Exam Anxiety and Its Associated Risk Factors Among Indian Medical Undergraduates

Background: Exam anxiety is a global troublesome psychological problem, impairing the academic perfor-mance of medical students. This study was planned to estimate the prevalence and associated risk factors of Exam anxiety among Indian medical students Methodology: A cross-sectional analytical study was conducted among 230 Indian medical undergraduate students. Westside Test Anxiety Inventory (WTAI) was used to estimate the level of Exam anxiety among medical students. We utilized multivariable logistic regression to identify independent risk factors among medical students. Results: The prevalence of high Exam Anxiety among medical students was 49.6 % (95% CI 43.9-57.0). The mean age of the students was 21.3 years. Multivariable logistic regression revealed the presence of excessive course load [AOR=2.22,95% CI:(1.03,4.78)], the presence of psychological stress [AOR=2.89,95% CI:(1.51,5.48)] and low self-esteem [AOR=8.15,95% CI:(1.51,43.96)] to be independent risk factors for exam anxiety. Conclusions: Our studyfindings suggest that the prevalence of Exam anxiety is very high among Indian un-dergraduate medical students. Our study also showed that the perception of excessive course load, psycholog-ical stress and low self-esteem were the independent risk factors in medical students.

Alleviate Examination Anxiety and conserve Mental Health of the Adolescent Students: the future of the nation

Adolescents are the potential human resources of every nation. Various determinants may influence the mental and physical well-being of the youth. Examination anxiety is one such. It is a prevalent problem for many adolescent students; affecting approximately 10-40 percent of all students. Yoga can act as one of the best alternative methods of treatment. It aims at creating and preserving a proper balance between the body and the mind. 61 adolescent students, of age group 14-16 years, suffering from examination anxiety participated in this study. Examination Anxiety Scale for adolescents, developed and standardized by the investigators, was used for assessing examination anxiety. The subjects were divided into two groups randomly- the experimental group and the control group. The experimental group participated in the yoga intervention program for six weeks, whereas, the control group did not participate in the same. After six weeks, both the groups were assessed again. The result showed that the mean examination anxiety score reduced from 71.70 to 68.80 for the experimental group and it was statistically significant at (P<0.05). For the male and the female experimental groups, the mean examination anxiety score reduced from 71.84 to 68.92, and 72.12 to 68.71, respectively. For the male group, reduction in examination anxiety score was not statistically significant (P =0.106) whereas, for the female group changes were statistically significant (P <0.05). From the result, it can be concluded that yoga has a significant effect on attenuating the examination anxiety. Further, the result showed that yoga reduced examination anxiety in both males and females. However, the positive effect of yoga intervention was more significant in females than in males

Survey on anxiety and depression among the third-year junior high school students in Nanning city / 四川精神卫生

ObjectiveTo study the anxiety and depression status of the third-year junior high school students in Nanning city， and to discuss their relationships with test anxiety， so as to provide references for targeted psychological intervention for students. MethodsFrom May to June， 2021， a simple random sampling method was adopted to randomly enroll three classes of third-grade students from one junior high school in each district and county of Nanning city. The selected students were assessed using Test Anxiety Scale （TAS）， Self-rating Anxiety Scale （SAS） and Self-rating Depression Scale （SDS）. Thereafter， Pearson correlation analysis was conducted to explore the correlation among each scale score. ResultsA total of 2 080 students participated in the survey， and 1 826 （87.79%） valid questionnaires were collected. Among them， 999 students （54.71%） felt uncomfortable due to the test. Anxiety and depression were detected in 577 （31.60%） and 830 （45.45%） students， respectively. TAS score of female students was higher than that of male students ［（16.75±6.78） vs. （15.08±6.97）， t=-5.136， P<0.01］， SAS score of female students was higher than that of male students ［（46.05±10.43） vs. （44.16±10.87）， t=-3.769， P<0.01］， and SDS score of female students was higher than that of male students ［（52.34±12.44） vs. （49.98±12.17）， t=-4.039， P<0.01］. Correlation analysis showed that SAS and SDS scores were positively correlated with TAS score （r=0.574， 0.531， P<0.01）， and the correlation still existed after further controlling for age and gender （r=0.570， 0.526， P<0.01）. ConclusionThe third-year junior high school students in Nanning city suffer a high prevalence rate of anxiety and depression， and the two psychological states have positive relations with TAS. Furthermore， both anxiety and depression are more severe in female students than in male students.

Ansiedad ante exámenes en universitarios: papel de engagement, inteligencia emocional y factores asociados con pruebas académicas / Test Anxiety university students: role of engagement, emotional intelligence and factors associated to academic test solving

Resumen Introducción: La ansiedad ante los exámenes (AE) es común entre universitarios e implica manifestaciones cognitivas, motoras y fisiológicas de tensión y preocupación permanente ante la evaluación que puede afectar su desempeño académico. Objetivo: Evaluar si el engagement, la inteligencia emocional y los factores asociados con la realización de pruebas académicas predicen las manifestaciones de AE en una muestra de 400 estudiantes universitarios. Método: Mediante un diseño predictivo transversal se evaluó el engagement (Vigor, Dedicación, Absorción), la inteligencia emocional (Atención, Claridad, Reparación) y diversos factores relacionados con pruebas académicas, analizando su relación con las manifestaciones de AE, y se construyeron modelos de regresión categórica para definir el nivel predictivo de las variables. Resultados: Se descartó la relación entre engagement y AE (p>0,05) mientras que Claridad y Reparación se asociaron inversamente con las manifestaciones de AE, excepto las fisiológicas. Diferentes factores asociados con la realización de exámenes como control docente, temor a la evaluación y tipo de preguntas predicen las respuestas de ansiedad fisiológica (R2=0,10, p<0,01), motora (R2=0,09, p<0,01) y cognitiva (R2=0,12, p<0,01). La Claridad predice negativamente la ansiedad motora (β=-0,131, p<0,01). Conclusiones: Engagement académico y AE se registran como variables independientes una de la otra, entre tanto, la Claridad emocional regula débilmente la ansiedad motora. Factores cognitivos y situacionales al momento de realizar exámenes son relevantes en el desencadenamiento de la respuesta ansiosa.

Abstract Introduction: Test Anxiety (TA) is common among university students and involves cognitive, motor, and physiological manifestations of tension and permanent concern about exams that may affect their academic performance. Objective: Assess whether engagement, emotional intelligence and factors associated with academic test solving predict the manifestations of TA in a sample of 400 university students. Method: Using a cross-sectional predictive design, engagement (Vigor, Dedication, Absorption), emotional intelligence (Attention, Clarity, Repair) and several factors related to academic test solving were evaluated, analyzing their relationship with the manifestations of TA, and categorical regression models were constructed to define the predictive level of the variables. Results: The relationship between engagement and TA was discarded (p>0,05) while Clarity and Repair were inversely associated with TA manifestations, except the physiological ones. Different factors associated with exams such as professor control, fear of exams and the question type predict physiological (R2=0,10, p<0,01), motor (R2=0,09, p<0,01) and cognitive (R2=0,12, p<0,01) anxiety responses. Clarity predicts motor anxiety (β=-0,131, p<0,01) negatively. Conclusions: Academic engagement and TA are registered as independent variables of each other; meanwhile, emotional Clarity regulates motor anxiety weakly. Cognitive and situational factors at the time of exams are relevant in the triggering of the anxious response.

Procrastinación, ansiedad ante los exámenes y rendimiento académico en estudiantes universitarios / Procrastination, test anxiety and academic performance on university students

Resumen La procrastinación se define como una tendencia conductual a postergar tareas que, por sus características poco motivadoras o tediosas, no son atractivas para quien las realiza, y cuyo retraso puede acarrear consecuencias negativas. El propósito de este estudio es examinar el efecto de la procrastinación académica y la ansiedad ante los exámenes sobre el rendimiento académico, así como la relación entre ambas variables. Para ello, se ha realizado una investigación con 201 estudiantes universitarios empleando el Inventario Alemán de Ansiedad frente a los Exámenes Adaptado (GTAI-A), la Escala de Procrastinación Académica (EPA) y un registro de las calificaciones obtenidas por los participantes recogidos a través de un autoinforme. Los resultados revelan la presencia de ansiedad ante la evaluación y la procrastinación académica en estudiantes universitarios, e indican que la ansiedad ante los exámenes muestra una relación negativa con el rendimiento académico. De igual forma, la procrastinación se relaciona con dos factores de ansiedad (interferencia y falta de confianza), incidiendo de forma indirecta en dicho rendimiento. Adicionalmente, se han encontrado diferencias significativas en el rendimiento académico en función de los diferentes niveles de ansiedad identificados (χ2(2,201) = 16.929; p = .001). En conclusión, para prevenir e intervenir en el bajo rendimiento académico y en los problemas psicosociales asociados, los servicios universitarios de atención psicológica deben considerar la influencia de múltiples variables, de forma que se apliquen programas de intervención específicos para cada dimensión, aumentando así los niveles de eficacia y eficiencia en su labor asistencial.

Abstract Procrastination is defined as a behavioral tendency to postpone tasks that, because of their unmotivating or tedious characteristics, are not attractive to the performer, and whose delay can lead to negative consequences. This is the behavior of delaying responsibilities, being aware of their importance and the repercussions of the delay. These consequences can affect the personal, social, occupational and academic spheres of individuals. Therefore, the purpose of this study is to examine the relationship of academic procrastination and test anxiety on academic performance, as well as the relationship between the two variables. In this way, the aim is to achieve a better understanding of the links between the three variables, which will serve as a theoretical basis for preventing and intervening in the negative repercussions of procrastination. To this end, an investigation has been carried out with 201 college students, using the German Test Anxiety Inventory (GTAI-A), the Academic Procrastination Scale (EPA), and a record of the qualifications obtained by the participants collected through a self-report. This is a correlational design that does not include experimental manipulation of variables or randomization of the sample, so the aim is not to establish causal relationships but to determine the direction and strength of the associations between variables. The results reveal the presence of academic procrastination and test anxiety in university students. Specifically, the majority of participants (45.3 %) reflected a medium level of anxiety, 28.9 % reflected a high level and 25.9 % showed a low level. In the total sample, procrastination showed a mean score of 30.3 points out of 60. As for the relationships of both variables with academic performance, test anxiety shows a negative relationship with academic performance, so higher levels of anxiety are associated with worse grades. Procrastination does not show a significant and direct relationship with grades, but it is related to two anxiety factors (interference and lack of confidence), indirectly affecting academic performance. In addition, significant differences in academic performance have been found based on the different anxiety levels identified (χ2(2,201) = 16.929; p = .001), with the high anxiety group obtaining a lower mean score (M = 5.74; SD = 1.27). This supports the hypothesis that test anxiety is negatively associated with academic performance. Moreover, it has been found that comparing the medium and low anxiety groups, the differences are not significant, but comparing each of them with the high anxiety group they are. Therefore, significant differences in the grades only appear when the level of anxiety is high. That is, a moderate level of anxiety is adaptive, and only becomes detrimental if it becomes high. In conclusion, to prevent and intervene in academic underachievement and associated psychosocial problems, university psychological services should consider the influence of test anxiety, procrastination and other cognitive, behavioral, motivational and emotional variables. According to this study, intervention in test anxiety is a central aspect, as it has a direct effect on academic performance. In the same way, procrastinating behaviors can be intervened, as they interfere indirectly in academic outcomes, being associated with cognitive manifestations of test anxiety. The relative weight of the different variables associated with academic achievement varies according to each student, so that an individualized approach to these types of problems would increase the levels of effectiveness and efficiency in the care provided by university psychological services. Finally, the need for more research to identify the factors associated with low academic performance and the relationships between them is highlighted, in order to facilitate the design of effective interventions for different student profiles.

Transtorno de ansiedade generalizada entre estudantes de cursos de pré-vestibular / Generalized anxiety disorder among university-entrance preparation course students

RESUMO Objetivo Medir a prevalência de sintomatologia de transtorno de ansiedade generalizada (TAG) entre estudantes de um curso pré-vestibular do sul do Brasil e sua associação com fatores sociais, demográficos, acadêmicos e psicológicos. Métodos Este estudo teve delineamento transversal, tendo como participantes estudantes com idade igual ou superior a 18 anos de um curso pré-vestibular privado do sul do Brasil. Foi administrado um questionário autoaplicável que avaliava aspectos sociais, demográficos, acadêmicos, de ansiedade relacionada à prova e estresse percebido. O desfecho analisado foi a sintomatologia de TAG, por meio do instrumento General Anxiety Disorder-7 (GAD-7). Para análise multivariável, utilizou-se a regressão de Poisson com ajuste robusto da variância. Resultados Participaram 137 alunos (taxa de resposta de 90,7%) e a prevalência de sintomatologia de TAG foi de 41,4%. Após análise ajustada, ser do sexo feminino, ter estudado em escola privada, ter maiores escores de estresse percebido e de ansiedade relacionada à prova permaneceram como fatores de risco. Estar com 19 anos apresentou-se como fator de proteção. Conclusões A ansiedade relacionada à prova foi o fator mais fortemente associado com a sintomatologia de TAG, o que sugere que as emoções e preocupações específicas do contexto de avaliação podem predispor o indivíduo a maior risco de desenvolver esse transtorno. A partir desses resultados, sugere-se a inclusão de profissionais da saúde mental no contexto do pré-vestibular, assim como intervenções direcionadas ao desenvolvimento de uma relação saudável entre o aluno e suas demandas acadêmicas.

ABSTRACT Objective To measure prevalence of symptomatology of generalized anxiety disorder (GAD) among students from a university-entrance preparation course in southern Brazil and its association with social, demographic, academic and psychological factors. Methods This study had a cross-sectional design and participants were students aged 18 years or older from a private university-entrance preparation course in southern Brazil. A self-administered questionnaire that assessed social, demographic, and academic variables, as well as test-related anxiety and perceived stress was administered. The outcome analyzed was the symptomatology of GAD through the General Anxiety Disorder-7 (GAD-7) instrument. Poisson regression with robust adjustment of variance was used in multivariate analysis. Results 137 students participated (90.7% response rate) and the prevalence of GAD symptomatology was 41.4%. After adjusted analysis, being female, having studied in a private school, having higher perceived stress and test anxiety scores remained as risk factors. Being 19 years old was a protective factor. Conclusions Anxiety regarding the test was the factor most strongly associated with symptomatology of GAD, which suggests that the emotions and concerns specific to the context of evaluations may predispose the individual to a higher risk of developing this disorder. Based on these results, we suggest the inclusion of mental health professionals in the context of university-entrance preparation courses, as well as interventions aiming the development of a healthy relationship between the student and their academic demands.

Instrumentos de avaliação da ansiedade da criança hospitalizada / Instrumentos de evaluación de ansiedad de niños hospitalizados / Anxiety assessment tools in hospitalized children

Resumo Objetivo Identificar na literatura os instrumentos existentes para a avaliação da ansiedade em crianças hospitalizadas. Métodos Trata-se de uma revisão integrativa. As buscas foram realizadas de janeiro a maio de 2017 nas seguintes bases de dados: PubMed, LILACS e CINAHL, com os descritores anxiety, hospitalized child, inpatients, children, emotional responses, emotional manifestation, emotional reactions, validation studies, manifest anxiety scale e test anxiety scale. Resultados Após a seleção, foram analisados 33 artigos, sendo identificados dez instrumentos para a avaliação da ansiedade da criança. Oito instrumentos utilizaram a Escala de Likert nas respostas, um empregou a escala analógica de um a dez e o único instrumento que utilizou uma estratégia lúdica, o desenho dirigido, foi o Child Drawing: Hospital. Conclusão Recomenda-se a tradução, adaptação transcultural e validação do instrumento CD:H. Este estudo visa contribuir para o conhecimento dos enfermeiros pediatras no manejo da ansiedade da criança em unidades pediátricas, a fim de diminuir seu sofrimento emocional durante a hospitalização.

Resumen Objetivo Identificar en la literatura los instrumentos existentes para evaluar la ansiedad de niños hospitalizados. Métodos Se trata de una revisión integradora. Las búsquedas se realizaron de enero a mayo de 2017 en las siguientes bases de datos: PubMed, LILACS y CINAHL, con los descriptores anxiety, hospitalized child, inpatients, children, emotional responses, emotional manifestation, emotional reactions, validation studies, manifest anxiety scale y test anxiety scale. Resultados Luego de realizar la selección, se analizaron 33 artículos, en los que se identificaron diez instrumentos para evaluar la ansiedad de niños. Ocho instrumentos utilizaron la escala de Likert en las respuestas, uno empleó la escala analógica de uno a diez y el único instrumento que utilizó una estrategia lúdica, el dibujo dirigido, fue el Child Drawing: Hospital. Conclusión Se recomienda la traducción, adaptación transcultural y validación del instrumento CH:H. Este estudio tiene el objetivo de contribuir para el conocimiento de los enfermeros pediatras en el manejo de la ansiedad de los niños en unidades pediátricas, a fin de reducir su sufrimiento emocional durante la hospitalización.

Abstract Objective Identify existing tools for the assessment of anxiety in hospitalized children in the literature. Methods An integrative review was undertaken. The searches took place from January to May 2017 in the following databases: PubMed, LILACS and CINAHL, using the descriptors anxiety, hospitalized child, inpatients, children, emotional responses, emotional manifestation, emotional reactions, validation studies, manifest anxiety scale and test anxiety scale. Results After the selection, 33 articles were analyzed, in which 10 child anxiety assessment tools were identified. Eight instruments used the Likert scale in the answers, one used the analogue scale from one to ten and the only instrument that used a playful strategy, directed drawing, was the Child Drawing: Hospital. Conclusion The translation, cross-cultural adaptation and validation of the CD:H is recommended. This study aims to contribute to pediatric nurses' knowledge in the management of child anxiety in pediatric wards, with a view to reducing their emotional suffering during hospitalization.

Validation of an anxiety scale for prenatal diagnostic procedures / Validação de uma escala de ansiedade para procedimentos diagnósticos prénatais

ABSTRACT OBJECTIVE: To perform a cross-cultural adaptation of the Prenatal Diagnostic Procedures Anxiety Scale questionnaire for application in the Brazilian cultural context. METHODS: The translation and back translation processes followed internationally accepted criteria. A committee of experts evaluated the semantic, idiomatic, experimental and conceptual equivalence, proposing a pre-final version that was applied in 10.0% of the final sample. Afterwards, the final version was approved for the psychometric analysis. At that stage, 55 pregnant women participated which responded to the proposed Brazilian version before taking an ultrasound examination at a public hospital in Santa Catarina, in the year of 2017. The Edinburgh Postnatal Depression Scale was used as an external reliability parameter. The internal consistency of the instrument was obtained by Cronbach's alpha. Validation was performed by exploratory factorial analysis with extraction of principal components by the Kaiser-Guttman method and Varimax rotation. RESULTS: The Cronbach's alpha value of the total instrument was 0.886, and only the percentage of variance from item 2 (0.183) was not significant. The Kaiser-Guttman criterion defined three factors responsible for explaining 78.5% of the variance, as well as the Scree plot. Extraction of the main components by the Varimax method presented values from 0.713 to 0.926, with only item 2 being allocated in the third component. CONCLUSIONS: The Brazilian version is reliable and valid for use in the diagnosis of anxiety related to the performance of ultrasound procedures in prenatal care. Due to the lack of correlation with the rest of the construct, it is suggested that item 2 be removed from the final version.

RESUMO OBJETIVO: Proceder à adaptação transcultural do questionário Prenatal Diagnostic Procedures Anxiety Scale para aplicação no contexto cultural brasileiro. MÉTODOS: Os processos de tradução e retrotradução seguiram critérios aceitos internacionalmente. Um comitê de especialistas avaliou as equivalências semântica, idiomática, experimental e conceitual, propondo uma versão pré-final que foi aplicada em 10,0% da amostra final. Em seguida, foi aprovada a versão final para a análise psicométrica. Nessa etapa participaram 55 gestantes que responderam à versão brasileira proposta antes de realizarem um exame ultrassonográfico em um hospital público de Santa Catarina, no ano de 2017. A Edinburgh Postnatal Depression Scale foi utilizada como parâmetro de confiabilidade externa. A consistência interna do instrumento foi obtida pelo alfa de Cronbach. A validação foi realizada por análise fatorial exploratória com extração de componentes principais pelo método de Kaiser-Guttman e rotação Varimax. RESULTADOS: O alfa de Cronbach do instrumento total foi 0,886, e apenas o percentual de variância do item 2 (0,183) não foi significativo. O critério de Kaiser-Guttman definiu três fatores responsáveis por explicar 78,5% da variância, assim como o gráfico de Escarpa. A extração dos componentes principais pelo método Varimax apresentou valores de 0,713 a 0,926, sendo apenas o item 2 alocado no terceiro componente. CONCLUSÕES: A versão brasileira é confiável e válida para uso no diagnóstico de ansiedade relacionada à realização de procedimentos ultrassonográficos no pré-natal. Devido à falta de correlação com o restante do construto, sugere-se a retirada do item 2 da versão final.

Magnitude spectrum and predictors of depression in adolescent girls of rural Varanasi

Background: Depression is a common but serious problems among adolescent. It has profound adverse effect on their physical as well as mental health. Now days it is one of the common and ignorant psychiatric problems in adolescents. Objectives: 1. To assess magnitude and spectrum of depression in rural adolescent girls. 2. To pinpoint predictors of depression in adolescent girls. Method: A community based cross-sectional design was adopted for this study. Four hundred adolescent girls were selected from rural Varanasi by adopting appropriate sampling technique. Socio demographic, personal and diet related information were obtained on a predesigned and pretested schedule. CES depression scale was applied to assess the level of depression. The data thus obtained was analyzed using SPSSv21.0.In order to pin point correlates logistic regression analysis was done. Results: On applying psychological rating scale in all 75.2% subjects were at risk of depression. Mild to moderate and severe depression prevailed in 21.3% and 54.0% subjects respectively. Higher AOR for depression prevailed in menstruating girls (AOR 3.82; 1.41- 10.34), higher education of study subjects (AOR 2.89; 1.09-7.70), irregular breakfast habits (AOR 7.09; 2.59-19.41) and average (AOR 8.02; 2.64-24.27) as well as poor (AOR 18.24; 45.88-71.86) life skills. Conclusion: Three out of four rural adolescent girls were at risk of depression. Menstrual status, subjects literacy, breakfast habit and category of life skill were significant predictors of depression status.

Procrastination, Perfectionism and Test Anxiety: A Perilous Triad

Background: Student life is dotted with undertaking of several tests at different levels. It is only natural forsome students to react to the task of preparing for tests by procrastinating till the very last moment or byspending excessive time on mastering perfection. In fact, sometimes striving for perfection can itself lead toprocrastination or we actually procrastinate so that we can be perfect. The strength of each of theseresponses has a profound influence on our test anxiety levels. Thus, this study aimed to examine therelationship between procrastination, perfectionism and test anxiety.Methods: The sample consisted of 89 participants, all between the age group of 17-19. The ProcrastinationScale for student population by Lay to measure procrastination levels, Multidimensional Personality Scaleby Hewitt and Flett to measure perfectionism levels and Westside Test Anxiety Scale by Richard Driscollto measure test anxiety levels have been used for this purpose.Results: Results revealed a moderate negative correlation between self-oriented perfectionism andprocrastination whereas a moderate positive correlation has been found each in the case of sociallyprescribed perfectionism and procrastination, socially prescribed perfectionism and test anxiety as well asprocrastination and test anxiety. All the correlations are statistically significant.Conclusion:The research has important implications for understanding the necessity of bringing about achange in the current education system and also at institutional and individual levels for tackling theproblems of procrastination, perfectionism and test anxiety which are commonly faced by Indian collegegoing adolescents today.

Attentional bias towards emotional information in test-anxiety individuals: Evidence from eye movement / 第二军医大学学报

Objective To explore whether attentional bias plays an important role in the development and maintenance of anxiety by eye tracking technology. Methods A total of 80 students preparing for College English Test 6 participated in current study. The emotional Stroop paradigm and eye movement tracking were used to compared the difference of attentional bias for emotional information between high test anxiety individuals (test anxiety scale score≥15) and low test anxiety individuals (test anxiety scale score<15). Results In the emotional Stroop task, the reaction time of the negative block was significantly longer than that of the positive block in the high test anxiety individuals (t=2.184, P=0.035), while there was no significant difference between the two emotion blocks in the low test anxiety individuals (t=-0.161, P=0.875). In eye movement tracking experiment, the first fixation duration (t=2.117, P=0.041) and total duration (t=2.254, P=0.027) of the negative block were significantly longer in the high test anxiety individuals than those in the low test anxiety individuals. The total duration of the positive block was significantly longer in the low test anxiety individuals than that in the high test anxiety individuals (t=2.226, P=0.029). Conclusion High test anxiety individuals show attentional bias towards negative information, suggesting that attentional bias has an effect on the development and maintenance of anxiety.

Adaptação cultural do instrumento Child Drawing: hospital / Cultural adaptation of the instrument Child Drawing: Hospital

Introdução: A hospitalização representa para as crianças um momento geralmente assustador e incomum à sua rotina, pois frequentemente são submetidas a procedimentos hospitalares, bem como a tratamentos terapêuticos que podem acarretar dor, sofrimentos físicos e psicológicos. Estudos demonstram que, apesar de algumas crianças verbalizarem suas necessidades e sentimentos, outras não o fazem tão claramente, o que exige do profissional de enfermagem uma abordagem mais lúdica e criativa, tal como o desenho. Entretanto, é importante também realizar intervenções nessas necessidades, tornando-se imprescindíveis escalas e instrumentos validados para proceder tal ação. Um dos instrumentos existentes, porém ainda não traduzido e adaptado no Brasil, é o CD:H Child Drawing: Hospital, um instrumento que analisa a ansiedade de crianças hospitalizadas em idade escolar por meio do desenho. O instrumento CD:H é peculiar, no sentido que o que deve ser traduzido são as instruções de aplicação do instrumento e de análise do desenho realizado pela criança. Apesar de ser aplicado em crianças, o profissional que utiliza o instrumento é quem deve entender as instruções de aplicação e análise, a fim de que todos os profissionais que o utilizarem possam chegar ao mesmo diagnóstico do nível de ansiedade, confirmando a sua aplicabilidade. Objetivo e Método: O objetivo deste estudo foi adaptar o instrumento para a língua portuguesa falada no Brasil, de acordo com as diretrizes de adaptação transcultural de Guillemin, Beaton e Bombardier (1993) e Beaton et al. (1998, 2000, 2007) adotando os seguintes passos: a) Tradução; b) Revisão e Síntese das traduções; c) Comitê de Juízes; d) Retrotradução; e) Reavaliação da pontuação dos resultados; f) Validação de face e de conteúdo. Resultados: Foram realizadas duas traduções independentes do inglês para o português por duas pessoas fluentes na língua pretendida. Após as traduções, pesquisadora, orientadora e tradutora realizaram reuniões para gerar a síntese das traduções. O Comitê de Juízes foi composto por oito enfermeiros de quatro regiões do Brasil: Sul, Sudeste, Nordeste e Centro-Oeste. O valor mínimo necessário de Razão de Validade de Conteúdo (RVC) deveria ser igual ou maior a 0,75, a partir do cálculo realizado pelo psicometrista pelo Critério de Lawshe (Wilson, Pan, Schumsky, 2012). O instrumento como um todo foi bem avaliado pelo Comitê de Juízes, com boa validade semântica e de conteúdo, com RVC=1 (66,95%) e RVC de 0,75 a 1 em 175 itens do CD:H VB (73,23%). Os 15 itens discordantes (6,28%), que receberam o índice RVC de 0,75, tiveram modificações gramaticais para uma melhor adequação do instrumento. Foi elaborada somente uma retrotradução do português para o inglês e a revisão do instrumento por um professor associado da Escola de Enfermagem de uma universidade norte-americana pela impossibilidade de as autoras originais o fazerem. Após rigoroso processo de tradução e adaptação transcultural, a versão final do instrumento Child Drawing: Hospital foi finalizada, apenas com ajustes gramaticais e a substituição do crayon pelo lápis de cor como principal adaptação cultural, uma vez que, na cultura brasileira, as atividades de desenhar e pintar geralmente são realizadas com lápis de cor e não giz de cera. Conclusão: Este estudo é a primeira fase do processo de validação do instrumento CD:H, tendo sido realizada sua tradução e adaptação cultural, obtendo-se o instrumento Child Drawing: Hospital Versão Brasileira CD:H VB. Pode-se concluir que os objetivos do estudo foram alcançados e que o instrumento CD:H VB tem condições de continuar o processo de validação a ser realizado posteriormente.

Introduction: Hospitalization is normally a frightening and unusual time for children, because in such occasions they often undergo hospital procedures, as well as therapeutic treatments that can lead to pain, besides physical and psychological suffering. Studies show that, while some children verbalize their needs and feelings, others do not do it so clearly, a situation that requires a more playful and creative approach from the nursing professional, such as the use of drawing. However, it is also important to make interventions about such needs. Considering that, it is necessary to validate scales and instruments to carry out such action. One of the existing instruments, but not yet translated or adapted in Brazil, is CD:H - Child Drawing: Hospital, an instrument that aims at analyzing the anxiety of hospitalized children of school age through drawing. The CD:H instrument is peculiar, in the sense that what should be translated are the instructions for applying the instrument and analyzing the drawing performed by the child. Although the instrument is applied in children, the professional who uses it is the one who must understand the instructions for application and analysis, so that all professionals who use it can arrive at the same diagnosis for the level of anxiety, confirming the instruments applicability. Objective and Method: The objective of this study was to adapt the aforementioned instrument to the Portuguese language spoken in Brazil, according to Guillemin, Beaton and Bombardier (1993) and Beaton et al. (1998, 2000, 2007). The study was based on the following steps: a) Translation; b) Review and Synthesis of translations; c) Expert Committee; d) Back-translation; e) Re-evaluation of the scores of the results; f) Validation of face and content. Results: Two independent translations were performed from English to Portuguese by two professionals fluent in the intended language. After this process was finished, researcher, counselor and translator held meetings to generate a synthesis of all translations. The Expert Committee was composed of eight nurses from four regions of Brazil: South, Southeast, Northeast and Midwest. The minimum required Content Validity Ratio (CVR) value should be equal to or greater than 0.75, based on a calculation performed by a psychometrist, which was based on the Lawshe's Criterion (Wilson; Pan; Schumsky, 2012). The instrument as a whole was well evaluated by the Expert Committee, presenting good semantic and content validity, with CVR=1 (66.95%) and CVR of 0.75 to 1 in 175 CD:H VB items (73.23%). The 15 discordant items (6.28%), which received the CVR index of 0.75, suffered grammatical modifications for better instrument suitability. Only a back-translation from Portuguese to English and a revision of the instrument by an associate professor of the Nursing School of an American university was carried out, because the original authors could not do so. After rigorous transcultural translation and adaptation, the Child Drawing: Hospital instrument received its final version, with only grammatical adjustments and the replacement of crayons with colored pencils, which was considered the main cultural adaptation, since, in Brazil, the activities of drawing and painting are usually done with colored pencil, and not crayon. Conclusion: This study represents the first phase of the validation process of the CD:H instrument, offering translation and cultural adaptation. As a result, the instrument Child Drawing: Hospital Versao Brasileira (CD:H VB) was obtained. It can be concluded that the objectives of this study were achieved and that the CD:H VB instrument is able to have its validation process continued later in the future.

Trait vs. state anxiety in different threatening situations / Ansiedade traço versus ansiedade estado em diferentes situações de ameaça

Abstract Objective Anxiety as a uni- or multidimensional construct has been under discussion. The unidimensional approach assumes that there is a general trait anxiety, which predisposes the individuals to increases in state anxiety in various threatening situations. In this case, there should be a correlation between state and trait anxiety in any situation of threat. Therefore, the aim of this study was to investigate the correlation between trait and state anxiety in participants exposed to two different anxiogenic situations: interpersonal threat (Video-Monitored Stroop Test - VMST) and physical threat (third molar extraction - TME). Methods Participants with various levels of trait anxiety (general trait: State-Trait Anxiety Inventory - STAI, Hospital Anxiety and Depression Scale; specific trait: Social Phobia Inventory, Dental Anxiety Scale) had their anxious state evaluated (STAI, self-evaluation of tension level, heart rate, electromyogram activity) before, during and after the VMST or the TME. Results In VMST, trait anxiety correlated to state anxiety (psychological parameters) in all test phases. However, in TME, the only trait measurement that correlated to state anxiety (psychological parameters) was the Dental Anxiety Scale. Conclusion Trait anxiety correlates positively to state anxiety in situations of interpersonal threat, but not of physical threat.

Resumo Objetivo A ansiedade como um construto uni ou multidimensional tem estado em discussão. A abordagem unidimensional presume que há uma ansiedade-traço geral, a qual predispõe o indivíduo a aumentar a ansiedade-estado em situações de ameaça. Neste caso, deveria existir uma correlação entre estado e traço ansioso em diferentes situações ameaçadoras. Portanto, o objetivo deste estudo foi avaliar a correlação entre ansiedade-traço e ansiedade-estado em participantes que foram expostos a duas situações ansiogênicas diferentes: ameaça interpessoal (Teste de Stroop Monitorado por Vídeo - TSMV) e ameaça física (exodontia do terceiro molar - ETM). Métodos Participantes com vários níveis de ansiedade-traço (traço geral: Inventário de Ansiedade Traço-Estado - IDATE; Escala Hospitalar de Ansiedade e Depressão; traço específico: Inventário de Fobia Social, Escala de Ansiedade Dental de Corah) tiveram seus estados ansiosos avaliados (IDATE, escala analógica de tensão, frequência cardíaca, eletromiografia) antes, durante e depois do TSMV ou da ETM. Resultados No TSMV, a ansiedade-traço correlacionou-se com a ansiedade-estado (parâmetros psicológicos) em todas as fases do teste. Entretanto, na ETM, a única medida de traço que se correlacionou com a ansiedade-estado (parâmetros psicológicos) foi a Escala de Ansiedade Dental de Corah. Conclusão A ansiedade-traço correlaciona-se positivamente com a ansiedade-estado em situações de ameaça interpessoal, mas não de ameaça física.

Anxiety before dental surgery under local anesthesia: reducing the items on state anxiety in the State-Trait Anxiety Inventory-form X

BACKGROUND: It is important to evaluate preoperative anxiety and prepare sedation when performing dental surgery under local anesthesia. Spielberger's State-Trait Anxiety Inventory (STAI) is useful for predicting preoperative anxiety. State anxiety is defined as a subjective feeling of nervousness. Reduction in the number of the state anxiety items (questions) will be clinically important in allowing us to predict anxiety more easily. METHODS: We analyzed the STAI responses from 1,252 patients who visited our institution to undergo dental surgery under local anesthesia. Multiple linear regression analysis was conducted for 9 groups comprising anxiety level determinations using the STAI; we then developed a coefficient of determination and a regression formula. We searched for a group satisfying the largest number of requirements for regression expression while setting any necessary conditions for accurately predicting anxiety before dental surgery under local anesthesia. RESULTS: The regression expression from the group determined as normal for preoperative state anxiety was deemed the most suitable for predicting preoperative anxiety. CONCLUSIONS: It was possible to reduce the number of items in the STAI by focusing on “Preoperative anxiety before dental surgery.”

Moderating effect of emotional expressivity on relationship between test anxiety and working memory capacity / 中国心理卫生杂志

Objective:To investigate the moderating role of emotional expressivity in the relationship between test anxiety and working memory capacity (WMC).Methods:Totally 332 college students were selected.The Test Anxiety Inventory (TAI),Emotional Expressivity Inventory (EEI) and Arithmetic Operation-Word Memory Span Task (OSPAN) were used to measure the severity of test anxiety,working memory capacity,and degree of emotional expressivity,respectively.Results:TAI scores were negatively correlated with WMC scores (r =-0.36,P ＜0.01).Emotional expressivity had a moderating effect between scores of test anxiety and WMC (β =0.19,P ＜0.01).Test anxiety score negatively predicted WMC score in students with low emotional expressivity (β =-0.74,P ＜ 0.01),whereas it couldn't predict WMC in those with high emotional expressivity (β =-0.07,P ＞0.05).Conclusion:It suggests that higher emotional expressivity could buffer the negative effect of test anxiety on working memory capacity.

Análisis estructural y desarrollo de una versión breve de la versión en español del Inventario de Ansiedad ante Exámenes (TAI-E) en universitarios de Lima / Structural analysis and development of a short form of the Test Anxiety Inventory ­ Spanish version (TAI-S) in college students from Lima

El presente estudio tuvo como objetivos examinar la estructura interna de la versión en español del Inventario de Ansiedad ante Exámenes (TAI-E), y obtener una versión breve. Fue evaluada una muestra de 376 universitarios peruanos (73.1% mujeres) entre 16 y 55 años (M = 20.71). La estructura interna del TAI-E fue analizada mediante el modelamiento de ecuaciones estructurales (análisis factorial confirmatorio), y la versión breve fue obtenida teniendo como base un modelo Bifactor y criterios conceptuales. Fueron evaluados cuatro modelos: ortogonal, oblicuo, bifactor y unidimensional. En cuanto a los resultados, el TAI-E está constituido por una sola dimensión. Del mismo modo, la versión breve muestra indicadores robustos y evidencias de equivalencia empírica con la versión extensa. Finamente, las dos versiones mostraron coeficientes de confiabilidad con magnitudes elevadas. En conclusiones, las dos versiones estudiadas evidencias propiedades psicométricas favorables que respaldan su uso en el contexto peruano.

The aim of the present study is to examine the internal structure of the Test Anxiety Inventory-Spanish version (TAI-S) and have a brief version. It was assessed of a sample of 376 Peruvian university students (73.1% women) between 16 and 55 years old (M = 20.71). The internal structure of TAI-S was analyzed by using structural equation modeling (factorial confirmatory analysis) and the short version was obtained on the basis of a Bifactoral model and conceptual approaches. Four models were evaluated: orthogonal, oblique, bifactor and one-dimensional. As the result, the TAI-S is constituted by a single dimension. Likewise, the short version shows robust indicators and based on the empirical evidence with the long version. Finally, the two versions showed reliability coefficient with high magnitudes. In conclusion, the two version studied show favorable psychometric properties that support its use in the Peruvian context.

Written Educational Material Relieves Anxiety after Endoscopic Biopsy: A Prospective Randomized Controlled Study / 대한소화기학회지

BACKGROUND/AIMS: Patients who undergo endoscopic biopsy suffer anxiety until results are confirmed. This study assesses the effects of written educational material on the anxiety level of patients following endoscopic biopsy. METHODS: This study was a randomized controlled study trial with 83 patients divided into the following three groups: a biopsy group given written educational material prepared by our institution following the biopsy (intervention group, n=28), a biopsy group without written material (biopsy only group, n=25), and a control group without biopsy (control group, n=30). The anxiety level of each patient was evaluated three times using Spielberger's State-Trait Anxiety Inventory (STAI): for baseline at the first visit to our institution, at the day of endoscopy, one day later, and one week after the procedure. We compared baseline characteristics, STAI scores at each visit, and differences in STAI scores among the three groups. RESULTS: No difference was found in STAI score among groups at baseline and before and after the endoscopic procedure. However, the STAI-state score of the intervention group was slightly lower than biopsy only group one day post-procedure (40.3+/-7.7 vs. 43.9+/-7.1, p=0.135). The STAI-state score significantly decreased from pre- to post-procedure only in the intervention group (-2.75+/-6.1 vs. 0.92+/-4.0, p<0.027). CONCLUSIONS: Use of written educational material for patients having biopsy might lessen their anxiety level.

The Intervening Role of Alexithymia in the Relationship between Attachment Styles and Test Anxiety among Gifted High School Students / 가정의학회지

BACKGROUND: Given the importance of test anxiety among gifted students, the present study was conducted to assess the intervening role of alexithymia in the relationship between test anxiety and attachment styles. METHODS: By means of simple random sampling, 300 participants were selected out of all the students at two high schools in Khorramabad, which are affiliated with the Iranian National Organization for Development of Exceptional Talents (SAMPAD). Test anxiety, alexithymia, and attachment style questionnaires were used for data collection. Pearson correlation and path analysis tests were used to analyze the data. RESULTS: The results showed a positive relationship between test anxiety and avoidant and anxious attachment styles. Alexithymia and test anxiety were also positively related. Moreover, the results indicated that 12% of changes in test anxiety were explained by avoidant and anxious attachment styles as well as alexithymia. The relationship between the avoidant attachment style and test anxiety was 0.06 through alexithymia. However, no significant relationship between anxious attachment and test anxiety through alexithymia was found. CONCLUSION: The avoidant attachment style leads to test anxiety when the level of alexithymia increases in an individual.

The mediating effects of test anxiety on the relationship between socially-prescribed perfectionism and academic burnout of female college students in a dental hygiene department / 대한구강보건학회지

OBJECTIVES: The purpose of this study was to uncover the mediating effects of test anxiety on the relationship between socially prescribed perfectionism and academic burnout in enrolled in a dental hygiene department. METHODS: This study administered a survey consisting of the Socially Prescribed Perfectionism Scale, the Revised Test Anxiety Scale, and the Maslach Burnout Inventory-Student Survey to 310 female college students in the dental hygiene department at G City. The data were analyzed with correlation analysis using SPSS 21.0 and AMOS 20.0. partial mediating effects of test anxiety between socially prescribed perfectionism and academic burnout. RESULTS: The results suggest that the higher the levels of socially prescribed perfectionism, the greater the increase in academic burnout. In addition, socially prescribed perfectionism increases test anxiety when academic burnout is high. The analysis of mediating effects in the indirect path of the model revealed that adaptive socially prescribed perfectionism had a negative effect on academic burnout by increasing test anxiety. These findings and their implications were discussed. CONCLUSIONS: In order to reduce socially imposed perfectionism, it is necessary to reduce growing academic burnout, and test the value and success criteria of this model. There remains however, the fact that there is a need to focus on career goals and criteria that need to be met in order to be successful. By lowering test anxiety, psychological stability is improved and in turn, a stable college life enables dental hygiene students to more freely access psychological support. Therefore, a proactive attitude toward education is vital in preventing test anxiety and socially prescribed perfectionism.

Efficacy of Wrist-ankle Acupuncture plusAuricular Point Sticking for Pre-exam AnxietySyndrome / 上海针灸杂志

ObjectiveTo observe the efficacy of wrist-ankle acupuncture plus auricular point sticking in treating pre-exam anxiety syndrome.MethodSixty patients with pre-exam anxiety syndrome were randomized into a treatment group to receive wrist-ankle acupuncture plus auricular point sticking (30 cases, 11 cases dropped out) and a control group to receive auricular point sticking (30 cases, 1 dropped out). In the treatment group, the bilateral Upper 1 zones were punctured regarding the wrist-ankle acupuncture, and for the auricular point sticking, Heart (CO 15), ear Shenmen (TF 4), Endocrine (CO 18), Adrenal Gland (TG 2p), Subcortex (AT 4) were selected. In the controlgroup, the same auricular points were treated. For both groups, the intervention began from 1 week prior to the exam, 3 d as a treatment course, and the therapeutic efficacy was evaluated after 2 successive courses. The Sarason Test Anxiety Scale (TAS) and autonomic function test were used to assess the anxiety severity before and after treatment. ResultThe total effective rate was 84.2% (16/19) in the treatment group versus 82.8% (24/29) in the control group, and the difference was statistically insignificant (P>0.05). The TAS score dropped significantly in the control group after intervention (P<0.01).ConclusionWrist-ankle acupuncture plus auricular point sticking and auricular point sticking alone both can effectively improve the symptoms of pre-exam anxietysyndrome.