Journal of Education and Health Promotion

Abstract BACKGROUND: The immense comorbidity among disorders could be ascribed to common
trans‑diagnostic processes. The term trans‑diagnostic has been of interest in both pathology
and psychology. Trans‑diagnostic treatments were created as opposed to treatments based on
single‑diagnosis treatments. It addresses the common underlying mechanisms in a range of comorbid
disorders. Trans‑diagnostic treatment is one of the new psychological treatments, and its efficacy has
been proven on many psychological variables. The main focus of the current study is on designing
unified trans‑diagnostic interventions and their efficacy on the shared mechanisms of comorbid
obsessive personality disorder with anxiety, depression, and obsessive‑compulsive disorder.
MATERIALS AND METHODS: the sequential transformative strategy has two stages; qualitative
and quantitative. In The first and qualitative section of the research, explanatory research will be
carried out to investigate the trans‑diagnostic intervention using a systematic review. To validate
the trans‑diagnostic intervention, and simultaneously with the trans‑diagnostic intervention, a
questionnaire has been prepared and given to 10 psychology experts and professionals in the
treatment field concerning content validity by evaluators.
Quasi‑experimental research will be assessed with a pre‑test, post‑test, and a two‑month follow‑up
after confirming the validity and reliability of the intervention in the quantitative section.
CONCLUSION: Designing unified trans‑diagnosis interventions and their efficacy on the common
mechanisms of comorbid obsessive personality disorder with anxiety, depression, and obsessive‑compulsive
disorder is an effective treatment method for helping those suffering from a personality disorder. Clinical
psychologists, psychology experts, psychiatrists, and mental health experts are all the immediate
beneficiaries of this study. Moreover, clients could benefit from this intervention with less money and time.

Abstract During the COVID‑19 pandemic, people are using social media more than usual routine because they
rely on online sources to seek health information for themselves and their loved ones. The spread of
inaccurate and misleading information via social media has a number of detrimental psychological
effects on members of society. The aim of this systematic review was to describe the impact of social
media on the mental health of the general population. An extensive systematic search was done till the
last month of 2021 for collecting the evidence using the PRISMA technique. The search was mainly
focused on the article leading with keywords and search engines used during the course of the study
were Pubmed, Semantic Scholar, Mendeley, and Science direct. Articles for this study were selected
based on the predetermined eligibility criteria and performed quality assessment by using the NHLBI
quality assessment tool. Most of the studies included in this review are found fair (score between
9 and 12) quality. Out of 866 publications, 533 articles were included in the initial screening, after
duplication removal 46 full‑text articles were assessed for eligibility and 14 studies were selected for
systematic review. In most of the studies, maximum participants used social media as a primary source
of information. Relatively high rates of symptoms of depression (14.14% to 48.3%), anxiety (7.4% to
47.82%), and prevalence of stress increased to 37.67% are reported after exposure to social media
for coverage of COVID‑19 news in the general population. Risk factors of psychological distress are
associated with female gender, younger age group, marital status, staying alone, and duration of
exposure to mass media. Increased exposure to COVID‑19 information through mass/social media
is associated with highly significant levels of psychological health issues; mitigating the hazardous
effect of social media exposure during the COVID‑19 pandemic on the psychological health of the
general population is an international public health priority.

Abstract BACKGROUND AND AIM: Several research works show that anxiety is more common in women,
low‑income classes, and middle‑aged and elderly populations. The present study aimed to investigate
the role of positive and negative memories in patients’ anxiety referred to the dental clinics, offices,
and schools of Kerman, Iran, in 2018–2019.
MATERIALS AND METHODS: In this cross‑sectional, descriptive, analytical study, the participants
were selected among individuals referred to the dental offices, schools, and clinics of Kerman, Iran.
In this study, 500 questionnaires were distributed among the participants (based on census method),
and of these, 482 of which were reviewed (response rate = 96.4%). The questionnaire used in this
study contained four categories of questions, including demographic information, general questions
about dentistry, Corah’s Dental Anxiety Scale, and Autobiographical Memory Questionnaire. Analysis
of variance, t‑test, and Chi‑square test were used to analyze.
RESULTS: Overall, 281 participants were female, and 201 were male. Based on the findings, dental
visits were enjoyable and pleasant experiences for 154 participants, and 165 patients were anxious
while the dentist prepared for a restorative treatment. This study showed that people with negative
memories had more anxiety. Anxiety was also significantly associated with positive memories, higher
education, and gender (female) (P < 0.05). Also, the most negative memories of dental treatments
were associated with increased anxiety about dental treatments in adults (P < 0.05), while positive
memories did not have a relationship any with decreased anxiety (P > 0.05).
CONCLUSION: The most negative memories of dental treatments were associated with increased
anxiety about dental treatments in adults, while positive memories did not have any expected inverse
relationship with anxiety.

Abstract BACKGROUND: Due to the role of education in improving anxiety and essential skills of mothers
for caring for their infants, this study aimed to investigate the effect of education based on the health
belief model (HBM) on anxiety among mothers of infants with retinopathy of prematurity (ROP).
MATERIALS AND METHODS: This randomized controlled clinical trial was performed on 67 mothers
with premature infants admitted to the ROP unit of Khatam Al Anbia Eye Hospital in Mashhad,
Iran from 2019 to 2020. Participants were randomly allocated to intervention and control groups.
Intervention was designed based on HBM during six sessions, each of 45–60 minutes duration. The
control group received routine educations according to the hospital policies. The maternal anxiety,
adherence with follow‑up examinations and the rate of neonatal retinal vascularization were evaluated
using an HBM‑ based questionnaire and State‑Trait Anxiety Inventory questionnaire and checklists,
respectively. Data was analyzed by using SPSS software, version 16, using Chi‑squared test, Fisher’s
exact test, independent t test, and Mann–Whitney U test.
RESULTS: Based on our findings, no significant difference was observed between the two groups
before the intervention regarding the mean score of maternal anxiety (P = 0.141). However, after
intervention, the mean score of maternal anxiety decreased significantly from 67.0 ± 6.3 to 38.5 ± 6.6
in the intervention group and increased from 69.8 ± 3.1 to 68.3 ± 3.4 in the control group (P < 0.001).
In the intervention group, the mean scores of model constructs (perceived susceptibility and
severity, perceived benefits, barriers, self‑efficacy and cue to action) increased significantly after
intervention (P < 0.001).
CONCLUSIONS: Education based on HBM appear to be an efficient method to improve maternal
anxiety among mothers of infants with retinopathy of prematurity. Accordingly, nurses and treatment
staff can provide interventions in the NICU based on the HBM to the parents of hospitalized and
premature infants.

Abstract BACKGROUND/AIM: The COVID‑19 pandemic has created a long period of stress for people
worldwide and has significantly affected sleep duration. The pandemic revealed new stress factors
that are likely to affect sleep. Uncertainty is a factor that leads to anxiety and depression, which
affects sleep. It should also be noted that reductions in sleep quality rather than sleep duration are
associated with negative consequences on mental health. This study aims to investigate online that
how this situation affected university students.
MATERIALS AND METHODS: This research, with a descriptive study design, was conducted in
Turkey between June 01, 2021 and July 30, 2021. The sample included 604 people who accepted
voluntary participation, chosen by the random selection method. In the study, sociodemographic
information form, Pittsburgh sleep quality index (PSQI), morningness–eveningness questionnaire
scale (MEQ Scale), Beck depression inventory (BDI), and Beck anxiety inventory (BAI) were used as
data collection tools. Pearson correlation analysis was utilized to examine the relationship between
the scales. Multiple regression analysis was performed to investigate the role of morningness–
eveningness, anxiety, depression, and insomnia severity on sleep quality.
RESULTS: Sleep quality was negatively correlated with morningness–eveningness scores (r = –0.32,
P < 0.01), and positively and significantly related with anxiety (r = 0.43, P < 0.01), depression (r = 0.40,
P < 0.01) and insomnia severity (r = 0.55, P < 0.01). According to regression coefficients, while
anxiety (ꞵ = 0.041, P < 0.001) and insomnia severity scores (ꞵ = 0.226, P < 0.001) positively predicted
sleep quality, depression did not predict it significantly (ꞵ = 0.009, P > 0.05). A significant difference was
found in sleep quality according to morning, evening, and intermediate types (F = 27.401, P < 0.001).
CONCLUSION: Events related to the COVID‑19 pandemic are associated with reduced sleep quality
in connection with increasing negative moods. Considering the importance of sleep for a healthy
life, efforts should be made to raise awareness about this issue and to provide psychological help
to affected individuals.

Abstract BACKGROUND: Psychological disorders, such as depression and anxiety, are common among
individuals who have experienced coronavirus disease 2019 (COVID‑19); however, diagnosis may
be challenging and subjected to invalidity. This study aimed to examine agreement between online
self‑assessment and psychiatric telephone interview among COVID‑19 survivors.
MATERIALS AND METHODS: This cross‑sectional descriptive study was carried out from March
to June 2021 in Afzalipour Hospital, Kerman, Iran. The inpatients confirmed with COVID‑19 were
contacted within the first week after discharge and were asked to fill the Hospital Anxiety and
Depression scale (HADS) and socio‑demography questionnaire. They were later interviewed using
Hamilton Depression Rating Scale (HAM‑D) and Hamilton Anxiety Rating Scale (HAM‑A). Agreement
between the data extracted from self‑report and telephone interview was analyzed using Cohen’s
kappa coefficient, sensitivity, and specificity.
RESULTS: Out of 200 post‑COVID patients, 60 participants completed all assessments. Prevalence
of depression was observed to be 88% via telephone interview and 45% via self‑assessment.
Moreover, 83% of the participants were diagnosed with anxiety according to the telephone interview,
in comparison to 31% diagnosed with anxiety using self‑report questionnaire. The agreement between
online self‑assessment and telephone interview for depression and anxiety was not significant
(κ = 0.08 and κ = 0.1, respectively).
CONCLUSION: The discordance between online self‑report and clinician’s assessment via phone
contact interview indicates that using self‑report evaluations is not sufficient as the single assessment
tool for mental health monitoring and reflects the need to employ multiple assessments for diagnosis
of psychiatric problems in pandemics.

Abstract BACKGROUND: The rapid and widespread of COVID‑19 has caused distress and havoc among
people in all walks of life. Such impact has been more pronounced among HCWs. We sought to
examine how health care workers (HCWs) knowledge about COVID‑19 and perceived anxiety can
influence preventive practices.
MATERIALS AND METHODS: In this cross‑sectional study a multiple regression analysis was
applied to examine the relationship between knowledge, anxiety, and preventive practices among
267 participants work in different settings in a variety of health care organizations in different regions
in Saudi Arabia. To estimate potential associations, a multiple regression analysis was applied.
Standardized beta‑coefficients and their 95% confidence intervals were estimated to examine the
outcome variable and the predictors’ associations.
RESULTS: Our findings shows that HCWs had high levels of knowledge about COVID‑19, perceived
anxiety, and preventive practices. In examining the relation between HCWs characteristics and their
knowledge about COVID‑19, older HCWs have been shown to have higher knowledge compared
to younger HCWs. Finally, the model to estimate the impact of knowledge about COVID‑19 and
perceived anxiety on preventive practice showed that both have a significant impact.
CONCLUSIONS: HCWs tendency to adhere to preventive practices is related to their levels of
knowledge and perceived anxiety. Such a relationship can inform administrators and policymakers
in the health care field to design health promotion campaigns to ensure all HCWs are aware of the
nature of communicable diseases and the risk they might entail.

Abstract BACKGROUND: The high prevalence of coronavirus disease‑2019 (COVID‑19) has a lot of stress on
medical students. This study was conducted to investigating the adaptation strategy with COVID‑19
health anxiety in nursing students
MATERIALS AND METHODS: This study was designed as a cross‑sectional study. Participants
of the study were 431 students of the Nursing and Midwifery Faculty of Shahid Beheshti University
of Medical Sciences. Inclusion criteria were studying at the time of the outbreak of COVID‑19 and
willingness to participate in the study. Data collection tools included participated in the study. Data
collection tools included a demographic questionnaire, Health Anxiety and Coping Inventory for
Stressful Situations (Short Form). Reliability of tools was assessed and confirmed with Cronbach’s
alpha coefficient. Cronbach’s alpha coefficient of health anxiety was 0.76 and Cronbach’s alpha
coefficient of Coping Inventory for Stressful Situations was 0.79. Data were collected between July
2020 and September 2020. Pearson’s correlation coefficient was used to examine the relationship
between the data. Data were analyzed with SPSS 26.
RESULTS: Findings indicated that most of the participants were female, single, 22–28 years old, and
undergraduate students. The mean of COVID‑19 health anxiety was 5.59 ± 17.04. Results showed
that 19.58 ± 5.05 of the participants used avoidance‑focused adaptation strategies, 25.12 ± 3.88
problem‑focused adaptation strategies, and 19.32 ± 5.13 emotion‑focused adaptation strategies.
CONCLUSION: The COVID‑19 health anxiety was higher in female, young, and married students.
The problem‑focused adaptation strategy should be further taught so that students can better coping
with COVID‑19 health anxiety.

Abstract BACKGROUND: A growing body of literature now identifies higher levels of anxiety, depression, and
stress among medical students as a distinct mental health domain. The competency‑based medical
education (CBME) curriculum was introduced to revamp the existing curriculum with an aim to garner
constructive impact on the mental health of undergraduate medical students. As such, we sought
to draw comparisons between the mental health of medical students, studying the old (2018 batch)
and the new (2019 batch) medical education systems in India.
MATERIALS AND METHODS: We designed a survey that contained structured questions
pertained to anxiety (HAM‑A, GAD‑7), depression (HAM‑D, BDI), and stress (PSS) amongst medical
undergraduate students of 2018 and 2019 batches at the Government Doon Medical College (GDMC),
Dehradun, India.
RESULTS: Contrasting the 2018 and 2019 batches, the introduction of CBME resulted in a significant
two‑fold decrease in moderate anxiety, as exhibited by both HAM‑A (6.0 vs 3.0, P = 0.016) and
GAD‑7 (3.5 vs 1.0, P = 0.037) scales, although no significant change in mild and severe anxiety, and
overall depression (BDI: P = 0.05, HAM‑D: P = 0.05) or stress (PSS: P = 0.86) was found.
CONCLUSION: The CBME system has made a significant impact on the mental health of
undergraduate medical students for anxiety, albeit its effect on depression and stress remains
equivocal. Future studies are warranted to compare the effect of CBME in other undergraduate and
postgraduate courses across the country to help predict the psychological impact of the newfangled
CBME education system.

Abstract BACKGROUND: Anxiety is the most common health problem and the second leading cause of
disability worldwide. Patients undergoing surgery often experience anxiety. It is necessary to use
appropriate interventions to achieve the best results. The aim of this study is to develop, implement,
and evaluate of anxiety management program for gynecological surgery patients under spinal
anesthesia.
MATERIALS AND METHODS: This participatory action research will be conducted through four
phases; problem identification, planning, action, and evaluation phases in the Gonbad‑e‑Kavous
Shahada, hospital in northeastern of Iran. These phases will be guided based on the Promoting
Action on Research Implementation in Health Services framework. Participants will be included using
purposive sampling method. We will use both of qualitative (semi‑structured interview, observation)
and quantitative (questionnaire) approaches for data collection through the study.
CONCLUSION: For anxiety management of patients, context‑based interventions should be
performed. Combination of multidimension approach based on health‑care providers, patients, and
environment will have an effect to solve the problem in the clinical setting.

Abstract BACKGROUND: Medical education is competitive across the globe. The long duration of the medical
and paramedical courses and exposure to clinical settings potentially causes mental health issues.
The aim of this study was to estimate the prevalence of depression, anxiety and stress among
undergraduate students in a private medical college in South India.
MATERIALS AND METHODS: This cross‑sectional study was conducted among paramedical and
medical students at a private medical college hospital and research center in South India in the
year 2021. The required sample size was calculated as 783 with an expected prevalence of 53%,
95% confidence interval (CI), design effect 2.0, and non‑response of 10%. The study participants
were selected based on simple random sampling. After obtaining informed consent, the data was
collected using an email questionnaire. Standard data collection tools such as the Perceived Stress
Scale (PSS); and the Depression, Anxiety and Stress Scale ‑ 21 (DASS‑21) questionnaire were
used. The investigator computed the odds ratio (OR) and adjusted odds ratio (aOR) with a 95% CI.
RESULTS: Out of 1200 students, 1015 (85%) responded to the email questionnaire. Among them, 639
were females (63%), and 925 were paramedics (91%). Prevalence of depression, anxiety and stress
were 59%, 43% and 11%, respectively. Almost 95% of students experienced moderate‑to‑severe
stress in the last one month. Prevalence was higher among females and students of medical
courses. Students of final year of college (aOR = 2.0; 95% CI = 1.2–3.5) and students of medical
course (aOR = 1.5; 95% CI = 1.1–2.4) were independently associated with stress among the study
participants.
CONCLUSION: There is high prevalence of depression, anxiety and stress among medical college
students in south India. The final year of study and medical course were independently associated
with higher stress than others. We recommend periodic assessment of mental health status and
additional mental health care for final year students and medical students.

Abstract BACKGROUND: Midwifery services help maintain and improve the health of the community. However,
a comprehensive examination reduces students’ psychological well‑being by creating anxiety. For this
purpose, the present study was conducted to determine and compare the effect of two educational
methods based on mindfulness and cognitive emotion strategies on psychological well‑being and
anxiety of eighth‑semester midwifery students before the final clinical trial.
MATERIALS AND METHODS: This study was a quasi‑experimental three‑group study with available
sampling method that was performed on 30 eighth‑semester midwifery students of the School of
Nursing and Midwifery of Isfahan University of Medical Sciences in 2020–2021. Data collection tools
were psychological well‑being and Test Anxiety Questionnaire. Two intervention groups were trained
for eight sessions. The control group did not receive any training program. The data collected by
SPSS version 22 software were analyzed by analytical statistical tests of ANOVA and least significant
difference post hoc test.
RESULTS: The results showed that there was a statistically significant difference between the three
groups in terms of components of test anxiety and psychological well‑being. Furthermore, emotion
regulation training and mindfulness‑based training reduced test anxiety and increased students’
psychological well‑being before the comprehensive test (P = 0.001).
CONCLUSION: It is recommended that educational programs be considered before the comprehensive
examination to promote the mental health and success of these students.

Abstract BACKGROUND: In the COVID‑19 outbreak, women with a history of miscarriage need more mental
health. Anxiety and meta‑worry as consequences of miscarriage, besides concerns due to pregnancy
during coronavirus, show the necessity of appropriate online and face‑to‑face educational counseling.
This study aimed to evaluate the effectiveness of online metacognitive educational counseling versus
face‑to‑face method on anxiety and meta‑worry in these women.
MATERIALS AND METHODS: In this randomized clinical trial, 80 women with a history of
miscarriage, anxiety, and meta‑worry referred to Imam Jafar Sadegh hospital (labor, women ward
and women clinic), Meybod, Iran, were selected conveniently and randomly assigned into two
groups (n = 20/each). The participants received 8‑session metacognitive educational counseling
package online or face‑to‑face. Data were collected by Beck Anxiety Inventory, Wellz meta‑worry
questionnaire at baseline, week eight, and follow up as primary outcomes and analyzed via SPSS
software (Anova and Repeated measure statistic tests).
RESULTS: Anxiety in the 12th week (online group 13.75 ± 3.59 vs. face to face 18.25 ± 5.91,
P = 0.04) was statistical significantly less than baseline (respectively 22.15 ± 5.67 vs. 22.35 ± 4.93,
P =  0.56); with fewer anxiety scores in the online group. Meta‑worry in the 12th week (online
group 11.90 ± 2.59 vs. face to face 15.70 ± 4.06, P = 0.03) was statistically significant compared to
baseline (respectively 17.15 ± 2.70 vs. 18.50 ± 3.47, P = 0.36); with fewer meta‑worry scores in the
online group. Belief about worry in 12th week (online group 66.50 ± 14.60 vs. face to face 78.45 ± 9.27,
P = 0.01) was statistical significantly less than baseline (respectively 85.50 ± 8.87 vs. 86.05 ± 8.85,
P = 0.96); with less score of belief about worry in the online group.
CONCLUSION: Online and face‑to‑face metacognitive educational counseling methods decreased
anxiety, meta‑worry, and belief about worry in women with miscarriage. But online educational
counseling was more effective. Distance online counseling in COVID‑19 can help the mental health
of women with miscarriage.

Abstract BACKGROUND AND PURPOSE: Most patients experience anxiety before heart surgery. On the 
other hand, spiritual health can improve the candidate patient’s adaptation to surgery. Therefore, 
this study aimed to investigate the effect of group logotherapy on spirituality and anxiety of patients 
undergoing cardiac surgery.
MATERIALS AND METHODS: In this quasi‑experimental study, 60 hospitalized candidates for 
cardiac surgery were randomly assigned to two groups (30 in the experimental group, 30 in the 
control group). To measure anxiety and relationship with God, Beck Anxiety Questionnaire and the 
researcher‑made scale about relationship with God (reconstruction of Lawrence’s scale of perception 
of God) were used, respectively. In the intervention group, in addition to drug therapy, individuals 
received two sessions of group discussion and spiritual skills training using the behavioral‑cognitive 
method with emphasis on spiritual thoughts and problem‑solving methods, but the control group 
received only drug therapy. Data were analyzed using SPSS software.
RESULTS: In the experimental group, the anxiety scores mean in the posttest and follow‑up were 
significantly lower than the pretest (P < 0.05), while the mean anxiety in the control group in the 
posttest stage was not significantly different, but at the follow‑up stage, it was significantly lower 
than the pretest, but the decrease in mean anxiety in the experimental group was greater (P < 0.05). 
The mean subscales of relationship with god (influence, divine providence, acceptance, presence, 
challenge, benevolence) were significantly higher in the experimental and control groups in the 
follow‑up stage than the pretest, but the increase in the mean of these variables was more in the 
experimental group in the follow‑up stage (P < 0.05).
CONCLUSION: Findings showed that the components of relationship with God are a good predictor 
of pre‑surgery anxiety, so by focusing on spiritual training of patients who are candidates for surgery, 
the incidence or severity of anxiety can be reduced.

Abstract BACKGROUND: Medical students who are prone to psychological stress due to their overburdened 
curriculum, are at an increased risk of getting adversely affected by the pandemic. The present study 
was planned to assess the anxiety level among undergraduate medical students across the country 
using generalized anxiety disorder scale (GAD‑7).
MATERIALS AND METHODS: In this online survey, anonymous data was collected through Google 
forms from undergraduate students from all the phases of MBBS course across the country from 
August 15, 2020, to October 15, 2020. Section I collected various demographic information, section 
II included GAD‑7 questionnaire for assessing anxiety and section III had open‑ ended questions 
about their impending fear, uncertainties, and apprehensions. The data was expressed in percentage 
and association among the variables was determined using Chi‑square test. Thematic analysis of 
the open‑ended responses was done.
RESULTS: Among the sample of 1208 students, 81% were from urban areas. During the pandemic, 
77% were residing with their parents and 71% parents having stable jobs. Eighty percent students had 
no relative diagnosed with COVID‑19, whereas 52% students had family members with comorbidity. 
The GAP score showed mild, moderate, and severe anxiety in 27, 24, and 16% students, respectively. 
Anxiety was significantly associated with rural setting and with COVID‑19 positive or comorbid family 
member (P < 0.05). Open ended responses revealed that majority of the students were finding it 
difficult to cope with the academic stress at home but still did not want to join back.
CONCLUSION: With such a high incidence of anxiety among medical students, it is pertinent to 
safeguard the mental health and implement efficient approaches to upkeep the scholastic, physical, 
emotional, and professional well‑being of medical students during such vulnerable times.

Abstract BACKGROUND: The loss of a pregnancy can result in grief, guilt, self‑doubt, anxiety, and
post‑traumatic stress disorder (PTSD). Considering the side effects mentioned for mental health
and the fact that the symptoms will linger if left untreated and even adversely affect the subsequent
pregnancies. The current study was designed to assess the impact of individual counseling on stress,
anxiety, and depression in mothers with pregnancy loss.
MATERIALS AND METHODS: The study commenced 100 women who experienced pregnancy loss
(in Urmia/2018-2019); they were enrolled using convenience sampling and block randomization. The
intervention group received four individual counseling sessions (weekly sessions with a duration of
1 h) based on Warden’s principles. The control group received routine care. The Depression Anxiety
Stress Scale (DASS‑42) was filled out at baseline, the pre‑ and post‑intervention. Analyses were
performed using the Chi‑square, paired, or individual t‑tests, when necessary. P value < 0.05 was
considered significant.
RESULTS: There were no significant differences regarding socio‑demographic characteristics and
clinical features between groups at baseline. Intra‑group analysis showed that all outcome measures
in the intervention group were significantly improved. According to inter‑groups analysis, a significant
association was found between pre‑test and post‑test in the intervention group (P < 0.05).
CONCLUSION: Results of this study can clarify the psychological effects of pregnancy loss in these
mothers and help the officials and responsible parties to plan the treatment and rehabilitation of these
women and include them in the healthcare system.

Abstract Coronavirus disease 2019 (COVID‑19) has caused different kinds of psychological consequences.
Identifying and providing psychological plans and protocols can be effective in promoting patients’
mental health. The study was conducted to investigate the effect of psychological interventions in
response to stress, anxiety, and depression in COVID‑19 patients. The present study was performed
based on a systematic review. The studies were done by using different combinations of keywords
in databases such as Science Direct, ProQuest, PubMed, and Google scholar search engines and
in Persian databases such as Magiran, SID, Iranmedex from July 25 to September 7, 2020. Out
of 4533 articles that were found after extensive search, 9 articles were evaluated and qualitatively
analyzed for data extraction with the 2010 consort checklist. The final articles were from different
countries of China, the USA, France, Italy, and Iran and were about COVID‑19 patients and their
health‑care providers. Interventions ranged from relaxation, music therapy to mental health and
extensive psychological skills including adaptation methods, mindfulness and self‑care, and crisis
management. Anxiety was the highest and then stress and depression were the next indicators. The
results showed a positive effect of these interventions on stress, anxiety, depression, and even the
quality of life, sleep and family and child function. The number of studies in this field is increasing. We
see a variety of psychological and educational interventions every day. It is hoped that by designing
standard protocols for psychological intervention, effective steps can be taken to improve the mental
health of patients and health‑care providers.

Abstract BACKGROUND: COVID‑19 initiated in December 2019 in Wuhan, China, and over a period of
time, the infection outspread across the world in a rapid pace. To protect the people and to further
limit the spread of infection, lockdown was declared in most parts of the world including India.
As all people were forced to stay indoors during this pandemic, internet was the only source of
entertainment whose overuse has side effects on anxiety and sleep quality. This study is aimed to
know the impact of Internet addiction during COVID‑19 on anxiety and sleep quality among college
students of Bhubaneswar city.
MATERIALS AND METHODS: This was a web‑based cross‑sectional, questionnaire study. It
administered 475 students from six colleges. The students were assessed by a proforma containing
demographic details, patterns of internet use, Youngs Internet Addiction Test, Generalised Anxiety
disorder score, and the Pittsburgh Sleep Quality Index. Statistical analysis was done using SPSS
version 21.0 using Chi‑square test and Wilcoxon signed‑rank test.
RESULTS: The mean age of the study group was 18.81 ± 1.189. Out of 475 students, 60.6% were
female and 39.4% were male. 23.6% and 13.4% of recruited students had severe internet addiction
and anxiety disorder, respectively. The mean global PSQI score in the study was 6.356 ± 1.88.
About 84.6% of the students had poor global sleep quality score. All components of sleep quality
were significantly associated (P = 0.000) with different degrees of internet addiction except sleep
duration (P = 0.589) and efficiency (P = 0.767).
CONCLUSION: Females were highly addicted than males. The study findings specified that students’
excessive internet usage leads to anxiety, and affects mental health. Monitoring and controlling
students’ internet addiction through informative sessions on how to use the Internet adequately is
useful.

Abstract BACKGROUND: As pediatric surgeries are rising and current methods to reduce perioperative 
anxiety are lacking in preschool children. The purpose of this study was to determine the effect of 
video games on preoperative anxiety in 3‑ to‑6‑year old of a sample of Iranian children undergoing 
elective surgery children.
MATERIALS AND METHODS: In the current quasi‑experimental pretest posttest design, after 
standard translation, the modified Yale preoperative anxiety scale was administered to 102 children 
undergoing surgery from December 2016 to August 2017 in Kermanshah, Iran. Children are assigned 
to an intervention or control group. Each child’s anxiety was measured at two points at the time of 
arrival and after waiting for 20 min in the holding area. Data were analyzed by SPSS, version 22. The 
Chi‑square, independent t‑test, and paired t‑test at the significance level of P < 0.05 were performed.
RESULTS: There was no significant difference between the mean anxieties in control 
group (42.58 ± 18.54) and intervention group (46.11 ± 14.09) before the game (P = 0.282). However, 
after playing the video game in control groups (53.26 ± 18.00) and game groups (34.88 ± 10.81), 
there was a significant difference in favor of the video game (P < 0.001).
CONCLUSION: Findings of the present study suggest that approved video game by experts 
to decrease mean preoperative anxiety in 3‑ to‑6‑year‑old children. Therefore, video games 
recommended to be implemented at the preventive level in hospital.

Abstract BACKGROUND: Coronavirus disease (COVID‑19) and resulting restrictions have impacted 
populations’ lifestyles and posed a challenge regarding their behaviors, including physical 
activity (PA). This study aimed to evaluate PA patterns of university students during the COVID‑19 
outbreak. We also analyzed the association of participants’ characteristics, including their level of 
anxiety, under the pandemic conditions, with adherence to the world health organization (WHO) 
recommendations for PA.
MATERIALS AND METHODS: This cross‑sectional study comprised 717 Moroccan university 
students recruited during the COVID‑19 pandemic. The Global Physical Activity Questionnaire (GPAQ 
V.2) was used to evaluate PA. Data on sociodemographic characteristics and anxiety levels were 
also collected. Anxiety was assessed using State‑Trait Anxiety Inventory (STAI). Descriptive and 
inferential statistical analysis was carried out. The association between participants’ characteristics 
and PA was studied using regression models.
RESULTS: Of all participants, 33.2% did not achieve the recommended levels of PA. The daily 
median (25th–75th percentile) time spent in PA was 34.3 min (12.7–98.6), whereas the median time 
of sedentariness was 10 h per day (6–14). Multivariate analysis showed that female sex (OR = 0.63; 
95% CI: 0.44–0.90; P < 0.05) and high level of state anxiety (OR = 0.43; 95% CI: 0.20–0.92; P < 0.05) 
were negatively associated with the achievement of the WHO recommended PA.
CONCLUSION: The reported PA patterns of university students during the current outbreak should 
be taken into account and evoke the necessity of encouraging this population to adhere to the 
recommended PA levels. Targeting state anxiety related to the conditions we are facing may have 
a promising effect on the promotion of PA.

Abstract BACKGROUND: Human anatomy instruction is mostly focused on cadaver dissection and prosected 
specimen examination. Exposure to cadaver dissection can be a stressful experience that may cause 
a wide variety of symptoms among students of health sciences. To compare and evaluate the effect 
of in‑vitro and in‑vivo exposure on cadaveric anxiety, disgust propensity and sensitivity, and attitude 
toward death and dying among 1st‑year medical and nursing students.
MATERIALS AND METHODS: An open‑label randomized trial (matched‑control experimental 
design) was conducted among 127 1st‑year Medical and Nursing students from a selected Institute of 
National Importance, Bhopal, India during 2015. The participants were divided into an experimental 
and control group based on matched trait anxiety scores using the Trait Anxiety Inventory. Followed 
by preassessment, video demonstration with cadaver dissection (in vitro exposure) was then 
administered to the experimental group, while the control group had direct exposure to cadaver 
dissection (in vivo exposure).
RESULTS: The study showed that there was a statistically significant difference in state anxiety 
related to cadaver dissection in the experimental group (P = 0.01). However, video‑demonstration of 
cadaver dissection did not have any effect on disgust propensity and sensitivity and attitude toward 
death and dying.
CONCLUSION: The findings provided evidence that video‑demonstration of cadaver dissection 
reduced anxiety, although it did not have any effect on disgust and attitudes of death. The dissection 
hall experience may evoke feelings of anxiety and disgust that need to be addressed through advanced 
preparedness and coping strategies, especially among medical and nursing students.

Abstract BACKGROUND: The novel 2019 COVID‑19 spreads by respiratory and aerosols, and this elevates 
the risk of dentistry during this pandemic. Widespread disease, in a short time, creates stress and has 
a psychological impact. The aim of this study was planned to assess the stress level of the dentists 
living or practicing or studying in hot spots which could help to understand mental status among the 
general dentists during COVID‑19 lockdown.
MATERIALS AND METHODS: This cross‑sectional study was conducted during the period of 
August 10 to August 25, 2020, on an Internet platform after getting consent from the dentists and 
practitioners using the Perceived Stress Scale (PSS). Chi‑square association was used. Parametric 
tests such as independent t‑tests and one‑way ANOVA were also used. In all instances, P < 0.05 
was considered statistically significant.
RESULTS: This study had a total response from 1044 dental students and dentists residing in hot 
spot zones in Tamil Nadu. Out of them, 68.4% were female and 31.6% were male. 37.9% of the 
participants were dental practitioners and 32.5% were undergraduate students. There is a significant 
association between age groups and PSS, work style, and PSS. There is no significant association 
between gender and PSS and degree and PSS.
CONCLUSION: This study shows that levels of distress were higher than expected during the 
COVID‑19 pandemic among the dentists and majority of the respondents have moderate‑to‑high‑stress 
levels. As the unlock has been started throughout the country, it is the right time to work with the 
authorities and focus on formulating protocols for disinfection and sterilization and work on treating 
the patients with exact safety measures for the welfare of the patients.

Abstract BACKGROUND: Natural delivery is distressing, and the mother’s anxiety in this condition can have 
negative impacts on the fetus, mother, and the delivery process. Hence, many women tend to use 
pharmacological or nonpharmacological methods for reduction of labor stress and anxiety. The aim 
was to assess the effect of supportive care and acupressure during labor on the mother’s anxiety 
level and arterial oxygen pressure of the umbilical cord of infants.
MATERIALS AND METHODS: This performed on 150 pregnant women were randomly assigned 
to two interventions and a control group in the delivery ward of the selected educational center of 
Shiraz University of Medical Sciences (Shoushtari Hospital) in Iran. Mothers’ anxiety scores before 
(beginning of the active stage of labor) and after intervention (the end of the first stage of labor) were 
measured using Spielberger’s questionnaire. Then, infants’ cord blood samples for arterial blood 
gas and hematologic analyses were sent to the hospital’s laboratory. After all, the data with SPSS 
version 16 and using Pearson’s correlation coefficient, one‑way ANOVA, were analyzed.
RESULTS: The mean of anxiety score in the control group was 21.1% and in the supportive group 
and the acupressure group, respectively, decreased by 37.5% and 34.8%, respectively (P < 0.001). 
The mean of PO2
 was also reported in the maternal supportive, acupressure, and control groups, 
40.4 ± 8.8, 27.4 ± 2.8, and 18.1 ± 3.7, respectively. Additionally, a significant correlation was found 
between mothers’ anxiety scores after the intervention and the mean of PO2 (P = 0.014).
CONCLUSION: The supportive care and acupressure at BL32 acupoint reduced mothers’ anxiety 
and consequently improved fetal oxygenation. Therefore, these methods are recommended to be 
used during labor for improving birth outcomes.

Abstract BACKGROUND: The depression, anxiety, and stress is a major educational problem among 
students all around the world. The purposes of this study were to determine the depression, anxiety, 
and stress among the high school adolescent children in public and private schools in Rangareddy 
district, Telangana state.
MATERIALS AND METHODS: The present study was a cross‑sectional study. The study sample 
considered 120 children from private schools and 259 children from public schools were studied. The 
study tool used was a questionnaire containing DASS (Depression, Anxiety, and Stress scale and 
sociodemographic characteristics. The data were expressed as proportion and mean values (Analysis 
of variance, independed t‑test, and Pearson correlation) spatially tests were used at a significance 
level of P < 0.05).
RESULTS: The overall prevalence of depression in children from the public school was found to 
be only 5%, that of anxiety was 20.8%, and that of stress was 15.8%; the overall prevalence of 
depression in children from private schools was found to be 1.9%, that of anxiety was 20.5%, and 
that of stress was 20.1%.
CONCLUSION: In both schools, anxiety and atress were found to be more among study participants. 
Depression was observed to be less. But if they have more anxiety and stress and if not taken proper 
care at this point of time, it might get converted into a state of Depression.

Abstract BACKGROUND: Adolescence is a stressful time period. Adolescents experience new changes 
physically, mentally, emotionally, and socially. The purpose of this study was to determine the effects 
of acceptance and commitment therapy (ACT) on anxiety (primary outcome), depression, and quality 
of life (secondary outcomes) of adolescents.
MATERIALS AND METHOD: This was a quasi‑experimental study with pre and postintervention 
design. One hundred female students aged 16–18 years with mild to moderate anxiety selected 
through multistage cluster sampling from five educational districts of Tabriz. During six group 
counseling sessions, students were consulted with the acceptance and commitment approach 
according to the protocol. Beck Anxiety and Depression Inventory and the World Health Organization 
brief Quality of Life Questionnaire consultation were completed before, immediately after, and 8 weeks 
after the consultation. Data were analyzed using repeated measure ANCOVA.
RESULTS: The mean anxiety score decreased significantly immediately after the intervention (mean 
difference [MD]: −4.0, 95% confidence interval [CI]: −5.9 to − 2.0; P < 0.001) and 8 weeks later (MD: 
−3.9, 95% CI: −5.8 to − 1.9; P < 0.001). The mean depression score immediately (P < 0.001) and 
8 weeks after intervention (MD; −4.2, CI: −1.6 to − 6.8), P < 0.001) declined significantly. The mean 
overall quality of life score increased significantly after the intervention (P < 0.001) and 8 weeks 
later (MD: 4.7, 95% CI: 7.1–2.3, P < 0.001) compared to baseline.
CONCLUSIONS: Based on the effectiveness of counseling based on ACT on anxiety, depression, 
and quality of life in the female students with the mild and moderate anxiety over time, it can be used 
as a helpful method in high schools.