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Background: Nursing students are often subjected to bullying during their clinical practices, but few study has examined associations of bullying with psychological status among these groups, and how they cope with the bullying., Objectives: This study aimed to evaluate the experience and psychological status of clinical placement setting bullying among nursing students attending clinical practices, and explore students' coping strategies when bullied., Design: A mixed methods., Settings: Six tertiary hospitals in Northwest China., Participants: A total of 687 nursing students completed the questionnaire survey, of which 18 nursing students participated in the qualitative interview., Methods: A two-phase hybrid study was produced. During first phase, data were collected by using the Bullying Behavior Scale in Nursing Education (BNEQ) and the Depression, Anxiety and Stress Scale (DASS-21). Subsequently, those who have experienced bullying in the workplace were invited to participate in a face-to-face interview (second phase) which focused on exploring students' deeper insights., Results: Of the 687 students involved, 72.19 % had experienced various types of bullying. Of them, 92.11 % experienced implicit violence. Those with higher education levels and from rural were more likely to experience bullying. Students were prone to greater psychological stress when exposed to bullying. "Pretending not to see" (33.16 %), "reporting to superiors" (30.10 %), and "doing nothing" were the most common ways students responded. Four themes were obtained from the qualitative interviews: (a) impaired self-esteem; (b) career rejection; (c) psychological stress; and (d) the decline of humanistic care., Conclusion: Our findings suggest that senior nursing students experience multiple types of bullying during the clinical practices, leading to a high level of psychological stress, which further effect students' professional approval and self-esteem. To prevent such incidents, we need to call on university and hospitals' support to help students successfully cope with bullying., Competing Interests: Declaration of competing interest The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (Copyright © 2024. Published by Elsevier Ltd.)

Sulfur mustard (SM), a chemical warfare weapon has been used in conflicts. The delayed impact of sulfur mustard on mental and physical health of veterans remains a topic of significant concern. This cross-sectional study investigated the serum levels of brain-derived neurotrophic factor (BDNF), interleukin (IL)-1β, and IL-6 in 227 SM-chemical veterans receiving long-term financial support and 77 healthy individuals. Their mental health status and life satisfaction were assessed through three self-report questionnaires (General Health Questionnaire - 28, GHQ-28; Depression, Anxiety & Stress Scale, DASS-21; 36-Item Short Form Survey, SF-36). Our findings revealed higher levels of anxiety/insomnia, and psychiatric symptoms in the veterans compared to the control group (P < 0.05), accompanied by depression, stress, and anxiety as measured by the GHQ-28 and DASS-21 assessments. Severe depression and social dysfunction were not prevalent in the veterans compared to the control group (P > 0.05) according to the GHQ-28 findings. The SF-36 assessment indicated overall better health conditions for SM participants, with higher scores across various domains (general health, social function, and mental health) and two mental and physical dimensions in the veterans compared to the control group (P < 0.05). IL-1β and IL-6 levels were lower in the SM-exposed group than in the control group, while the BDNF level was higher in the SM-exposed group (P < 0.05). Alterations in BDNF, IL-1β, and IL-6 levels along with results of the mentioned questionnaires may be evidence of partial improvement in the mental and physical health of the SM-exposed individuals receiving the financial support., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier B.V.)

Introduction: The incidence of post-pandemic psychiatric disorders has increased globally in recent decades. Generalized anxiety disorder (GAD) is one of the psychiatric disorders that are partially associated with emotional factors. It can affect the quantity and quality of saliva, present as xerostomia, and trigger the emergence of the geographic tongue (GT)., Purpose: This case report aims to discuss the management of xerostomia and geographic tongue in a patient with GAD., Case: A 26-year-old male patient complained of dry and sore mouth for one month after taking medication from the psychiatry department, was diagnosed with GAD, and had already consumed the antidepressant sertraline. Extraoral examination showed dry and exfoliative lips. Intraoral examination showed white plaque with depapilation on the dorsal tongue, frothy saliva, buccal mucosa and dorsal tongue sticking to the dental mirror. The unstimulated salivary flow rate was <0.2 mL/min (sialometry method). The Depression, Anxiety, and Stress Scale-21 (DASS-21) questionnaire was used to estimate the psychological condition and showed an extremely severe level of anxiety (score = 13). The established oral diagnoses were GT with mild xerostomia and exfoliative cheilitis., Case Management: For two months, patients received hyaluronic acid gel and mouthwash, as well as a non-pharmacological approach to healthy lifestyle counseling. There was an improvement in xerostomia, and the GT became asymptomatic, with a reduction of DASS score in this patient., Conclusion: Improved psychological conditions will improve xerostomia, but the clinical appearance of the geographic tongue is more difficult to eliminate., Competing Interests: The authors declare no conflicts of interest in this work. The patients have approved and written informed consent for the publication of this case report, including the images, by prioritizing the confidentiality of patient identity. The institution has also approved the publication of this report. The drug formula we wrote about in the case management is the commercial preparation of Gengigel® gel and Gengigel® mouthwash. However, there is no conflict of interest., (© 2024 Putri et al.)

Background: Mental distress among retirees and older people is a severe public health challenge, and information on new risk groups is needed. This study aims to identify subgroups of old-age retirees with varying associations between low social support and mental distress by applying model-based recursive partitioning (MOB)., Methods: We used the Helsinki Health Study follow-up survey data of old-age retired former municipal sector employees of the City of Helsinki, Finland. Phase 1 data were collected in 2000-2002, when all participants were employed, Phase 2 in 2007, Phase 3 in 2012, Phase 4 in 2017, and Phase 5 in 2022 (n = 4,466, 81% women). Social support and covariates were measured at each Phase 1-5 and the outcome, mental distress (Depression Anxiety Stress Scales [DASS-21]) was measured at a single occasion, during Phase 5. The three subscales and the common factor of general distress were analysed separately. An approach rooted in computational statistics was used to investigate risk factor heterogeneity in the association of low social support and mental distress. MOB combines decision trees with regression analysis to identify subgroups with the most significant heterogeneity among risk factors., Results: Median (IQR) general distress score from DASS-21 was 5.7 (3.0, 9.0), while Social Support Questionnaire number-score (SSQN) was 1.5 (1.15, 2.05). The primary effect modifier for the association between social support and general distress was education (p < 0.001). Those with high education had a different association of low social support and general distress than those with low or medium education. Additionally, the subgroup with low and medium education had a significant effect modification for age (p = 0.01). For the association between low social support and depressive symptoms, the moderating effect of education was dependent on gender, as men with medium-high education had the weakest association, while for women with medium-high education the association was strongest., Conclusions: Our results suggest that stratification by sociodemographic variables is justifiable when investigating risk factors of mental distress in old-age retirees. The incongruent association of low social support and depressive symptoms in men with medium-high education compared to women with medium-high education is a promising target for confirmatory research., (© 2024. The Author(s).)

Objective: In this study, we evaluated the psychometric properties of the Depression Anxiety Stress Scales 21 items (DASS-21) in a mild traumatic brain injury (mTBI) sample., Method: Treatment-seeking adults ( n  = 347) were recruited from outpatient rehabilitation services in New Zealand. Dimensionality, reliability, person separation index, and differential item functioning (DIF) of the DASS-21 were examined using Rasch analysis., Results: Initial analysis of the complete 21-item DASS showed poor overall fit due to problems with individual items. Fit to the Rasch model was excellent when treated as three composite scores. The stress subscale demonstrated adequate model fit, dimensionality and good reliability. For anxiety, fit was not good, reliability was unsatisfactory and DIF was evident on one item. When this item was removed, fit to the model was still inadequate as was reliability. DIF was also evident for depression, but when this item was removed, fit to the model was adequate., Conclusion: The DASS-21 is a psychometrically sound measure of distress and stress for adults seeking treatment following mTBI. Ordinal to interval score conversion tables are provided to increase the precision of measurement. When assessing depression in a mTBI population, a 6-item depression subscale is recommended. Caution is advised in using the DASS-21 anxiety subscale alone.

Introduction: Coronavirus disease 2019 (COVID-19) has an extremely high infection rate. This study aimed to investigate emotional states and COVID-19 infection of medical workers during the self-management strategy to COVID-19., Methodology: Questionnaires were collected via an online questionnaire platform from 20 December 2022 to 19 January 2023, including demographic characteristics, number of vaccine doses, COVID-19 test results, occupation, attendant situations of workers, clinical symptoms, disease duration, and the Depression, Anxiety and Stress Scale 21., Results: A total of 748 complete questionnaires were collected. The average age of participants was 33.61 ± 8.94 years, and 79.55% participants were female. The proportion of anxiety was significantly higher in the infection group (52.32%) than in the non-infection group (28.45%) (p < 0.001), as was the proportion of stress (41.47% vs. 31.90%, p = 0.046). Medical students (odds ratios (OR) 0.54, 95% confidence interval (CI) 0.31-0.93) and other staff (OR 0.63, 95% CI 0.40-0.98) had a lower risk for depression than doctors (p = 0.024), and attendant and infective situations of workers was the risk factor for depression (p = 0.007). Occupation (p = 0.029) and infected workers (p = 0.001) were related to anxiety. Infected attendant workers had a higher risk for stress (OR 1.97, 95% CI 1.12-3.48) than uninfected attendant workers (p = 0.019)., Conclusions: Most medical workers infected with COVID-19 had emotional disorders during the COVID-19 pandemic. Attention and useful measures are suggested to support medical workers., Competing Interests: No Conflict of Interest is declared, (Copyright (c) 2024 Xue Li, Qian Zhang, Wenkun Li, Jian Wei, Jie Xing, Xun Yang, Peng Li, Shutian Zhang.)

Objectives: We aimed to investigate the presence of common psychological factors (i.e., stress, depression, anxiety) and their impact on the Oral health-related quality of life (OHRQoL) in patients diagnosed with four oral mucosal diseases (OMDs): recurrent aphthous ulcers (RAU), oral lichen planus (OLP), oral leukoplakia (OLK), and oral submucous fibrosis (OSF)., Methods: A total of 229 patients with clinically diagnosed OMDs were enrolled in this study, consisting of 55 RAU, 68 OLK, 50 OLP, and 56 OSF patients. The patients were statistically analyzed for psychological problems and OHRQoL using the Visual Analog Scale (VAS)､ the 5-item Oral Health Impact Profile (OHIP-5) and the Depression Anxiety Stress Scale-21 (DASS-21) scales., Results: There were 229 valid questionnaires collected, consisting of 83 females and 146 males with a mean age of 45.24 ( SD  = 11.88) years. Multiple regressions between DASS-21 scores and OHIP-5 scores revealed generally negative impacts of psychological problems on OHRQoL, with depression on OLP ( β  = 0.47), OLK ( β  = 0.65) and OSF ( β  = 0.38), stress on RAU ( β  = 0.29), OLP ( β =  0.72), OLK ( β  = 0.38) and OSF ( β  = 0.60), and anxiety on OLP ( β  = 0.33), OLK ( β =  0.49) and OSF ( β  = 0.51)., Conclusions: Psychological problems like depression, stress, and anxiety were found to be prevalent in OMDs patients and adversely affected their OHRQoL. The results support the biopsychosocial medical model in the treatment of OMDs patients., Clinical Significance: The present study reinforced the crucial roles of psychological factors in impacting OMDs patients' OHRQoL. Therefore, it is necessary to monitor patients' psychological status and OHRQoL using questionnaires like DASS-21 and OHIP-5. Followed by psychological interventions, the treatment is expected to be enhanced., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors. Published by Elsevier Ltd.)

Background: Depression, anxiety, and stress disorders have significant and widespread impacts worldwide, affecting millions of individuals and their communities. According to the World Health Organization, depression impacts the daily lives of more than 300 million people, making it one of the most important diseases globally. Treatment for these mental disorders (MD) typically involves medication and psychotherapies, but also incorporates technological resources like Artificial Intelligence (AI) to indicate personalized therapies and care. While various AI approaches have been applied in the context of MD in the literature, they often focus solely on aiding diagnosis., Objective: This research proposes an AI approach for mapping symptoms and assisting in the personalized care of depression, anxiety, and stress., Methods: Symptom mapping utilizes data mining (DM) techniques to generate rules representing knowledge extracted from data of 242 patients collected using the Depression, Anxiety, and Stress Scale (DASS-21). This knowledge elucidates how symptoms impact the severity degrees of considered MDs. Subsequently, the generated rules are employed to construct a Fuzzy Inference System (FIS) for inferring the severities of MDs based on patient symptoms and personal data., Results and Conclusions: The results achieved in the DM (accuracy ≥92.98 %, sensibility ≥86.02 %, specificity ≥97.32 %, and kappa statistic ≥87.98 %), indicating consistent patterns, along with the results produced by the FIS, demonstrate the potential of the proposed approach to assist health professionals in rapidly predicting symptoms of depression, anxiety, and stress, thereby facilitating outpatient screening and emergency care. Furthermore, it can improve the association of symptoms, referral to specialized care, therapeutic proposals, and even investigations of other diseases unrelated to MD., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Breast cancer impacts the psychological well-being of women, leaving them at risk of developing depression, anxiety, and other stress-related disorders. The Depression Anxiety Stress Scales (DASS-21) is a widely used measure, although empirical evidence regarding its psychometric properties in the breast cancer population is limited. The purpose of this study was to conduct an exhaustive analysis of the psychometric properties of the DASS-21 in a sample of Spanish women diagnosed with breast cancer. Participants were 289 breast cancer patients who completed the DASS-21 and other questionnaires measuring life satisfaction, positive and negative affect, flourishing, perceived stress, and breast cancer-specific stressors. In terms of validity evidence based on the internal structure of the DASS-21, adequate fit indices were obtained for the model based on three first-order factors (depression, anxiety, stress) and one second-order factor (general psychological distress). Reliability coefficients (McDonald's omega) ranged from .84 to .95. Validity evidence based on relationships with other variables was also provided by moderate and strong correlations with well-being indicators and stress measures. The results support the use of the DASS-21 for measuring general psychological distress in the breast cancer context, where it may provide useful information for the design of psychological interventions with patients., (© 2024. The Author(s).)

Objective: To study the effects of playing mother's recorded voice to preterm infants in the NICU on their mothers' mental health as measured by the Depression, Anxiety and Stress Scale -21 (DASS-21) questionnaire., Design/methods: This was a pilot single center prospective randomized controlled trial done at a level IV NICU. The trial was registered at clinicaltrials.gov (NCT04559620). Inclusion criteria were mothers of preterm infants with gestational ages between 26wks and 30 weeks. DASS-21 questionnaire was administered to all the enrolled mothers in the first week after birth followed by recording of their voice by the music therapists. In the interventional group, recorded maternal voice was played into the infant incubator between 15 and 21 days of life. A second DASS-21 was administered between 21 and 23 days of life. The Wilcoxon rank-sum test was used to compare DASS-21 scores between the two groups and Wilcoxon signed-rank test was used to compare the pre- and post-intervention DASS-21 scores., Results: Forty eligible mothers were randomized: 20 to the intervention group and 20 to the control group. The baseline maternal and neonatal characteristics were similar between the two groups. There was no significant difference in the DASS-21 scores between the two groups at baseline or after the study intervention. There was no difference in the pre- and post-interventional DASS-21 scores or its individual components in the experimental group. There was a significant decrease in the total DASS-21 score and the anxiety component of DASS-21 between weeks 1 and 4 in the control group., Conclusion: In this pilot randomized control study, recorded maternal voice played into preterm infant's incubator did not have any effect on maternal mental health as measured by the DASS-21 questionnaire. Data obtained in this pilot study are useful in future RCTs (Randomized Controlled Trial) to address this important issue.

Purpose: Pandemics usually have inequitable effects on the most vulnerable groups of society. Since the start of COVID-19, there has been a horrifying upsurge in cases of sexual and gender-based violence against women, globally. Consequently, frequent breaking news of sexual violence in media aggravated mental distress and worry among women. In this cross-sectional study, we investigated the impact of the rise in active circulation of news of sexual violence on the mental health of working women and students using the validated DASS-21 questionnaire., Methods: A total of 303 women with diverse socio-demographic backgrounds participated in the study. We performed a chi-square test to analyze the association of increase in media reporting with DASS-21total and sub-categories scores. Multivariate linear regression was performed on propensity score-matched subjects to identify psychosocial predictors of mental distress., Results: Increased self-reported worries in response to rise in media reports of sexual violence was found to be significant predictor of mental distress (p < 0.002). Moreover, highly significant correlation between the increase in media reports and scores of depression, anxiety, and stress was observed (p < 0.001)., Conclusions: The rise in media reporting of sexual violence in the after math of COVID-19 was found to have a significant psychological impact on the mental health of Pakistani women. This is the first study of its kind on the subject and provides fundamental findings for shaping policy change on responsible media reporting of sexual violence., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.)

Research indicates that social media use can lead to addiction, fear of missing out, higher stress levels, anxiety, and experiencing symptoms typical of depression. The purpose of the present study was to conduct a Polish adaptation of the Social Media Escapism Scale and to assess its associations with fear of missing out, Facebook addiction, thought suppression, and the experience of stress, anxiety, and symptoms typical of depression. Two studies were conducted, the first adaptive and the second testing associations. The first study included 383 participants aged 18 to 63 (M = 23.51; SD = 5.7). To adapt the scale, the following were used: the Bergen Facebook Addiction Scale, the fear of missing out Scale, and the demographic questionnaire. The second study included 417 participants aged 18 to 60 (M = 26.33; SD = 9.7). The study tested relationships using the same three scales used in the first study, and also Depression, Anxiety, Stress Scale, and the White Bear Suppression Scale. The Polish version of the Social Media Escapism Scale revealed a univariate structure with strong internal consistency (α = .91). The adapted scale was associated with fear of missing out and Facebook addiction. In study 2, the structural equation modeling analyses revealed that fear of missing out, Facebook addiction and escapism were positively related to thought suppression and the experience of anxiety, stress, and depression symptoms. In addition, thought suppression partially mediated the relationship between harmful media use and anxiety, stress, and depression. Furthermore, the findings reveal a positive correlation between escapism and several psychological constructs, including fear of missing out, Facebook addiction, as well as aspects of depression and suppression, thereby lending support to the convergent validity of the adapted measure under investigation. The results can be used in psychological intervention and developing support and treatment programs for social network addiction., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background and Objective : This study aimed to explore the impact of physical activity on depression, anxiety, and stress among pregnant women in the Jazan region of Saudi Arabia. Materials and Methods : A descriptive cross-sectional study was conducted among pregnant women attending randomly selected prenatal clinics in primary healthcare hospitals in Jazan, Saudi Arabia. The calculated sample size was 350. Data were collected conveniently through a semi-structured questionnaire covering demographic details, pregnancy-related characteristics, physical activity assessed using the Pregnancy Physical Activity Questionnaire (PPAQ), and mental health parameters evaluated by the Depression, Anxiety, and Stress Scale-21 (DASS-21). The statistical analyses included descriptive statistics and Wilcoxon and Kruskal-Wallis rank sum tests, with significance levels set at p < 0.05. Results : The study involved 406 pregnant females. Nearly a third (31%) had a family history of depression, anxiety, or distress. The prevalence of depression, anxiety, and stress was 62.6%, 68.7%, and 38.4%, respectively. The mean sedentary, light, moderate, vigorous, and total energy expenditures were 1.512, 24.35, 22.32, 4.84, and 53.02 metabolic equivalent tasks/day. Anxious females exhibited higher light activity (median 24, p = 0.033), while stressed ones showed higher light (median 25, p = 0.039), moderate (median 20, p < 0.001), and vigorous activity (median 3, p < 0.001). A significant association was observed between total energy expenditure and stress levels ( p < 0.001). Conclusions : This study underscores the importance of physical activity in managing depression, anxiety, and stress among pregnant women in Jazan, Saudi Arabia. The findings suggest a need for tailored interventions to promote physical activity to improve mental well-being during pregnancy.

Objective: The aim of this study was to investigate the status of health-related quality of life in Chinese patients with ankylosing spondylitis (AS) and to analyze factors associated with the Assessment of SpondyloArthritis international Society Health Index (ASAS-HI) in AS and its relationship with disease activity and psychological status., Methods: A cross-sectional study of 484 patients with AS attending 10 hospitals in China from March 2021 to September 2023 was recruited. The ASAS-HI assessed general health and functional status; the Depression Anxiety Stress Scales (DASS-21) assessed psychological disorders such as anxiety, depression, and stress; and the Functional Assessment of Chronic illness Therapy-Fatigue Scale (FACIT-F) assessed patients' fatigue symptoms; the Ankylosing Spondylitis Disease Activity Score-C-Reactive Protein (ASDAS-CRP), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), and Bath Ankylosing Spondylitis Measurement Index (BASMI) were used to assess patients' disease activity and functional impairment. The correlation between ASAS-HI and the ASDAS, poor psychological status, and fatigue symptoms was observed. Univariate and multivariate logistic regression analyses were used to explore the relevant influencing factors of ASAS-HI., Results: A total of 484 patients were included in this study of whom 162 were in poor health, 139 in moderate health, and 183 in good health. On univariate analysis, disease activity is an important factor affecting ASAS-HI. People with extremely high disease activity (ASDAS ≥ 3.5) had a 12 times elevated risk of having poor health status (OR = 12.53; P < 0.001). Other significant covariates included age ≥ 36 (OR = 1.58; P = 0.015), BMI ≥ 24 kg/m 2 (OR = 2.93; P = 0.013), smoke (OR = 1.96; P = 0.002), BASFI (OR = 1.49; P < 0.001), BASMI (OR = 1.22; P < 0.001), fatigue (OR = 6.28; P < 0.001), and bad psychological conditions such as depression (OR = 10.86; P < 0.001), anxiety (OR = 3.88; P < 0.001), and stress (OR = 4.65; P < 0.001). The use of bMARDs is inversely associated with the appearance of adverse health status (OR = 0.54; P = 0.012). There was no significant relationship between HLA-B27 and sex. Multivariable logistic regression showed that higher disease activity (ASDAS ≥ 3.5) (OR = 5.14; P = 0.005), higher scores of BASMI (OR = 1.10; P = 0.009), self-reported depression (OR = 3.68; P = 0.007), and fatigue (OR = 2.76; P < 0.001) were factors associated with adverse health status., Conclusion: The health status of AS patients is related to age, BMI, smoking, disease activity, poor psychological status, and fatigue and is influenced by a combination of multiple factors such as emotional state, economic level, pain, and dysfunction. Therefore, clinicians should pay attention to the early assessment of ASAS-HI in order to improve the prognosis of the disease. Key Points •Ankylosing spondylitis (AS) is a chronic inflammatory autoimmune disease with a long course and heavy disease burden, which greatly affects patients' quality of life. Therefore, this study aims to evaluate the health status of ankylosing spondylitis in the Chinese population and its influencing factors. •This is a multi-center cross-sectional study in China, which can better reflect the overall situation of the Chinese population., (© 2024. The Author(s), under exclusive licence to International League of Associations for Rheumatology (ILAR).)

Background/aim: Physicians work under high levels of stress due to factors such as excessive workload, emotional factors, and economic variables. This leads to various health problems such as depression, burnout, fatigue, and hopelessness, resulting in decreased interest in a medical career and an increase in career choice regret., Materials and Methods: The study included 300 volunteer resident physicians from Ankara University Medical Faculty Hospital. The data for the research were collected using a survey form prepared by reviewing the literature. The survey consisted of three parts, which questioned the physicians' sociodemographic characteristics and professional choices, including the Depression Anxiety Stress Scale-Short Form (DASS-21) items and the Decision Regret Scale., Results: Of the physicians, 216 (72.0%) chose the medical faculty due to personal preference. The percentage of those who were not regretful about their career choice was 14.3% (n = 43). Those not regretful about their career choice had fewer years in the profession than the others. According to the categorical assessment of the DASS-21, 73.7% (n = 221) of the physicians had depressive symptoms ranging from mild to severe, 78.7% (n = 236) had anxiety symptoms ranging from mild to severe, and 57.7% (n = 173) had stress symptoms ranging from mild to severe., Conclusion: Mental health problems such as depression, anxiety, and stress were common among the resident physicians independent of their sociodemographic characteristics, and this was also associated with the level of career regret. Improving working conditions and personal benefits, addressing economic and other issues for physicians, ensuring their well-being, preventing the development of mental health problems, and early screening and rehabilitation for those affected not only have personal benefits but also contribute positively to job satisfaction, strengthen the patient-physician relationship, and have a significant impact on healthcare services., Competing Interests: Conflict of interest: The authors declare that there are no conflicts of interest., (© TÜBİTAK.)

Background: Infertility is a global issue and carries significant mental health implications. Data on mental health among infertile women in Saudi Arabia are limited., Objective: This study aimed to assess the prevalence and severity of depression, anxiety, and stress among infertile women in Saudi Arabia., Methods: This analytical cross-sectional study included women of reproductive age visiting governmental hospitals in Jeddah, Saudi Arabia. The participants were asked to fill out a pre-structured questionnaire, which included the Depression, Anxiety, and Stress Scale (DASS-21) to assess their mental health status. Data analysis was conducted using IBM SPSS Statistics, Version 29.0 (released 2023, IBM Corp., Armonk, NY). The three outcome variables derived from the DASS-21 were categorized into five distinct groups for descriptive purposes., Results: In this study, infertile women had significantly higher median scores for depression (18), anxiety (15), and stress (20) compared to fertile women who had median scores of 8, 8, and 10 for depression, anxiety, and stress, respectively. The differences between these two groups were statistically significant (p-value < 0.001). Furthermore, employed infertile women reported higher median scores for depression (87), anxiety (84.5), and stress (84.5) compared to unemployed women. In addition, infertile women with a monthly income of 10,001-20,000 SAR had notably higher median scores for depression (89.56), anxiety (90.22), and stress (89.94) compared to other income groups. These differences were statistically significant (p-values < 0.05)., Conclusion: Infertility significantly contributes to mental health issues among women in Saudi Arabia. The findings highlight the need for targeted psychological interventions alongside infertility treatment to enhance the quality of life of these women., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Ethics Committee of the Directorate of Health Affairs in Jeddah issued approval A01826. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Alsahel et al.)

Background: COVID-19 pandemic resulted in widespread and devastating physical, emotional, societal, and economic repercussions among workers in India., Objectives: To evaluate the impact of COVID-19 and to understand the challenges faced and coping mechanism adopted among fishermen community from the coastal area of Karnataka., Methodology: This community-based mixed-methods study included participants from a coastal Karnataka fishermen's community. Questionnaire based personal interviews collected information on sociodemographics, COVID-19 diagnosis, treatment, and related costs, COVID-19-appropriate behavior and were screened using DASS-21. Focus group discussions and key informant interviews were conducted to acquire qualitative data., Results: Quantitative data collection involved 107 participants, predominantly males [70.1%], aged between 46-60 years [37.4%] and low socioeconomic status [79.4%]. Among 107, 51 participants reported to have probable COVID-19 symptoms. Around 11% had tested for COVID-19 and two were admitted in hospital with mean hospital stay of seven days. According to DASS-21, 20.6%, 15.9% and 9.3% of participants screened positive for depression, anxiety and stress respectively. Nearly one third of the participants were found to have significant socioeconomic impact.Major challenges faced included loss of livelihood, inaccessibility to health care, repayment of loans, stigma related to COVID-19 and meeting educational expenses of children with one dropping out of college. Activities of local self-help groups in the community and grass root level marketing strategies to sell fish were highly successful in mitigating the impact as a community., Conclusion: COVID-19 had a significant impact on fishermen community and implies a need for better pandemic and disaster preparedness strategies in the community.

Background: Comprehensive data has shown that adolescents often suffer from depression, anxiety, and low self-esteem, and are in a particularly fragile stage of psychological, physiological, and social development. Left-behind children in particular tend to have significantly higher, state anxiety and depression compared to non-left-behind children. The Depression, Anxiety, and Stress Scale (DASS-21) is an effective tool for evaluating depression, anxiety, and stress, and is used to measure levels of depression, anxiety, and stress in groups from a variety of backgrounds. The purpose of this study was to determine the effectiveness, reliability, and measurement invariance of the DASS-21 in Chinese left-behind children., Method: The test and re-test method was used (N = 676), and the exploratory structural equation model (Mplus v.8.3) used to verify basic measurement models. For measurement invariance, the configural, weak, strong, and strict models were tested. The reliability of the DASS-21 was also tested using the collected data., Results: Analysis results showed that the DASS-21 had a stable three-factor structure in the sample of left-behind children in China. The measurement invariance test showed that gender and time not only had strong invariance, but also strict invariance. The results of cross left and non-left invariance indicated a lack of strict invariance. Finally, the McDonald's omega coefficient of the DASS-21 total scale was 0.864, and the internal consistency of each subscale was also good., Conclusions: The DASS-21 is shown to be an effective and reliable tool for measuring depression, anxiety and stress in Chinese left-behind children., (© 2024. The Author(s).)

Background: The aim of this study was to classify distinct subgroups of adolescents based on the severity levels of their mobile phone addiction and to investigate how these groups differed in terms of their psychosocial characteristics. We surveyed a total of 2,230 adolescents using three different questionnaires to assess the severity of their mobile phone addiction, stress, anxiety, depression, psychological resilience, and personality. Latent class analysis was employed to identify the subgroups, and we utilized Receiver Operating Characteristic (ROC) curves and multinomial logistic regression for statistical analysis. All data analyses were conducted using SPSS 26.0 and Mplus 8.5., Methods: We classified the subjects into subgroups based on their mobile phone addiction severity, and the results revealed a clear pattern with a three-class model based on the likelihood level of mobile phone addiction ( p  < 0.05). We examined common trends in psychosocial traits such as age, grade at school, parental education level, anxiety levels, and resilience. ROC analysis of sensitivity versus 1-specificity for various mobile phone addiction index (MPAI) scores yielded an area under the curve (AUC) of 0.893 (95% CI, 0.879 to 0.905, p  < 0.001). We also determined diagnostic value indices for potential cutoff points ranging from 8 to 40. The optimal cutoff value for MPAI was found to be >14, which corresponded to the maximum Youden index (Youden index = 0.751)., Results: The latent classification process in this research confirmed the existence of three distinct mobile phone user groups. We also examined the psychosocial characteristics that varied in relation to the severity levels of addiction., Conclusion: This study provides valuable insights into the categorization of adolescents based on the severity of mobile phone addiction and sheds light on the psychosocial characteristics associated with different addiction levels. These findings are expected to enhance our understanding of mobile phone addiction traits and stimulate further research in this area., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Wu, Jia, Li, Liu, Zhang, Zhang, Jia and Fan.)

Background: Stress, depression and anxiety are prevalent mental health concerns that are getting worse every day in the context of rapidly expanding megacities, where a rising number of people live in slums. The purpose of this study is to evaluate the state of mental health and related variables underlying mental health issues among the impoverished population., Methodology: A total of 384 slum residents from the Khulna division responded to our questionnaire, which included the DASS-21 and other pertinent questions. Using ordinal logistic regression, the significant factors were extracted., Results: The Cronbach's reliability coefficient for the DASS-21 scale lies between 0.79 and 0.89 which indicates the high reliability of the DASS-21 scales. According to the findings, roughly 72.7%, 84.1%, and 69% of participants slum dwellers experienced anxiety, depression, and anxiety problems respectively. The result of ordinal logistic regression shows, slum dwellers of female gender (B = 0.669*, 95% CI 0.141, 1.197), married (B = 1.506*, 95% CI 0.119, 2.893), having only one earning member in the family (B = 1.224*, 95% CI 0.526, 1.922), day laborers (B = 2.294*, 95% CI 1.115, 3.473), not being able to educate children due to financial problem (B = 0.558*, 95% CI 0.183, 0.932) were more likely to report high levels of anxiety, depression, and stress., Conclusion: The study finds that a significant portion of people who live in slums struggle with mental health issues. It also points to the need for further support, intervention, and study on Khulna's slum inhabitants who are experiencing mental health issues. The authors anticipate that the results will spur policymakers and government representatives to enhance financing for slum dwellers and employ psychological intervention strategies, both of which will aid in achieving the Sustainable Development Goal., (© 2024. The Author(s).)

Background: Smartphones have become an indispensable part of almost everyone's life. India has now become the leading and second-largest Smartphone market in the world. It has been noted that the purpose of Smartphone usage has exceptionally changed over the past few years, especially among students, professionals, and the common man. Smartphones have now become essential and the need of the hour, and medical students are no exception. Smartphones can make "smart students smarter"! There are now 10,275 unique applications labeled under the "Medical" and "Healthcare and Fitness" categories. The common medical applications used are MedCalc, Drug Infusion, Flashcards, Encyclopedia, Merck Manual, Medscape, PubMed, Epocrates, MedlinePlus, Lab test applications, Medical Dictionary, Eponyms etc. Despite the advantages and needs of smartphones, they have proven to be a source of potential hazard to human health, not only physical but also mental, social, and emotional well-being. There is consistent evidence for co-morbidity (such as obesity, heart diseases, neck and back pain, etc.) between excessive smartphone use and other psychiatric disorders, such as depression, anxiety, obsessive and compulsive disorder (OCD), and attention deficit hyperactivity disorder (ADHD) similar to internet addiction. The significant association of this addiction with poorer sleep quality and higher perceived stress has been a cause for concern. Hence, further investigation to explore the association between smartphone addiction and mental health, this study was undertaken., Materials and Methods: Our study was undertaken in Dr VMGMC, Solapur, from June to August 2022, after obtaining approval from the ethical committee, approval number 172/22. Total voluntary participation for the study was 600 (from first to final year), and accordingly convenient sample size was taken., Results: We found that out of the total participants, 42% of the participants had an average screen time of 4-6 h daily. A very small percentage of participants (4%) spent less than two hours in front of a screen. Alarmingly, 65% of the participants had an average screen time of more than 4 hours, which puts them at risk for the negative health impacts of prolonged screen time. Around 12% of them had symptoms of mild stress, 10.3% for mild anxiety, and 15.6% for mild depression. 10.6% had symptoms of moderate stress, 23.3% for moderate anxiety, and 16% for moderate depression. A small proportion of undergraduates, that is, 5%, 16%, and 11.6%, had symptoms of severe and extremely severe stress, anxiety, and depression, respectively., Conclusion: The study participants did not feel a lot of stress, anxiety, or depression symptoms when smartphones were used judiciously and mostly for non-social purposes (such as studying, listening to music, or watching videos). This investigation led us to the conclusion that there are some positive effects of smartphones on mental health. However, those who spent an excessive amount of time on their smartphones for social contact, with an average screen time of 5 h, showed signs of mild to moderate sadness, moderate anxiety, and tension, demonstrating that social media had a negative impact on the mental health of medical undergraduates. Therefore, efforts should be made to inform medical students about how using a smartphone is harming their mental health., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Journal of Education and Health Promotion.)

The Depression, Anxiety, and Stress Scale-21 (DASS-21) has been used in various countries to assess the mental states of individuals. The objectives of this study were to validate the DASS-21 for use in Guam, an island that endures a high burden of mental health challenges, such as suicide, and examine the predictive impact of selected health indicators on DASS-21 variables. Three years of data (2017-2019) were pooled from the Pacific Islands Cohort of College Students (PICCS) study conducted annually at the University of Guam. In total, 726 students were included in the secondary data analysis. MPlus statistical software was used to perform a confirmatory factor analysis (CFA) for the validation and structural equation modeling (SEM) for the predictive modeling. The results from the CFA suggested an acceptable model fit (RMSEA: 0.073, CFI: 0.901, TLI: 0.889, RMR: 0.044), while SEM suggested that sleep quality and physical activity were significant predictors of DASS-21 variables. Therefore, the DASS-21 is a valid instrument for measuring depression, anxiety, and stress among emerging adults in Guam., Competing Interests: The authors declare no conflicts of interest.

Background: The escalating worldwide concerns for mental health, significantly amplified by the COVID-19 pandemic, necessitates understanding the impact on vulnerable populations, such as university students. This study aims to investigate the prevalence and implications of depression, anxiety, and stress among university students in the United Arab Emirates (UAE) using the Depression, Anxiety, and Stress Scale-21 Items (DASS-21)., Methods: This study utilized convenience sampling to investigate the mental health of undergraduates in UAE universities using a bilingual DASS-21 questionnaire via Google Forms. Analysis was conducted using SPSS version 29.0, employing descriptive statistics, Chi-squared tests, Mann-Whitney tests, Kruskal-Wallis tests, and Multinomial Logistic Regression to analyze relationships between sociodemographic variables and mental health scores., Results: The study examined 332 students, with most female participants (81 %, n = 269) and individuals aged 18-20 (89.8 %, n = 298). It revealed higher mean DASS scores among females: Depression (M = 15.80, p  = 0.030), Anxiety (M = 17.63, p  < 0.001), and Stress (M = 22.61, p  < 0.001). Fourth-year students exhibited the highest DASS scores for depression (M = 30.33, p  = 0.002), anxiety (M = 21.33, p  = 0.002), and stress (M = 27.00, p  = 0.005). Younger participants aged 18-20 had an odds ratio (OR) of 4.925 for depression, indicating they were approximately five times more likely to experience depression., Conclusions: This study reveals gender, age, and academic-year variations in depression, anxiety, and stress among UAE university students. Specifically, our findings indicate higher levels of anxiety and stress among females and reveal academic-year and age-related patterns in mental health conditions. University support services in the UAE should better address student needs, including counseling focused on high school to university transition challenges., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Background and objectives Many research studies show that self-stigma related to weight can exacerbate mental health issues. There is also evidence suggesting that depression, anxiety, and stress could be predictors of weight stigma. However, these connections have not been thoroughly investigated among young people in Saudi Arabia, where there is a high prevalence of obesity. This study aimed to explore the relationships between depression, anxiety, stress, and weight self-stigma in Saudi Arabian adolescents and young adults. Materials and methods This cross-sectional study was conducted between January and March 2022 and utilized online surveys, including the Weight Self-Stigma Questionnaire (WSSQ) and Depression, Anxiety, and Stress Scale 21 (DASS-21). We conducted descriptive analysis, independent samples t-tests, analysis of variance (ANOVA), and linear regression for the statistical analysis using SPSS version 25 (IBM Corp., Armonk, NY). Results A total of 1624 participants were enrolled in this survey. Most participants (889, 54.7%) were females. The mean age was 20.73 years (SD: 2.63). Males were more likely to report self-stigma compared to females (p = 0.018). Weight self-stigma demonstrated significant positive associations with body mass index (BMI) (p = 0.0001) and depression, anxiety, and stress (p = 0.0001) scores. Further analysis revealed weight self-stigma was positively correlated with psychological distress levels in the study population (p = 0.0001). The results demonstrated a statistically significant difference between different regions of Saudi Arabia with weight self-stigma being more prevalent in the Al-Baha region and least prevalent in the Al-Madinah region. Conclusions The results of this study indicate robust positive correlations between weight self-stigma scores and depression, anxiety, and stress scale scores among adolescents and young adults in Saudi Arabia. Further epidemiological and clinical studies on the national level are warranted., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Ali et al.)

Background: Psychological distress may worsen during cancer treatment and affect well-being. Information on the prevalence of distress and its associated variables in cancer patients undergoing chemotherapy in rural Bangladesh has not been thoroughly explored. To address this, we aimed to assess psychological distress and its associated factors in patients with cancer undergoing chemotherapy., Methods: This cross-sectional study was conducted at a tertiary care hospital in rural Bangladesh. Only adult patients with cancer who were receiving chemotherapy were enrolled in this study. The validated Depression Anxiety Stress Scale was used to assess psychological distress. Frequency and percentages were used in descriptive analysis, and logistic regression analysis was performed to investigate potential associated factors for depression, anxiety, and stress., Results: Participants comprised 415 patients with a mean age of 46.3 years. The prevalence of depression, anxiety, and stress was 61.5%, 55.4%, and 22.0%, respectively. In the multivariate logistic regression analysis, patients with more than five family members and smokeless tobacco users had a significant association with depression, anxiety, and stress. In contrast, participants aged >60 years had a protective association with depression., Conclusions: Our findings show that patients with cancer receiving chemotherapy experience a high prevalence of depression and anxiety and that the use of smokeless tobacco and having six or more family members are associated with psychological distress. These findings will aid health professionals and policymakers in establishing and implementing improved care programs to ensure the greater mental health of cancer survivors, particularly in resource-limited settings., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Journal of Family Medicine and Primary Care.)

Introduction: The objective of this study is to evaluate the quality of life (QoL), depression, anxiety, and stress, along with associated factors among individuals with diabetes in Saudi Arabia., Methods: This survey was conducted at King Abdulaziz University (KAU), Jeddah, Kingdom of Saudi Arabia (KSA). The assessment of depression, anxiety, and stress related to Type 2 Diabetes Mellitus (T2DM) was conducted using the DASS-21 questionnaire, while diabetes-related QoL was evaluated using the revised version of the diabetes QoL questionnaire (RV-DQoL13). Data were analyzed using SPSS-26., Results: A total of 251 subjects were included in the study (165 [65.7%] males and 86 [34.3%] females, mean age 50.1 ± 14.5 years). The individuals with DM had a mean value of QoL of 29.16 ± 9.23, with 46.9% having poor QoL. Furthermore, in dimensions of QoL, almost half of the individuals reported high worry about the disease (49.6%), followed by a high diabetes impact (46.6%) and low life satisfaction (42.9%). The prevalence of depression, anxiety, and stress was 49.4, 71.7, and 49.8%, respectively. A significant correlation was found between depression, anxiety, and stress and DASS-21 scores with QoL ( p  < 0.001). The regression analysis indicated an association of distinct factors with QoL like age above 41 years ( p  = 0.004), being married ( p  < 0.001), being divorced ( p  = 0.04), higher education ( p  = 0.007), regular medicine intake ( p  = 0.01), regular exercise ( p  = 0.03), lipid profile ( p  = 0.01), HbA1c ( p  < 0.001), and DASS-21 scores ( p  < 0.001). Poor QoL score (TQoL score > 27) was significantly associated with depression, anxiety, and stress ( p  < 0.001). The participants with higher monthly income, shorter disease duration, regular medicine use, and altered lipid profile, and older subjects had a lower chance of depression, anxiety, and stress., Conclusion: Approximately half of individuals with T2DM experienced poor QoL, while the prevalence rates for depression, anxiety, and stress were 49.4, 71.7, and 49.8%, respectively. Scores in the domains of impact, worry, and satisfaction were below optimal levels. Several factors were linked to QoL and depression, anxiety, and stress, and an association was observed between DASS-21 scores and QoL., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Abualhamael, Baig, Alghamdi, Gazzaz, Al-Hayani and Bazi.)

Background Complete edentulism negatively impacts emotional, physical, social, and psychological well-being, leading to a decline in quality of life and heightened stress and anxiety. Stressful situations associated with edentulism can elevate cortisol levels, potentially increasing the risk of diabetes. Rehabilitation with complete dentures needs careful evaluation for its impact on general health, considering stress points and systemic effects. This study aimed to assess salivary cortisol levels in type 2 diabetes mellitus patients before and after complete denture rehabilitation, highlighting the intricate relationship between diabetes, cortisol, and the stress response. Methods This is a cross-sectional study centered on individuals with diabetes who were completely edentulous and undergoing evaluation by the outpatient prosthodontic department. Glycated hemoglobin, anxiety levels, and the fabrication of complete dentures were all accomplished with the participants' consent. Patients underwent evaluations before and one month after receiving complete denture rehabilitation. Results An absolute correlation between salivary cortisol levels and anxiety may be established because anxiety levels dramatically decreased during complete denture rehabilitation. Conclusion By learning how the patient's general health is related to their new set of complete dentures and how to correlate that information with dental rehabilitation, professionals can help patients better adapt to their new set of dentures., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Bansod et al.)

Objectives This study aimed to assess the relationship between depression, anxiety, stress, and disordered eating behaviors among schoolgirls in Riyadh, Saudi Arabia. The current study could provide insights into potential intervention strategies for addressing both aspects simultaneously, contributing to a more holistic approach in the field. Method Via simple sampling technique, the current quantitative, descriptive, and cross-sectional study included 347 female adolescents aged between 13 and 18 years in public schools in Riyadh, Saudi Arabia. A self-administered questionnaire comprised demographic information, items on body image satisfaction and perception, the Eating Attitude Test-26 (EAT-26), and the Depression, Anxiety, and Stress Scale-21 (DASS-21). Results Among the participants, 32.6% scored at or above the cutoff point on the EAT-26, indicating a negative eating attitude. Additionally, multiple factors such as age, obesity, body image dissatisfaction, and peer pressure were correlated with disordered eating behaviors, with excessive exercise being the most reported weight control behaviors. The prevalence of depression, anxiety, and stress were 58.5%, 73.2%, and 40.9%, respectively. Notably, anxiety was significantly associated with disordered eating behaviors. Conclusion In conclusion, disordered eating behaviors were reported by 32.6% of the participants, and symptoms of anxiety were significantly associated with these behaviors. Media consumption appeared to influence more than half of the participants in their weight loss attempts., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Makki et al.)

Sleep is essential for overall health, yet various sleep disorders disrupt normal sleep patterns, affecting duration, quality, and timing. This pilot study investigate the impact of a food supplement (SPINOFF ® ) on both sleep quality and mental well-being in 41 participants (mean age: 45.3 years). Initial assessments revealed sleep disturbances (Pittsburgh Sleep Quality Index-PSQ-mean score: 8.2) and insomnia symptoms (Insomnia Severity Index-ISI- mean score: 12.7). Mental health assessments showed psychological distress (Dass-21 Depression mean score: 4.2, Anxiety mean score: 6.9, Stress mean score: 11.6, Total mean score: 22.7). This study assessed sleep continuity using Awakenings per Night (ApN) via a smartwatch (HELO HEALTH ® ) and conducted the study in two phases: baseline (T0) and after 30 days of treatment (T1) (Phase A). No placebo-control was used in this study. After 30 days (Phase B), 21 patients were selected for reassessment. Eleven continued treatment for another 30 days (T2), while ten discontinued. Following the intervention, we observed remarkable improvements in sleep quality and mental distress. The SPINOFF ® supplement significantly reduced the PSQI scores (22.4%), indicating enhanced sleep quality. Additionally, there was a 19.6% decrease in ISI scores, demonstrating a reduction in insomnia symptoms. Moreover, overall psychological distress decreased by 19.5% signifying improved psychological well-being. In the second phase, participants who continued treatment experienced more substantial improvements, with a mean decrease of 0.8 points in PSQI scores (±0.9) and a mean decrease of 0.9 points in ISI scores. Our findings suggest that the SPINOFF ® supplement has the potential to effectively address both sleep disturbances and psychological distress in our study population.

Background: Migrant workers make up a third of the population of Saudi Arabia, approximately 13 million. Mental health disorders among this population are common, but very limited data exist currently., Aims: To assess the prevalence of moderate to severe symptoms of depression and stress among a sample of migrant workers in Saudi Arabia. To identify whether migrant-specific factors, such as occupation, nationality, duration of migration, and work characteristics, are associated with depressive and stress symptoms., Methods: A cross-sectional study of 2,123 migrants was conducted in Al Qassim, Saudi Arabia. Depressive and stress symptoms were assessed with the Depression, Anxiety, and Stress Scale (DASS-21). The outcomes were categorized into two levels (i.e. mild or no symptoms versus moderate to severe symptoms). Univariate and multivariate binary logistic regressions were used to assess the relationship with potential covariates., Results: The prevalence of moderate to severe depressive and stress symptoms was 7.3% and 3.6%, respectively. These did not vary by the duration of stay in the country or weekly work hours. However, there was substantial variance in the symptoms by participants' nationality and occupation. Participants from Bangladesh were 3.8 (95% CI [1.50, 9.62]) times more likely, and hospital cleaners were 6.5 (95% CI [2.12, 20.07]) times more likely to have depressive symptoms. Similarly, auto-repair workers were 6.3 times more likely to have symptoms of stress (95% CI [1.55, 25.90])., Conclusion: The prevalence of depressive and stress symptoms varied significantly depending on occupation and country of origin. It would behoove employers to screen for these mental health conditions and refer employees to the relevant healthcare services. Future studies could examine the feasibility of mental health screening programs among migrant employees.

Emotional disorders are pervasive in the acquired brain injury (ABI) population, adversely affecting quality of life and rehabilitation. This study aimed to explore the unique associative effects of alexithymia as measured by the Perth Alexithymia Questionnaire (PAQ; i.e., difficulty identifying positive/negative feelings, difficulty describing positive/negative feelings, and externally orientated thinking), on emotional outcomes as measured by the Depression Anxiety Stress Scale-21 (DASS-21) and Mayo-Portland Adaptability Inventory (MPAI-4) Adjustment index, in 83 adults with ABI. The addition of alexithymia to hierarchical multiple regression models (controlling for demographic, injury-related, and functional outcome variables) yielded statistically significant changes in R 2 for all emotional outcome measures (i.e., Depression, Anxiety, Stress, and Adjustment). Difficulty identifying negative feelings was found to be a significant unique predictor of Depression ( β  = .43 p  = <.001), Anxiety ( β  = .40, p <.001), Stress ( β  = .49, p <.001), and Adjustment ( β  = .26, p  = .001). Externally oriented thinking was found to be a significant unique predictor of Adjustment ( β  = -.15, p  = .033). These findings strengthen the argument that alexithymia, especially difficulties identifying negative feelings, may be an important risk factor for psychological distress in ABI and should be considered during early rehabilitation.

Background: The coronavirus disease 2019 (COVID-19) pandemic has impacted the mental health of the population globally with the increase in cases of depression, suicide, and self-harm. According to the World Health Organization, there has been an increase of 28% and 26% in major depressive disorders and anxiety, respectively, during 1 year of the COVID-19 pandemic. Only a few studies had been conducted in India assessing mental health, especially the post hoc effect of a pandemic. Therefore, the current study was conducted to estimate the prevalence of depression, anxiety, and stress in rural against urban populations as well as the contributing factors viz age, gender, socioeconomic class, change in occupation, and income., Materials and Methods: A community-based cross-sectional study was conducted from July 2021 to February 2022 among participants residing in the area covered by the Urban Health Training Centre (Ajmera, Pimpri, Pune) and Rural Health Training Centre (Alandi, Pune) of a medical college in Pune. One hundred fifty-four participants (total of 308) above 18 years of age who were not diagnosed or under treatment for psychiatric illness were interviewed using the Depression Anxiety Stress Scale - 21 (DASS-21) to screen for anxiety, depression, and stress in each setting., Results: Overall prevalence of mental distress was 35.71% ( n = 110). In the rural area, it was 29.2% ( n = 45) as compared to 42.2% ( n = 65). in the urban category. The prevalence of depression was significantly higher in urban areas (33.1%) compared to rural areas (19.4%), with an overall prevalence of 26.3%. The net prevalence of anxiety and stress was 35.7% and 15.6%, respectively, which were also higher in urban areas (Anxiety OR = 1.769, P = 0.018*; Stress OR = 2.262, P = 0.013). The upper middle class had the least psychological problems. Overall, 11% of participants had lost their jobs; 48.75% in rural and 37% of urban participants had a decrease in their income., Conclusion: The COVID-19 pandemic has resulted in an increased burden of mental illness. The prevalence of mental health problems is alarmingly high, especially in urban communities. To combat the global mental health pandemic, the interventions that mediate psychological distress must be quickly implemented. Due importance should be given to mental healthcare in the community., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Industrial Psychiatry Journal.)

Background: Health-care workers' psychological status is essential to Preventive control measures in a weak and unstable health system with poor infrastructural constraints. This study examines the psychological impact of the ongoing coronavirus disease 2019 (COVID-19) pandemic on the health-care providers working in primary health-care settings in Sudan., Materials and Methods: This is a health facility-based cross-sectional study conducted in primary health-care units in White Nile State, Sudan. The psychological impact of stress and anxiety was determined using the Depression Anxiety Stress Scale 21 (DASS-21). A self-administered questionnaire measured depression, anxiety, and stress. The population of this study included health professionals working in health centers, including physicians, nurses, technicians, pharmacists, and other support staff., Results: A total of 167 health professionals were systematically recruited. The mean anxiety score in the study population was 8.26 & 9.0 (corresponding to mild anxiety). Participants without anxiety constituted 26.35% ( n = 44) of the participants. Women were significantly more likely to be affected than men ( P = 0.0). Age (21-40 years), female nurses, and other health-care workers (anesthesiology, public health, health education, occupational health, psychiatry, etc.) could be strong predictors of psychological disorders ( P -value of 0.0)., Conclusion: This study provided evidence for primary health care at its preparatory levels, as they are the first line of protection against the COVID-19 pandemic. Addressing the high-risk population is a high priority in the preliminary phase., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Journal of Family Medicine and Primary Care.)

Background The COVID-19 pandemic has led to a significant increase in the prevalence of stress worldwide. However, the extent and factors associated with psychological distress during COVID-19 among the local population in Kedah, Malaysia, have not been adequately explored. This study aimed to determine the prevalence and factors associated with stress among the adult population in Kedah, Malaysia, during the COVID-19 pandemic. Materials and methods We conducted a cross-sectional study using a retrospective record review. A simple random sampling was applied among the adult population of Kedah who were screened for mental health well-being from January 2021 until March 2022. A proforma checklist that consists of sociodemographic and clinical factors and the date of screening was used to collect the data. A descriptive and multiple logistic regression was conducted, and analysis was done by SPSS version 26 (IBM Inc., Armonk, New York). The dependent variables were the presence of stress incorporated self-reported symptoms ranging from mild to very severe. The independent variables were sociodemographic, clinical factors, and movement control order period, which refers to the period when the state of Kedah experienced all the different phases of movement control order (MCO), which were from 1 January 2021 until 28 June 2021. Results In total, 562 adults were included. The mean age was 31.75 years, and the majority were female (69.6%). The prevalence of stress was 45.7% (95% CI 41.6%, 49.8%), with a total of 257 people. The majority of them did not have stress, consisting of 305 people (54.3%), followed by 69 people (12.3%) who reported severe stress, 67 people (11.9%) who reported moderate, 66 people (11.7%) who reported mild, and 55 people (9.8%) who reported very severe stress. The significant factor associated with stress among the adult population in Kedah, Malaysia, during the COVID-19 pandemic was the female gender (Adj OR 3.035 95% CI: 2.007 to 4.591, p-value <0.001). Being unemployed (Adj OR 2.171 95% CI: 1.480 to 3.185, p-value <0.001) and being under movement control order period was also associated with stress (Adj OR 0.383 95% CI: 0.264 to 0.555, p-value <0.001). Conclusion The prevalence of stress among the adult population during the COVID-19 pandemic in Kedah was 45.7%, with a total of 257 people, higher than other studies. Being female and unemployed was associated with stress, while the movement control order period was a protective factor against stress. Preventive strategies should be tailored based on the vulnerabilities of these groups, such as the development of more effective community-based interventions for safeguarding the mental health of the general public during future pandemics., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Ismail et al.)

Objectives: The COVID-19 pandemic increased psychological stress and decreased sleep quality, especially among young people. Aromatherapy alleviates psychological stress, and bergamot essential oil helps improve depression. This study aimed to verify whether bergamot essential oil use alleviates psychological stress due to the COVID-19 pandemic and improves sleep quality and morning wakefulness., Design: A placebo-controlled, randomized, open-label, two-arm, two-period crossover trial., Interventions: Each intervention period was 1 week, with a 1-week washout period between the two periods. Participants used a bergamot or placebo spray before bedtime and upon awakening in each period., Main Outcome Measures: The primary outcome measures were sleep quality and morning wakefulness, assessed using the Ogri-Shirakawa-Azumi sleep inventory MA version (OSA-MA). The secondary outcome measures were depression, anxiety, and stress, assessed using the Depression Anxiety Stress Scales-21 (DASS-21)., Results: A total of 48 university students participated in the study. A significant improvement was observed in "sleepiness on rising," "refreshing on rising," and "sleep length" in the bergamot group. Additionally, a significant improvement was observed in depression, anxiety, and stress., Conclusion: Using bergamot essential oil before bedtime helps relax the mind and body and provides sound sleep. It also improves mood and wakefulness when used upon awakening. Using aromatic essential oils is expected to relieve psychological stress and improve sleep quality and morning wakefulness., Competing Interests: Declaration of Competing Interest None., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Given that there is limited evidence concerning the psychometric properties of DASS-21 when applied to primary school students, the present study undertook a comprehensive exploration of the psychometric evidence supporting the use of the DASS-21 within this demographic. The research comprised three studies. In Study 1, the basic psychometric properties of internal consistency and construct validity were examined. A total of 3138 primary school students from three provinces in mainland China participated. The internal reliability of the overall scale was 0.93, and for all the subscales, it was higher than 0.80. Construct validity was partially supported. Both exploratory and confirmatory factor analyses upheld the factorial validity of the original three-factor structure. While convergent validity was established, the results showed unsatisfactory discriminant validity. The bifactor model showed that DASS-21 raw scores predominantly indicated the general factor, evidenced by the high explained common variance and omega-hierarchical values. However, the contributions from the three specific factors were minimal, with their omega hierarchical values all below 0.15. In Study 2, a longitudinal design was adopted, tracking 1366 primary school students from Southwest China over a three-month interval. The results further confirmed that the DASS-21 exhibited scalar time-invariance. The latent mean analysis showed that there were no statistically significant differences in the latent means of depression, anxiety, and stress between Time 1 and Time 2. In Study 3, which included 364 college students and 483 enterprise workers, the results demonstrated that the DASS-21 had measurement invariance across different populations. The latent mean analysis further confirmed that, in terms of the latent mean of all three subscales, both college students and enterprise workers had significantly higher scores than primary school students. Overall, the findings indicated that the DASS-21 is a suitable tool for screening schoolchildren for general psychological distress, but it is not suitable for discerning distinct negative mood state disorders., Competing Interests: Declaration of competing interest None., (Copyright © 2023. Published by Elsevier B.V.)

Background: Since February 2022, the nation of Ukraine has become entangled in an escalating conflict that erupted after coronavirus outbreak fostering a situation of indeterminacy and precariousness, which adversely affected several facets, especially psychological well-being. However, there is a lack of empirical evidence on the psychological well-being of Ukrainians during the Russo-Ukraine war, as well as their coping strategies in response to the war's repercussions. Consequently, this investigation endeavors to explore the prevalence of symptoms associated with depression, anxiety, stress, and insomnia and to correlate these symptoms with Ukrainians' effective coping mechanisms during the ongoing war., Methods: An online survey was administered in Ukraine from June to August 2022 due to the ongoing Russo-Ukraine conflict. The survey employed a quota sampling technique, targeting 2,664 individuals (≥18 years). Out of the total sample, 1,833 valid responses were obtained, yielding a response rate of 68. 81%. Depression, anxiety, and stress were measured using the depression, anxiety, and stress scale-21 (DASS-21), while the Pittsburgh sleep quality index (PSQI) was utilized to evaluate insomnia symptoms. In addition, Brief-COPE was adopted to evaluate the coping mechanisms of the selected study participants., Results: Of 1,833 Ukrainian adults, 60.5% had symptoms of stress; 62.4% of them reported symptoms of anxiety; and 58.2% reported symptoms of depression. Symptom criteria for insomnia were found in about 21.8% of the study sample. The factors of sex, living area, area occupied by Russian forces, and having older adults and children in the house were statistically significant with symptoms of depression, anxiety, stress, and insomnia. The productive coping strategies of self-distraction, using instrumental support, planning, and behavioral disengagement, were observed as statistically significant with four psychological constructs., Conclusion: The study outcomes highlight a substantial prevalence of symptoms related to depression, anxiety, stress, and insomnia attributed to the accumulated consequences of ongoing conflict and the COVID-19 outbreak. The aforementioned findings emphasize the imperative of providing healthcare services and facilitating effective coping strategies among Ukrainians amid the ongoing war., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Khan and Altalbe.)

Background: Stress, anxiety, and depression are major mental health concerns worldwide. A wide variety of digital mental health interventions have demonstrated efficacy in improving one's mental health status, and digital interventions that involve some form of human involvement have been shown to demonstrate greater efficacy than self-guided digital interventions. Studies demonstrating the efficacy of digital mental health interventions within the Asian region are scarce., Objective: This study aimed to investigate the potential efficacy of the digital mental health intervention, ThoughtFullChat, which consists of one-on-one, asynchronous, text-based coaching with certified mental health professionals and self-guided tools, in improving self-reported symptoms of depression, anxiety, and stress. The study also aims to examine the potential differences in efficacy among occupational subgroups and between sexes., Methods: A randomized controlled study was conducted among housemen (trainee physicians), students, faculty members, and corporate staff at International Medical University, Malaysia. A total of 392 participants were enrolled and randomized to the intervention (n=197, 50.3%) and control (n=195, 49.7%) groups. Depression, anxiety, and stress symptoms were measured using the Depression, Anxiety, and Stress Scale-21 items at baseline and after the 3-month intervention period. The Satisfaction with Life Scale and Brief Resilience Scale were also included, along with a questionnaire about demographics., Results: Significant decrease was observed in depression (P=.02) and anxiety (P=.002) scores in the intervention group. A subgroup (corporate staff) also demonstrated significant decrease in stress (P=.005) alongside depression (P=.006) and anxiety (P=.002). Females showed significant improvements in depression (P=.02) and anxiety (P<.001) when compared with males., Conclusions: This study provides evidence that the ThoughtFullChat app is effective in improving the symptoms of depression, anxiety, and stress in individuals, particularly among corporate staff from the educational field. It also supports the notion that mobile mental health apps that connect users to mental health professionals in a discreet and cost-efficient manner can make important contributions to the improvement of mental health outcomes. The differential improvements among occupational subgroups and between sexes in this study indicate the need for future digital mental health app designs to consider an element of personalization focused on systemic components relating to occupation., Trial Registration: Clinicaltrials.gov NCT04944277; https://classic.clinicaltrials.gov/ct2/show/NCT04944277., (©Yee Siew Lim, Jia Hui Quek, Xiu Wei Ching, Dominic Tao Ran Lim, Kean Ghee Lim, Chandramani Thuraisingham, Parikial Philip George. Originally published in JMIR Formative Research (https://formative.jmir.org), 22.09.2023.)

Background: Sleep quality has an important role in brain functioning and development. Affected sleep quality and mental health can negatively affect the academic performance of college students., Objective: To assess the effect of sleep quality and mental health on the academic performance of medical students at King Abdulaziz University, Jeddah, Saudi Arabia., Methods: We conducted a cross-sectional study among medical students at King Abdulaziz University. The dependent variable was the current grade point average (GPA). For the independent variables, two validated tools were used in the study: the Pittsburgh Sleep Quality Index (PSQI) for sleep assessment; and the Depression, Anxiety and Stress Scale (DASS-21) for mental health assessment., Results: A total of 382 responses were analyzed. The majority of students (86.6%) had GPAs greater than 3.75/5, while only 1% of the sample had a GPA lower than 2.75/5. The PSQI showed a median and interquartile range of (9, 6-11). Normal DASS-21 represented the majority as follows: depression at 67%, anxiety at 63.1%, and stress at 82.2%. In the statistical analyses, sleep quality, depression, anxiety, and stress were not statistically significant with the student's GPA., Conclusion: Low levels of sleep quality were found among medical students in our study. While sleep quality and mental health status did not show an effect on the GPA of the medical students, lower sleep quality was significantly correlated with increased scores of depression, anxiety, and stress. Our findings mandate interventions directed at improving sleep quality among medical students., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Yaghmour et al.)

Background: In recognizing the need for a reliable and valid instrument to assess psychological distress among children and adolescents, the present study translated the newly developed Depression Anxiety Stress Scale for Youth (DASS-Y) into Chinese, while also comparing its psychometric properties with those of the well-established DASS-21 within a primary and middle school demographic., Methods: Utilizing a combination of convenience sampling and purposive sampling, a cohort comprising 1,507 primary and 1,131 middle school students was recruited. Rasch analysis, confirmatory factor analysis (CFA), and structural equation modeling (SEM) were used in the data analysis., Results: Significant differences were observed between the DASS-Y and the DASS-21, notably within the anxiety subscale. The proportions of individuals with clinical mood disorders identified by the two scales demonstrated a significant disparity. Both scales, following an adjustment of responses, exhibited satisfactory internal consistency and convergent validity, with the acceptance of a three-factor structure. Furthermore, the DASS-Y showed superior discriminant validity relative to the DASS-21, providing more compelling evidence regarding concurrent validity., Conclusion: Overall, the Chinese version of the DASS-Y demonstrated superior robustness to the DASS-21 in terms of psychometric properties. The findings provide initial evidence for the psychometric properties of the DASS-Y from another culture., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Background: Adolescence represents a critical period characterized by extensive changes across various domains. While some of the changes and behaviors that emerge during this period can have detrimental effects on adolescents' present and future health, mental health disorders continue to constitute a leading cause of morbidity among young individuals., Objective: Assess the prevalence and determinants of depression, anxiety, and stress among secondary school students in Saudi Arabia., Methods: This analytical cross-sectional study utilized an online questionnaire to collect responses from secondary school students in Saudi Arabia. The Arabic version of the Depression, Anxiety, and Stress Scale - 21 Items (DASS-21) was used to measure depression, anxiety, and stress levels. Data were analyzed using IBM Statistical Package for the Social Sciences software (SPSS, version 29.0, IBM Corp., Armonk, NY, USA). The study included 702 participants., Results: The prevalence of anxiety was 35.2%, followed by depression (30.8%) and stress (14.7%). Females had significantly higher anxiety and stress scores than males (P=0.004, and P=0.011, respectively). Students who were bullied in the last 30 days had significantly higher depression, anxiety, and stress scores than those who were not bullied (P<0.001 for all). Participants who experienced physical assault in the last 12 months had significantly higher depression, anxiety, and stress scores than those who did not (P<0.001 for all). Participants who had had fights in the last 12 months had significantly higher depression (P=0.004) and anxiety (P<0.001) scores than those who did not. Participants who felt unsafe on the way to school had significantly higher depression, anxiety, and stress scores than those who did not (P<0.001 for all)., Conclusion: The study revealed prevalence rates of depression (30.8%), anxiety (35.2%), and stress (14.7%) among secondary school students in Saudi Arabia. The study highlights the importance of addressing social stressors such as bullying and physical assault and promoting a safe and supportive school environment to prevent mental health disorders in this population., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Barnawi et al.)

Background: Psychopathology could be brought on by an immune system disruption triggered by an infection. Psychiatric residual effects have been noted following prior coronavirus outbreaks., Method: This study is a cross-sectional study that examined the psychopathological influence of the COVID-19 pandemic among survivor students compared to students who have never been diagnosed as positive COVID-19 patients (i.e., healthy students). Further, the study identified the relationship between sociodemographic profiles and mental health. To examine the significance of psychological health differences we used the DASS-21, to measure depression, anxiety, and stress scales. There were seven questions to assess each dimension within the psychological scales. The respondents were selected randomly via online sources and completed the online self-reporting questionnaire between August 23 and October 2, 2021., Results: A total of 750 students completed the online questionnaire, with 677 participants (90.27% of those originally surveyed) included in the final analysis of this study. The mean score of the stress scale for healthy students ( M  = 16.88, SD = 12.3, N  = 537) demonstrated a significantly lower mean compared to COVID-19 survival students ( M  = 21.7, SD = 11.01, N  = 140), t (675) = -4.22, p  < 0.001. The mean of the depression scale for healthy students ( M  = 16.18, SD = 11.94) demonstrated significantly lower mean compared to COVID-19 survival students ( M  = 20.91, SD = 11. 90), t (675) = -4.18, p  < 0.001. The mean of the anxiety scale for healthy students ( M  = 12.50, SD = 10.72) demonstrated significantly lower mean compared to COVID-19 survival students ( M  = 19.43, SD = 11. 25), t (675) = -6.74, p  < 0.001., Conclusion: University students who were infected with COVID-19 had a traumatic experience, and thus developed psychological symptoms greater than students with no history of this infection., Competing Interests: The authors declare no conflict of interest., (© 2023 The Authors. Health Science Reports published by Wiley Periodicals LLC.)

Introduction: With the emergence of COVID-19, dental medicine students were faced with a new reality, as a modification of the learning methods in Dentistry colleges happened. The aim of this study was to characterise the possible effects of Covid-19 pandemic in terms of anxiety, depression, and stress among students of dentistry., Matherials and Methods: This cross-sectional study was conducted between October 2020 and May 2021. A total of 1115 participants from a total of approximately 3000 students from the seven university institutions that teach the master's degree in dentistry in Portugal, agreed to participate. An online self-reported questionnaire was applied through Google Forms® platform. The questionnaire was divided in three sections: the students' sociodemographic characterisation, pedagogical aspects, and questions about anxiety, depression, and stress using the Depression, Anxiety, and Stress-21 Scale., Results: Normal levels of anxiety, depression, and stress, were found in 41%, 36.7%, and 22.7% of the participants, respectively. Being female was the most significant and strong predictor of anxiety and stress, and for depression, not feeling fulfilled in the course they were in was the most significant variable., Conclusion: The participants presented high values of anxiety, depression, and stress, during the pandemic state. Gender and not feeling fulfilled in the course were important predictors., (© 2022 The Authors. European Journal of Dental Education published by John Wiley & Sons Ltd.)

Introduction: The mental health of South Asian women has been observed to be in regression lately, with sexual harassment as one of the major factors accounting for mental health deterioration, especially for women who leave their homes frequently for work and study. The COVID-19 pandemic not only augmented the mental health distress of the general female population but the rise in sexual violence against women is being consistently reported around the globe. Based on this background, we adopted a two-pronged strategy to assess whether working women and students aged 18-55 experienced a rise in sexual harassment in the 18 months after lifting the COVID-19 lockdowns. Secondly, using the well-validated psychometric test, DASS-21, we evaluated the psychiatric outcome of this change on the mental health of those women., Study Design: The study was designed as a quantitative, cross-sectional survey-based research., Methodology: A total of 303 women participated in this study. Personal interviews through a specifically designed questionnaire and psychometric test DASS-21 were administered to assess the mental health state of working women and female students, aged between 18 and 55 years old. The mean age of the participants was 37 ± 2.8. The study population was further categorized into two main groups of limited and frequent interactions based on varying levels of the frequency of leaving home and interacting with male strangers in their daily routine. Data were analyzed and the correlation between limited/frequent interaction and DASS-21 total scores and sub-scores of depression, anxiety and stress, and other sociodemographic variables were investigated using the Chi-square test, whereas psychosocial predictors of mental distress were evaluated using multiple linear regression analysis after matching limited and frequent interaction groups using a 1:1 propensity score-matched pair method for sociodemographic covariates., Results: Overall, approximately 50% of our study population experienced changes in the behavior of male strangers that could be categorized as harassment in their daily life interactions, whereas 33.66% of participants experienced relatively more sexual harassment post-pandemic than before it. This observation was significantly correlated with the frequency of male interaction ( χ 2 = 5.71, p  < 0.01). Overall, 34% of our study population scored >60 on the DASS21-total score, whereas 29.04% scored >21 on the depression scale. Alarmingly, >40% of the women in the frequent interaction group scored in the extremely severe range of anxiety and depression. Moreover, in the regression analysis, out of all the factors analyzed, the extent of everyday interaction with male strangers, an increase in fear of sexual crimes, and a self-perceived increase in mental distress during the 18 months post-pandemic were found to be highly statistically significant predictors of mental distress not only for total DASS 21 but also for the sub-scales of depression, anxiety, and stress., Conclusion: In Pakistan, women experienced a rise in sexual harassment cases post-COVID-19. An increase in sexual harassment was found to be a predictor of negative mental health in the form of depression, anxiety, and stress., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Akbar and Ghazal.)

Background: The Depression Anxiety Stress Scale 21 (DASS-21) is a mental health screening tool with conflicting studies regarding its factor structure. No studies have yet attempted to develop a computer adaptive test (CAT) version of it., Objective: This study calibrated items for, and simulated, a DASS-21 CAT using a nonclinical sample., Methods: An evaluation sample (n=580) was used to evaluate the DASS-21 scales via confirmatory factor analysis, Mokken analysis, and graded response modeling. A CAT was simulated with a validation sample (n=248) and a simulated sample (n=10,000) to confirm the generalizability of the model developed., Results: A bifactor model, also known as the "quadripartite" model (1 general factor with 3 specific factors) in the context of the DASS-21, displayed good fit. All scales displayed acceptable fit with the graded response model. Simulation of 3 unidimensional (depression, anxiety, and stress) CATs resulted in an average 17% to 48% reduction in items administered when a reliability of 0.80 was acceptable., Conclusions: This study clarifies previous conflicting findings regarding the DASS-21 factor structure and suggests that the quadripartite model for the DASS-21 items fits best. Item response theory modeling suggests that the items measure their respective constructs best between 0θ and 3θ (mild to moderate severity)., (©Jake Kraska, Karen Bell, Shane Costello. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 22.06.2023.)

Introduction Migraine is characterized by persistent headaches and a wide range of symptoms, such as nausea, vomiting, and photophobia. The chance of developing a chronic migraine might be increased by lifestyle variables like obesity, stress, and excessive medication use. According to previous studies in Saudi Arabia, migraines are more common there than they are globally. The study aimed to examine the migraine associations with depression, anxiety, and stress in the population of Makkah City, Saudi Arabia. Methods The study employed a descriptive cross-sectional design with a non-probability snowball sampling technique and an online questionnaire that included sociodemographic characteristics, the International Classification of Headache Disorders-3 (ICHD-3) criteria for migraine assessment, and the Depression, Anxiety, and Stress Scale-21 (DASS-21) measure for depression, anxiety, and stress. Results Our study included 418 participants, out of whom 73.7% were female and 26.3% were male. Regarding migraine, only 8.9% of participants met the ICHD-3 criteria for migraine headache screening, with a female predominance (78.4%). The study showed a high prevalence of depression, anxiety, and stress among the population (63.9%, 63.6%, and 55%, respectively), with females having a higher prevalence. Depression, anxiety, and stress had an equal prevalence of 78.4% among migraineurs, which was significantly higher than that of non-migraineurs. Conclusions The study found significant associations between migraine and depression, anxiety, and stress. This study provides insights into the association between these conditions. The study's findings suggest the need for screening and management of mental health conditions in patients with migraine. However, extensive efforts are needed to be applied in different cities and demographics for a more precise understanding of the association., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Babateen et al.)

Introduction: This study aimed to shed light on how young people from low-income families were responding to COVID-19., Methods: This cross-sectional study recruited young people aged between 18 and 24 years from the low-income-group communities. A convenience sampling approach was used. Google Surveys were used to gather data from the survey. The questionnaire consisted of an assessment of demographic characteristics, lifestyle factors, parent-youth conflict (Parental Environment Questionnaire, PEQ), resilient coping (Brief Resilient Coping Scale, BRCS), and psychological distress (Depression, Anxiety, and Stress Scale-short form, DASS-21)., Results: A total of 561 complete responses were received. The results showed a low level of parent-child conflict in the overall study population, with a median PEQ of 48.0 [interquartile range (IQR) 36-48]. Higher parent-child conflicts were found in females than in males (OR = 1.75, 95% CI 1.19-2.57) and in youth from households with an income below MYR 2000 than those earning MYR 3,001-5,000 (OR = 4.39, 95% CI 2.40-8.03). A low prevalence of depression (12.5%), anxiety (15.2%), and stress (6.4%) was found. Parent-child conflict remains the strongest significant predictor for higher levels of depression (OR = 10.90, 95% CI 4.31-27.57), anxiety (OR = 11.92, 95% CI 5.05-28.14), and stress (OR = 4.79, 95% CI 1.41-16.33) symptoms. Poor resilient coping was the second strongest predictor for depression and anxiety symptoms. Regarding lifestyle factors, a lower level of physical exercise was associated with higher symptoms of depression. By demographics, females reported more severe symptoms of depression and anxiety than males. Young people from low-income households reported greater severity in symptoms of depression, anxiety, and stress than those from high-income households. Young people who are employed also reported greater severity of anxiety symptoms than those who are unemployed., Discussion: The COVID-19 pandemic continues to have an unpredictable impact on the lives of vulnerable youth in low-income families that warrants attention in future advocacy efforts., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Wong, Farid, Alias, Yusop, Musa, Hu and Lin.)

Introduction: This study aims to shed light on parent-child relationships and the psychological health of parents from low-income families after the easing of the COVID-19 pandemic restrictions., Methods: This cross-sectional study recruited 553 parents of children aged 13-24 years in low-income community settings. The Parent-Child Conflict scale of the Parental Environment Questionnaire (PEQ) was used to measure parent-child conflict. Psychological distress was assessed using the Depression, Anxiety, and Stress Scale short form (DASS-21)., Results: The study revealed a low level of parent-child conflict in the overall study population, with a median PEQ of 48.0 (interquartile range [IQR] 36 to 48). Concerning demographics, married parents reported a likelihood of having a higher level of parent-child conflict over 3 times higher than single parents (OR = 3.18 95%, CI 1.30-7.75). More parent-child conflicts were also found in parents aged 60-72 years old who were unemployed, retired, or housewives and from lower-income groups. In regard to lifestyle factors, a higher level of physical activity and having enough sleep were associated with lower levels of parent-child conflict. Only approximately 1% of the participants reported symptoms of depression, anxiety, or stress., Discussion: Low risk exists for parent-child conflict and psychological sequelae following the easing of the COVID-19 pandemic restrictions, which could be due to various support measures implemented by the government. Vulnerable parents identified as being at risk of parent-child conflict warrant attention in future advocacy efforts., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Wong, Alias, Farid, Yusop, Musa, Hu and Lin.)

Background: An increase in depression, anxiety, and stress symptoms worldwide, attributed to the COVID-19 pandemic, has been reported. If not treated, it may negatively affect a person's everyday life by altering physical and social well-being and productivity and increasing expenditure on health care. Cognitive behavioral therapy (CBT)-based interventions are gaining popularity as a means to reduce stress and alleviate anxiety and depression symptoms. Moreover, CBT delivered through a mobile app has the same elements as traditional CBT training (eg, guided discovery). However, unlike conventional training, users of mobile apps are allowed to tailor their own experience at their own speed and schedule., Objective: This study aims to analyze Sensa users' retrospective data and explore the dose-duration effect to find the optimal usage time when the user showed results., Methods: The study cohort comprised 381 consecutive community-based nonclinical users who started using Sensa between October 2021 and March 2022. All users included in the study took the Depression Anxiety Stress Scale-21 (DASS-21) assessment at least 2 times. Other parameters from the database containing all self-reported data were gender, number of active days, total time of use, and age. The primary outcome of the study was a change in the DASS-21 score. Statistical analyses were performed using GraphPad Prism (version 9, GraphPad Software). In addition, a logistic regression model was created to predict how the obtained independent parameters influenced the DASS-21 score., Results: The main finding of our study was that the majority of participants who started using Sensa were experiencing depression, anxiety, and stress symptoms (92.13%, 80.05%, and 87.93%, respectively). There was a statistically significant decrease of the DASS-21 subdomain scores after the use of the application (anxiety: mean 7.25, SD 4.03 vs mean 6.12, SD 4.00; P=.001; depression: mean 11.05, SD 4.26 vs mean 9.01, SD 4.77; P=.001; stress: mean 11.42, SD 3.44 vs mean 9.96, SD 3.65; P<.001). Finally, the logistic regression model showed that users who were using the app for more than 24 days and had at least 12 active days during that time had 3.463 (95% CI 1.142-11.93) and 2.644 (95% CI 1.024-7.127) times higher chances to reduce their DASS-21 subdomain scores of depression and anxiety, respectively., Conclusions: Using the Sensa mobile app was related to decreased depression, anxiety, and stress symptoms., (©Sarunas Valinskas, Marius Nakrys, Kasparas Aleknavicius, Justinas Jonusas. Originally published in JMIR Formative Research (https://formative.jmir.org), 13.04.2023.)