A within-subject experimental design was applied to examine an eight-week weekly online music therapy protocol, including singing, wind instrument playing, and music visualizations. All self-report data were collected bi-weekly throughout the 16-weeks study period, including baseline and post-tests. The measures for respiratory symptoms included the Medical Research Council’s Dyspnea Scale (MRC Dyspnea), Chronic Respiratory Questionnaire-Mastery Scores (CRQ Mastery), and Visual Analogue Scale for breathlessness. The measures for the secondary psychosocial outcomes were the Beck Depression Inventory-Short Form, the Generalized Anxiety Disorder 7-item, the Hospital Anxiety and Depression Scale, the Fatigue Severity Scale, the Epworth Sleepiness Scale, the EuroQol 5-Dimension 5-Level, and the Connor-Davidson Resilience Scale. Results: Twenty-four participants were enrolled. The participants perceived a reduction in respiratory symptoms, and shortness of breath (MRC Dyspnea). Planned comparisons showed significant decreases in MRC from baseline to post-treatment (p = 0.008). The mixed-effects model, including pre-baseline and post-treatment, was significant (p < 0.001). Significant changes in Breathing VAS were consistent with improvements in MRC Dyspnea, showing a significant baseline-to-post difference (p = 0.01). The CRQ Mastery showed significant improvements from baseline to Week 12 (p < 0.001). No significant changes were observed in other secondary measures. Conclusions: Our preliminary findings suggest that this protocol is feasible, and as a result, may help individuals previously diagnosed with COVID-19 to cope with lasting respiratory symptoms and improve their perception of shortness of breath. Live music-making, including playing accessible wind instruments and singing, may contribute to an increase sense of control over breathing. As this was a feasibility study, we conducted multiple uncorrected statistical comparisons to explore potential effects. While this approach may increase the risk of Type I error, the findings are intended to inform hypotheses for future confirmatory studies rather than to draw definitive conclusions. Full article

Background: Emerging evidence highlights the role of physical exercise as a non-pharmacological intervention for reducing symptoms of anxiety and depression. While most research has focused on aerobic modalities and chronic training programs, the acute psychological impact of resistance training (RT)—particularly in healthy, active individuals—remains underexplored. This study addresses this gap by evaluating the immediate effects of a single RT session on anxiety and depression in healthy, active individuals. Methods: Fifty-six healthy, physically active participants (43 males, 13 females; M age = 24.41 ± 4.41 years) were randomly assigned to an experimental group (RT, n = 30) or a control group (stretching/mobility, n = 26). The RT session included multi-joint exercises performed at 70–75% 1RM, while the control session consisted of non-load-based mobility and flexibility exercises. Psychological responses were measured immediately before and five minutes after the session using the Hospital Anxiety and Depression Scale (HADS), which includes subscales for anxiety (HADS-A) and depression (HADS-D). Results: Non-parametric within-group analysis (Wilcoxon Signed-Rank Test) revealed a significant reduction in anxiety scores in the RT group (Z = −3.3, p < 0.001, r = −0.7), and a moderate but significant decrease in depression (Z = −2.8, p = 0.005, r = −0.6). No significant changes were observed in the control group for either variable. Between-group comparisons (Mann–Whitney U) showed significantly greater reductions in anxiety in the RT group (p = 0.021), while differences in depression deltas were not significant. A Quade ANCOVA confirmed that group assignment is significantly predictive for post-intervention anxiety levels (F(1, 54) = 8.46, p = 0.005), controlling for baseline values. Conclusions: A single session of moderate-to-high-intensity resistance training can acutely reduce anxiety symptoms in healthy physically active individuals. The effect on depressive symptoms appears more modest and variable, suggesting differential sensitivity to acute exercise stimuli. These findings support the use of RT not only for long-term psychological health but also as a feasible short-term intervention for emotional regulation in healthy active populations. Full article

Background: Despite losing weight, the majority of subjects retained an obese view of themselves. The aim of the study was to evaluate the usefulness of a 3D modeling tool in improving the body image of patients who have undergone bariatric surgery. Methods: Morbidly obese subjects involved in a medico-surgical obesity management program and having undergone a Roux en Y Gastric Bypass (RYGB) or a sleeve gastrectomy (SG) were prospectively included during their usual postoperative medical follow-up. The figure rating scale (FRS), body image questionnaire, and Hospital Anxiety Depression Scale test were performed. The FRS was assessed before and after visualizing their body image using a 3D modeling tool. Distributions between the groups for gender (female vs. male) and type of surgery (gastric bypass vs. sleeve gastrectomy) were tested with a Pearson’s chi² independence test. The significance threshold was p < 0.05. Results: We included 140 adults with sleeve gastrectomy (72.9%; n = 102) or gastric bypass (27.1%; n = 38). The mean time from surgery was 308.3 ± 111.4 days (63–511). Participants were mostly female (77.9%; n = 109). Nearly half of the subjects who had undergone bariatric surgery almost one year before modified their body perception after visualizing their avatar thanks to a 3D modeling tool. One third reduced their FRS score (“perceived body”) after visualizing their avatar. FRS score and body mass index (BMI) following surgery (“real body”) were significantly correlated before and after visualizing the 3D avatar, with a stronger correlation after visualizing the 3D avatar. Conclusions: A 3D modeling tool may improve body perception after weight loss in subjects with bariatric surgery. Being simple, non-invasive, not expansive, and easy to use during a consultation and to understand for the patient, a regular use of this tool may be largely implemented in clinical practice. Its usefulness in improving body image, mood disorders, and eating disorders and the further success of the surgery should be further evaluated. Full article