Search Results (528)

Anxiety disorders represent a significant global health challenge, yet a substantial treatment gap persists, motivating the development of scalable digital health solutions. This study investigates the potential of integrating passive physiological data from consumer wearable devices with subjective self-reported surveys to predict state–trait anxiety. Leveraging the multi-modal, longitudinal LifeSnaps dataset, which captured “in the wild” data from 71 participants over four months, this research develops and evaluates a machine learning framework for this purpose. The methodology meticulously details a reproducible data curation pipeline, including participant-specific time zone harmonization, validated survey scoring, and comprehensive feature engineering from Fitbit Sense physiological data. A suite of machine learning models was trained to classify the presence of anxiety, defined by the State–Trait Anxiety Inventory (S-STAI). The CatBoost ensemble model achieved an accuracy of 77.6%, with high sensitivity (92.9%) but more modest specificity (48.9%). The positive predictive value (77.3%) and negative predictive value (78.6%) indicate balanced predictive utility across classes. The model obtained an F1-score of 84.3%, a Matthews correlation coefficient of 0.483, and an AUC of 0.709, suggesting good detection of anxious cases but more limited ability to correctly identify non-anxious cases. Post hoc explainability approaches (local and global) reveal that key predictors of state anxiety include measures of cardio-respiratory fitness (VO₂Max), calorie expenditure, duration of light activity, resting heart rate, thermal regulation and age. While additional sensitivity analysis and conformal prediction methods reveal that the size of the datasets contributes to overfitting, the features and the proposed approach is generally conducive for reasonable anxiety prediction. These findings underscore the use of machine learning and ubiquitous sensing modalities for a more holistic and accurate digital phenotyping of state anxiety. Full article

Background: Heart rate (HR) and HR variability (HRV) are valid indices of psychophysical stress. Healthy individuals typically exhibit high vagal tone, as indicated by vagally mediated HRV (vmHRV) values. Despite current knowledge, HRV differences between anxious subjects and controls during a cognitive task have not yet been studied. Methods: Anxious people were compared to controls through the State–Trait Anxiety Inventory (STAI-Y), both considering State Anxiety (S-Anxiety) and Trait Anxiety (T-Anxiety) one at a time. Subsequently, a psychophysiological stress profile (PSP) was conducted to record HRV values (i.e., SDNN, RMSSD, and HF) at baseline and under induced stress with an electrocardiogram (ECG). During the stress test, the digit span forward task was conducted. Results: Significant differences were described by dividing the sample by S-Anxiety in the baseline values of log-HF (t = 2.68; p = 0.05; d = 0.85) and log-RMSSD (t = 2.34; p = 0.01; d = 0.74). Dividing the sample by T-Anxiety, significant differences were found in the reactivity (t = −2.26; p = 0.03; d = −0.70) and recovery (t = 2.11; p = 0.04; d = 0.66) log-HF values. Additionally, reactivity log-HF and recovery log-RMSSD values demonstrated significant discriminative power of 68% and 68%, respectively, in accurately identifying individuals with anxiety, as measured by T-Anxiety. Lastly, an association was found between the baseline HR value and the equivalent point of digit span forward in both the anxious (r = 0.59, p = 0.01) and control (r = −0.45, p = 0.05) groups. Conclusions: Although a high vmHRV is considered a protective factor against stress, our findings found that a reduced HRV modulation can distinguish a group of people with significant symptoms of anxiety and hinder cognitive efficiency. Full article

Background/Objectives: Virtual reality (VR) has been shown to reduce pain and anxiety in several specialties, but has not been investigated in the setting of steroid injections in rheumatology. We aimed to assess the impact of using a VR headset on pain and anxiety during epidural steroid injection via the sacral hiatus for lumbar radiculopathy. Methods: Patients received two injections via the sacral hiatus and were randomized into one of two groups: group 1 used the VR headset during the first injection and not during the second injection, while group 2 used the VR headset during the second injection but not the first. The primary endpoint was pain evaluated on a numeric rating scale. Secondary objectives were anxiety, measured using the STAI (State Trait Anxiety Inventory), and safety. These analyses were performed using the Mann–Whitney U test. Results: We included 116 patients over 18 years of age who were hospitalized in the Rheumatology department of the University Hospital of Reims and scheduled to receive at least two epidural steroid injections. We observed a significantly lower pain score during the first injection procedure (median 3 (IQ 1; 6) in group 1 vs. 5 (IQ 3; 7) in group 2, p = 0.045). The analysis for the second injection could not be performed by intention-to-treat due to the presence of a sequence effect. There was also a significant reduction in anxiety (p = 0.004 and p = 0.002 by per-protocol analysis). Conclusions: VR can significantly reduce pain and anxiety during epidural steroid injection via the sacral hiatus. Full article

Background: Informal caregivers of individuals with mild cognitive impairment (MCI) experience high levels of psychological and physical stress, with limited access to supportive interventions and time constraints. Virtual Reality (VR) technologies may provide brief and accessible opportunities to support caregiver well-being, particularly during waiting periods in clinical settings. This pilot study aimed to explore the potential of a semi-immersive VR intervention to enhance psychological well-being in informal caregivers. Methods: This non-randomized pilot study investigated the effects of a semi-immersive VR-based physical training program (K-HERO^®) on psychological well-being and coping strategies in informal caregivers. Participants were recruited from January to May 2025 at the IRCCS Centro Neurolesi “Bonino-Pulejo” (Messina, Italy), and the intervention was delivered individually in a dedicated room within the rehabilitation facility, while caregivers accompanied their relatives to treatment sessions. Ten caregivers completed six sessions (30–40 min each). The study was conducted in accordance with TREND reporting guidelines. Pre- and post-intervention assessments included the State-Trait Anxiety Inventory (STAI), Perceived Stress Scale (PSS), COPE Inventory, Caregiver Burden Inventory (CBI), and International Physical Activity Questionnaire (IPAQ). Visual Analog Scales and instrumental data from the VR system were used to monitor physical performance and user experience. Non-parametric statistics were applied. Results: Significant reductions were observed in avoidance (p = 0.033) and social support-based (p = 0.023) coping strategies. Differences emerged based on caregiver-patient relationships: parental caregivers showed increased anxiety, while offspring caregivers showed improvements. The intervention was well tolerated, with high usability and no adverse events reported. Conclusions: A short, structured, VR-based intervention delivered during clinical waiting periods may effectively reduce maladaptive coping strategies and support emotional well-being in informal caregivers. These findings highlight the potential of brief digital interventions in real-world care contexts. Larger randomized studies are needed to validate these preliminary findings and personalize interventions to different caregiver profiles. Full article

Background/Objectives: Adherence to therapeutic recommendations is a key factor influencing treatment effectiveness, particularly in older adults with chronic diseases. Emotional disorders, such as depression and anxiety, may significantly affect adherence and overall health outcomes. The aim of this study was to analyze depressive symptoms and trait anxiety in individuals aged 55 years and older and to determine their association with adherence to therapeutic recommendations. Methods: The study included 2040 participants (1406 women and 634 men) aged 55 to 100 years (mean age: 65 years), all of whom had chronic diseases, most commonly cardiovascular and metabolic conditions. The sociodemographic variables analyzed were age, gender, and education level. Emotional functioning was assessed using the State-Trait Anxiety Inventory (STAI) and the Beck Depression Inventory (BDI). Therapeutic adherence, defined as the extent to which patients followed their treatment plan, was measured with the Adherence in Chronic Diseases Scale (ACDS). Results: ACDS scores ranged from 0 to 28 points, with a mean of 23.84. The majority of participants demonstrated moderate adherence (1149 individuals; 56.3%), followed by high adherence (593 individuals; 29.1%), while low adherence was observed in 298 participants (14.6%). Age and education level were not significantly correlated with adherence (p > 0.05). However, BDI scores showed a weak but statistically significant negative correlation with adherence (r = −0.185; p < 0.05). Similarly, STAI scores demonstrated a weak but significant negative correlation with adherence (r = −0.203; p < 0.05). In addition, BDI and STAI results were moderately correlated with each other (r = 0.453; p < 0.05). No significant differences in adherence were observed between men and women. Conclusions: In this large cohort of over 2000 Polish adults aged 55 years and older with chronic diseases, higher levels of depressive and anxiety symptoms were consistently associated with poorer adherence, with the co-occurrence of both disorders further amplifying this effect. These findings provide confirmatory evidence from an underrepresented Central European population with multimorbidity and underscore the need for systematic mental health screening and adherence-focused interventions in older patients. Full article

Background: The number of students with Specific Learning Disorders (SLDs) in universities has recently increased. Thus, it is important to analyze their difficulties throughout their academic studies and propose adequate interventions to prevent emotional problems and dropout. Previous research has reported higher levels of internalizing problems (anxiety and depression) in students with SLDs compared to those with typical development. Surprisingly, academic burnout among students with SLDs remains a largely overlooked and under-researched issue. The present work is one of the first studies that seeks to address this critical gap by examining the levels of academic burnout, and exploring its relationship with depression and anxiety in university students both with and without SLDs. Methods: The sample included 120 university students (M = 42, F = 78; mean age = 21.16, SD = 2.26). Of these, 60 students had SLDs and 60 had typical development (TD). Students were asked to complete three questionnaires assessing burnout (BAT-C), depression (BDI-II), and anxiety (STAI-Y). Results: The comparison between groups revealed that students with SLDs reported significantly higher levels of total burnout (mean difference = −3.98, t[118] = −2.59, p = 0.011, d = 0.47) and trait anxiety (mean difference = −2.87, t[118] = −2.73, p = 0.007, d = 0.50), with a moderate effect size for both differences. They also exhibited greater cognitive impairment related to burnout (U = 2333.50, p = 0.006, r = 0.25). No group differences were found in depression. Path analyses showed that while trait anxiety mediated the burnout–depression link in both groups, state anxiety was a significant mediator only for students with SLDs (β = 0.22, p = 0.025). Conclusions: The findings provide new evidence of the importance of monitoring academic burnout and anxiety in students with SLDs. The results show that anxiety plays a crucial mediating role between burnout and depression in students with SLDs, reinforcing the need for specific psychological support programs in universities. Full article

Background: COVID-19 has limited pregnant and postpartum women’s access to mental health services, leading to the introduction of online interventions. Objectives: This study aims to compare the effectiveness of telepsychotherapy (i.e., psychotherapy provided through digital technology supporting real-time interactivity in the audio or audiovisual modality) with the one yielded by face-to-face interventions in treating perinatal depression and anxiety and to assess the therapist’s perceived alliance in both interventions. Methods: We collected anamnestic information and obstetrical risk factors for 61 women. We evaluated the effectiveness of face-to-face (N = 31) vs. telepsychotherapy (N = 30) interventions on depressive and anxiety symptoms at baseline (T0) and the end of treatment (T1) using the Edinburgh Postnatal Depression Scale (EPDS) and the State-Trait Anxiety Inventory (STAI-Y 1 and 2). We assessed the degree of alliance perceived by therapists with the Working Alliance Inventory (WAI-T). Results: Both groups showed significant decreases in depressive (EPDS face-to-face: T0 12.65 ± 5.81, T1 5.77 ± 4.63, p < 0.001; EPDS remote: T0 11.93 ± 5.24, T1 5.70 ± 4.46, p < 0.001; effect size: 0.002) and state anxiety (STAI-Y 1 face-to-face: T0 51.19 ± 13.73, T1 40.23 ± 12.86, p < 0.001; STAI-Y 1 remote: T0 51.10 ± 11.29, T1 38.00 ± 10.90, p < 0.001; effect size: 0.007//STAI-Y 2 face-to-face: T0 43.13 ± 12.11, T1 41.03 ± 13.06, p = 0.302; STAI-Y 2 remote: T0 44.20 ± 8.70, T1 39.30 ± 9.58, p = 0.003; effect size: <0.001) symptoms by the end of treatment. Women treated remotely also experienced a significant reduction in trait anxiety at T1 (p = 0.003). We found no significant differences in either symptomatology (EPDS; STAI-Y) between the two interventions at baseline or in the therapist-perceived alliance. Conclusions: Synchronous telepsychotherapy for perinatal depression and anxiety showed comparable treatment response to face-to-face interventions, with both modalities associated with significant symptom reduction and the establishment of a working alliance. These findings support the potential of telepsychotherapy as a valuable alternative when in-person services are not accessible, especially during emergency contexts. Full article

Background and Objectives: This study aimed to compare the effects of patient-preferred music delivered intraoperatively versus postoperatively on Emergence Delirium (ED) incidence, severity, and duration, while identifying predictors, to evaluate non-pharmacologic interventions for enhanced anesthetic management. Materials and Methods: In a prospective, single-blind, randomized controlled trial, 360 patients aged ≥ 65 years undergoing elective surgery under general anesthesia were randomized to intraoperative music, postoperative music, or control groups. Participants selected genres played via headphones. Primary outcome was ED incidence (Richmond Agitation–Sedation Scale [RASS] score ≥ +1 within 60 min after extubation); secondary outcomes included severity, duration, visual analogue scale pain scores, satisfaction, and adverse events. Results: Intraoperative music reduced ED incidence (13.8% vs. 28.7% in controls, p < 0.001) and severity (mean RASS 1.3 vs. 1.8, p < 0.01). Postoperative music shortened duration (15.2 vs. 22.5 min, p < 0.01) and pain (mean visual analogue scale 3.0 vs. 4.2, p < 0.01). Both improved satisfaction (p < 0.001). Higher preoperative State–Trait Anxiety Inventory scores predicted ED (odds ratio [OR] 1.06, p = 0.01), with music protective (OR 0.45–0.62). Conclusions: Intraoperative music effectively prevents ED, and postoperative music improves recovery. Integrating patient-preferred music and screening for anxiety may enhance peri-anesthesia care in elderly patients. Full article

Background/Objectives: Recent evidence suggests that gut microbiota plays an important role in anxiety and stress-related disorders through interactions along the gut–brain axis. Our aim was to determine the microbiological diversity of intestinal microorganisms in individuals with acute and remission phases of PD when compared to healthy individuals. Another aim was also to analyze the differences in the metabolic pathways occurring in the intestinal microbiota of individuals from the three analyzed groups. Methods: A diagnosis was established using the Mini-International Neuropsychiatric Interview (M.I.N.I). The gut’s microbiota composition was analyzed through bacterial 16S rRNA gene sequencing (V1–V2 regions). The clinical evaluations included a BMI measurement, Short Form-36 Health Survey (SF-36), Hamilton Anxiety Scale (HAM-A), Montgomery–Åsberg Depression Rating Scale (MADRS), Columbia-Suicide Severity Rating Scale (C-SSRS), and State-Trait Anxiety Inventory (STAI). Results: We recruited 62 participants (31 PD and 31 controls). After conducting quality control filtering, data from 54 participants were analyzed (25 PD, 11 acute, 14 remission, and 29 controls). Observed richness was lower in the acute PD (63) group than in the control (74) and remission (66) (p = 0.038) groups, whereas the Shannon and Simpson indices and beta diversity (PERMANOVA) were not significantly different. The Ruminococcus gnavus group was enriched in acute PD; no other deconfounded differences in microbial composition were detected. Predicted functional differences were detected by edgeR only and included the pathways that are related to steroid biosynthesis and innate immune signaling. Conclusions: Distinct gut microbial signatures were associated with PD, implicating both the metabolic and inflammatory pathways in disease pathophysiology. Full article

Background: Threatened preterm labor is associated with heightened emotional distress in pregnant women, including anxiety, guilt, and depressive symptoms. Effective coping relies on psychosocial resilience, particularly emotional suppression and perceived social support. This study examined the mediating role of social support in the relationship between anxiety and emotional suppression. Methods: The study was conducted in Poland between December 2024 and June 2025 among 213 women hospitalized due to threatened preterm labor. Participants completed the Berlin Social Support Scales, the State–Trait Anxiety Inventory, the Courtauld Emotional Control Scale, and a structured interview. Results: Women hospitalized for threatened preterm labor have moderate levels of anxiety as a state (M = 44.08 ± 10.59) and trait (M = 39.75 ± 9.99). Mediation analyses revealed that two dimensions of social support—perceived available support and Buffering–Protective support—significantly influenced the relationship between anxiety and emotional suppression (anger, depression and anxiety). In contrast, need for support, support seeking, and Currently Received Support were not significant mediators. Conclusions: The results indicate a complex interplay between anxiety, perceived support, and emotional suppression. The hypothesized simple buffering model was not confirmed. However, perceived available support was associated with reduced emotional suppression, suggesting a protective role. Buffering–Protective Support showed an activating effect, possibly encouraging emotional inhibition in stressful situations. These results underscore the importance of assessing perceived social support in clinical settings and tailoring psychological interventions for pregnant women at risk of preterm labor. Full article

Background: Celiac disease (CD) is a chronic, immune-mediated condition requiring lifelong adherence to a gluten-free diet. In children, CD can negatively impact not only physical health but also psychological well-being and quality of life. The burden of dietary restrictions, social limitations, and emotional stress may lead to increased anxiety and depressive symptoms. This study aims to compare the quality of life, anxiety, and depression levels in children with celiac disease to those of healthy peers without chronic illness. Methods: The research involved a total of 129 individuals aged 8–18 years (64 with celiac disease and 65 healthy volunteers) and their parents. To assess children with celiac disease and healthy children, we used a sociodemographic form that we created, along with the State-Trait Anxiety Inventory (STAI), Trait Anxiety Inventory (TAI), Children’s Depression Inventory (CDI), Pediatric Quality of Life Inventory (PedsQL), and Parent Quality of Life Inventory tests. Results: Celiac patients’ diet adherence, parental education level, and family income were found to be significantly associated with quality of life, as well as levels of depression and anxiety. (p < 0.037, p < 0.04, p < 0.004, respectively). Celiac patients had significantly lower BMI SDS (mean −0.55 ± 1.13, p < 0.001) and height SDS scores (mean −0.49 ± 1.28, p < 0.017). Key factors negatively affecting the quality of life in individuals with celiac disease were difficulty adhering to the diet and low family income levels. Conclusions: Elevated anxiety with reduced quality of life highlights the importance of integrating psychosocial support into the routine care of children with celiac disease. A holistic treatment approach that considers the psychosocial well-being of children can significantly improve their quality of life. Full article

Background: Museums are increasingly being recognized not only as cultural institutions but also as potential resources for enhancing psychological well-being. Prior research has shown that museum visits can reduce stress and anxiety, yet there is a pressing need for evidence-based interventions supported by neurophysiological data. While neuroscientific studies suggest a combined role of emotional and cognitive mechanisms in aesthetic experiences, less is known about the neural predictors of individual responsiveness to such interventions. Methods: This study was conducted in two Milan-based museums and included an initial profiling phase (sociodemographic information, trait anxiety, perceived stress, museum experience), followed by pre- and post-visit assessments of state anxiety and mood. Electrocortical activity was recorded via a portable brain–computer interface (BCI), focusing on the theta/beta ratio (TBR) as a marker of cortical–subcortical integration. Results: Museum visits were associated with significant improvements in mood (M = 1.17; p < 0.001) and reductions in state anxiety (M = −6.36; p < 0.001) in both arts and science museums. The baseline TBR predicted the magnitude of state anxiety change, alongside individual differences in trait anxiety and perceived stress. Conclusions: These findings support the idea that aesthetic experiences in museums engage both emotional and cognitive systems, and that resting state neurophysiological markers can help forecast individual responsiveness to well-being interventions. Such insights not only contribute to existing knowledge about the cognitive and emotional processes during aesthetic fruition, but could also guide future applications of personalized interventions in museum settings, further integrating cultural participation with mental health promotion. Full article

Anxiety has become an important issue affecting students’ mental health. There is some evidence that mindfulness-based art interventions (MBAIs) can reduce students’ anxiety symptoms. However, some studies have shown the opposite view. Therefore, it is necessary to explore whether MBAIs are effective in alleviating students’ anxiety. In this meta-analysis, we chose 17 articles that met the criteria for inclusion, involving a total of 1548 participants, to figure out how big an impact the interventions had on student anxiety as a whole. The results show that MBAIs can reduce students’ anxiety (g = −0.387, p = 0.000). The effect size varies based on different moderators, including learning stage, sample size, intervention type, research design, measuring instrument, and intervention duration. Intervention type, research design, and measuring instrument are significant moderators. Specifically, the mindfulness-based art intervention (MBAI) showed stronger effects than the mandala coloring activity. Single-group experimental designs showed significantly higher effect sizes than studies that included a control group, and studies that used other measurement instruments had significantly higher effect sizes than those that used the State–Trait Anxiety Inventory. On this basis, the researchers put forward specific suggestions based on MBAIs to alleviate the anxiety of students from different educational backgrounds. However, due to the nascent nature of this field, the number of included articles is relatively small. The effectiveness of the research needs further testing. Full article

Background/Objectives: Cancer represents a significant health challenge, with high mortality and morbidity rates. Its diagnosis often triggers chronic stress, adversely affecting patient outcomes. Exercise has emerged as complementary therapy, enhancing treatment adherence and mitigating the side effects of chemotherapy. This study examines the effects of mild exercise during chemotherapy on patient anxiety. Methods: This prospective paired cohort study was conducted in the General Oncology Hospital of Kifisia “Agioi Anargyroi” in Athens, Greece. Adult cancer patients undergoing chemotherapy participated, excluding those with cognitive, hearing, or motor impairments, those who experienced side effects, or those who declined consent. Anxiety was measured before and after a 20-minute exercise routine performed during chemotherapy, using the Greek-translated State–Trait Anxiety Inventory (STAI). The exercise regimen included warm-up, full-body stretching, and cool-down exercises. Pre- and post-exercise scores were analyzed using the Wilcoxon signed-rank test. Results: Forty-five patients (20 women, 25 men; mean age 69.02 ± 10.62 years) with various cancer backgrounds participated. Pre-intervention anxiety levels were in the borderline “moderate” range, dropping post-exercise to the “low” range. Mean STAI scores decreased from 37.73 ± 13.33 to 32.00 ± 14.22 (p < 0.0001), with a medium-large effect size (Cohen’s d for paired samples = −0.646). No significant correlation was found between age and anxiety scores. Discussion: This study found a significant short-term reduction in anxiety, suggesting that incorporating mild exercise during chemotherapy may help in alleviating patient stress. The medium-to-large effect size supports the potential for meaningful short-term benefits. Conclusions: Incorporating mild exercise during chemotherapy may help reduce anxiety and psychological burden. These findings underscore the need for more comprehensive research in larger, more diverse populations to better understand the benefits of incorporating mild exercise during chemotherapy. Full article

The COVID-19 pandemic precipitated unprecedented social isolation measures, profoundly disrupting daily life, educational routines, and mental health worldwide. University students, already susceptible to psychological distress, encountered intensified challenges under remote learning and prolonged confinement. This longitudinal study examined fluctuations in anxiety and mood among 102 Brazilian university students during the pandemic, distinguishing between those solely engaged in academic pursuits and those simultaneously balancing work and study. Data collected via the Brunel Mood Scale and State-Trait Anxiety Inventory in April and July 2021 revealed that students exclusively focused on studies exhibited significant increases in depressive symptoms, anger, confusion, and anxiety, alongside diminished vigor. Conversely, participants who combined work and study reported reduced tension, fatigue, confusion, and overall mood disturbance, coupled with heightened vigor across the same period. Notably, women demonstrated greater vulnerability to anxiety and mood fluctuations, with socioeconomic disparities particularly pronounced among females managing dual roles, who reported lower family income. These findings suggest that occupational engagement may serve as a protective factor against psychological distress during crises, underscoring the urgent need for tailored mental health interventions and institutional support to mitigate the enduring impacts of pandemic-related adversities on the student population. Full article