Abstract

Developmental prosopagnosia (DP) is a condition that indicates the inability to recognize individuals by their faces from birth, without any history of brain damage. The assessment of face recognition ability and diagnosis of DP involve the use of face tests such as the Cambridge Face Memory Test (CFMT) and the Cambridge Face Perception Test, along with self-reported measures like the 20-Item Prosopagnosia Index (PI20). Face recognition accuracy is affected by anxiety. However, previous studies on the relationship between face recognition ability and anxiety have not used the PI20 measure. This study aimed to investigate the relationship between self-reported measures of face recognition ability and anxiety tendencies among healthy young individuals for DP diagnosis and its implications. We used a face recognition test, involving the PI20, CFMT, Visual Perception Test for Agnosia–Famous Face Test (VPTA–FFT), and State-Trait Anxiety Inventory (STAI). We assessed the performance of 116 Japanese young adults (75 females, median age of 20.7 years, with a standard deviation of 1.2). Subsequently, we conducted a statistical analysis to examine the relationship between the outcomes of the face recognition tests and STAI scores using Pearson correlation analysis and single correlation coefficients. The results showed a positive correlation between state anxiety and PI20 (r = 0.308, p = 0.007), and a weak positive correlation was also observed between trait anxiety and PI20 (r = 0.268, p = 0.04). In contrast, there was no correlation between CFMT and VPTA–FFT with respect to STAI. The results of the hierarchical multiple regression analysis also suggested that the correlation between the performance on the PI20 (self-report) and objective measures of face recognition performance (the CFMT and the VPTA–FFT) are driven by differences in anxiety. This study is the first to explore the relationship between face recognition abilities and anxiety using the PI20 self-report measure. There are implications for future research on the diagnosis of DP and the relationship between anxiety and face recognition.

Introduction

Face recognition ability enables individuals to differentiate and identify faces, playing a crucial role in interpersonal recognition and everyday communication. Clinical and functional imaging studies have highlighted that brain lesions, particularly in regions such as the fusiform gyrus, can lead to face recognition impairment. In recent years, there has been a growing interest in the field of face recognition research regarding developmental prosopagnosia (DP). DP refers to a condition in which individuals experience lifelong impairments in face recognition despite possessing normal visual and intellectual capabilities since birth. Clinically, there is no indication of overt central nervous system disorders, and neuroimaging studies also reveal the absence of organic brain lesions (Bate & Tree, 2017; Behrmann & Avidan, 2005; Cook & Biotti, 2016; Duchaine & Nakayama, 2006a). Epidemiological studies in Europe and Asia have reported a prevalence rate of approximately 1.9 %–2.9 % of the population (Bowles et al., 2009; Kennerknecht et al., 2006; Kennerknecht et al., 2008). People with DP encounter challenges and psychosocial difficulties in their interpersonal interactions due to impaired face recognition (Yardley et al., 2008). Early diagnosis and support are crucial, especially before adulthood and entering the workforce.

Currently, diagnosing DP presents challenges due to the absence of established strict objective criteria or biological markers (Barton & Corrow, 2016; Susilo & Duchaine, 2013). Previous studies have revealed ambiguous criteria for diagnosing DP and differentiating it from conditions other than DP in face recognition tests (Bate & Tree, 2017; Dalrymple & Palermo, 2016). Dalrymple and Palermo (2016) provided guidelines that define DP as objectively poor performance on face memory tests and a subjective feeling of repeated face recognition failures in daily life. The authors emphasized the importance of using questionnaires and interviews to assess face recognition difficulties in daily life and highlighted the limitations of relying solely on questionnaires for DP diagnosis, as individuals with DP may lack accurate insight into their own face recognition abilities.

Conclusions

The present study is the first to investigate the relationship between self-reported face recognition abilities and anxiety in young, healthy Japanese individuals using the self-perception face recognition test PI20. The findings indicated that unlike the objective face recognition tests CFMT and VPTA–FFT that showed no association with anxiety, the self-perception test scores may be influenced by state anxiety. Self-reporting, at least in its current form, provides limited insights into predicting face recognition performance in young individuals and diagnosing DP. Therefore, self-reporting is insufficient to evaluate face recognition abilities in young individuals, and DP cannot be diagnosed solely based on self-perception tests. It is necessary to combine self-perceived indicators of face recognition impairment with other perception-based face recognition function tests and consider the presence and extent of anxiety tendencies. Our findings have significant psychological implications for understanding face recognition impairments, DP diagnosis, and clinical practices. In the future, expanding research to investigate the interaction between facial and expression recognition abilities and anxiety is expected to enhance the accurate diagnosis and support for young individuals with facial recognition impairments.

Abstract

Background
Anxiety disorder, depression, and bipolar disorder are common psychiatric disorders, and their association with autoimmune thyroiditis (AIT) has been of great interest. This study aimed to investigate the potential causal relationship between these psychiatric disorders and AIT.

Methods
We used publicly available summary statistics from large-scale genome-wide association studies to select, quality control and cluster genetic variant loci associated with anxiety disorder, depression, bipolar disorder and AIT as instrumental variables (IVs). The Mendelian randomization (MR) study mainly used inverse variance weighting (IVW) combined with MR-egger regression and weighted median estimation (WME) to estimate bidirectional causality between mental disorders and AIT. In addition, we conducted heterogeneity and multivariate tests to verify the validity of IVW.

Results
Two-sample bidirectional MR analysis revealed a positive causal link between depression and AIT. The forward MR analysis of IVW (OR 1.614, 95 % CI 1.104–2.358, P = 0.013) and WME (OR 2.314, 95 % CI 1.315–4.074, P = 0.004) demonstrated thatdepression potentially elevate the risk of AIT development, while, our investigation did not uncover a causal relationship between anxiety disorder, bipolar disorder and AIT. The results of reverse MR analysis showed that there was no significant causal relationship between AIT and anxiety disorder, depression, and bipolar disorder (P > 0.05).

Conclusions
The results of the forward MR analysis suggest a positive association between depression, and AIT risk, while indicating no support for a causal link between anxiety disorder or bipolar disorder and AIT risk based on the current data. Subsequent studies will be essential for elucidating the biological mechanisms and potential confounders underlying these associations.

Introduction

Autoimmune thyroiditis (AIT) stands as the most prevalent autoimmune endocrine disorder (Ruggeri et al., 2018), affecting an estimated 3–5 % of the general population (McLeod and Cooper, 2012). Predominantly afflicting women, its incidence escalates with advancing age (McLeod et al., 2014; Hollowell et al., 2002), soaring up to 20 % among elderly women (Surks et al., 2004). Furthermore, it serves as the primary cause of hypothyroidism. In the initial stages, AIT usually manifests with common hypothyroidism symptoms, such as mood disturbances, anxiety, or depression (van Zuuren et al., 2013), while, AIT can also precipitate hyperthyroidism.

Anxiety disorder, depression, and bipolar disorder are prevalent mental disorders with genetic and clinical overlap, suggesting that they may share common etiologic mechanisms (Tondo et al., 2017; Trede et al., 2005; Anttila et al., 2018). Research indicates a shared pattern of abnormal regional intrinsic brain activity in depression and bipolar disorder, particularly implicating the insula, medial prefrontal cortex, and cerebellum (Gong et al., 2020). The lifetime prevalence of anxiety disorder among individuals with bipolar disorder is estimated to be at least 40 %, even exceeding 50 % (Seon et al., 2021; Kessler et al., 1997; Vieta et al., 2001). Recent evidence suggests that the comorbidity of anxiety disorder with bipolar disorder is as high as that of monophasic depression (Preti et al., 2016).

Conclusion

We conducted the first bidirectional Mendelian randomization study of anxiety disorder, depression, bipolar disorder and autoimmune thyroiditis. Depression increases the risk of AIT, while no causal relationship has been found between anxiety disorders, bipolar disorder and AIT. Psychiatric disorders lead to AIT mainly through the expression of related genes affecting the levels of T and B lymphocytes or through the hypothalamic-pituitary-thyroid axis affecting the feedback regulation mechanism to induce thyroid dysfunction. We look forward to more clinical and experimental research data to validate the relationship between psychiatric disorders and AIT. In the meantime, we need to focus on more updated and larger data sets to explore whether there is a causal relationship between other psychiatric disorders and AIT.

Abstract

Considerable work has advanced understanding of the nature, causes, management, and prevention of anxiety disorders in children and adolescents over the past 30 years. Prior to this time the primary focus was on school refusal and specific phobias. It is now recognised that children and adolescents experience the full gamut of anxiety disorders in very similar ways to adults and that anxiety disorders in the paediatric years can predict a lifelong mental-health struggle. Given the vast array of specific studies in this field, the current review summarises current knowledge about these high prevalence disorders, points to overarching limitations, and suggests potentially important future directions. Following a brief historical overview, the review summarises knowledge about demographic and epidemiological characteristics, distal and proximal risk factors, current treatment directions, and prevention. There is still a great deal to learn about the causes and treatments of child and adolescent anxiety disorders. By amalgamating our current knowledge, this review provides a window to the research directions that are likely to lead to future advances.

Introduction and historical overview

Like much research in applied psychology, the history of treating anxiety in young people1 can be traced back over a century. For the most part, the history of evaluating treatment for anxiety disorders in young people can be described as rigorous, highly informative, and an exemplar of incremental science. In short, much has been learned (Higa-McMillan et al, 2015; Southam-Gerow & Prinstein, 2014) and reasonable confidence can be ascribed to the findings, given the overall methodological quality of the work.

The Diagnostic and Statistical Manual of Mental Disorders (DSM) exemplifies such progress, and across the several editions and even within versions of the DSM, the labels for the anxiety disorders in young people have evolved. For example, overanxious disorder was described in the third edition of the DSM reflecting excessive worry, concerns about personal competence, need for reassurance, and self-consciousness. This specific disorder was later eliminated partly due to its overlap with social phobia. Thus, most young people who would have met criteria for this diagnosis would now be diagnosed with the more clearly delineated generalised anxiety disorder, reflecting persistent and excessive worry, with excessive concern about routine matters and difficulty managing worry. Social phobia has been renamed social anxiety disorder, the persistent fear of social/performance situations involving potential scrutiny by others. In contrast, the label separation anxiety disorder, referring to young people who have an unusual-for-their-level-of-development severity of intense anxiety tied to separating from a caregiver, has remained over time. The more recent iterations of DSM, to its credit, provide detailed diagnostic criteria that are useful, though not without limitations, for making differential diagnoses. For example, selective mutism has appropriately now been moved into the anxiety disorders (American Psychiatric Association, 2013) from its previous placement among a broad range of disorders first evident in childhood. However, strong overlap with social anxiety disorder (Milic, Carl, & Rapee, 2020), raises serious questions about whether these disorders really require separate diagnostic labels. On the other hand, obsessive compulsive disorder has been moved out of the group of anxiety disorders with the publication of the DSM-5. However, the marked overlap between obsessive compulsive disorder and anxiety disorders (Stein et al., 2010), its similar response to treatment (Hudson, Rapee, et al., 2015), and its historical conceptualisation as an anxiety disorder, raise questions about this decision. Similar concerns exist for post-traumatic stress disorder, which was also moved outside of the anxiety disorder category in DSM-5.

Conclusion

Scientific research into paediatric anxiety disorders has increased dramatically over the past 30 years. As a result, we now have far greater knowledge about key characteristics, risk and maintaining factors, treatments, and prevention of these highly prevalent disorders. Nonetheless, the field has a long way to go. As an example, although we now have very well-established programs for the treatment of anxiety disorders in young people, less than half are free of all anxiety disorders immediately following treatment (James et al., 2020). This proportion typically increases over the following months (Hudson et al., 2009; Rapee, Abbott, Baillie, & Gaston, 2007), but the fact remains that a significant proportion of young people with anxiety disorders continue to meet criteria for their disorder even following our current best efforts at treatment. This, combined with the very low proportion of anxious young people in the community who receives empirically-validated treatment (Gandhi et al., 2022; Reardon et al., 2020) makes paediatric anxiety disorders a serious risk for long-term disability (King et al., 2020; Swan et al., 2018). By summarising the current state of the literature into paediatric anxiety disorders, we have highlighted key gaps in our knowledge and potentially important directions for future research. Among the many remaining important issues, a few in particular, stand out.

Abstract

Introduction

     Globally, COVID-19 pandemic has a significant impact on mental health. In Nepal, COVID-19 positive cases have to self-isolate at home in multi-generational and multi-family households. This could be strongly associated with depression, anxiety, and stress-related health outcomes. Additionally, COVID-19 related stigma and fear of transmission may intensify depression, anxiety, and stress symptoms. This study determined the prevalence of depression, anxiety, and stress symptoms and their association with presence of COVID-19 symptoms and comorbid conditions among home isolated COVID-19 positives in the Karnali province, Nepal.

Methods

     We conducted a cross-sectional study to assess depression, anxiety, and stress symptoms among 402 home isolated COVID-19 patients of Karnali province from January to May 2021 using “Depression, Anxiety and Stress Scale-21 (DASS-21)”. We interviewed patients to collect socio-demographic, DASS-21, COVID-19 symptoms, comorbid conditions, and self-treatment. We conducted a telephonic interview using a standardized questionnaire using Kobotoolbox. We calculated the prevalence of depression, anxiety, and stress symptoms. We utilized univariate and multivariate logistic regression to determine their association with the presence of COVID-19 symptoms and comorbid conditions. In multivariate logistic regression, we adjusted sociodemographic factors (age, gender, ethnicity, marital status, monthly family income, education level), smoking status and history of self-treatment. We reported adjusted odds ratios (aOR) with 95% confidence intervals. All analyses were conducted in R (version: 4.0.3).

Results

     The prevalence of depression, anxiety and stress symptoms among home isolated COVID-19 patients were 8.0% (95% CI: 5.5 to 11.1), 11.2% (95% CI: 8.3 to 14.7), and 4.0% (95% CI: 2.3 to 6.4) respectively. Higher odds of depression symptoms (aOR: 2.79; 95% CI: 1.08–7.20, p = 0.03), anxiety symptoms (aOR: 3.65; 95% CI: 1.57 to 8.52; p = 0.003) and stress symptoms (aOR: 7.41; 95% CI: 1.37 to 39.94; p = 0.02) were associated significantly with presence of COVID-19 symptoms in past week. Higher odds of anxiety symptoms were associated with the presence of comorbid conditions (aOR = 2.79; 95% CI: 1.05 to 7.44; p = 0.04).

Conclusion

     Depression, anxiety, and stress symptoms were present in a significant proportion of home isolated COVID-19 patients in western Nepal and positively associated with the presence of COVID-19 symptoms. In this global COVID-19 pandemic, it is important to provide timely counseling to high-risk groups like those with comorbidities and COVID-19 symptoms to maintain a high level of mental health among home isolated COVID-19 patients.

Introduction

     There is growing evidence that the current COVID-19 pandemic is causing severe mental health effects on people globally [[1], [2], [3], [4]]. Studies conducted globally found a positive association between mental health with the presence of COVID-19 symptoms [5] and comorbid status [6]. The COVID-19 pandemic spread throughout the globe, it instilled significant fear, worry, and concern in the general public, as well as in specific groups such as older individuals, caregivers, and those with underlying health issues [7]. The COVID-19 pandemic is likely to exacerbate social isolation and loneliness which are strongly associated with anxiety, depression, self-harm, and suicide attempts across the lifespan [[8], [9], [10]]. The misinformation from the media, lack of knowledge on COVID-19, lack of effective treatments, and significant economic losses may have resulted in higher levels of depression, anxiety, and stress during the COVID-19 pandemic [11,12]. Anxiety and depression might also be triggered by COVID-19 symptoms such as fever and shortness of breath [13]. Psychological trauma could result in a mixture of emotional surges like nightmares, self-blame, and experiencing recurrent thoughts of trauma [14]. COVID-19 has the potential to cause mental health crises with long-term consequences, particularly in Nepal [15].

Conclusion

     The prevalence of depression symptoms, anxiety symptoms, and stress among home isolated COVID-19 patients of Karnali province were common. They were positively associated with the presence of COVID-19 symptoms whereas anxiety symptoms with comorbid status. One key implication of this study is that, in this global COVID-19 pandemic, Nepal government should provide timely counseling and psychological support to those who are already affected with depression symptoms, anxiety symptoms and stress; and those under high-risk like those with comorbidities and COVID-19 symptoms to maintain a high level of mental health among home isolated COVID-19 patients.

Abstract

Students are always required to have good self-esteem. Still, psychological problems, such as excessive anxiety, will cause discomfort and distress, avoid social situations, and interfere with daily life, made them feel worthless. The purpose of the study was to determine the effect of self-esteem on anxiety through life skills training. The research subjects were 14 students divided into two groups, namely the experimental group and the control group. The measurement uses a self-esteem scale and an anxiety scale. Data analysis used non-parametric analysis, namely Mann Whitney, Wilcoxon, and Spearman’s Rank Correlation Test. The results of this study indicate a significant decrease in anxiety with increased self-esteem using life skills training for students.

Introduction

The spread of Covid-19 causes various psychological problems, one of which is anxiety in people in various countries [1,2]. Individuals who are affected by psychological problems, as many as 16% show symptoms of depression, 29% experience anxiety, and 8% experience stress [3].

Anxiety is a problem that most often occurs in students compared to the general population [4,5]. Students experiencing anxiety tend to be more common in women compared to men [4,6].

Anxiety is directly related to emotions and impacts a person’s way of thinking to physical problems. The symptoms of anxiety are excessive tension, unnatural sweating, tense muscles, and excessive restlessness [7,8]. Anxiety is followed by three or more symptoms of restlessness, feeling depressed, easily tired, difficulty concentrating, irritability, muscle tension, disturbed sleep, and irritability [9].

The impact caused by anxiety can be in the form of physical, affective, and cognitive changes [10,11]. Cognitively the impact can be in the form of changes in perception to the existence of cognitive processes that are relevant to avoiding the dangers felt by individuals with anxiety [12]. Someone with anxiety often experiences worry and uncontrollable about an event that happened in the past or will happen in the future, they experience excessive worry about their performance [13]. While the consequences that occur in students who experience anxiety are difficulties in making decisions, including choosing the desired career, in addition to the emergence of problems in education until they are expelled from the lecture bench [14].

Conclusion

Based on the research that has been done, it can be concluded that there is a decrease in anxiety due to increased self-esteem by using life skills training for students. Giving life skills training can increase self-esteem in students so that the anxiety felt by students decreases. In addition, the development of training methods or psychological interventions does not always have to look young but can also be done online with certain applications. The world of education, such as universities, can also apply this program to prepare students to face various problems, especially the Covid-19 pandemic.

Abstract

Climate change is a serious threat to human health and the awareness of this threat can elicit ecological anxiety (eco-anxiety), which could be considered a rational and potentially adaptive response. However, the experience of eco-anxiety does not always lead to adaptive behaviour. The present study investigated whether differential patterns of selective attention towards climate-related information, and variability in this attention, might explain this inconsistent relationship. Participants completed a dot-probe assessment of attentional bias to images of both climate change mitigation strategies and of climate change causes and consequences, and measures of eco-anxiety, climate change belief, environmental self-efficacy, and general psychological symptoms. Engagement in pro-environmental behaviours was measured using a daily behavioural diary. Eco-anxiety and attentional bias independently predicted behaviour, but did not interact. However, attentional bias variability moderated the relationship between eco-anxiety and behaviour, such that higher eco-anxiety predicted greater behavioural engagement, but only when attentional bias variability was low. This was the first known study to examine the potential moderating effect of attentional bias on the relationship between eco-anxiety and pro-environmental behaviours. This growing field of research can help in identifying how the rational response of eco-anxiety can be better harnessed to motivate an adaptive response to the climate crisis.

Introduction

Climate change has become the most prominent threat to human health in the twenty first century (Costello et al., 2009, Ripple et al., 2020). Whilst the physical implications of climate change have been widely investigated, there remains a scarcity of research into the psychological ramifications (Cianconi et al., 2020, Hayes and Poland, 2018, Rocque et al., 2021). This is problematic as two thirds of people worldwide (Flynn et al., 2021, Patrick et al., 2021) report concerns about climate change. Climate-related concerns appear to be most prevalent amongst individuals under the age of 35 (Searle & Gow, 2010), with the prevalence of climate-related anxiety as high as 80% (ReachOut, 2019). Young people and future generations are disproportionately affected by climate change as they will endure the consequences throughout their lifetime (Burke et al., 2018, Philipsborn and Chan, 2018, Sanson et al., 2019). Therefore, distress and anxiety about the current and future state of the planet is understandably common amongst young people.

Ecological anxiety (eco-anxiety) refers to the experience of heightened feelings of distress relating to ecological crises, including anthropogenic climate change (Pihkala, 2020a). Studies have shown that climate-related distress is associated with symptoms of depression and pathological anxiety, insomnia, panic attacks, and obsessive thinking (Jones et al., 2012, Ogunbode et al., 2021, Searle and Gow, 2010, Verplanken et al., 2020). Eco-anxiety is not currently recognised as a clinical disorder. Nevertheless, the American Psychiatric Association has acknowledged the psychological implications of climate change on the human psyche, defining eco-anxiety as the “chronic fear of environmental doom” (Clayton et al., 2017, p. 68). However, some argue that such a narrow conceptualisation of eco-anxiety can lead to the inappropriate pathologizing of a largely rational response (Hickman, 2020, Pihkala, 2020b). Given the genuine threat of climate change and ecological degradation, experiencing fear and worry can be considered a rational and reasonable response (Clayton, 2020, Heeren and Asmundson, 2023, Verplanken and Roy, 2013).

Conclusion

This research was the first known investigation into the potential role of attentional bias in the relationship between eco-anxiety and pro-environmental behaviours. Taken together, our findings suggest that the experience of eco-anxiety in young adults predicts an adaptive behavioural response to climate change particularly when there is low attention dysregulation. This has significant implications for the current understanding of eco-anxiety amongst young adults and its adaptive potential in addressing the issue of climate change. This is not to discount the societal response and more systemic, policy-driven changes needed to address the climate crisis (Mah et al., 2020). However, if greater eco-anxiety is predictive of individual pro-environmental behaviours, then we appear to be faced with a double-edged sword. Whilst eco-anxiety is predictive of pro-environmental behaviours that are helpful for climate change mitigation, it is crucial that the experience of eco-anxiety is manageable and does not develop into a pathological form of anxiety that interferes with an individual’s ability to function.

Abstract

Background

     The study explored the differences in nightmare, insomnia, depression, anxiety, and cognitive deficits among adolescents and the chain mediating effects of insomnia, depression, and anxiety on the relationship between nightmares and cognitive deficits in adolescents.

Methods

     An online survey was used to collect demographic data of 6014 adolescents and assess nightmare, insomnia, depression, anxiety, and cognitive deficits using the Chinese Version of Nightmare Distress Questionnaire, Insomnia Severity Index, Patient Health Questionnaire 9, Generalized Anxiety Disorder 7, and Perceived Deficits Questionnaire-Depression. Spearman correlation analysis and the SPSS function “PROCESS macro” were used for correlation and mediation analyses, respectively.

Results

     Female adolescents, senior high school, and poor academic performance had higher nightmare, insomnia, and cognitive deficit scores; those living in the city had higher depression and anxiety scores. Cognitive deficits were positively correlated with nightmares, insomnia, depression, and anxiety. Further, insomnia, depression, and anxiety had a chain mediating effect between nightmares and cognitive deficits in adolescents. Nightmares indirectly affect cognition deficits by affecting insomnia and then depression and anxiety symptoms.

Limitations

     As this was a cross-sectional study, the causal relationship between the variables could not be determined. Moreover, reporting bias and volunteer bias might be present.

Conclusions

     These findings suggest that clinicians should identify adolescents with frequent nightmares early and provide timely treatment to minimize negative outcomes and possibly limit the chronicity of nightmare disorder. It is significant to maintain the physical and mental health development of adolescents to reduce the risk of insomnia, depression, anxiety, and cognitive deficits.

Introduction

     Sleep disorders are an important issue affecting the health of adolescents. They impact important daily functions, such as behavior, emotion, learning, and so on, which has aroused widespread concern in society. Adolescents can experience several challenges that can seriously affect their sleep, including physical factors (such as internal circadian delay) and psychological development (such as school load, being ostracized by groups, parents’ divorce, etc.) (Dewald et al., 2010). The main symptoms of sleep disorders in adolescents include difficulty falling asleep, difficulty maintaining sleep, early awakening, and lack of sleep sense. Sleep disorders are diagnosed as symptoms that last for three months and occur at least three or more times a week (American Psychiatric Association, 2013). Sleep disorders are also a core symptom of many mental illnesses, such as depression, anxiety, and cognitive dysfunction. They can be a cause or a manifestation of mental illness (Alvaro et al., 2017).

     Nightmares are common among adolescents, which typically occur during REM sleep. According to statistics, 7 % of adolescents aged 12–18 years from China have had nightmares in the previous month (Chiu et al., 2012). The International Classification of Sleep Disorders, third edition (ICSD-3) defines nightmares as “coherent dream sequences that seem real and become increasingly more disturbing as they unfold. Emotions usually involve anxiety, fear or terror. The dream content most often focuses on imminent physical danger to the individual, but may also involve other distressing themes” (Mainieri et al., 2021). Evidence shows that nightmares are related to many negative health conditions, such as insomnia, drowsiness, emotional and behavioral disorders, post-traumatic stress disorder, and suicidal concept (Liu et al., 2019; Zhou et al., 2020; Liu et al., 2017; Karia et al., 2016; Russell et al., 2018). Nightmares affect daytime functioning, decrease overall well-being, increase anxiety and stress before and after sleep, and correspond to negative emotions (Schredl et al., 2021; Antunes-Alves and De Koninck, 2012; Carr et al., 2021).

Conclusion

     Studies of numerous Chinese adolescents have shown that nightmares are associated with cognitive deficits in adolescents. Furthermore, the link between nightmares and cognitive deficits was mediated mainly by insomnia, depression, and anxiety. These findings suggest that clinicians should identify adolescents with frequent nightmares early and provide timely treatment to minimize negative outcomes and possibly limit the chronicity of nightmare disorder. To reduce the risk of insomnia, depression, anxiety, and cognitive deficits, it is considerably important to maintain the physical and mental health development of adolescents.

Abstract

Background

     The outbreak of Coronavirus disease (COVID-19) in 2019 and the resulting quarantine may have increased the prevalence of mental health problems in adolescents. The aim of this study was to explore the association between the effects of home-based learning during the pandemic and the risks of depression, anxiety, and suicidality among junior and senior high school students.

Methods

     An online survey using Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder (GAD-7) was conducted between 12 to 30 April 2020, on a total of 39,751 students. Multivariable logistic regression analysis was used to analyze the risk factors of associated depression, anxiety and suicidality during the pandemic.

Results

     Prevalence of depression, anxiety symptoms and suicidality found was 16.3% (95% CI: 16.0, 16.7), 10.3% (95% CI: 10.0, 10.6) and 20.3% (95% CI: 19.9, 20.7), respectively. Participants with female gender and in junior high school, with poor overall sleep quality and poor academic performance and very worried about being infected during COVID-19 were highly associated with the risk of depression, anxiety symptoms and suicidal ideation (all P<0.001).

Conclusions

     Prevalence of self-reported mental health problems for adolescents using home-based distance learning was high. Implementing measures (e.g., wearing face masks) and spending only moderate time focusing on COVID-19-related information could be protective factors for mental health. These results provide suggestions for teachers and policy makers regarding adolescent improving sleep quality (sufficient sleep) and academic performance and reducing worry about pandemic during quarantine to prevent mental health problems.

Introduction

     Since the first outbreak of the Coronavirus disease (COVID-19) at the end of 2019, the COVID-19 pandemic was listed as a global public health emergency of international concern by the World Health Organization (WHO, 2020). In order to contain the spread of COVID-19, most recently, the Chinese Government issued a stay-at-home order, which meant that mass quarantine was mandatory during the initial outbreak of COVID-19 (Brooks et al., 2020). For example, only residents were allowed to enter residential communities, the wearing of face masks was made compulsorily, and non-essential community services were shut down (Leung et al., 2020). Meanwhile, 107 countries as estimated by the UN Educational, Scientific and Cultural Organization (UNESCO) on 18 March 2020, had implemented national school closures related to COVID-19, affecting 862 million children and adolescents (UNESCO, 2020). In particular, there were more than 220 million children and young people confined to their homes in China, according to the Ministry of Education of China (Ministry of Education of China, 2020). Normal daily life shifted for adolescents to home-based distance learning models, which has resulted in substantial disruption to the lives of students and their families and which may have longer-term consequences for adolescent health (Golberstein et al., 2020). There are obvious advantages to remote learning, e.g., accessibility and comfort during online learning, however, the limitations of inefficient learning, lack of eye contact and feedback from teachers, inattention and the difficulty in maintaining academic integrity are also of concern (Mukhtar et al., 2020). Although adolescence is a transitional and critical developmental period with brain and body maturation, students still faced further challenges in terms of losing structure and support, routine social connections, social distancing and loneliness, less physical activity, spending more time on screens, increased irregular sleep patterns, and less favorable diets, resulting collectively in weight gain and a loss of cardiorespiratory fitness (Brazendale et al., 2017; Loades et al., 2020). These challenges have been associated with increased mental health problems in adolescents, including an increase in anxiety, depression, loneliness and a loss of motivation and purpose (Caspi et al., 2006). Therefore, adolescent mental health needs to be prioritized during the COVID-19 pandemic.

Conclusions

     The current findings indicate that the prevalence of depression, anxiety symptoms and suicidal ideation is relatively high, particularly for respondents who are female and in junior high school, with poor academic performance and negative health status, spending more than three hours focusing on COVID-19 information, very worried about being infected and those who did not implement preventive measures. Additionally, high risk of mental health problems is indicated in students who had poor overall sleep quality, little or no physical activity and who were spending more than five hours on the internet. These study findings contribute to a greater understanding of mental health problems during pandemics in both junior and high school students, especially in terms of suicidal ideation. The research will help to identify risk factors in the mental health of adolescents and provides some suggestions to prevent and manage according to the above factors, such as spending less time online, taking enough physical exercise (30–60 minutes per day), and improving sleep quality (for example, taking sufficient sleep, keeping exercise). Further longitudinal studies of the long-term effects of the COVID-19 pandemic and quarantine on adolescents are needed to expand on this research.

Abstract

     Online peer victimized adolescents are at an increased risk of several behavioral and emotional problems. Most cyberbullying interventions have focused on reducing the frequency of online peer aggressions. Meanwhile, less attention has been given to building resilience in victims to reduce the impact of victimization on their mental health. This study tested the effects of an online growth mindset intervention aimed at building resilience in victims. Eight hundred and fifty-six adolescents (47.10% female) were randomly assigned to the resilience vs. educational control intervention. The adolescents completed measures of online peer victimization, behavioral and emotional problems (online peer aggressions, depression, social anxiety, eating problems, and non-suicidal self-injury), entity theory of personality beliefs, and attitudes toward defending the victims of online peer aggressions at pretest and at three and six months. The resilience intervention reduced the predictive association between online peer victimization and online peer aggression and social anxiety, and it increased the association between online peer victimization and attitude towards defending the victims. The resilience intervention also reduced the entity theory of personality beliefs in all adolescents. These results are promising given that the intervention lasted only approximately 40–45 min.

Introduction

     Online peer aggressions are a major problem among adolescents. They consist of behaviors of threat, harassment, and embarrassment through electronic means or devices (Chun, Lee, Kim, & Lee, 2020). When these behaviors include as properties the vulnerability of the victims and the repetitiveness of the behaviors they are labeled as cyberbullying (Chun et al., 2020; Smith et al., 2008). According to a scoping review that included 159 studies distributed worldwide, the prevalence of online peer victimization in the last year varied from 1.0 to 61.1% (Brochado, Soares, & Fraga, 2017). Adolescents who are victims of online peer aggressions exhibit an increased risk of several emotional and behavioral problems. For example, findings of several meta-analyses reveal significant relationships between online peer victimization and anxiety, depression, low self-esteem, self-harming behaviors, and suicidal ideation (Fisher, Gardella, & Teurbe-Tolon, 2016; John et al., 2018; Katsaras et al., 2018). A recent meta-analysis of longitudinal studies found cyberbullying victimization as a predictor of internalizing problems, such as anxiety and depression (Marciano, Schulz, & Camerini, 2020). Online peer victimization was also associated with other behavioral problems, such as aggressions and social problems with peers and family members (Fisher et al., 2016). Moreover, the meta-analysis of longitudinal studies conducted by Marciano et al. (2020) showed that victimization significantly predicted perpetration of online aggressive behaviors over time, contributing to the perpetuation of these problematic behaviors and to the bully-victim circle. Beyond the emotional and behavioral problems highlighted in previous meta-analyses, some studies have also found a significant relationship between online peer victimization and eating problems as, for example, body dissatisfaction and unhealthy eating behaviors (Calvete, Orue, & Gámez-Guadix, 2016; Marco, Tormo-Irun, Galán-Escalante, & Gonzalez-García, 2018; Salazar, 2021).

Conclusions

     The findings of this study support the benefit of this growth mindset intervention in reducing the typical increase in social anxiety and online peer aggression after being victimized and improving attitudes to defend victims. The high prevalence rates of victimization among adolescents and the adverse effects that this victimization entails call for the implementation of interventions to reduce the effects of these aggressions. This type of short intervention, which can be applied easily and cheaply in schools, can be a useful tool. Future studies should continue to investigate its effects on other problems and in the long term.

Abstract

Background:

Methods

Results

Conclusions

Introduction

Methods and Materials

Results

Discussion

References

Acknowledgements

Disclosures

Abstract

Background:
The amygdala is widely implicated in both anxiety and autism spectrum disorder. However, no studies have investigated the relationship between co-occurring anxiety and longitudinal amygdala development in autism. Here, the authors characterize amygdala development across childhood in autistic children with and without traditional DSM forms of anxiety and anxieties distinctly related to autism.

Methods:
Longitudinal MRI scans were acquired at up to four timepoints for 71 autistic and 55 typically developing (TD) children (~2.5-12 years, 411 timepoints). Traditional DSM anxiety and anxieties distinctly related to autism were assessed at study Time 4 (~8-12 years) using a diagnostic interview tailored to autism: The Anxiety Disorders Interview Schedule-IV with the Autism Spectrum Addendum. Mixed effects models were used to test group differences at study Time 1 (3.18 years), Time 4 (11.36 years), and developmental differences (age-by-group interactions) in right and left amygdala volume between autistic children with and without DSM or autism distinct anxieties, and TD.

Results:
Autistic children with DSM anxiety had significantly larger right amygdala volumes compared to TD at both study Time 1 (5.10% increase) and Time 4 (6.11% increase). Autistic children with autism distinct anxieties had significantly slower right amygdala growth compared to TD, autism-no anxiety, and autism-DSM anxiety groups and smaller right amygdala volumes at Time 4 compared to the autism-no anxiety (-8.13% decrease) and autism-DSM anxiety (-12.05% decrease) groups.

Conclusions:
Disparate amygdala volumes and developmental trajectories between DSM and autism distinct forms of anxiety suggest different biological underpinnings for these common, cooccurring conditions in autism.

Introduction

Symptoms of autism spectrum disorder (ASD or autism) include impaired social interaction and communication and restricted repetitive behaviors (1). It is estimated that 42-69% of autistic individuals also meet diagnostic criteria for a clinical anxiety disorder (2,3). Though the amygdala has been widely implicated in both anxiety and autism (4), only three studies have investigated associations between amygdala structure and anxiety within autism (5–7). No studies of autism have investigated the development of the amygdala longitudinally in relation to anxiety, nor the associations between different forms of anxiety and the amygdala in autism.

Clinical anxiety can manifest in several forms, including generalized anxiety disorder (GAD), separation anxiety, specific phobia, and social phobia (henceforth ‘DSM anxiety’) (1). However, distinguishing anxiety from ASD symptoms is challenging (2,8). Recently developed tools recognize classically defined symptoms of anxiety (e.g., anticipatory anxiety, fearful avoidance) that manifest within contexts that are somewhat unique to autism. These symptoms would not be captured by traditional assessments (9). Such autism-distinct anxieties (henceforth ‘distinct anxiety’) include fears related to social confusion (as opposed to fear of negative evaluation which is required for a DSM diagnosis of social phobia), uncommon phobias (e.g., specific sounds, facial features), excessive worry related to losing access to materials related to circumscribed interests, and fears of change (3).

Abstract

Background

Clinical Features of Lockdown Anxiety

CBT to Decrease Symptoms and Build Resilience

Practical Application of CBT

Role of the NP

Conclusion

References

Abstract

     Mental health morbidity has increased amid the COVID-19 pandemic due to social isolation, impairment of basic needs, financial instability, and fears of the virus. New cases of anxiety and depression have been on the rise, while preexisting mental and chronic illnesses have been exacerbated. Cognitive behavioral therapy (CBT) is a highly flexible technique used to manage an array of mental illnesses. CBT may be of particular benefit under conditions of social isolation and virtual health care delivery. This report addresses the critical role of nurse practitioners in navigating effective CBT for mental wellness.

Background

     The prevalence of mental illness and substance use is steadily rising in Canada and the United States. These illnesses are associated with an estimated economic burden of $51 billion annually in Canada and $225.1 billion in the US.1,2 A significant portion of the Canadian (56%) and American (41.5%) population has experienced increased stress and anxiety as a result of the COVID-19 pandemic.3,4 In addition, mental illness and substance use are risk factors for early mortality, accounting for an average of 10 to 20 years of life lost.1 During times of extreme stress, such as a global pandemic, rates of mental illness would be expected to rise rapidly.

     The current COVID-19 global pandemic and subsequent forced quarantines and physical lockdowns have dominated every aspect of people’s lives worldwide. The pandemic measures have dramatically increased anxiety and fear related to contracting the virus, acquiring required medical supplies, receiving timely medical assistance, and accessing basic necessities and food items. Social, economic, educational, and recreational opportunities were abruptly ceased by governments during the pandemic, which further exacerbated perceived threats to safety and security.5,  6,  7,  8,  9,  10,  11 Compulsory mandates to conduct work from home disrupted work routines and schedules and placed additional strain on individuals’ mental health. Work from home orders also led to dissociation between home and work responsibilities. The consequences of the pandemic are catastrophic for society and have been associated with increased mortality and morbidity, social isolation, and loss of financial security and employment.5,  6,  7,  8,  9,  10,  11 Due to the negative global impacts of the pandemic on mental health, the purpose of this report is to address cognitive behavioral therapy (CBT) for mental wellness and the role of the nurse practitioner (NP) in providing this therapy.

Conclusion

     The COVID-19 pandemic has profoundly impacted and increased overall burdens on mental health, perpetuating a mental health pandemic. As a result, mental wellness needs to be integrated rather than ignored as a routine component of all health care encounters. The pandemic measures and subsequent lockdowns have presented an opportunity to close existing gaps in the delivery of mental health services through the integration of effective alternative therapies and methods. In particular, COVID-19–induced stress and anxiety can be successfully treated using CBT techniques. Growing research confirms that CBT can be delivered remotely or as self-guided support, both of which are particularly beneficial under pandemic restrictions. Remote use of CBT could revive a sense of joie de vivre in patients who have suffered from isolation, stress, and anxiety as a result of the COVID-19 pandemic.