Pakistan has one of the world's largest adolescent populations, yet evidence on the prevalence and correlates of depressive and anxiety symptoms in adolescents remains limited, particularly in rural settings. This study aimed to estimate the prevalence of depressive and anxiety symptoms and examine their associations with household characteristics in a community-based sample of adolescents from the predominantly rural district of Matiari, Pakistan. We examined cross-sectional data from 718 girls (9.0-14.9 years) and 678 boys (10.0-15.9 years) participating in the Nash-wo-Numa Study. Trained psychologists administered the Sindhi versions of the Short Mood and Feelings Questionnaire and the Screen for Child Anxiety Related Emotional Disorders to assess adolescents' depressive and anxiety symptoms. Prevalence estimates and 95% confidence intervals were derived based on validated cut-off scores. Household correlates of depressive and anxiety symptoms were examined in multivariable negative binomial regression models. Approximately 8% of boys and 10% of girls exhibited clinically-significant depressive symptoms. The prevalence of clinically-significant anxiety symptoms ranged from 6% in boys and 8% in girls for generalized anxiety to 24% in boys and 39% in girls for separation anxiety symptoms. Girls experienced more depressive symptoms, panic/somatic and generalized anxiety symptoms than boys at age 12, more separation anxiety symptoms from age 11 onward, and more social anxiety symptoms from age 12 onward. In both sexes, depressive and anxiety symptoms were higher among adolescents exposed to intimate partner violence against their mothers and to moderate‑to‑severe food insecurity, and were lower among those with a homemaker mother. Among girls, maternal mental well‑being attenuated the association between food insecurity and depressive symptoms. Depressive and anxiety symptoms are common among adolescents living in Matiari. Adolescents exposed to intimate partner violence against their mother, moderate-to-severe food insecurity, and poor maternal mental health may be at increased risk of depression and anxiety in predominantly rural Pakistan and may benefit from targeted prevention and intervention strategies.
While physical activity is a preventive factor against depression and anxiety, less is known about how the timing of physical activity throughout the day is associated with improved mental health the next day among workers. This study investigated the association between physical activity in the late afternoon and early evening and next-day symptoms of depression and anxiety among workers. We conducted a secondary analysis of a two-week longitudinal study. Participants were full-time, daytime workers employed in either the private or public sector, residing or working in urban areas of Japan, and owning a personal smartphone. Participants were instructed to install Google Fit app to passively track physical activity. They also completed daily web-based surveys between 5:00 PM and 6:00 PM, using the Japanese K6 scale to assess depression and anxiety symptoms. Physical activity was categorized into two timeframes: late afternoon (3:00 PM to 6:00 PM) and early evening (6:00 PM to 9:00 PM). A K6 score ≥ 5 was classified as a high symptom level for depression and anxiety. Associations were analyzed using generalized linear mixed models, adjusting for age, gender, and previous-day depression and anxiety symptoms. A total of 116 participants met the eligibility criteria, contributing 1,400 observation days. A high symptom level for depression and anxiety was reported on 259 days (18.5%). Physical activity in the late afternoon showed a non-significant negative association with next-day depression and anxiety symptoms (OR = 1.00, 95% CI: 0.99-1.01, p = 0.472). In contrast, early evening activity indicated a marginally significant association with lower symptoms (OR = 0.99, 95% CI: 0.97-1.00, p = 0.061). Regarding the covariates, a higher K6 level on the previous day and younger age (≤ 39 years) were significant predictors. Subgroup analyses showed significant negative associations for having low levels of depression and anxiety symptoms on the previous day (K6 score < 5) (OR = 0.98, 95% CI: 0.96-0.997, p = 0.023) during this timeframe. Physical activity in the early evening was associated with reduced risk of next-day depression and anxiety symptoms, particularly when prior-day symptom levels were lower.
Patients with gastroesophageal reflux disease (GERD) often experience typical or atypical symptoms accompanied by depression, anxiety, and low quality of life (QoL). In patients with various diseases, having a Type D personality has been linked to an elevated risk of developing symptoms such as depression and anxiety, as well as reduced QoL. The objectives of this study were to examine the influence of Type D personality on GERD symptoms, depression and anxiety, and QoL and to identify the causal relationships among the variables influencing QoL in patients with GERD. A cross-sectional correlational design and convenience sampling were used, and 149 patients with GERD were enrolled as study participants from the gastroenterology outpatient clinic of a university hospital in the Republic of Korea. Data were collected using structured questionnaires and tested using SPSS 28.0 and Amos 23.0. Approximately 46% of the participants met the criteria for inclusion in the Type D personality group. This group exhibited higher levels of depression and anxiety and diminished QoL than the non-Type D personality group. In the multiple regression model, GERD symptoms, depression and Type D personality were found to have a significant influence on QoL. In the structural equation model, GERD symptoms, depression, and Type D personality were shown to affect QoL, explaining 51.7% of the total variance in QoL. Two factors, namely depression and GERD symptoms, were identified as mediators of the association between Type D personality and QoL. The results of this study indicate a relatively high frequency of Type D personality among patients with GERD. When assessing QoL in patients with GERD, it is essential to consider the influence of Type D personality in conjunction with symptom experience and the presence of depression and anxiety. In particular, managing depression and symptoms in patients with GERD and a Type D personality may offer an effective approach to improving QoL in this patient group.
Adolescent mental health in Sub-Saharan Africa remains critically understudied despite high burden estimates. We assessed the psychometric properties of Western-derived instruments, prevalence of depression and anxiety symptoms, associations with psychosocial and sociodemographic factors, and symptom network structures in a large multi-year sample of Kenyan adolescents. We administered depression (PHQ-8), anxiety (GAD-7), social support, perceived control, and wellbeing measures to 7865 Kenyan secondary school students aged 12-20 across three studies (2021-2023). Both PHQ-8 (α = 0.70) and GAD-7 (α = 0.78) demonstrated adequate reliability, and confirmatory factor analyses supported unidimensional structures with acceptable fit (PHQ-8: RMSEA = 0.052, CFI = 0.945; GAD-7: RMSEA = 0.056, CFI = 0.970). Overall, 30.3% (95% CI 29.3-31.3%) and 25.1% (95% CI 24.2-26.1%) of participants met the ≥ 10 cut-off for clinically elevated depression and anxiety symptoms, respectively, with descriptive variation across study years (2021: 42.1% [39.6, 44.6%], 37.5% [35.1, 40.0%]; 2022: 25.3% [23.8, 26.8%], 21.7% [20.3, 23.2%]; 2023: 29.7% [28.1, 31.3%], 22.5% [21.1-24.0%]); direct year-on-year comparison is limited by differences in wave composition. Mixed-effects modelling identified social support (B = - 0.08) and perceived control (B = - 0.29 for depression, B = - 0.24 for anxiety) as robust protective factors. Final-year students showed elevated symptoms (B = 0.93, B = 0.77), as did students in girls' schools relative to mixed schools (B = 1.35, B = 1.27). Perceived academic ability showed a strong inverse gradient with both outcomes (excellent ability: B = - 2.51 for depression, B = - 1.76 for anxiety). Network analysis identified worry-related symptoms as most central, with hopelessness and nervousness serving as the primary bridges between depression and anxiety domains. Western-derived measures demonstrated adequate psychometric properties with Kenyan adolescents. Depression and anxiety were highly prevalent and varied by sex, school form, and school type. Social support and perceived control were the strongest protective factors; academic pressure and girls' school attendance were associated with elevated symptoms. Network analyses identify worry, hopelessness, and negative self-evaluation as possible candidate intervention targets warranting empirical evaluation. These findings underscore the urgent need for contextually grounded, school-based mental health provision in Kenya and comparable Sub-Saharan African settings.
Identifying core mental health symptoms is crucial for precision-targeted interventions, especially in resource-limited settings. However, symptom structures among individuals actively seeking telemental healthcare remain underexplored in Bangladesh and similar contexts. This study aimed to map symptom severity, factor structures, and interrelationships between depressive and anxiety symptoms to inform precision-driven mental healthcare approaches. We conducted an observational study among 4,900 patients who attended a health facility-based telemental healthcare in Bangladesh from January 2023 to July 2024. We assessed depression using PHQ-9 and anxiety using GAD-7 and applied exploratory factor analysis and network analysis. Overall, 84% (95% CI: 83-86) screened positive for depressive symptoms, 85% (95% CI: 83-86) screened positive for anxiety symptoms, and 77% (95% CI: 76-78) presented co-occurring symptoms. Commonly reported symptoms included fatigue (57%), anhedonia (42%), sleep disturbance (42%), nervousness (70%), and uncontrollable worrying (66%). Factor analysis revealed "depressed mood" (λ = 0.58) and "anhedonia" (λ = 0.51) as core depressive features, and "uncontrollable worry" (λ = 0.68) and "nervousness" (λ = 0.61) as core anxiety features. Network analysis revealed strong associations between "anhedonia" and "depressed mood" in depression and "trouble relaxing" and "restlessness" in anxiety. "Uncontrollable worrying" showed the highest centrality, and "sleep disturbance" and "trouble relaxing" served as important bridge symptoms linking depression and anxiety domains. Depressive and anxiety symptoms in people seeking telemental healthcare cluster around a small number of key and connecting symptoms, rather than contributing equally to overall distress. Precision mental healthcare in resource-limited settings can use this structure to direct limited time and resources toward the symptoms that matter most. Protocol Registration: Institutional Review Board (IRB) of https://www.icddrb.org/. Protocol number: PR-22103.
There is a pronounced gap between demand and actual mental health service utilization, with earlier estimates suggesting that nearly 90% of affected individuals with depression or anxiety do not receive the care they need despite being the most prevalent and highest contributor for global burden. The present study aims to identify contact coverage gap and explore barriers while seeking care among those who screen positive for depression and anxiety. A community-based cross-sectional study was conducted among 1304 adults aged 20-60 years who had resided in Kailali, Nepal for at least 6 months. Multistage random technique was utilized to select the participants from three rural municipalities and three municipalities. Depression and anxiety were assessed by using widely recognized screening tools, namely, the Patient Health Questionnaire-9 (PHQ-9) and the Beck Anxiety Inventory (BAI). Barriers to care were measured using the Barriers to Access to Care Evaluation (BACE). Out of 1304 study participants, around 15.2% were screened positive for at least one (depression and/or anxiety) illness. Screening positive for depression (13.3%) was higher than anxiety (7.5%). Only 28.3% of individuals who were positive for anxiety and/or depression contacted with service providers. Among those who sought care, most had visited traditional healers (98.2%). Major barriers to care were unaffordable cost (38.4%), self-solving attitude (22.2%), preference for alternative types of care (21.7%), busy schedule with work (16.7%), speculating it will resolve itself (15.2%), and not being sure where to seek for mental health services (12.6%). Contact coverage was significantly associated with morbidity and lack of awareness on available services. There was a significant contact coverage gap in mental health care, as we found that only 28.3% of adults who tested positive for depression and/or anxiety had contact with any provider, largely due to barriers such as financial constraint, busy schedule, self-reliant attitude, preference for traditional healing, and lack of awareness on available services. These results warrant efforts to close the gap in coverage for care through addressing barriers.
Both children with autism spectrum disorder (ASD) and their parents are at a high risk of experiencing anxiety and depression. Recent studies have indicated that laughter yoga can create happiness and reduce negative emotions in adults. However, there are limited studies about how laughter yoga benefits children with ASD and parents of children with ASD. This feasibility study aims to explore the recruitment, retention rate, protocol adherence and acceptability of a laughter yoga programme in children with ASD and their parents. Moreover, it investigates the safety issues and the effects of laughter yoga on reducing depression and anxiety in children with ASD, as well as parenting stress in their parents. This study protocol describes a feasibility study aimed at evaluating the feasibility and acceptability of a laughter yoga intervention for children with ASD and their parents. This feasibility study uses a randomised, wait-list-controlled trial and pre-test-post-test design. The primary outcomes include recruitment rate, screening rate, attendance rate, dropout rate, perceptions of laughter yoga, difficulties encountered and safety issues. The secondary outcomes focus on depressive and anxiety symptoms among children with ASD and parenting stress levels. Data will be collected before the intervention (T0), immediately after the intervention (T1) and 3 months after the intervention (T2). 66 children with ASD and their parents will be recruited in Hong Kong through social media posts. Participants will be randomly assigned to either the laughter yoga group or the wait-list-control group. The laughter yoga group will receive the intervention which consists of 12 classes of 1-hour laughter yoga over 6 months. After the intervention, families will be invited to join a family-based semi-structured interview, which aims at understanding participants' experiences, safety concerns and feedback they may have. The wait-list control group will receive no treatment until the completion of T2. The collected data will be used to evaluate the feasibility and acceptability of laughter yoga for children with ASD and their parents. This study was approved by the Human Subject Ethical Subcommittee of The Hong Kong Polytechnic University (No.: HSEARS20230723002). The results of the research project will be published in an academic journal. NCT06326255.
Objective: To examine associations between depression, anxiety, substance use, and academic success among undergraduate students. Participants: Data were drawn from 76,406 students in the 2022-2023 Healthy Minds Study, with undergraduate analytic subsamples ranging from approximately 23,600 to 47,400 complete cases. Methods: Secondary analyses were conducted using zero-inflated Poisson regressions to assess relationships among depression, anxiety, alcohol, and marijuana use. Ordinary least squares and ordered logit models evaluated associations between mental health, substance use, and academic success. Results: Depression and anxiety were associated with alcohol and marijuana use, with depression showing a stronger association with alcohol involvement. Anxiety attenuated the association between depression and alcohol consumption. Depression and more frequent marijuana use were associated with lower self-reported grades, while anxiety showed a positive association with grades in multivariable models. Conclusions: Depression was consistently associated with substance use and academic outcomes, although effect sizes were small and associations were modest in magnitude.
Anxiety and depression are common conditions among medical students. In recent years, numerous factors associated with these disorders have been investigated; however, evidence regarding the role of dietary habits remains limited. To evaluate the association between dietary habits and the presence of anxiety and depressive symptoms among medical students at a private university in Lima, Peru. An analytical cross-sectional study was conducted in 2025 among medical students aged 18 years and older. Dietary habits were assessed using the Healthy Eating Index, while anxiety and depression were measured using the GAD-7 and PHQ-9 scales, respectively. Poisson regression with robust variance was used to calculate prevalence ratios (PR). A total of 264 students were included. Only a minority had healthy dietary habits (1.1%), and the prevalences of anxiety (34.9%) and depression (45.1%) were high. For each additional point in the Healthy Eating Index, the prevalence of anxiety decreased by 3% (aPR: 0.97; 95% CI: 0.95 to 0.98), while the prevalence of depression decreased by 2% (aPR: 0.98; 95% CI: 0.96 to 0.99). Dietary habits were inversely associated with the prevalence of anxiety and depression among medical students. These findings highlight the importance of promoting healthy dietary patterns as part of comprehensive strategies for the prevention and promotion of mental health in this population.
Depressive and anxiety symptoms are prevalent in Multiple Sclerosis (MS) and Endometriosis (EMS), yet their underlying processes remain poorly understood. Guided by a transdiagnostic framework (Nolen-Hoeksema & Watkins, 2011), this study examined anxiety sensitivity, intolerance of uncertainty, distress tolerance, and rumination as mediators of the pathways between neuroticism and depressive and anxiety symptoms. Further, pain severity in EMS and gait-disability in MS were examined as contextual moderators of factor-symptom relationships. Population-based cohorts of individuals with MS (T1, baseline: n = 229; T2, 6-month-follow-up: n= 134) and EMS (T1, n= 399; T2, n= 130) completed online surveys. The relationships between neuroticism, cognitive factors, and affective symptoms were evaluated cross-sectionally and prospectively within an integrated path model. Structural invariance testing explored the plausibility of a common model. Cross-sectionally, distress tolerance and rumination emerged as consistent mediators, with the largest effect for distress tolerance in the depressive pathway in the MS group (β = 0.17, 95% CI:0.02, 0.33). Anxiety sensitivity and intolerance of uncertainty demonstrated symptom- and disease-specific associations. Longitudinally, distress tolerance mediated the relationship between neuroticism and residualised change in anxiety symptoms in MS (β= 0.10, 95% CI:0.04, 0.17), whereas in EMS, distress tolerance and anxiety sensitivity showed indirect effects in the depressive pathway. No interaction effects were detected. Although structural non-invariance was observed, substantial convergence in pathways was observed across diseases. Distress tolerance is a candidate transdiagnostic factor linking neuroticism with affective symptoms, underscoring its therapeutic relevance. Findings extend an emerging evidence-base of cross-disease parallels into the psychological domain.
The phenomenon of global aging is becoming increasingly salient, and the mental health of older women requires greater attention. However, there is a conspicuous paucity in the exploration of anxiety-depression comorbidity patterns among Chinese older women, as well as the correlation between intergenerational relationships with adult children and these comorbid conditions. About 20,153 older women aged 65 years or above from the China Aging and Health Survey (CAHS) were included in the study. Depression and anxiety were assessed using the Patient Health Questionnaire-9 (PHQ-9) and the 7-item Generalized Anxiety Disorder (GAD-7) Questionnaire, respectively. Latent profile analysis (LPA) was utilized to identify subgroups of older women exhibiting similar patterns of symptoms. To examine the association between intergenerational relationships with adult children and the comorbid patterns of anxiety and depression, multinomial logistic regression was employed. Finally, stratified analyses were conducted to perform sensitivity testing. LPA revealed three profiles: low (n = 13,658), moderate (n = 5762), and high comorbidity (n = 733). Poorer intergenerational relationships with adult children significantly increased odds of moderate (odds ratio [OR] = 1.079, 95% confidence interval [CI]:1.045-1.114) and high comorbidity (OR = 1.187, 95% CI:1.006-1.275) versus the low-comorbidity group after covariate adjustment. Stratified analyses confirmed robustness. Anxiety-depression comorbidity patterns in older women can be classified into three categories: low, moderate, and high comorbidity. Moreover, intergenerational relationships with adult children are associated with these comorbid patterns, with more frequent interactions corresponding to lower levels of comorbidity.
Depression and anxiety rank among the leading causes of global disability, yet traditional treatments reach only a minority of affected individuals. The COVID-19 pandemic further exacerbated this crisis, triggering a ~ 25% worldwide surge in anxiety and depression prevalence. In parallel, immersive digital environments (the "metaverse") are maturing as platforms for creative expression and social connection. This review proposes that immersive metaverse art - interactive art experiences in VR/AR - can act as a multilevel psychobehavioral modulator. We integrate recent evidence showing that such experiences enhance engagement (flow, presence), enable identity exploration (customizable avatars, cultural narratives), and engage neurocognitive systems (reward, attention, regulation). Empirical studies of VR art interventions report acute mood improvements, stress reduction, and greater social connectedness. We synthesize these findings into a conceptual model linking core components (immersion, creative agency, social avatar, cultural symbolism) to mediating processes (flow, meaning-making, belonging) and outcomes (symptom relief, emotional regulation, behavioral activation). Rather than examining these domains as separate interdisciplinary themes, the review integrates them within a unified clinical framework focused on transdiagnostic mechanisms relevant to depression and anxiety. We compare immersive art therapy with traditional art therapy, noting unique advantages (scalability, personalization) and novel risks (overdependence, identity diffusion). Finally, we outline translational pathways - e.g. integrating VR art with cognitive therapies and highlight the need for rigorous trials and cross-cultural validation. Overall, immersive metaverse art emerges as a promising, if nascent, approach to mental health intervention, warranting further empirical and ethical scrutiny.
This study investigated mental health outcomes of young adult women in relation to physical activity and sleep patterns before, during, and after Ramadan. A prospective repeated-measures cohort study was conducted in the Department of Physical Therapy at Jazan University, Saudi Arabia. Healthy women aged 18-30 years were recruited through convenience sampling, with exclusions for chronic illness, pregnancy, lactation, psychological disorders, or recent hospitalization. Self-reported data were collected online at three time points: before Ramadan, during Ramadan, and after Ramadan. The study assessed physical activity using the International Physical Activity Questionnaire-Short Form, sleep quality using the Pittsburgh Sleep Quality Index, and emotional states using the Depression, Anxiety, and Stress Scale-21. Thirty young adult females participated in the study. Physical activity showed a gradual increase, with significant improvements from pre-Ramadan to Ramadan (p =0.039) and from pre-Ramadan to post-Ramadan (p =0.009). Sleep was significantly disrupted during Ramadan, with shorter duration (p <0.001) and poorer global sleep quality (p =0.002), followed by marked improvement post-Ramadan (all pairwise p ≤.001). Stress levels peaked during Ramadan and declined significantly afterward (p =0.010), whereas depression and anxiety remained stable across all phases (p >0.05). Regression analyses showed that poorer sleep quality significantly predicted higher depression, anxiety, and stress before and during Ramadan (all p ≤.002), but not after Ramadan. Physical activity and BMI were not associated with mental health outcomes. The study found that while depression and anxiety stayed stable across the Ramadan periods, stress decreased after Ramadan. Sleep quality consistently related to mental health, whereas increased physical activity during Ramadan showed no link to emotional well-being. Overall, sleep and stress emerged as the key factors influencing well-being throughout the Ramadan cycle. This study explored how Ramadan fasting influences physical activity, sleep, and mental health in young women. Thirty healthy women aged 18–30 years in Saudi Arabia completed online surveys before, during, and after Ramadan to report their activity levels, sleep patterns, and emotional well-being. Physical activity increased during Ramadan and stayed higher afterward compared to before fasting. In contrast, sleep was noticeably disrupted during Ramadan, with shorter sleep duration and poorer sleep quality. After Ramadan, both sleep duration and overall sleep quality improved significantly. Mental health patterns showed mixed results. Depression and anxiety levels remained steady across all three phases. Stress levels rose during Ramadan but dropped significantly once Ramadan ended. Poor sleep quality was strongly linked to higher depression, anxiety, and stress before and during Ramadan, but this connection disappeared after Ramadan. Increased physical activity did not show a direct relationship with mental health outcomes. Overall, Ramadan fasting was associated with more physical activity, temporary sleep disturbances, and improvements in stress and sleep quality after fasting. Sleep quality emerged as an important factor for emotional well-being, suggesting that supporting healthy sleep habits may help young women maintain resilience during lifestyle changes such as Ramadan fasting.
Gastrointestinal symptom-specific anxiety (GSA) is increasingly recognized as an important construct in the disease experience of inflammatory bowel diseases (IBD). However, it remains unclear to what extent GSA overlaps with general anxiety in the IBD population, and whether it is associated with disability beyond general anxiety and other clinical and demographic variables. First, we examined how many patients with elevated GSA do or do not experience general anxiety, and vice versa. Second, we assessed the unique contribution of GSA to variance in IBD-related disability, keeping general anxiety, disease activity, and other variables constant. In a cross-sectional survey study, over 1000 IBD patients completed questionnaires on general anxiety (the anxiety subscale of the Hospital Anxiety and Depression Scale [HADS]), GSA (the Visceral Sensitivity Index [VSI]), IBD-related disability (the IBD Disk), and self-reported clinical disease activity (Patient-Reported Outcomes [PRO] and Manitoba IBD Index [MIBDI]) alongside a set of general demographic and clinical questions. GSA and general anxiety frequently co-occurred, but 38.0% of patients reported GSA without general anxiety. Additionally, GSA was significantly associated with IBD-related disability (P < .001) even when general anxiety, disease activity, and other variables were controlled for. Although general anxiety showed the strongest association with disability (β = .27), the association for GSA (β = 0.22) was stronger than for clinical disease activity (β = .18) and other demographic and clinical variables. Overall, this highlights the clinical significance of GSA beyond general anxiety and disease activity in IBD.
The effectiveness of non-specialist provider-delivered care for mood and anxiety disorders has been established, but effects in violence-exposed populations remain unclear. We examine the net effectiveness of psychosocial treatments delivered by non-specialists to adults experiencing distress following interpersonal and war-related violence. In this systematic review and meta-analysis, we searched MEDLINE/PubMed, Embase, PsycINFO, Global Health, Cochrane Library, Latin American and Caribbean Health Sciences Literature, and SciELO from Jan 1, 2000, to June 1, 2025. Studies were included if they were psychosocial treatment randomised controlled trials for adults exposed to violence; additionally, the treatment had to be delivered by a non-specialist provider. Pairs of authors double-screened and double-extracted data by applying a codebook developed for this study. We extracted information on data, population characteristics, and four primary outcomes (depression, post-traumatic stress disorder, anxiety, and impairment symptom severity), and used standardised checklists to assess risk of bias. We pooled study-level data in pairwise meta-analyses using a random-effects model to examine subgroup differences by national setting, treatment setting, provider type, violence type, and treatment focus. Our study did not involve people with lived experience of mental health conditions. This protocol was registered a priori with PROSPERO (CRD42022306099). We screened 54 748 abstracts and identified 45 eligible studies conducted with adults exposed to violence and reporting psychosocial distress. The sample included 9431 participants (mean age 37·9 years; 95% CI 37·7 to 38·1); reporting on sex or gender and ethnicity differences was inconsistent across the included studies. Sample sizes differed by outcome (N=9431 for PTSD; N=9060 for depression; N=8983 for impairment; and N=6545 for anxiety), altogether totalling 34 019 unique data-points. Overall, non-specialist-delivered treatments outperformed control conditions in reducing anxiety (standard mean difference -0·44, 95% CI -0·57 to -0·32; p<0·0001), depression (-0·41, -0·51 to -0·31; p<0·0001), post-traumatic stress disorder (-0·34, -0·44 to -0·24; p<0·0001), and impairment symptoms (-0·34, -0·47 to -0·22; p<0·0001). A similar pattern of effects was seen in the sensitivity analyses (-0·30 [-0·49 to -0·10] to -0·55 [-0·79 to -0·30]; p<0·0001). The strongest treatment effects emerged among refugees. Treatment effects were replicated in most subgroups with a few exceptions: all outcomes for veterans were non-significant, depression and anxiety severity among interpersonal violence survivors did not significantly improve, and transdiagnostic treatments showed a clear benefit across all outcomes. Most studies had some bias (k=44 [98%]) and variability between studies for the main outcomes ranged from I2=77-84%. Small to moderate clinical benefits for non-specialist-delivered care were observed across a broad set of treatments for diverse populations exposed to violence worldwide. These comprehensive analyses can inform psychosocial programming related to setting, providers, types of violence, and treatment foci, to combine treatment and implementation approaches for specific settings and populations. None.
Individuals with a Diagnostic and Statistical Manual of Mental Disorders (DSM) anxiety or depressive disorder tend to report a lack of agency in social situations. Agency represents one dimension in the interpersonal circumplex model while communion represents the other dimension. In the present study, we mapped six anxiety and depressive disorders examined within the Netherlands Study of Depression and Anxiety (NESDA) onto this model. To this end, we used the structural summary method to reduce Inventory of Interpersonal Problems scores of NESDA Wave 6 participants with a current diagnosis (n = 412) to interpersonal profiles for each of the six examined disorders. The Displacement parameter represents the blend of agency and communion and provided insight into which interpersonal problem theme is most characteristic for a disorder. Amplitude represents the distinctiveness of this theme, and Elevation provides an indication of the level of general interpersonal distress associated with the disorder. Unexpectedly, general interpersonal distress was highest for dysthymia, not major depressive disorder. As expected, however, all disorders (social phobia, generalized anxiety disorder, panic disorder, agoraphobia, dysthymia, and major depressive disorder) were primarily characterized by a submissive interpersonal style. Additionally, we found greater general interpersonal distress among participants with comorbid anxiety and depression than among participants with depression or anxiety alone. The main finding was that the different anxiety and depressive disorders had comparable interpersonal profiles. This supports the notion that interpersonal style may be a transdiagnostic factor in the emergence and maintenance of these disorders, contributing to interpersonal distress particularly in individuals with comorbid disorders.
Eating disorders (EDs) are prevalent among college students and may lead to severe consequences. This study aimed to examine the prevalence and correlates of EDs among Chinese college students and to investigate the relationship between EDs and suicide risk. A cross-sectional study was conducted among 18,578 Chinese college students between October 17 and 29, 2023. Participants completed questionnaires assessing demographic characteristics, EDs, depression, anxiety, and suicide risk. Logistic regression analyses were performed to identify factors associated with EDs in the total sample, as well as factors associated with suicide risk among participants with EDs. The prevalence of EDs was 13.6% among Chinese college students. Multivariate logistic regression analysis revealed that body mass index, urban or town residence, left-behind experiences, maternal education at the senior high school level or above, depression, anxiety, suicidal ideation, and suicide attempts were independent correlates of EDs. Among participants with EDs, 19.5% reported suicidal ideation or suicide attempts. Variables such as age, left-behind experiences, chronic physical illness, family history of mental disorders, depression, and anxiety were independently associated with suicide risk. EDs are prevalent among college populations and are associated with suicide risk. Therefore, it is imperative to specifically monitor suicide risk among individuals with EDs. Intervention strategies should focus on co-occurring depressive and anxiety symptoms to decrease suicidality in affected individuals. Eating disorders are prevalent among college students and are associated with severe adverse outcomes, including suicidality. This study examined the prevalence of eating disorders and their associated factors among Chinese college students. We surveyed 18,578 college students in China in October 2023. Results indicated that approximately 13.6% of the students had eating disorders. Students were more likely to have eating disorders if they had a high body mass index, urban residence, had left-behind experiences, maternal education of senior high school education or above, or had depression and anxiety. Furthermore, approximately 19.5% of students with eating disorders reported suicidal ideation or suicide attempts. These findings demonstrate that eating disorders and suicide risk often co-occur. Colleges should monitor suicide risk among students with eating disorders and provide interventions targeting depression and anxiety to ensure their safety.
The physical, emotional, and social wellbeing of U.S. high school-aged adolescents is a growing public health concern. To describe the development and initial effects of an 8-week Bharatanatyam (Indian Classical Dance) intervention on wellbeing indicators in Midwestern high school students. Using a single arm design, freshmen at a Midwestern high school completed an ethics-approved 8-week Bharatanatyam program teaching movements rooted in social cognitive theory and cultural foundations. At baseline, four, and 8 weeks, participants completed PROMIS Pediatric Profile-25 (Physical Function Mobility, Anxiety, Depressive Symptoms, Fatigue, Peer Relations, Pain Interference, and Pain Intensity), Body Appreciation Scale, Anti-Bias Behavior Scale (PSABBS), State Mindfulness Scale, and an 8-item acceptability questionnaire. Analyses included descriptive statistics, paired t-tests, Cohen's d effect sizes, Pearson's correlations, and linear regressions. Forty-six students provided assent and parental consent and completed the intervention. Most were female (62%) and Caucasian (80%). Feasibility and retention indicators were high (83-89%). Fifty-nine percent reported independent exercise 2-5 times weekly. Controlling for exercise frequency, significant decreases (P < 0.05) were observed between baseline and 8 weeks in PROMIS Anxiety (d = .80), Depressive Symptoms (d = .51), Fatigue (d = .61), and Pain Intensity (d = .77), with significant increases in Peer Relations (d = .80) and Body Appreciation (d = .97). Positive associations were found between anti-bias attitudes and lower anxiety (r = .485, P < .05), depressive symptoms (r = .510, P < .01), fatigue (r = .395, P < .05), and pain intensity (r = .567, P < .05). Anti-bias attitudes had significant associations with pain intensity, depression, and anxiety, and mindfulness was significantly associated with (P < .05) body appreciation. This study provides initial evidence that an 8-week Bharatanatyam program improved emotional health and physical symptoms (ie, fatigue and pain) among adolescents, with mindfulness and anti-bias attitudes associated with overall wellbeing. Further testing with more rigorous study designs is warranted.
Black and African American cancer survivors may experience elevated distress yet remain underrepresented in psychosocial intervention research and face cultural, institutional, and practical barriers to supportive care engagement. This single-arm pre-post mixed methods study evaluated feasibility and acceptability of a group coping skills program, Mind Over Matter (MOM), among Black and African American women with cancer (#NCT06168825). Secondary aims included estimating preliminary changes in patient-reported outcomes to inform the design and power calculations of a future randomized trial. MOM is a 5-week, group-based psychoeducational program grounded in cognitive behavioral therapy and acceptance and commitment therapy to address cancer-related distress. Participants were recruited through community partners, healthcare systems, and social media. Outcomes were assessed at enrollment and 6 weeks and included anxiety, depression, and physical symptoms. Feasibility was evaluated through participation and completion rates, while acceptability was assessed using home practice engagement, satisfaction ratings, delivery preference, and telehealth usability. From January-April 2024, 78 women expressed interest, 39 (50.0%) consented (74.3% breast cancer, 49.7% diagnosed ≤ 2 years), 36 initiated the program, and 26 (72.2%) completed MOM. Most participants (96.2%) practiced coping skills weekly, and 96.2% planned to continue using them. On a 7-point scale, 73.1% selected the highest satisfaction rating. Telehealth usability was high (M = 5.7/7), with 61.5% preferring virtual delivery and 26.9% reporting no format preference. Anxiety and depression symptoms decreased significantly, with no significant change in physical symptom severity or interference. MOM is feasible and acceptable for Black and African American women with cancer. Intentional recruitment, culturally responsive design, and telehealth delivery were critical to engagement. Findings support further testing in larger controlled trials. NCT06168825.
Auditory dysfunction such as tinnitus is a common sequelae of traumatic brain injury (TBI), and has been associated with neurobehavioral outcomes, including cognitive decline, depression, and anxiety. Few studies have examined associations between concussion history and tinnitus independent of confounding by blast injury or occupational noise exposure. This study investigated concussion history and tinnitus among former professional American-style football (ASF) players, and evaluated whether tinnitus mediates associations between concussion history and neurobehavioral outcomes. This cross-sectional study included former ASF players who contracted with a professional league after 1960 and completed self-administered questionnaires between 2019-2025. Surveys assessed football exposure, auditory dysfunction, and mental health. Cumulative head injury exposure was measured using self-reported concussion signs and symptoms during play. Tinnitus was self-reported and assessed concurrently with validated measures of perceived cognition, depression, and anxiety. Logistic regression evaluated associations between concussion symptom history and tinnitus, and linear regression models assessed mediation and interaction effects. Among 1085 participants (mean age 57.9 ± 13.5 years; 32.4% Black; 6.1 ± 3.7 seasons), greater concussion symptom history was associated with increased odds of tinnitus (highest vs. lowest quintile: OR = 2.90; 95%CI 1.91-4.43; p < 0.0001). Tinnitus did not mediate associations between concussion symptom history and neurobehavioral outcomes. However, associations with perceived cognition (p-interaction = 0.1), depression (p-interaction < 0.01), and anxiety (p-interaction < 0.01) were larger among participants reporting tinnitus. Greater concussion symptom history was associated with increased reporting of tinnitus, and neurobehavioral associations were stronger among those with tinnitus. Clinicians should consider tinnitus when evaluating long-term cognitive and mental health outcomes following repeated head injury.