Poor SRH and chronic disease were associated with anxiety, depression, and their comorbidity among residents, and MHL had an independent protective and partial mediating role in these associations and was negatively associated with three psychological outcomes.
Abstract
Anxiety and depression are important mental health problems worldwide, and their comorbid state, anxiety-depression comorbidity (ADC) , has greater symptom severity. With the increasing burden of chronic non-communicable diseases, residents’ physical and mental health problems have shown an overlapping trend. The mediating role of mental health literacy (MHL) between physical health and psychological outcomes warrants further investigation. Based on the national survey initiative, this study conducted a large-scale stratified multistage population survey across all districts and counties of Chongqing, southwest China, and included 36,874 permanent residents. Mental health literacy (MHL) was assessed using the National Mental Health Literacy Questionnaire (NMHLQ). Depression and anxiety were screened using the Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder-7 (GAD-7), respectively. Descriptive analyses were performed to characterize epidemiological features. Multivariable regression analysis was conducted across the three psychological outcome groups of anxiety, depression, and their comorbidity to explore the effects of self-rated health (SRH) and chronic disease on multiple psychological outcomes and the effects after variable adjustment, and subgroup analysis and sensitivity analysis were used to test robustness. The Bootstrap resampling method was used to test the mediating effect, and the standardized path coefficients and effect proportions of each mediation model were calculated. The positive screening rates for anxiety, depression, and ADC in the surveyed area were 2.72% (1004/36874), 4.53% (1672/36874), and 2.11% (777/36,874), respectively. The odds of anxiety, depression, and comorbidity among residents with fair or poor SRH were 2.76 (95% CI 2.40–3.17), 3.31 (95% CI 2.97–3.69), and 2.98 (95% CI 2.55–3.49), respectively. The corresponding odds among residents with chronic disease were 1.40 (95% CI 1.21–1.62), 1.51 (95% CI 1.35–1.70), and 1.41 (95% CI 1.19–1.65), respectively. MHL was negatively associated with the three psychological outcomes. After adjustment for relevant covariates, stratified analysis, and sensitivity analysis, the above associations remained robust. Multivariable logistic regression and multi-group mediation effect analysis showed that MHL had an independent protective role and played a 7–8% partial mediating role in the effects of SRH and chronic disease on mental health outcomes. Poor SRH and chronic disease were associated with anxiety, depression, and their comorbidity among residents, and MHL had an independent protective and partial mediating role in these associations. These findings suggest that residents’ MHL should be improved, and integrated interventions combining chronic disease management with psychological screening should be strengthened.
To explore the network structures and gender differences of mental health literacy (MHL) and depressive/anxiety symptoms in maintenance hemodialysis (MHD) patients and identify core symptoms and bridge symptoms. We used convenience sampling to recruit 757 MHD patients from 6 hospitals in Sichuan Province, China. The Patient Health Questionnaire (PHQ-9), the Generalized Anxiety Disorder Scale (GAD-7), and the Chinese version of the Multidimensional Mental Health Literacy Scale (MMHL) were used for assessment. A network model was constructed, with centrality indicators and bridge strength calculated, network comparison tests and stability and accuracy tests were performed. The total score of MHL significantly negatively correlates with depressive symptoms (r = -0.22) and anxiety (r = -0.18). PHQ4 (Feeling tired or having little energy) and GAD4 (Trouble relaxing) showed higher strength centrality (1.205 and 1.184 respectively), while the strength of MHL2 (beliefs) was relatively high in the MHL cluster (0.546). In the bridge symptom analysis, the bridge strength of MHL2 (beliefs) was the highest (0.253), and PHQ3 (Trouble falling or staying asleep, or sleeping too much) was the key bridge symptom (0.143). Of note, significant difference was observed in the network structure between genders (p = 0.034). Our study mapped the complex interplay between MHL and depressive/anxiety symptoms in MHD patients. Fatigue is the core symptom, while the beliefs dimension of MHL and sleep problems are the key bridging symptoms. Future interventions should focus on fatigue, sleep, enhancing MHL knowledge, and reshaping positive beliefs, while considering gender-specific factors.
Depression and anxiety contribute substantially to the mental health burden in low- and middle-income countries, yet clinic-based evidence from Pakistan remains limited. This study examined the distribution of depressive and anxiety symptom severity and their sociodemographic correlates in outpatient mental health clinics in Pakistan. This cross-sectional study included 267 participants recruited through consecutive sampling from four urban outpatient mental health clinics in Pakistan. Depression and anxiety were assessed using Hamilton Depression Rating Scale-17 and Generalized Anxiety Disorder Scale-7, respectively. Symptom severity was categorized as low, moderate, and high based on cut-offs (HDRS-17: 0–13, 14–26, ≥ 27; GAD-7: 0–9, 10–14, ≥ 15). Sociodemographic correlates included gender, age, marital status, educational attainment, employment status, and socioeconomic status. Multinomial logistic regression was used to estimate adjusted associations. Moderate-to-high symptom severity was common for both depression and anxiety. For depression, 64.8% of participants had high depressive symptom severity and 22.3% had moderate symptom severity. For anxiety, 32.6% had high anxiety symptom severity and 30.3% had moderate symptom severity. In adjusted analyses, unemployment was significantly associated with higher depression severity (OR = 2.55, 95% CI: 1.23–5.29). Low socioeconomic status was associated with moderate anxiety severity (OR = 6.08, 95% CI: 1.97–8.75), while middle socioeconomic status was associated with higher anxiety severity (OR = 6.11, 95% CI: 2.79–13.23). Gender, age, marital status, and education showed no consistent adjusted associations. This study extends clinic-based mental health evidence from Pakistan by showing that depressive and anxiety symptom severity is strongly patterned by socioeconomic disadvantage. The findings shift attention from individual symptom burden alone to the broader social conditions shaping clinical mental health presentations.
Anwar Khan, Amalia Bt Madihie· Discover Public Health· 0 citations
Background University students, particularly those in healthcare-related fields, face substantial mental health challenges exacerbated by the Coronavirus disease 2019 (COVID-19) pandemic. Despite the recognized importance of mental health in mitigating psychological distress, research assessing mental health related depression and anxiety among these healthcare-related students remains limited. Methods A cross-sectional study was conducted between April and May 2023 at a medical university in Shandong Province, China. A total of 10,267 students completed the Symptom Checklist-90 (SCL-90), 12,950 completed the Self-Rating Depression Scale (SDS), and 12,735 completed the Self-Rating Anxiety Scale (SAS). Data were analyzed using descriptive statistics, t-tests, ANOVA, and logistic regression to assess the prevalence and risk factors for depression and anxiety. Results Among 12,950 medical university students, 67.49% were asymptomatic for depression, while 15.89, 16.10, and 0.52% exhibited mild, moderate, and severe depressive symptoms, respectively. Anxiety assessment of 12,735 students showed 89.93% were asymptomatic, with mild, moderate, and severe anxiety present in 8.04, 1.56, and 0.46%. SDS scores differed significantly across academic grades (p < 0.001) but not by gender, whereas females had slightly higher SAS scores than males (p = 0.015). The prevalence of depression and anxiety varied significantly across academic departments (p < 0.001). Multivariable analysis identified academic grade as an independent predictor of both depression and anxiety severity, with department and gender additionally associated with moderate depression. Conclusion Healthcare related students demonstrate moderate levels of psychological distress, with distinct demographic and academic patterns. Targeted interventions are urgently needed, particularly for younger students and those in high-stress majors. Enhancing mental health could play a crucial role in mitigating the burden of depression and anxiety in this vulnerable population.
Rui Guo, Zhiyong Yuan, Wei Yan et al.· Frontiers in Psychology· 0 citations
OBJECTIVES
The association between mental health literacy and personal and interpersonal mental health experiences with personal stigma is increasingly recognized. However, the underlying mechanisms remain unclear. This study investigated the hypothesized mediating role of social support networks between mental health literacy and personal and interpersonal mental health experiences, and personal depression stigma among Chinese older adults.
METHODS
Using a cross-sectional design with 1,044 participants, we measured depression stigma with the Depression Stigma Scale, mental health literacy through vignettes, and social support with the Lubben Social Network Scale. Personal and interpersonal mental health experiences were assessed with yes/no questions. Structural equation modeling was used to examine their hypothesized relationships.
RESULTS
Mental health literacy (b = -0.616, p < 0.001) and personal mental health experiences (b = -1.327, p < 0.001) were statistically associated with lower levels of personal depression stigma. Social support networks show statistical mediation in the relationships between mental health literacy, personal mental health experiences, and personal depression stigma (CFI = 0.977; TLI = 0.956; RMSEA = 0.035; SRMR = 0.027).
CONCLUSION
Our cross-sectional study suggested that mental health literacy and personal mental health experiences were associated with lower levels of personal depression stigma in Chinese older adults, with their associations being statistically mediated by the presence of informal social support networks.
Jessie Ho-Yin Yau, D. Leung, Jessica Kang Qi Lee et al.· Aging & Mental Health· 0 citations
Caregivers of patients with Severe Persistent Mental Illness (SPMI) face tremendous challenges. They often experience elevated levels of burden, depression, and anxiety. These factors negatively impact their quality of life (QoL). However, few studies have examined caregiver burden and its psychological effects in Saudi Arabia. This study aims to assess caregiver burden in relation to socio-demographic characteristics and its correlation with depression, anxiety, and QoL. The study tool consisted of validated questionnaire, including the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), abridged Arabic version of the Zarit Burden Interview (ZBI), and the World Health Organization Quality of Life-Brief Version (WHOQOL-BREF). A cross-sectional convenience sample of 120 participants was recruited from the Psychiatry Outpatient Clinics at King Saud University Medical City in Riyadh, Saudi Arabia. Our results showed a significant positive correlation between caregiver burden and depression and anxiety scores (p < 0.001). Moreover, significantly higher burden levels were found among female caregivers and those residing with patients, p = 0.04 and p = 0.002, respectively. Additionally, the severity of mental illness was also associated with an increased burden level (p = 0.001). Notably, spouses and children reported significantly higher burden levels (p = 0.036). In multivariable analyses, caregiver anxiety and perceived severity of the patient’s mental illness were independently associated with higher caregiver burden, while depressive and anxiety symptoms were independently associated with poorer quality of life.Furthermore, a significant negative correlation was found between caregiver burden and the physical and psychological QoL domains (p < 0.001 and p = 0.013, respectively). Collectively, our findings highlight the mental health challenges faced by caregivers of individuals with SPMI in Saudi Arabia, which negatively impact their QoL. Consequently, these findings substantiate the urgent need for targeted support interventions, particularly those addressing caregiver anxiety, depression, and the challenges associated with severe mental illness, especially for caregivers who live with or care for individuals with SPMI.
Fatimah Albrekkan, Shuliweeh Alenezi, A. Ghesheyan et al.· PLoS ONE· 0 citations
Mental health problems in young adults with hypertension are often underrecognized, despite their potential impact on quality of life and long-term outcomes. Evidence in younger populations remains limited, particularly in longitudinal and multicenter settings.
To examine the relationship between hypertension duration, mental health symptoms, and quality of life among young adults, as well as to explore psychosocial stressors identified through qualitative inquiry.
This multicenter longitudinal study recruited patients aged 18–45 years with hypertension from outpatient clinics across several Indonesian cities. Participants were assessed at baseline using the Depression Anxiety Stress Scale-21 (DASS-21) and the WHO Quality of Life-BREF (WHOQOL-BREF).
Hypertension duration was recorded as a continuous variable. A subset of participants underwent semi-structured interviews to explore psychosocial stressors. Quantitative data were analyzed using correlation analysis, while qualitative data were analyzed thematically.
A total of 791 participants were included in the study, with a mean age of 33 ± 10.14 years, and women slightly outnumbered men. This study found that a longer duration of hypertension was associated with worse overall quality of life (r = -0.45) and lower psychological well-being (r = -0.40). Notable correlations also emerged between hypertension duration and higher levels of anxiety (r = -0.42), depression (r = -0.38), and stress (r = -0.30), while socioeconomic and psychosocial stressors emerged as major contributing factors.
This multicenter longitudinal study suggests a direct link between early-adulthood hypertension and subsequent psychological distress, particularly anxiety and depressive symptoms, as well as lower quality of life with aging. Recent findings underscore that hypertension in young individuals extends beyond cardiovascular risk and may also impose a substantial mental health burden. Evidence identifying socioeconomic and psychosocial stressors as key predisposing factors further strengthens the rationale for incorporating routine mental health screening and psychosocial interventions into standard hypertension management protocols, thereby enhancing patients’ quality of life and potentially improving long-term clinical outcomes.
In this multicenter longitudinal cohort, a longer duration of hypertension was associated with greater psychological distress and poorer quality of life among young adults. These findings support the integration of routine mental health screening into hypertension care.
E. Effendy, M. M. Amin, V. Camellia et al.· Clinical Practice & Epid...· 0 citations
