The Impact of the COVID-19 Pandemic on Medical Education: a Systematic Review of Distance Learning, Student's Perceptions, and Mental Health

Introduction: the COVID-19 pandemic has impacted on mortality and several adverse health outcomes. It has also affected education as schools and universities had to adapt to remote learning due to social isolation strategies.Objective: to analyze the pandemic's impact on medical education including undergraduate and graduate students and lecturers, as follow: i) teaching methods adopted by education institutes during shutdown, ii) students and lecturers' perceptions and iii) impacts on students' mental health.Methods: this systematic review includes the following study designs: cross-sectional, surveys, case-control, cohort, and clinical trials. The literature search was performed in four databases: PubMed, Scopus, Embase, and SciELO . The risk of bias and the quality of the evidence were evaluated.Results: a total of 1,576 articles were identified through searching databases, and 40 articles were included. We found the use of several teaching methods such as virtual platforms and social media, pre-recorded videos, discussion forums and others. Student's challenges related to interference during online study such as family distractions, lack of a study room, challenges with internet connectivity, difficulties in communication between students and lecturers, gaps encountered during clinical skills learning. Lecturers' challenges were difficulty in grasping students' progress and learning outcomes and the lack of experience in online teaching. Only five studies explored mental health issues of medical students and found the occurrence of depression, anxiety, and stress. However, their prevalence was not comparable due to the use of different diagnostic instruments.Conclusion: there has been a wide range of teaching methods implemented for distance learning of medical students globally. The perceptions of medical students about these methods and their impact were also varied. Infrastructure, family, and curriculum problems represented the greatest difficulties in adherence and satisfaction with distance learning. However, the flexibility of digital learning was one of the factors that helped reduce these problems. Regarding mental health, the occurrence of anxiety, depression, and stress was reported.

Introdução: a pandemia de COVID-19 teve impacto na mortalidade e em vários resultados adversos para a saúde. Também afetou a educação, pois escolas e universidades tiveram que se adaptar ao ensino remoto devido às estratégias de isolamento social.Objetivo: analisar o impacto da pandemia na educação médica, incluindo alunos de graduação e pós-graduação e professores, a saber: i) métodos de ensino adotados pelas instituições de ensino durante a paralisação, ii) percepções de alunos e professores e iii) impactos na saúde mental dos alunos.Método: esta revisão sistemática inclui os seguintes desenhos de estudo: transversal, surveys, caso-controle, coorte e ensaios clínicos. A pesquisa bibliográfica foi realizada em quatro bases de dados: PubMed, Scopus, Embase e SciELO. O risco de viés e a qualidade da evidência foram avaliados.Resultados: um total de 1.576 artigos foram identificados por meio de busca em bancos de dados, e 40 artigos foram incluídos. Constatamos a utilização de diversos métodos de ensino como plataformas virtuais e redes sociais, vídeos pré-gravados, fóruns de discussão e outros. Desafios dos alunos relacionados à interferência durante o estudo online, como distrações familiares, falta de uma sala de estudo, desafios com conectividade à Internet, dificuldades de comunicação entre alunos e professores, lacunas encontradas durante o aprendizado de habilidades clínicas. Os desafios dos professores foram a dificuldade em compreender o progresso dos alunos e os resultados de aprendizagem e a falta de experiência no ensino online. Apenas cinco estudos exploraram questões de saúde mental de estudantes de medicina e encontraram a ocorrência de depressão, ansiedade e estresse. No entanto, sua prevalência não foi comparável devido ao uso de diferentes instrumentos de diagnóstico.Conclusão: existe uma ampla gama de métodos de ensino implementados para o ensino a distância de estudantes de medicina em todo o mundo. As percepções dos estudantes de medicina sobre esses métodos e seu impacto também foram variadas. Problemas de infraestrutura, família e currículo representaram as maiores dificuldades de adesão e satisfação com o ensino a distância. No entanto, a flexibilidade do aprendizado digital foi um dos fatores que ajudou a reduzir esses problemas. Em relação à saúde mental, foi relatada a ocorrência de ansiedade, depressão e estresse.

Prevalencia y características clínicas de los síntomas depresivos y ansiosos de los trabajadores de una institución de salud en Medellín durante la pandemia por COVID-19

Introducción: Afrontar las circunstancias de la vida y el trabajo que la pandemia por COVID-19 ha impuesto al personal sanitario implica un reto extraordinario: cuidar y atender a otros, exponiéndose a sí mismos al contagio. A médicos, enfermeras, terapeutas y demás personal asistencial y no asistencial en clínicas y hospitales, se les pide estar preparados para trabajar en situaciones extraordinariamente complejas y estresantes, lo que los hace vulnerables a problemas mentales. Objetivo: Determinar la prevalencia y las características clínicas de los síntomas ansiosos y depresivos del personal que trabaja en una institución de salud en Medellín, Colombia. Métodos: Estudio observacional, descriptivo y transversal, a partir de una encuesta disenada al efecto, la cual incluyó 2 escalas para tamizar síntomas depresivos y ansiosos, además de variables sociodemográficas. Resultados: Se incluyó a 1.247 trabajadores de la institución de salud. El 14,6% reportó síntomas depresivos y el 18,5%, ansiosos clínicamente significativos. Se encontró una mayor proporción de síntomas depresivos y ansiosos moderados-graves en la modalidad de trabajo presencial. Conclusiones: Los síntomas ansiosos y depresivos son muy prevalentes entre los trabajadores de una institución de salud de Medellín durante la pandemia de COVID-19. Dado el papel vital del sector salud en tiempos de pandemia, el desarrollo de programas de salud mental que aborden los problemas de esta población debería considerarse una prioridad.

Introduction: The COVID-19 pandemic has represented an extraordinary challenge for health workers as they care for others while exposing themselves to contagion. Doctors, nurses, therapists and other non-care staff in clinics and hospitals are asked to be prepared to work in particularly complex and stressful situations, which makes them vulnerable to mental health problems. Objective: To determine the prevalence and clinical characteristics of anxiety and depression symptoms in staff working at a health institution in Medellin, Colombia. Methods: Observational, descriptive and cross-sectional study, based on a survey designed for the investigation, which included two scales to screen depression and anxiety symptoms, as well as sociodemographic variables. Results: A total of 1,247 workers from the health institution were included. Of these, 14.6% reported symptoms of depression and 18.5% of clinically significant anxiety. A higher proportion of moderate to severe depression and anxiety symptoms was found in those working face to face. Conclusions: Anxiety and depression symptoms are highly prevalent among staff at a health institution in Medellin, Colombia, during the COVID-19 pandemic. Given the vital role of the health sector in times of pandemic, the development of mental health programmes that address the problems of this population should be considered a priority.

Potencial terapêutico dos canabinoides na ansiedade e depressão: uma revisão integrativa da literatura / Therapeutic potential of cannabinoids in anxiety and depression: an integrative review of the literature / Potencial terapéutico de canabinoides en ansiedad y depresión: una revisión integrativa de la literatura

Introdução: Os transtornos psiquiátricos, principalmente ansiedade e depressão, são queixas muito prevalentes na população mundial. Atualmente, esse fato move a comunidade científica a realizar estudos para avaliar alternativas que possam contribuir no tratamento dessas doenças. Por isso, a Cannabis Medicinal (CM) vem ganhando espaço na sociedade e parece ser uma opção terapêutica viável e vantajosa. Objetivo: Evidenciar os possíveis usos terapêuticos dos componentes presentes na planta Cannabis no manejo da ansiedade e depressão. Métodos: Trata-se de uma revisão bibliográfica integrativa, elaborada a partir de trabalhos científicos acerca da ação da Cannabis Medicinal como uma alternativa para o tratamento da ansiedade e depressão. Foram considerados artigos originais e completos publicados em português, espanhol e inglês nos últimos dez anos, de 2013 até 2023, obtidos nas plataformas SCIELO, PUBMED e LILACS. Resultados: As substâncias presentes na planta Cannabis, principalmente o Canabidiol (CBD), parecem ser uma opção promissora e potencialmente benéfica, especialmente para os casos que não respondem aos tratamentos convencionais. Conclusão: A partir dos estudos analisados, evidencia-se que os estudos atuais disponíveis sobre a eficácia dos canabinoides no tratamento dos transtornos mentais são de qualidade variável. Sendo assim, apesar da CM ser uma possível opção para o tratamento de transtornos mentais, ainda se faz necessária a realização de mais pesquisas para elucidar plenamente como funcionaria sua utilização na prática clínica. PALAVRAS-CHAVE: Uso Terapêutico da Cannabis; Depressão; Ansiedade; Revisão Integrativa.

Introduction: Psychiatric disorders, mainly anxiety and depression, are very prevalent complaints in the world population. At the moment, this fact is driving the scientific community to carry out studies to evaluate alternatives that may contribute towards the treatment of these diseases. For this reason, Medicinal Cannabis (CM) has been gaining space in society and seems to be a viable and advantageous therapeutic option. Objective: To show the possible therapeutic uses of the components present in the Cannabis plant in the management of anxiety and depression. Methods: It is an integrative bibliographic review, elaborated from scientific papers about the action of Medicinal Cannabis as an alternative for the treatment of anxiety and depression. They were considered original and complete articles published in Portuguese, Spanish and English in the last ten years, from 2013 until 2023, obtained on the platforms SCIELO, PUBMED and LILACS. Results: The substances present in the Cannabis plant, mainly Cannabidiol (CBD), seem to be a promising and potentially beneficial option, especially for cases that do not respond to conventional treatments. Conclusion: From the studies analyzed, it is evident that the current available studies on the efficacy of cannabinoids in the treatment of mental disorders are of variable quality. Therefore, although CM is a possible option for the treatment of mental disorders, it is still necessary to carry out more research to fully elucidate how its use would work in clinical practice.

Introducción: los trastornos psiquiátricos, principalmente la ansiedad y la depresión, son quejas muy frecuentes en la población mundial. Por el momento, este hecho está llevando a la comunidad científica a realizar estudios para evaluar alternativas que puedan contribuir al tratamiento de estas enfermedades. Por esta razón, el Medicamento de Cannabis (CM) ha venido ganando espacio en la sociedad y parece ser una opción terapéutica viable y ventajosa. Objetivo: destacar los posibles usos terapéuticos de los componentes presentes en la planta de Cannabis en el manejo de la ansiedad y la depresión. Métodos: Se trata de una revisión bibliográfica integradora, elaborada sobre la base de un trabajo científico sobre la acción del Medicinal Cannabis como alternativa para el tratamiento de la ansiedad y la depresión. Se consideraron artículos originales y completos publicados en portugués, español e inglés en los últimos 10 años de 2013 a 2023, obtenidos en las plataformas SCIELO, PUBMED y LILACS. Resultados: Las sustancias presentes en la planta Cannabis, principalmente Canabidiol (CBD), parecen ser una opción prometedora y potencialmente beneficiosa, especialmente en los casos que no responden a tratamientos convencionales. Conclusión: De los estudios analizados se desprende que los estudios actuales disponibles sobre la eficacia de los cannabinoides en el tratamiento de los trastornos mentales son de calidad variable. Por lo tanto, aunque la MPC es una posible opción para el tratamiento de los trastornos mentales, todavía se necesita una investigación más profunda para explicar plenamente cómo funcionaría su uso en la práctica clínica.

Psychological impact of the COVID-19 pandemic on anaesthetists in an academic institution in South Africa

Background: Anaesthesiology is considered to be a medical speciality that can result in high levels of stress. The COVID-19 pandemic required anaesthetists to rapidly adopt additional challenging roles. This study describes the psychological impact of the pandemic on anaesthetists and identified and compared factors associated with depression, anxiety, stress, and post-traumatic stress disorder (PTSD). Methods: A cross-sectional study design was used. An anonymous questionnaire was used to collect data utilising convenience sampling and results were reported using descriptive statistics and logistic regression analysis. The order of importance for the sources of stress and organisational support was determined by calculating the median rank. Results: The majority of the participants were between ages 31­40 (62.6%), male (59.8%), registrars (47.6%), had no comorbidities (73.8%), and had no known mental illness (79.9%). Having a previous diagnosis of a mental health illness was linked with greater levels of depression (OR [95% CI] = 4.50 [2.02­10.24], p < 0.001), anxiety(OR [95% CI] = 3.9 [1.7­9.0], p = 0.001), stress (OR [95% CI] = 3.8 [1.6­9.2], p = 0.002), and PTSD (OR [95% CI] = 5.4 [2.2­13.5], p < 0.001). Sources of stress identified included: insecure access to appropriate personal protective equipment, being exposed to COVID-19 at work, and taking the infection home to family. Conclusion: Participants with a history of mental illness were predisposed to developing negative psychological symptoms as a result of the pandemic. The main source of stress identified was insecure access to appropriate personal protective equipment.

A multivariate generalizability analysis of the short version of depression-anxiety-stress scale / 中华行为医学与脑科学杂志

Objective:To test the reliability of the short version of the depression-anxiety-stress scale (DASS-21) in adolescents through generalizability theory.Methods:Total of 458 adolescents from three middle schools in Guizhou and Sichuan province were surveyed with the DASS-21 from November to December 2021.Based on multivariate generalization theory(MGT), the generalization coefficients, reliability indexes and variance contribution ratios were calculated.mGENOVA 2.1 was used for data analysis.Results:The generalizability coefficient and reliability index for the total scale of DASS-21 were 0.927 and 0.922, respectively.The generalizability coefficients of depression, anxiety and stress subscales were 0.808-0.840, and the dependability indexes were 0.789-0.832.The contribution ratios of depression, anxiety and stress subscales to the general score were 33.20%, 33.94% and 32.86%, respectively.The stress subscale (34.95%) contributed the most to the relative error variance, and the anxiety subscale (36.98%) contributed the most to the absolute error variance.Conclusion:The DASS-21 has excellent test reliability in adolescents, and it can be used both as the norm-referenced test and the criterion-referenced test in the actual assessment of negative emotions in adolescents.

Anxiety, Depression and Stress Among Medical Students in Malaysia During COVID-19: A Cross-Sectional Study

@#Introduction: This study aimed to determine the prevalence and factors associated with psychological distress following the COVID-19 pandemic among medical students at one of the public universities in Malaysia. Method: From August to October 2020, a web-based cross-sectional study was conducted among undergraduate medical students at a public university. DASS-21, Brief Resilience Scale and WHOQOL-Bref questionnaires were used in this study. Results: The prevalence of depression was 40.5%, anxiety 46.0% and stress 30.9%. Based on multivariate logistic regression, a higher quality of life score is associated with a lower likelihood of depression (AOR=0.583, p<0.001), anxiety (AOR=0.726, p<0.001), and stress, (AOR=0.702, p<0.001) respectively. Likewise, a higher resilience score is less likely to be associated with depression (AOR=0.880, p=0.002), anxiety (AOR=0.880, p=0.002), and stress (AOR=0.850, p<0.001). Older age (OR=0.700, p=0.020) was associated with less stress and being on campus (OR=3.436, p=0.021) was at risk of stress during the COVID-19 pandemic. Conclusion: Our results suggest that medical students with higher quality of life and resilience scores had less depression, anxiety and stress. Older age was associated with less stress, and during the COVID-19 pandemic, being on campus was at risk of stress. Various stakeholders need to keep these findings in mind and identify those who are at risk for developing depression, anxiety, and stress in order to take further action to improve their quality of life and resilience

Associations between Sociodemographic, Body Mass Index, Body Image Perception, Physical Activity and Sleep Quality with Mental Health among University Students in Universiti Putra Malaysia during the COVID-19 Pandemic

@#Introduction: Mental health problem among university students during COVID-19 pandemic became one of the global main issues. There is limited study on mental health among university student during COVID-19 pandemic. Therefore, this study aimed to determine the associations between socio-demographic, body mass index, body image perception, physical activity and sleep quality with mental health among university students in Universiti Putra Malaysia. Methods: This is a cross-sectional study with a total sample of 130 students aged 18 to 25 years old which were recruited through a multistage sampling. An English online self-administered questionnaire was used to collect the data on socio-demographic characteristics, weight and height, body image perception (BSQ-8C), physical activity (GPAQ), sleep quality (PSQI), and mental health (DASS-21). Results: Majority of the respondents were female (76.2%), Malay (78.5%), in second year of study (28.5%), from low income family (59.2%) and stayed with parents during COVID-19 pandemic (57.7%). Results showed 44.6% of respondents had depressive symptoms, 56.9% had anxiety symptoms and 29.2% had stress symptoms with severity mild to extremely severe. Body mass index (r=0.205, p<0.005), body image perception (r=0.538, p<0.001), and sleep quality (r=0.460, p<0.001) were associated with depression subscale. Meanwhile, body image perception (r=0.449, p<0.001), and sleep quality (r=0.450, p<0.001) were correlated with anxiety subscale. Stress subscale was correlated with body image perception (r=0.473, p<0.001) and sleep quality (r=0.492, p<0.001). Conclusion: Affected students should be helped and referred to healthcare practitioner to ensure they able to overcome with these problems and remains healthy during this pandemic.

Prevalence of Mental Health Problems Among University Students and Association With Body Mass Index (BMI) and Diet Quality

@#Introduction: Numerous factors contributed to the susceptibility of university students to develop mental health issues. Objective: This study aimed to assess the prevalence of mental health problems among International Islamic University Malaysia (IIUM) students and their relationships with diet quality and body mass index (BMI). Methods: A cross-sectional study was conducted among 104 students. The Depression, Anxiety, and Stress Scale (DASS-21) was used to assess students’ depression, anxiety, and stress levels. The Malaysian Healthy Eating Index (M-HEI) was used to assess diet quality. Spearman Rho was used to determine the relationships between variables. Results: Approximately 69.4% (n = 34), 71.4% (n = 35), and 48.9% (n = 34) of male students experienced moderate to extremely severe symptoms of depression, anxiety, and stress, respectively. In contrast, 85.4% (n = 47), 89.1% (n = 49), and 54.6% (n = 30) of female students had moderate to extremely severe symptoms of depression, anxiety, and stress, respectively. No correlations were found between diet quality and BMI with students’ mental health problems. For male students, there were negative significant associations reported between fat-rich foods (r = -0.447, p-value = 0.001) and sugar-rich foods (r = -0.332, p-value = 0.020) intake with depression; a positive significant relationship between fruit intake and anxiety (r = 0.284, p-value = 0.048); a positive relationship between fruit intake and stress (r = 0.300, p-value = 0.036); and a negative relationship between fat-rich foods and stress (r = -0.293, p-value = 0.041). Female students only had a significant negative correlation between fish intake and anxiety (r = -0.376, p-value = 0.005). Conclusion: No associations were found between diet quality, BMI, and mental health problems. A more profound comprehension of the connections between risk factors and mental health could lead to new intervention strategies.

Multiple linear regression approach to deduce Internet addiction impact on the psychosocial wellness of young medical students

Background: The Internet is an inevitable part of life especially in the education sector, but at the same time irrational use of the Internet causes behavioral disorders. A high number of personality disorders such as impulsive behavior, depression, anxiety, and stress were also observed among medical students. Aim and Objectives: Hence, the present study hypothesized to find out the association of depression, anxiety, and stress with Internet addiction (IA) among young medical students. Materials and Methods: A cross-sectional survey was conducted among 250 1st-year medical students after taking ethics approval and written informed consent. Personal information and socio-demographic profile of participants were obtained. Young IA Test and Depression Anxiety Stress Scale (DASS-21) survey questionnaire was self-administered by participants. To identify the risk and protective factors for IA with DASS-21 step-wise multiple linear regression analyses were performed. Results: The prevalence of IA was 24.0 % with mean scores (±Standard Deviation [SD]) of 39.01 (±16.99) among the medical students. Depression, anxiety, and stress mean scores (±SD) were 5.44 (±4.21), 4.94 (±3.84), 6.77 (±3.83), respectively. Students with IA had a statistically significant difference (P = 0.001) in all domains of DASS-21 over the non-internet addicted. A statistically significant positive relationship of IA with depression (coefficient of determination (R2), (R2 = 0.22)), anxiety (R2 = 0.26), and stress (R2 = 0.33) were observed. Conclusions: 1/4th of the medical students were internet-addicted and 3.0% having severe anxiety. 22.0% of depression, 26.0% of anxiety, and 33.0% of stress among young medical students are attributable to IA. The rational use of the internet should be learned for psychological health and well-being.

Salud mental de médicos y enfermeras en situaciones de crisis sanitaria / Mental health of doctors and nurses in health crisis situations

RESUMEN Introducción: La pandemia de la COVID-19 ha generado muchas repercusiones en la salud mental de la población, sobre todo en aquellos que se encuentran trabajando en la primera línea de atención. Objetivo: Caracterizar al personal de la salud de primera línea, según el nivel de depresión, ansiedad y estrés, en el contexto de la pandemia por la COVID-19. Métodos: Estudio observacional, descriptivo y transversal. Se encuestó a profesionales de la salud involucrados en la atención de primera línea a pacientes COVID-19 en áreas críticas, entre octubre y diciembre de 2020. Se utilizó la Escala de depresión, ansiedad y estrés para medir las variables dependientes; además, se recolectaron las variables epidemiológicas: sexo, edad y tipo de profesión. Se realizó un análisis descriptivo de los datos mediante tablas de frecuencias/porcentajes y tablas cruzadas. Resultados: De los 86 médicos y enfermeros encuestados, el 36,05 % presentaba depresión, a predominio del nivel moderado, 55,81 % presentaba ansiedad a predominio del nivel leve y 53,49 % presentaba estrés, a predominio del nivel leve. Se encontraron mayores niveles de depresión (71 %), ansiedad (75 %) y estrés en el personal del sexo femenino (73,91 %), en el grupo etario de 41-60 años se encontraron mayores niveles de estrés (64,52 %), ansiedad (64,58 %) y estrés (30,43 %); en el grupo profesional de enfermeros se encontraron mayores niveles de depresión (67,71 %), ansiedad (72,92 %) y estrés (67,39 %). Conclusión: De los 3 trastornos psicopatológicos estudiados en los profesionales de la salud, se presenta en mayor porcentaje la ansiedad, seguido del estrés y la depresión. Los participantes de sexo femenino, el grupo etario de 41-60 años y los enfermeros, presentan mayores niveles de depresión, ansiedad y estrés.

ABSTRACT Introduction: The COVID-19 pandemic has generated many repercussions in the mental health of the population, especially in those working in the front line of care. Objective: To characterize front-line health care personnel according to the level of depression, anxiety, and stress in the context of the COVID-19 pandemic. Methods: Observational, descriptive, cross-sectional study. Health professionals involved in the first-line care of COVID-19 patients in critical areas were surveyed between October and December 2020. The Depression Anxiety and Stress Scale was used to measure the dependent variables; in addition, epidemiological variables were collected: sex, age and type of profession. A descriptive analysis of the data was performed using frequency/percentage tables and cross tables. Results: Of the 86 physicians and nurses surveyed, 36.05 % presented depression, predominantly at the moderate level, 55.81 % presented anxiety, predominantly at the mild level, and 53.49 % presented stress, predominantly at the mild level. Higher levels of depression (71 %), anxiety (75 %) and stress were found in female personnel (73.91 %), in the 41-60 age group higher levels of stress (64.52 %), anxiety (64.58 %) and stress (30.43 %) were found, and in the professional group of nurses higher levels of depression (67.71 %), anxiety (72.92 %) and stress (67.39 %) were found. Conclusion: Of the 3 psychopathological disorders studied in the health professionals, the one with the highest percentage is anxiety, followed by stress and depression. Female participants, the 41-60 years age group, and nurses have higher levels of depression, anxiety and stress.

Contemporary prevalence and predictors of anxiety among patients living with HIVAIDS in Ghana

Objectives: To identify the prevalence and associated factors of anxiety in people living with HIV/AIDS in a tertiary centre in Ghana. Design: The study employed a cross-sectional design. Setting: The study was conducted in the outpatient HIV clinic of a tertiary hospital. Participants: Participants were adult PLWHA receiving OPD care, including those established on combined antiretroviral therapy (cART) and newer patients who were not on cART. Four hundred ninety-five participants aged ≥30 years were consecutively enrolled on the study. Interventions: Demographic and clinical data were collected using standard questionnaires and patient files. Anxiety was assessed using the Hospital Anxiety and Depression Scale (HADS). Multivariate logistic regression analysis was done to identify associated factors. Main outcome measure: Proportion of PLWHA who had HADS score of ≥8 Results: Overall prevalence of anxiety was 61.0% (95%CI: 56.6 ­ 65.3), with no significant difference between recently diagnosed (≤ 6 months, 64.3%) and those with established diagnoses (>6 months, 59.1%). Urban residence (aOR: 1.67, 95%CI: 1.12 ­ 2.51), alcohol use (aOR: 1.64, 95%CI: 1.13 ­ 2.38) and depression (aOR: 13.62, 95%CI: 7.91 ­ 23.45) were independently associated with anxiety. Conclusion: In this sample, 6 in 10 Ghanaian PLWHA had evidence of anxiety. Liaison with the national mental health service for more comprehensive and integrated care and further research into the mental health of PLWHA is recommended to reduce this high burden of anxiety

Comorbid anxiety and depression among women receiving care for breast cancer: analysis of prevalence and associated factors

Background: Living with breast cancer has been associated with increased risk for common mental health problems including depression and anxiety. However, the prevalence of comorbid anxiety and depression (CAD) and their associated factors have received little attention especially in low- and middle-income countries (LMICs) including Ghana. Objectives: This study examined the prevalence of CAD and its correlates in the context of breast cancer. Methods: Participants were 205 women receiving care for breast cancer at a Tertiary Hospital in Ghana. The Hospital Anxiety and Depression Scale (HADS) and socio-demographic questionnaires were administered to the participants. Results: Findings from the study showed that the prevalence of CAD, anxiety and depression was 29.4%, 48.5% and 37.3% respectively. CAD was significantly predicted by patients' English language reading ability, shared decision making and good doctor-patient relationship. Anxiety was significantly predicted by shared decision making and good doctor-patient relationship whereas depression was significantly predicted educational status, patients' English language reading ability, shared decision making and good doctor-patient relationship. Conclusion: The findings suggest relatively high prevalence of comorbid anxiety and depression which could negatively impact breast cancer treatment outcomes and therefore, improved interpersonal relationships between doctors and their patients as well as literacy skills are warranted

Evaluation of depression and anxiety symptoms, alcohol consumption, and binge eating in older adults undergoing bariatric surgery: a 6-year follow-up / Avaliação dos sintomas de depressão e ansiedade, consumo de álcool e compulsão alimentar em idosos submetidos à cirurgia bariátrica: seguimento de 6 anos

INTRODUCTION: The literature remains scarce on the late effects of bariatric surgery on the general health of patients who underwent such procedures at an older age. The present study aimed to evaluate depression and anxiety symptoms, risky alcohol consumption, and binge eating in older adults undergoing bariatric surgery. METHODS: This study used current data (from medical records and tests) to conduct a cross-sectional study. A total of 74 individuals aged 60 years and older who underwent bariatric surgery after 55 years of age at a specialist center for obesity management located in Brazil were included and evaluated by the Beck Depression Inventory, Beck Anxiety Inventory, Alcohol Use Disorders Identification Test, and Binge Eating Scale. Demographic and clinical data related to the surgical procedure (weight loss) were also collected. The Cochran-Armitage trend test, Pearson's χ2 test, and a multiple linear regression model were used as needed. A p < 0.05 was considered significant. RESULTS: The individuals were white (65.70%) and women (78.30%), with a mean age of 65.8 (SD 3.90) years. The mean time elapsed from surgery to evaluation was 75.70 (SD 43.70) months; 10.80% of the participants had moderate to severe depression, 8.10% moderate to severe anxiety, and 5.40% risky or high-risk alcohol consumption. None of the participants had binge eating problems. Weight regain was not associated with depressive symptom severity or risky alcohol consumption, but it was significantly associated (p = 0.034) with few or neither anxiety symptoms. Excess weight loss was not associated with any study variable. CONCLUSION: The results show a low prevalence of mental symptoms in older adults undergoing bariatric surgery compared to data from the literature on younger adults undergoing the same procedure.

INTRODUÇÃO: A literatura ainda é escassa sobre os efeitos tardios na saúde geral de pacientes idosos submetidos à cirurgia bariátrica. O presente estudo teve como objetivo avaliar os sintomas de depressão e ansiedade, consumo de álcool de risco e compulsão alimentar em idosos submetidos à cirurgia bariátrica. METODOLOGIA: Este estudo utilizou dados atuais (de prontuários e exames) para realizar um estudo transversal. Um total de 74 indivíduos com 60 anos ou mais que se submeteram à cirurgia bariátrica após os 55 anos em um centro especializado em tratamento da obesidade localizado no Brasil foram incluídos e avaliados pelo Inventário de Depressão e Ansiedade de Beck, Alcohol Use Disorders Identification e Escala de compulsão alimentar. Dados demográficos e clínicos relacionados ao procedimento cirúrgico (perda de peso) também foram coletados. O teste de tendência Cochran-Armitage, o teste do χ2 de Pearson e um modelo de regressão linear múltipla foram usados conforme necessidade. Um p < 0,05 foi considerado significativo. RESULTADOS: Os indivíduos em sua maioria eram brancos (65,70%) e mulheres (78,30%), com média de idade de 65,8 (DP 3,90) anos. O tempo médio decorrido desde a cirurgia até a avaliação foi de 75,70 (DP 43,70) meses; 10,80% dos participantes tinham depressão moderada a grave, 8,10% ansiedade moderada a grave e 5,40% consumo de álcool de risco ou alto risco. Nenhum dos participantes teve problemas de compulsão alimentar. O ganho de peso não foi associado à gravidade dos sintomas depressivos ou consumo de álcool de risco, mas foi significativamente associado (p = 0,034) com poucos ou nenhum sintoma de ansiedade. A perda de excesso de peso não se associou a nenhuma variável do estudo. CONCLUSÕES: Os resultados mostram baixa prevalência de sintomas mentais em idosos submetidos à cirurgia bariátrica em comparação com dados da literatura em adultos jovens submetidos ao mesmo procedimento.

Auriculoterapia em profissionais de enfermagem na pandemia do coronavírus: estudo de casos múltiplos / Auriculotherapy in nursing professionals during the coronavirus pandemic: a multiple case study

Objetivou avaliar o efeito antes e depois de uma sessão de auriculoterapia nos níveis de ansiedade, depressão e estresse nos profissionais de enfermagem escalados para atuar na assistência durante a pandemia do coronavírus. Estudo de caso, com casos múltiplos e uma unidade de análise. Estabeleceu-se uma amostra por conveniência de 41 profissionais. Aplicou-se o instrumento de caracterização sociodemográfica e a escala de Depression, Anxiety, and Stress Scale, antes e após uma sessão de auriculoterapia com protocolo de 10 acupontos. Teste de Wilcoxon e T emparelhado foram empregados para análise. Níveis de ansiedade, depressão e estresse apresentaram resultados significativos, cujas medianas reduziram de seis para quatro (p<0,001), nas variáveis depressão e ansiedade, e a média de estresse reduziu de 19,37 para 11,95 (p<0,001). A auriculoterapia foi efetiva na redução de distúrbios emocionais nos profissionais de enfermagem.

This study aimed to evaluate the levels of anxiety, depression and stress before and after an auriculotherapy session, in nursing professionals working during the coronavirus pandemic. Case study, with multiple cases and one unit of analysis. A convenience sample of 41 professionals was established. The sociodemographic characterization instrument and the Depression, Anxiety, and Stress Scale were applied before and after an auriculotherapy session with a 10-acupoint protocol. The Wilcoxon and t tests were paired for analysis. Anxiety, depression and stress levels showed significant results, the medians decreased from six to four (p<0.001), in the variables depression and anxiety, and the average stress decreased from 19.37 to 11.95 (p<0.001). Auriculotherapy was effective in reducing emotional disorders in nursing professionals.

Effect of acupuncture on the cognitive function of migraine patients with depression/anxiety disorder / 中国针灸

OBJECTIVE@#To observe the effect of five-element acupuncture on the cognitive function repair of migraine patients with depression/anxiety disorder.@*METHODS@#The migraine patients with depression/anxiety disorder (19 cases, 5 cases dropped off) were taken as the observation group, and received five-element acupuncture twice a week for 8 weeks. Healthy subjects (19 cases) were selected by demographic data matching as the control group. The cognitive function was evaluated with the event related potential (ERP) technique, and the latency and amplitude of visual evoked potential P300 were adopted as the observation indexes. The headache days (every 4 weeks), headache intensity [visual analogue scale(VAS) score], and headache impact test-6 (HIT-6) score, Hamilton depression scale (HAMD) score and Hamilton anxiety scale (HAMA) score were used as the observation indexes for curative effect.@*RESULTS@#Before the treatment, latency of target stimulus at Fz [ (417.5±34.3) ms] in the observation group was extended compared with the healthy subjects of the control group [(388.6±42.1) ms, @*CONCLUSION@#There are some cognitive impairments in migraine patients with depression/anxiety disorder. Five-element acupuncture not only relieves headache, anxiety and depression effectively, but also improves the activation level of the frontal lobe. It significantly repairs the impaired cognitive function.

Association between Psychological Status and Functional Outcome in Surgically Managed Fractures around Hip in Geriatric Patients - A Prospective Study

@#Introduction: Fractures around the hip in the geriatric population not only lead to functional but also psychological impairment. Psychiatric disturbances can be associated with poor participation in rehabilitation, increased risk of falling again, and higher rates of mortality. The present study was undertaken to assess the association between the psychological status and functional outcome of surgically managed elderly Indian patients who had sustained fractures around the hip. Materials and methods: The present study was a hospital based prospective, single centre study. One hundred and two geriatric patients who had sustained hip fracture and had been managed surgically, having no cognitive dysfunction, living independently, having unhindered walking capability before the fracture, were included in the study. They were called for follow-up at 3rd, 6th, and 12th month after the hip surgery. Psychological assessment was done by the Hospital Anxiety and Depression Scale (HADS) and functional outcome by using the Harris hip score (HHS). Results: Our study did not show association between psychological status and functional outcome except in one sub-group. Significant correlation was observed between the psychological status and functional outcome in most of the patients in the extra-capsular group. We have identified improvement in the depression, anxiety and functional scores during the follow-up. Conclusion: We conclude that psychiatric disturbances in a geriatric patient after undergoing a surgery for hip fracture may lead to poor recovery. We recommend that all such geriatric patients should undergo a psychological assessment and proper therapy should be instituted to achieve good functional recovery

Empowering Single Mothers through Creative Group Counselling: An Effective Intervention to Improve Mental Wellbeing

@#Introduction: Single parent families, especially, those headed by single mothers are becoming increasingly common around the world especially in Malaysia. Single mothers generally suffer from poorer mental health, job discrimination, abuse and neglect. Hence, they often experience high anxiety, depression, and stress. This calls for research to empower their mental wellbeing. The present study examined the effectiveness of creative group counselling in increasing self-compassion, and decreasing depression, anxiety and stress among single mothers. Methods: A quasi experimental pre-test post-test design was employed in the study. Research participants consisted of 36 single mothers placed in two experimental and two control groups. The instruments used were Self-Compassion Scale and Depression Anxiety and Stress Scale. A self-compassion module was developed that comprised creative therapeutic activities which was administered to the participants in the experimental groups via a 7-session group counselling programme. Participants in the control groups, on the other hand, took part in guidance activities. Semi structured interviews were also performed to gather feedback on the impact of the creative intervention from three single mothers. Results: Findings revealed that creative group counselling successfully increased the level of self-compassion among single mothers. Additionally, the depression, stress and anxiety scores of single mothers were lower after joining the group counselling programme. Furthermore, three themes emerged from the present study which are i) be kind to oneself; ii) mistakes are part of life; and iii) self-transformation. Conclusion: It is evident that the implementation of creative group counselling improves the mental wellbeing of single mothers.

Depression, Anxiety, and Stress among Students in Newly Established Remote University Campus in Indonesia

@#Introduction: Studies show that many university students experience common mental health problems, such as depression, anxiety, and stress. In severe cases, these problems can cause disability that may hinder youths from achieving their potential academic or career development. This study aims to measure the occurrence and levels of depression, anxiety, and stress and their determinants among undergraduate students of a recently established remote campus in Indonesia. Methods: This cross-sectional study was conducted in Banyuwangi, East Java from September- December 2017. Exactly 229 students were randomly selected using cluster sampling. Mental health status was measured using Depression, Anxiety, and Stress Scale. We used multivariable logistic regression to determine factors related to depression, anxiety, and stress. Results: The prevalence of depression, anxiety, and stress were 25.0%, 51.1%, and 38.9% respectively among these students. Level of education was associated with depression and stress, but not with anxiety. The fifth semester students had significantly greater odds of depression (AOR = 2.27; 95% CI: 1.04-4.93; p value = 0.04) and stress (AOR =2.18; 95% CI: 1.10-4.37; p value = 0.03) compared to the seventh semester students. No variables were significantly associated with the occurrence of anxiety. Conclusion: Fifth semester students had a greater risk for depression, anxiety, and stress compared to students at a higher level of education. The present study highlights the need for policies in new universities to provide a routine psychological support and counseling for students undergoing semesters that place greater mental burden.

Risk Factors of Depression, Anxiety and Stress Among Adults Attending Primary Health Clinics in an Urban Area in Klang Valley, Malaysia

@#Introduction: Mental health problem is an important public health issue which causes deterioration in quality of life, function and financial capabilities. According to the National Health and Morbidity Survey (NHMS) 1996, the prevalence of mental problem among adults in Malaysia was 10.7% and this has increased to 29.2% in NHMS 2015. The aim of this study was to evaluate the burden of depression, anxiety and stress among adults in a city in Klang Valley, Malaysia including its associated factors. Methods: A cross-sectional study was conducted by analysing secondary data obtained from screening program performed in six primary health clinics in the city throughout 2016. There were 576 adults participated in the screening program which consisted of mental health screening using Depression, Anxiety, Stress 21 (DASS-21) questionnaire and health status screening using Health Status Screening Form. Results: The prevalence of depression was 20.5%, anxiety was 44.5%, while stress was 10.1%. By using logistic regression, history of being abused was the only significant protective factor associated with depression, anxiety and stress with OR of 0.062 (95% CI 0.007; 0.563, p=0.004), OR of 0.001 (95% CI 0.000; -, p=0.001) and OR of 0.026 (95% CI 0.003; 0.238, p<0.001) respectively. Other independent variables were not statistically significant. Conclusions: As conclusions, surprisingly the risk of depression, anxiety and stress were not increased among participants who reported history of being abused. This was probably due to good coping mechanism among them. Nevertheless, early intervention needs to be emphasized to prevent mental disorders among this group of people in community.

Effectiveness of Progressive Muscle Relaxation in Reducing Depression, Anxiety and Stress among Haemodialysis Patients attending a Public Hospital at Central Java Indonesia

@#The increasing trend of Chronic Kidney Disease (CKD) prevalence in Indonesia is a public health concern as it increases mortality, morbidity and burden of disease that has great implication on the health economic. In addition, CKD patients who are more likely to undergo hemodialysis is commonly associated with psychological problems such as depression, anxiety and stress and these have added more to the disease burden. Immediate measures such as progressive muscle relaxation (PMR) to reduce the psychological symptoms is of great importance before the symptoms progress into psychiatric disorders. The study was aimed to evaluate the effectiveness of PMR in reducing symptoms of depression, anxiety and stress among patients undergoing hemodialysis. It was a quasi-experimental, pretest-posttest control study that recruited 60 eligible respondents who underwent hemodialysis and was randomly allocated into intervention and waitlist control groups. Respondents in the intervention group performed PMR twice a day for two weeks. Mean scores of depression, anxiety and stress of respondents were examined before and after intervention using Depression, Anxiety and Stress Scale–21 questionnaire (DASS-21). Results showed that mean scores of depression, anxiety and stress differed significantly before and after intervention between groups and within the intervention group (p<0.05). PMR was effective to reduce the psychological symptoms among patients underwent hemodialysis. This highlight the importance to screen psychological symptoms among those patients and PMR should be taught to them as one of the stress-reducing measures.