Category: Anxiety

ABSTRACT

This short paper is about mental health and why it affects teens the most as well as why mental health isn’t taken seriously in India. This is something that’s very interesting and it’s also something that’s really displeasing as mental health issues should be given equal importance just like any other health problem/sickness. Raising awareness can help defeat the stigma associated with mental health issues. The main purpose of this paper is to obviously spread news on this issue. The paper first begins with a brief introduction on mental health and its effects on high-schoolers worldwide. It then proceeds with anxiety in high schoolers. The main part of this paper is about mental health in India, a few reasons as to why it is not taken seriously and what India has done so far. Although India is considered to be the world’s most depressed country things are now changing and in the past few years a few things have actually been done to help out on this issue and hopefully in a few years India will be able to get rid of this title.

Introduction

Nearly one in three of all adolescents ages 13 to 18 will experience an anxiety disorder and these numbers have been rising consistently. Teen anxiety statistics are at a new peak. Between 2007 and 2012 the anxiety disorders in children and teens went up by 20% (McCarthy, 2019). Its obvious that it is rising year by year but no one is really sure why a few reasons could be because of high expectations and a high pressure to succeed- high schoolers more than ever, feel weight to succeed. Surveys of eighth graders discover that young individuals believe that they need to pick a career as soon as possible and they are continually comparing themselves to others. Todays high school students experience overpowering levels of pressure with respect to academic strength, athletic capacity and extracurricular engagement, based on the expanded requirements for college acceptance.

i) Anxiety in high-schoolers

High schoolers face strong competition with respect to standardized testing, college admissions and career planning. It could also be because of social media – social media plays a huge role in students’ life. Teens and children today are always connected to social media. Being on social media isn’t a bad thing but research shows that teenagers who use social media are more anxious, unhappy and stressed out than those who don’t use social media. Constantly comparing themselves to others has a negative impact on well-being. Additionally, investing time online on social media keeps teens from doing other activities such as exercising or interacting with their friends and family. Having continuous access to news, information and data can create increased levels of anxiety in teens. It can be difficult to feel secure when we are always confronted with media focusing on negative news (Welch, 2019). For many high schoolers, this leads to higher levels of anxiety. Anxiety can lead to serious mental health problems. Whatever the reason, rise in anxiety is a serious issue for the youth. Anxiety can lead to genuine mental health problems- substance use, depression and even suicide. It can meddle with the capacity to focus and learn causing school issues that can have a lifelong impact. It can also lead to physical issues, such as migraines, digestive issues and heart disease. Teens who suffer from anxiety disorders find relief that’s temporary through the use of drugs and/or alcohol. The plausibility of addiction intensifies when a teen tries to self-medicate to relieve anxiety. Alcohol and benzodiazepines are two examples of substances high schoolers commonly utilize to self-medicate undiagnosed anxiety disorders. These substances influence the brain in a comparative way, giving transient decreases in anxiety. And they are also two of the most addictive and accessible substances for teens. When it comes to teen anxiety early intervention is basic. Parents/guardians shouldn’t wait for a teen to “grow out of it”. Its necessary to seek help as soon as you see red flags or warning signs in their behaviour- before teenagers are abusing substances or engaging in risky behaviours to relieve their anxiety. A few ways in which a parent/guardian can help ais to pay attention to what their child is encountering, remain calm when they are anxious and to change their expectations during periods of high stress, such as standardized testing and even occasions that will make their child anxious.

ii) Mental health in India

According to an estimate by the world health organization (WHO), mental illness makes about 15% of the total disease conditions around the world. The same estimate also proposes that India has one of the biggest populations affected from mental illness. WHO has labelled India as the ‘world’s most depressing country’ (ETHealthWorld, 2020). Additionally, between 1990 and 2017, 1 in 7 individuals from India have suffered from mental illness ranging from anxiety, depression to more severe conditions like schizophrenia. In India mental health isn’t taken very seriously a few reasons as to why its not could be because of lack of awareness, stigma and judgement and fear. There’s a huge stigma around individuals suffering from mental health issues. They are usually labelled as ‘lunatics’ by society. This leads to a cycle of shame, disgrace and isolation of the patients. There is also a shortage of mental healthcare workforce in India. According to WHO, in 2011, there were 0.301 psychiatrists and 0.047 psychologists for every 100,000 patients suffering from a mental health issue in India. In a society that doesn’t take mental health seriously coming upfront and speaking up about it will take a lot of courage as you will be judged. Sometimes your own family and friends will brush aside and ignore the issue and won’t really hear you out. Statistics show that by 2020, India will have the highest population of people suffering from anxiety and depression in the world.

It is high time people come out more straightforward and talk about mental health. The government needs to provide better healthcare facilities, and remove the stigma associated with it. We need to educate people and sensitize them towards the signs, symptoms and side effects of mental health issues, while normalising the idea or thought of seeking support. India still has a long way to go with respect to mental health care. However, with the passing of the mental healthcare bill by the government of India, we trust that the deprived sections of society will have better access to services. Things are changing gradually and positively as many people have come forward and spoken about the issue. The future in general tends to stress out high schoolers and teenagers as people keep talking about how competitive it is to get into college and people most of the time expect high schoolers to be certain and to have everything figured out which is stressful as most kids may not be sure. It is a good thing that many schools have counsellors now so that the children could talk to them in case of any problem or in case they aren’t really comfortable speaking to their close ones. This is something more people need to talk about.

The two bar graphs below have been created to show the response of other high schoolers/ teens just to see if they all have the same perspective. From the first graph it is clear that most of them feel that school is the main reason for their stress although only ten of them have responded with a strong yes. However, from the second graph it seems as if they strongly believe in what they responded with and most of them have responded with a no that mental health isn’t taken seriously in India.

A study in behavioural neurosciences in 2006, said that being stressed out for long increased anxiety. The medical reasoning is that stress hormones, like cortisol and corticotropin-releasing hormone, which help respond to an immediate threat, end up boosting anxiety when stress continues to stay high. When the experience of doing a daily task becomes a chore; when you seem to be putting in a lot of effort and pushing harder and harder but functioning less and less effectively; when you no longer find joy in doing things that you once loved your mind is exhausted, these are a few signs that your mental health is in a bad shape. Indian culture values closeness, family unity and security making it a collectivist society such societies interdependence. Social rules for behaviour are strict in these societies and deviations in behaviour often result in shame while blame and guilt are experienced in individualistic societies. In Asian cultures and societies shame and anxiety are closely related and have been closely related for a really long time. Social anxiety is most common in adolescents and a few factors are trouble in adapting/coping with academics, having few friends, lack of closeness with parents.

Nowadays people aren’t really aware of the importance of mental health. People in India tend to belittle the issue. Many individuals feel or think that mental illness could be an individual shortcoming. India’s number of mental health beds was found to be below the average with 2.15 beds for 100,000 patients. Thus, a major concern in India is that there are gaps in the treatment. In few parts of the nation, accessible mental health resources are still severely lacking. Rural zones/areas do not have working psychiatrists or psychologists. Many researchers show that those suffering from mental health issues may not get the treatment needed due to stigma or lack of access to help. The NIMHANS study reveals that due to stigma associated with mental health issues and disorders nearly eighty percent of those with mental health issues had not gotten any treatment in spite of being sick for over twelve months. (MK, 2019)

iii) What India has done so far

The central government has reacted to tending to mental health concerns with coming out with much needed Mental Health Bill in 2016 which was a year later cleared as Mental Healthcare Act 2017. The Mental Healthcare Act 2017 was informed on 29 may,2018 after an expert committee of healthcare experts framed rules as well as regulations for the states to follow and develop. This acts as a reference point to manage people with mental illness. Significantly only Gujarat and Kerala have a standalone mental health approach. The Act,2017 guarantees healthcare, treatment and recovery of people with mental sickness from mental health services run or funded by the government in a way that does not barge in on their rights and respect. It guarantees that the individual influenced with mental sickness has the right to live a life with dignity and respect by not being discriminated on any basis. It assures free treatment for people who are homeless or belong to below poverty line. The Act promises a person with mental sickness the right to privacy in regard with his mental wellbeing, mental healthcare, treatment and physical healthcare, it also indicates the method and strategy to be followed for admission, treatment and discharge of mentally-ill individual. It clearly states that a person with mental sickness will not be subjected to electro-convulsive treatment without the utilize of muscle relaxants and anaesthesia. Also, electro-convulsive treatment will not be performed for minors. Further. Sterilization will not be performed on mentally ill patients. A remarkable include of the Act 2017 is the introduction of advanced directives which should be certified by a therapeutic specialist or enlisted with the Mental Health Board. It gives people suffering from a mental health issue the right to select their mode of treatment, and by nominating representatives who will ensure that their choices are carried out.

REFERENCES

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Just because an illness cannot be seen, does not mean it does not exist. While a physical illness often manifests itself in ways that are clearly visible such as coughing, sneezing or vomiting, the same cannot always be said for mental illnesses. People with mental illness can often put up a front, so much so that it is difficult to know that someone is battling an illness. According to Edlin & Golanty (2019), mental illness is “alternations in thinking, emotions, and/or intentional behaviors that produce psychological distress, medical illness, and/or impaired functioning” (p. 64). There are a multitude of mental illness that have been researched and defined over the past decades, including anxiety,

Anxiety is the most prevalent mental health disorder. Anxiety is a response to a future situation that is perceived as threatening, yet it has not actually happened and today, there are multiple types of anxiety disorders that have been defined (Edlin & Golanty, 2019, p. 73). While some worry is considered normal, constant worry and anxiety is considered a disorder, called generalized anxiety disorder (GAD). It is important to note that “in most anxiety disorders, patients usually process fear-inducing information in excessive detail that overwhelms their ability to appraise it properly. They cope by separating the information into good and bad with no gray area in between” (Bystritsky, Khalsa, Cameron & Schiffman, 2013, p. 32). This paper will provide a complete overview of anxiety from the history to present day, as well as terms, statistics and ways to treat the illness.

Terms

It is important to not confuse a normal amount of anxiety or fear with having a mental illness. To start, it is important to understand what it means to be mentally healthy, as well as its three components, before diving into what characterizes a mental illness. Edlin & Golanty (2019) provided a comprehensive view of mental health, which is “a state of mental well-being in which every individual realizes his or her own potential, can cope with the normal stressors of life, can work with productively and fruitfully, and is able to make a contribution to his or her community” (p. 64).

Being in a state of good mental and emotional health has three components: psychological, emotional and social, but when one of those components becomes irregulated or disturbed for a period of time, one might have a mental illness. Being mentally healthy means having a biologically healthy brain and nervous system and also interpreting the world realistically and being in sync with the environment. It is also important to note that mental health does not look the same for everyone, as Edlin & Golanty (2019) stated, “to be mentally healthy, we do not have to be like everyone else. Being true to ourselves leads to greater satisfaction in life than social conformity does” (p. 65). It is important that one understands the difference between anxiety and depression. Anxiety is characterized by persistent worry, whereas depression is a state in which a person experiences sadness, hopelessness, and a lack of motivation for a period of more than two weeks, and the feelings are so severe that activities that one enjoys while in their normal state are interfered with (Anxiety and Depression Association of America, n.d., para. 7). While many people are mentally healthy, the statistics surrounding anxiety disorders are staggering.

Statistics

Nearly 1 out of every 5 adults in the United States experiences some type of mental illness in a given year. The exact percentage of people affected in a 2016 study was 18.5 percent of Americans, and nearly 1 of 25 adults in the country will experience a mental illness that interferes with one or more major activities (National Alliance on Mental Illness, 2016, para. 1-2). With a multitude of mental illnesses defined, anxiety is the most prevalent disorder. Anxiety disorders have been around for many years, but the extent of how common mental disorders are was revealed over 30 years ago. According to Bystritsky et al., (2013), “Anxiety disorders are present in up to 13.3% of individuals in the US and constitute the most prevalent subgroup of mental disorders” (p. 30). While anxiety is more common in adults than children and teenagers, that does mean that it does not exist among youngsters. Typically, when someone is diagnosed with a mental illness, it is commonly done when the individual is a teenager (age 14) or in their mid-20s. According to the NAMI (2016), “one-half of all chronic mental illness begins by the age 14; three-quarters by the age of 24 (para. 14). While these statistics focus on mental illness and anxiety in general, research has been done and statistics announced regarding anxiety in males vs. females and people in different walks of life.

From 2001-2003, the National Institute of Mental Health conducted a country-wide survey on mental illness (specifically anxiety) and released statistics regarding the prevalence of anxiety disorders. The study was done face-to-face in over a two-year period and had an initial response rate of 70.9 percent of households. The study was again updated in 2017. The NIHM stated that in an adult’s lifetime, 31.1 percent of adults living in the United States experienced some type of an anxiety disorder, but anxiety disorders were significantly more common in females. Among adults 18 years of age or older, the prevalence of an anxiety disorder was higher for females (23.4) compared to males (14.3 percent) (NIMH, 2017, para. 4). Listing the percentage of individuals with an anxiety disorder does not provide information on the severity of the disorder. Further research was conducted, and the data showed that the majority of anxiety disorders experienced by adults involved just mild or moderate impairment (77.2 percent), while slightly more than 1-of-5 individuals battled a serious anxiety disorder (22.8 percent). (NIMH, 2017, para. 7). Ultimately, although there is a high number of people battling anxiety, it is not something that has just become common, but has rather been battled for thousands of years, albeit with different terminology.

History: From BC to 1980

Dr. Marc Crocq in France compiled a comprehensive history of anxiety and stated that anxiety was at first believed to not have truly been an illness prior to 19th century, but today, that argument is becoming more and more invalid. According to Crocq (2015), “There are indications that anxiety was clearly identified as a distinct negative affect and as a separate disorder by Greco-Romano philosophy and physicians. In addition, ancient philosophy suggested treatments for anxiety that are not too far removed from today’s cognitive approaches (p. 320). Early philosophy focused heavily on fear, but both Stoics and Epicureans offered thoughts on anxiety.

Epicurius, a philosopher known for a school of thought called Epicureanism, believed that worry was a hindrance to living a happy life. Although Epicurius did not specifically use the term anxiety, it is clear that the philosopher was discussing it because of how in depth the writing mentioned being worry free. Today, persistent worry is one of the traits of anxiety. Epicruis believed that an individual needed to strive for a state known as ataraxia, where the person lived a life without worry (Crocq, 2015, p. 320). Epicurius’ writings were lost but seemed to lay the foundation for the discovery of anxiety, so to speak.

At one point, anxiety seemingly disappeared as a classified illness, although Crocq stated that patients with anxiety still existed, despite being diagnosed with other illnesses. However, in the early 1600s, Robert Burton discussed the idea of being melancholy and within that he mentioned anxiety. According to Crocq (2015), “Burton’s work is generally quoted in the context of depression. However, Burton was also concerned with anxiety. At that time, the meaning of melancholia was not limited to depression but also encompassed anxiety (p. 321). It could be argued that Burton laid the foundation for anxiety being classified as its own set of mental illnesses, although that would not happen for over one hundred years. In the 1700s, panic attacks became associated with melancholia, and anxiety was still under that same umbrella at the time. During that same century, Boisser de Sauvages published a French medical textbook, which contained ten different classes of diseases, with mental illnesses being defined under the eighth category (Crocq, 2015, p. 322). Despite de Sauvages work, which actually was the last medical textbook written in Latin, anxiety would not be at the forefront of the discussion until the late 1800s.

Physician George Miller Beard was one of the first individuals to involve anxiety as a component of a new disease category, including neurasthenia and neuroses. In 1869, Beard’s description of neurasthenia included anxiety and depression (Crocq, 2015, p. 322). Although Beard was among the first to include anxiety as a symptom, Sigmund Freud was the one who developed many of the terms for anxiety disorders, and those terms are still associated with anxiety disorders more than 150 years later (Crocq, 2015, p. 322). Fast forward to the 1950s when anxiety truly became a prevalent disorder. Why? Mental orders had their own publication – the Diagnostic and Statistical Manual of Mental Disorders.

The Diagnostics and Statistical Manual of Mental Disorders is referred to as DSM with a dash and roman numeral signifying the version. In DSM-I, a 1952 publication, anxiety went hand-in-hand with a psychoneurotic disorder because the chief symptom of a psychoneurotic disorder was anxiety (Crocq, 2015, p. 323). At the time, anxiety was associated with a dangerous or threatening situation. According to Crocq (2015), “anxiety in psychoneurotic disorders was interpreted as a danger signal sent and perceived by the conscious portion of the personality. It was supposedly produced by a threat from within the personality” (p. 323). To expand, coming from within the personality simply refers to impulses such as anger and hostility or emotions. Therefore, anxiety could be summarized as the reaction to a dangerous situation produced from one’s personality and manifested in the form of anger, hostility, resentment or extreme emotion. In the second version of DSM, neuroses were the main category in which anxiety disorders fell. Although it was associated with a category dealing with mental illness, major strides and expansion on anxiety disorders were not made until the start of a new decade in 1980.

Anxiety Disorders in the Present: 1980-2019

With the publication of DSM-III in 1980, anxiety was placed in its own chapter and included several different types of disorders. While phobias were still included as anxiety disorders, anxiety states had its own classification with several sub-categories. The subcategories included types of anxiety that are commonly discussed and diagnosed today, including panic disorder, general anxiety disorder and obsessive-compulsive disorder (Crocq, 2015, p. 323). Additionally, a chapter was added for anxiety disorders in adolescents, rather than just focusing on adults. For children, three types of anxiety were referenced: separation anxiety disorder, avoidant disorder of childhood or adolescence, and overanxious disorder (Crocq, 2015, p. 323). Seven years later, DSM-III-R was published, and medical professionals were now able to diagnose anxiety without the diagnosis of depression along with it. Crocq (2015) summarized it saying, “…the most important change in the DSM-II-R (1987) classification of anxiety disorders was the elimination of the DSM-III hierarchy that had prevented the diagnosis of panic or any anxiety disorder if these occurred concurrently with a depressive disorder” (p. 324). Minor, if any, strides were made in the diagnosing and understanding of anxiety disorder in DSM-IV, but DSM-V, published less than six years ago in May of 2013, once again presented groundbreaking research for the classification of anxiety disorders.

DSM-5 grouped anxiety disorders that were in DSM-IV into three groups, anxiety, OCD, and trauma and stressor related disorders. This change in grouping was done because of the common features that each of the disorders shared, but significant medical research played a role. “For the first time, the increasing knowledge about the different brain circuits underlying stress, panic, obsessions, and compulsions played a role in classification … In addition, mixed anxiety-depressive disorder was not retained as a category in DSM-5 because, among other reasons, that diagnosis proved too unstable to follow up” (Crocq, 2015, p. 324). In the same year that DSM-5 was published, a group of physicians designed the ABC Model of Anxiety.

The ABC Model of Anxiety aims to help today’s physicians diagnosis the disorder. Through the years, the classifications of anxiety helped a physicians ability to diagnose anxiety disorders, while the goal of the model is to give patients a management tool. The ABC model is the idea that alarms (A), beliefs (B) and coping strategies (C) all interact together in space and can help explain anxiety. Bystritsky et al., (2013) said that understanding how those three things work together should lead to more precise diagnoses of anxiety and that although anxiety patients react to emotional situation (alarms) and develop a set of beliefs that coping strategies can help reduce anxiety (p. 31). This is an example of new approach to anxiety management that does not involve medication. Thankfully, due to adequate research and advances in medicine, there are a variety of ways to treat anxiety and ensure that a patient receive proper treatment.

Treating Anxiety and Finding Help

Today, there are a multitude of options for patients requiring treatment for an anxiety disorder. From therapy to mindfulness to medications and lifestyle changes, anxiety disorders can be effectively managed and controlled so that the individual can live a successful lifestyle. It is of utmost importance, however, that the individual always consults a physician that is trustworthy before making any decisions regarding treatment of anxiety disorder.

Medications: SSRIs, and SNRIs

When it comes to anxiety, there are a multitude of medicines that are used to treat the disorder. SSRIs (Selective Serotonin Reuptake Inhibitors) are typically the first group used. SSRIs include drugs such as Pfizer, Prozac, Paxil and Zoloft. The main thing that SSRIs do is increase the amount of serotonin in an individual’s brain. According to the Mayo Clinic (2018), “Serotonin is one of the chemical messengers (neurotransmitters) that carry signals between brain cells. SSRIs block the reabsorption (reuptake) of serotonin in the brain, making more serotonin available. SSRIs are called selective because the drug seems to primarily affect serotonin, not other neurotransmitters” (para. 2). SNRIs are another common medication used to help fight anxiety. Serotonin-norepinephrine reuptake inhibitors include Effexor and Cymbalta among others. SNRIs work to increase amounts of specific neurotransmitters in the brain. SNRIs get its name due to the fact that it increases serotonin and norepinephrine (Pittman, 2017, para. 3). SNRIs should not be used for short periods of time because the drug will actually increase anxiety when first used. Pittman (2017) said that individuals using SNRIs will typically see a change after 10 days and that the medication will work by promoting the brain’s neuroplasticity (para. 6). While these medications are often helpful, it is important that individuals receiving treatment for a mental disorder also understand the value of therapy, coping and lifestyle changes.

Cognitive Behavioral Therapy

Commonly known as CBT, cognitive behavior therapy is not a medication that will make a patient feel less anxious but rather a method that focuses on the thoughts associated with anxiety. Cognitive behavior therapy “helps identify and then neutralize the thoughts that many trigger anxiety” (Harvard Health Publishing, 2017, para. 10). In CBT that is administered via a therapist, the patient is given strategies from a trained professional in an environment that fosters comfort and openness. The therapist will help the patient reduce the alarms and irrational thoughts or beliefs associated with their anxiety and cope with their situation (Bystritsky et al., 2013, p. 37). To be successful, a patient must use the strategies developed in consultation with the therapist to change their thought pattern. Edlin & Golanty (2019) mention that CBT is done to help people examine and change their thoughts that may specifically contribute to their anxiety (p.77). CBT takes time to become successful and often hinges on the patient’s ability to use the strategies present.

CBT can be paired with a medication such as an SSRI (Selective Seratonin Reuptake Inhibitor) or used alone in the treatment of anxiety. Bystritsky et al., (2013) fears that patients who self-administer CBT may not be effective and suggests that patients undergo CBT that is therapist directed (p. 37). One of the best things about Cognitive Behavioral Therapy is the clinical experience of physicians regarding the success of it. CBT has lower relapse rates compared to the use of medication alone because it is proven (through clinical observation) that it has a longer effect if the patient continues to use the strategies presented in therapy sessions (Bystristsky, 2013, p. 37). While CBT is one type of therapy used for the treatment of anxiety disorders, mindfulness and coping strategies are two other methods that do not require medicine.

Coping With Anxiety

In addition to medicine and therapy, one of the most popular ways that patients are encouraged to deal with anxiety battles is through the development of coping strategies and changing the train of thought associated with anxiety and situations that produce a feeling of distress. According to Edlin & Golanty (2019), “Coping strategies are ways to deal with the emotional distress that comes from not having your needs met” (p. 69). One of the ways that the duo suggest coping is by changing the thoughts of whatever is causing one anxiety. The authors also mention that an anxious person can avoid a situation, but their first suggestion was to “attack the situation head-on, saying, ‘I’m nervous about meeting new people, but I’ll go to the party anyway” (Edlin & Golanty, 2019, p. 69). One of the keys to successful coping is the ability to identify stressors. Physicians Karen Lawson and Sue Towey suggest that anxious individuals work to determine what causes stress and anxiety and work to not only reduce stress and relax, but also “cultivate resilience” so that individuals can handle stressors that arise and must be dealt with (i.e. are unavoidable) (Lawson & Towey, 2016, para. 12). While there are ways to cope, the biggest question is how an anxious person begins to effectively cope with their situation and mental disorder.

Support

Therapy and support are two of the major ways that individuals with anxiety learn to develop coping strategies. Support is readily available from mental health professionals, including psychotherapists. “Psychotherapists are professionals who have undergone considerable training to help people deal with their emotional distress … A psychotherapist can facilitate change that makes a person’s life better. The change comes about not only by talking but also by helping the distressed person adopt new behaviors and attitudes” (Edlin & Golanty, 2019, p. 70). Along with medicine, therapy and learning to cope, certain lifestyle changes are recommended for individuals who battle anxiety.

Lifestyle Changes

One of the most important things for an individual with an anxiety disorder is to get an adequate amount of exercise. Exercise might be the place to begin if a person with anxiety is looking to become healthier. Research shows that exercise helps improve anxiety symptoms, and there is science to back it up. While exercise can help someone gain self-esteem or confidence, “exercise stimulates the body to produce serotonin and endorphins, which are chemicals in the brain (neurotransmitters)” (Lawson & Towey, 2016, para. 2). In addition to exercise, diet changes are a key component for someone who is looking to overcome anxiety. From abstaining from alcohol and cutting out sweet drinks such as soda or tea, it is important that an individual with an anxiety disorder fuel their body properly. Lawson & Towey (2016) recommend plenty of water and calcium and a reduction of fats to properly fuel one’s body and help the brain to work. “The brain is one of the most metabolically active parts of the body and needs a stream of nutrients to function. A poor diet may not provide the nutrients necessary to produce neurotransmitters and may provoke symptoms of anxiety or depression.” (para. 5).

Finding Help

When it comes to finding a therapist, physician or support group, there are many options and different medical professionals with a unique specialization. One place for an individual seeking help for anxiety is the “Find a Therapist” Directory on the Anxiety and Depression Association of America website. The list is by no means exhaustive and includes only physicians with a desire to be included, but has doctors who specialize in anxiety, depression, OCD and PTSD. Additionally, the National Alliance on Mental Health has an entire section of its website devoted to support. The NAMI focuses not on support groups or therapy but support that friends and family members can offer. The website deals with help, preparation for what could happen during a crisis and recovery.

Related Objectives: Healthy People 2020

Healthypeople.gov, which is run by the United States Department of Health and Human Services, has provided a list of comprehensive objectives regarding a variety of mental disorder. The majority of objectives related to anxiety (i.e. not dealing with depression alone) deal with treatment of the disorder. Shockingly in 2006, only 79.0 percent of primary care facilities were able to provide mental health treatment to individuals in need or to give a referral (US Department of Health and Human Services, 2019, para. 6). Seeing that the number was low, the Department of Health and Human Services has set a goal of improvement (see MHMD-5), so that nearly 9 out of every 10 primary care doctors’ offices can provide treatment for anxiety in office or provide a referral.

Going beyond the fact that facilities need to either treat individuals with a mental health disorder or provide a referral, a goal of Healthy People 2020 is to see an increase in people receiving treatment if it is needed, regardless of whether the individual is an adolescent or adult. A maximum of 10 percent improvement has been set as the standard for the increase in people receiving proper treatment (US Department of Health and Human Services, 2019, para. 7,10). MHMD-6 noted that of the children diagnosed with a mental disorder, only 68.9 percent received the necessary help when statistics were taken in 2008, but the goal for 2020 is for 75.8 percent to receive treatment.

For adults 18 and older (MHMD-9), the percentage of those obtaining proper treatment was even lower than children. The baseline year (2008) showed that only 6.5 out of 10 individuals battling a serious received treatment, but in 2020, it is hoped that 72.3 percent of affected individuals will receive treatment (US Department of Health and Human Services, 2019, para. 10). While treatment for a mental health disorder is important, it is equally important that individuals are able to carry out a normal lifestyle as much as possible.

The last objective related to anxiety dealt with increasing the employment rate of individuals battling a serious mental disorder (MHMD-8). 12 years ago, only 56 percent of people with a serious mental illness were employed (US Department of Health and Human Services, 2019, para. 9). The goal for 2020 is to increase that number by 5.1 percent and see 61.6 percent of affected individuals employed.

If strides continue to be made, there is an opportunity for the stigma surrounding mental illness to be eliminated. The majority of the objectives presented on healthypeople.org had a desired increase of five to seven percent. If a seven percent increase happens three times in the next 36 years, then healthypeople.gov will have objectives to see all facilities treating mental health disorders or offering a referral. Additionally, the target percentage for children receiving treatment for children and adults would both be above 90 percent.

Summary and Conclusion

Mental illness are present in millions of individuals worldwide, including the United States. The illness might not always be seen because its symptoms can be hidden or masked, unlike a physical illness such as the flu or cancer. While anxiety is just one of multiple mental disorders, it is incredibly prevalent, today. Normal amounts of anxiety arise in people, but when the levels get beyond normal and begin to interfere with normal life activities, a person is said to have anxiety disorder. According to Reynolds (2014), anxiety can be incredibly expensive to treat, with costs being in excess of $78 million in total annually or $2,700 per patient (p. 2). However, despite the cost, there is hope for those battling anxiety as social support groups, coping, therapy and even medication can help someone live a successful life. Although the illness might never be able to be completely eradicated, it is possible to treat it. Once an individual recognizes that treatment is needed and discusses the proper path to management, the path to living a better life has begun. Through a variety of treatment options and a never quit attitude by the United States Department of Health and Human Services to provide better treatment for anxiety, the disease has become manageable.

References

1. Anxiety and Depression Association of America. (n.d.). Coping strategies. Retrieved from https://adaa.org/tips
2. Bystritsky, A., Khalsa, S., Cameron, M., & Schiffman, J. (2013). Current diagnosis and treatment of anxiety disorders. Journal of Pharmacy and Therapeutics, 38(1), 30-44,57. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3628173/pdf/ptj3801030.pdf
3. Crocq, MA. (2015). A history of anxiety from Hippocrates to DSM. Dialogues in Clinical Neuroscience, 17(3), 319-325. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4610616/
4. Edlin, G., & Golanty, E. (2019). Health & wellness (19th ed.). Jones & Bartlett Learning: Burlington, MA.
5. Harvard Health Publishing. (2017). Overcoming anxiety. Retrieved from https://www.health.harvard.edu/mind-and-mood/overcoming-anxiety
6. Lawson, K., & Towey, S. (2016). What lifestyle changes are recommended for anxiety and depression? Retrieved from https://www.takingcharge.csh.umn.edu/what-lifestyle-changes-are-recommended-anxiety-and-depression
7. Mayo Clinic (2018). Selective serotonin reuptake inhibitors. Retrieved from https://www.mayoclinic.org/diseases-conditions/depression/in-depth/ssris/art-20044825
8. National Institute of Mental Health. (2017). Any anxiety disorder: Statistics. Retrieved from https://www.nimh.nih.gov/health/statistics/any-anxiety-disorder.shtml
9. National Alliance on Mental Illness. (2016). Mental health by the numbers. Retrieved from https://www.nami.org/learn-more/mental-health-by-the-numbers
10. Pittman, C. (2017). What you need to know about your snri. Retrieved from https://www.anxiety.org/serotonin-norepinephrine-reuptake-inhibitor-snri
11. Reynolds, K. (2014). Cost effectiveness of treating generalized anxiety disorder in adolescence: A comparison by provider type and therapy modality. Retrieved from https://scholarsarchive.byu.edu/cgi/viewcontent.cgi?article=6752&context=etd
12. United States Department of Health and Human Services. (2019). Mental health and mental disorders. In 2020 Topics and Objectives. Retrieved from https://www.healthypeople.gov/2020/topics-objectives/topic/mental-health-and-mental-disorders/objectives

Shyness refers the quality or state of being shy. It’s synonyms are bashful, reserved, introversion, being timid, fearfulness, nervousness, hesitation and doubt. Having social anxiety however, refers to the intense fear of being judged or rejected within a social setting. Synonyms of anxiety are worry, concern, unease, angst, nervousness, stress, suspense, disquiet and fearfulness. So how does shyness relate and stem into social anxiety disorder?

Shyness, on one hand, has many causes. It could be caused from biological differences in the brain to overprotective parents. The term shyness is also connected to a low self esteem issue. Children who are not allowed to experience things at a young age also lead to shyness. Their surrounding and interactions with parents will do the same thing. Then again 15% of infants are born with a predisposition to be shy. This leads to very underdeveloped social skills, hence why homeschool kids are very awkward in a social interaction.( Heitz) Shyness can not be found as a disorder, but rather just a personality trait of its own. This also comes with introversion, which is just a general tendency to be quiet and reserved or behavioral inhibition which is when you are timid or fearful around strangers, which is common in any case. ( Ford. 3)

Shyness and self consciousness is something like spending hours working up the nerve to go to prom, blushing when called on in class, spending hours choosing what to wear on the first day of school and trying out for a sports team and being nervous about the results. Social anxiety, however, is spending days working up the nerve to ask somebody to prom only to give up and decide you don’t want to go , blushing when called on then skipping class because that was embarrassing, spending an hour choosing an outfit then second guessing the clothes you chose and wondering who all is judging you, and you just don’t try out because you fear the rejection. (Ford 34)

Although, Shyness is a usual trait for those with social anxiety disorder, it is not always the case. Only half have reported being shy. People who are shy, don’t have the negative effects of Social Anxiety. With that, only 25% of shy people meet the requirement to have social anxiety disorder. The two do overlap, but social anxiety is not a personality trait but shyness is. Those with social anxiety tend to have really weak relationships and do badly to school. (Richards)

When somebody with social anxiety still goes to school they are usually seen as just a super shy person.they typically avoid talking, not wanting to read outloud, fear of performing in front of others, worrying about being judged, not speaking up, hesitant to play sports, and just really anxious about a test.(Ford 33)

Shyness and social anxiety can be started in the beginning years of their lives. Children with SAD( social anxiety disorder) do not usually develop these skills very well and can often be dismissed as extreme shyness. SAD can cause a huge impact on career success, learning, financial independence, and relationships. With only about 75% of people not getting the help that they need for sad it can lead to the abuse of drugs and alcohol. ( Cuncic)

Social Anxiety is an actual disorder which can be treated. At first it was just a minor problem now it is huge in the United States. Social anxiety and social phobia are one and the same. (Ford. 10) Causes of social anxiety are genetics, personal experience, demographics and chemicals within the brain. Some signs that somebody might have social anxiety are avoiding being the center of attention, being around strangers, excessive fear of being teased or criticised, and being anxious about the anxiety, making it worse. Physical signs of social anxiety may include blushing, weeping, nausea, shaking, and abdominal pain.(Timothy)

Social anxiety can start as something very small and irrelevant until all you can really see the embarrassment and humiliation which a social interaction may cause. The constant dread of social interaction can lead it intense worry. This will then hold you back from your true potential in life. (Ford 23)

SAD is more tolerated in group focused societies. Shyness and withdrawn behaviors are more accepted within these societies. Shyness and social anxiety are the same thing within this form of society. The community tries to makes things less awkward. Those with SAD tend to have unrealistic fears because those within the community will try to make things less awkward and uncomfortable for those with social anxiety disorder. (ford 31)

Many can not see social anxiety disorder from the outside, and it is more of a mental disorder. Red signs for SAD, in general, include worrying for days about an event, worrying about the past, confused or just freezing in social situations, difficulty with public speaking, not inviting friends together in fear of being the center of attention, staying home even though you want to go out and enjoy things, fearing to talk and not making eye contact, feeling like an outsider, and last but certainly not least, sweating, trembling, and blushing. (Ford 32/33)

Anxiety is a natural reaction to a threat that happens at a certain stress point. It increases your attention and you can face practically anything. But with an anxiety disorder, your brain can lose perception of perception. Clinical Anxiety includes an anxiety disorder, specific phobias, and panic disorders. This is a cognitive misinterpretation of a situation. Somebody with general anxiety disorder responds to normal situations as if they are life threatening. Panic disorders are blindsided by crippling fear and pain. This is the most intense form of anxiety and the root of all phobia. The most common clinical anxiety is social anxiety disorder. It is a consuming fear of social situations. (Hagerman chapter 4… all of it)

Social Anxiety disorder can then trigger panic attacks,which are triggered by certain events. This then leads to a panic disorder, which makes you panic about panicking. (Ford 30)Many issues come two for the price of one. Depression, substance abuse, and eating disorders can come with SAD. Depression is just a constant low mood and loss of interest in practically anything and everything. Substance abuse is when you try to find some sort of instant relief with a drug( marijuana and alcohol are common)and eating disorders such as bulimia and anorexia. (Ford 43)

Signs of an eating disorder such as anorexia and bulimia can come from your general social anxiety. Anoxia and bulimia can come from being super self conscious and envious of somebody else who may be thinner than you. Anorexia signs include sudden dramatic weight loss, moving food around on a plate, claiming not to be hungry even though you are, thinking you’re fat even though you are underweight, extremely fearful of gaining weight, stopping of menstruation, refusing to eat, excuses to avoid meal time, excessively counting calories, wearing baggy closes to high the weight loss and weighing yourself all the time. Signs of bulimia are eating large amounts only to throw it up later, exercising frequently, regardless of other conditions, such as your health or the weather. ( Ford 56)

There is medication for social anxiety. The 70% who take medication for social anxiety disorder do get better, versus the 30% who take a placebo, which is just a sugar pill. The many variations of drugs for anxiety include SSRI’s, SNRI’s, MAOI and benzodiazepines.

SSRIs are Selective Serotonin Reuptake Inhibitors which is for Social Anxiety Disorder, Obsessive Compulsive Disorder, Panic disorders, phobias, Post- Traumatic Stress Disorder and Bulimia. Selective serotonin reuptake inhibitors are antidepressants and are usually the first choice for many doctors. The drug increases the serotonin in the brain, hence serotonin reuptake. Some common SSRI’s are Paxil and Zoloft

SNRI’s are Serotonin- Norepinephrine Reuptake Inhibitors. They are for depression, Social Anxiety, and long term pain. Serotonin- Norepinephrine Reuptake Inhibitors ease depression by changing the brain chemistry. Common SNRI’s are Effexor XR, Cymbalta and Fetzima.

MAOIs are Monoamine oxidase inhibitors. This drug is an antidepressant. They are used for depression, anxiety disorders, and panic disorders. They also mess with the brain chemicals but you have to be very careful and have a strict diet when taking these, or else you risk heart failure. It can be taken specifically for anxiety but it is rarely used. BuSpar, Marplan and Azilect are common MAOIs.( Ford 70)

Although anxiety can be treated with medication and drugs of sorts, there are those tree huggers who do not want to put anything in their temple of a body. So, it the next choice. It is proven that 30 to 45 minutes of physical activity 3 to 5 days a week will cover a wide range of health problems. Obesity, blood pressure, bone density, cardiovascular fitness, academic performance, depression and anxiety can be prevented through doing a run every day. (Hagerman 22)

Exercise provides a distraction from somebody’s anxiety, teaches your brain that an increased heart rate does not equal a panic attack or there is any danger, improves resilience with your mind, sets you free from an every day anxiety, reroutes your brain to chill out, and builds brain resources so you aren’t as anxious. Exercise counteracts anxiety and depression most of the time.

Athletes are afforded many positive opportunities such as traveling, making new friendships, receiving praise, and experiencing the thrill of winning. For many athletes; however, these experiences are accompanied by anxiety. There are two components of anxiety, a cognitive component and a somatic component. (Liebert & Morris, 1967; Borkovec, 1976; Davidson & Schwartz, 1976 as cited in Kais, K.; Raudsepp, L., 2005). Cognitive anxiety refers to negative expectations as well as having concerns about performance, the cost of failure, negative self-evaluation, assessment of one’s ability compared to others, the failure to concentrate, and inattentiveness. Somatic anxiety is the physiological affect including an increase in autonomic arousal and negative feelings including nervousness, upset stomach, tension, increased heart rate, rapid breathing, sweating, and shaking. (Kais, K.; Raudsepp, L., 2005). While many people may experience these symptoms occasionally, student athletes experience them frequently and negatively enough to impact their personal lives, academic performance, and athletic potential. (Goldman, 2014).

College athletes often struggle to manage the stress and anxiety of college coursework, the demands of their sport including practice and games, the pressure from family, and maintaining friendships. In his book Emotions in Sports, Yuri Hanin wrote, “of all the psychological factors thought to influence sport performance, anxiety is often considered the most important.” (Hanin, Y.L., 2000 as cited in Fullerton, C., n.d.). Two types of anxiety have been identified – state and trait. State anxiety is anxiety at a given time, and trait anxiety is an increase in state anxiety when exposed to certain stressors. (Hanin, Y.L. 2000 as cited in Fullerton, C., n.d.). Several theories exist to

describe the relationship between anxiety and athletic performance such as the inverted-U hypothesis, the drive theory, and the individual zones of optimal functioning model. (Ford, J.L.; Ildefonso, K.; Jones, M.L.; & Arvinen-Barrow, M., 2017). The inverted-U hypothesis states that low anxiety leads to low performance and increased anxiety leads to better performance to an optimal point; however anxiety beyond the optimal point causes performance to decline. (Yerkes & Dodson, n.d. as cited in Ford, J.L. et al., 2017). The drive theory states that a linear relationship exists between state anxiety and performance; higher anxiety leads to better performance and lower anxiety leads to poorer performance. (Hull, C.L., 1945 as cited in Ford, J.L. et al., 2017). Hanin’s individual zones of optimal functioning model suggests that individuals have an optimal anxiety zone where they can reach their peak performance; however, if their anxiety is above or below this zone, their performance will drop. (Ford, J.L. et al., 2017). In athletes, anxiety is often defined as sports-related performance anxiety. This anxiety leads to an unpleasant response to the stress of participating in a sport. Anxiety is a feeling of worry, nervousness, or unease, typically about a future event or something with an uncertain result. In the student athlete, the threat is often linked to their ego – “If I lose, I am a loser.” Coaches can help to reduce these thoughts and subsequent anxiety in a variety of ways.

While an athletic coach is responsible for teaching athletes a particular sport and evaluating their individual performance in order to prepare for competition, they also need to consider the emotional well-being of their players. Little research exists that identifies ideal coaching behaviors. However, coaching attitude and behaviors are perceived and given meaning by individual athletes which determines their attitude

toward both the coach and the sport experience. Coaches need to encourage their players and understand that they can be the determining factor on emotional experiences of athletes. (Ramis, Y.; Torregrosa, M.; Viladrich, C.; and Cruz, J., 2017). Often, coaches unintentionally increase a student athlete’s anxiety when trying to motivate by using phrases such as “the next goal is critical” or “the team is counting on you”. Research shows that nearly 85 percent of athletic trainers believe anxiety disorders are currently an issue with student athletes at their schools. (Goldman, 2014). By having empathy and understanding, a coach can support these athletes. Depending on the coach’s knowledge and comfort level as well as the severity of the sports-related performance anxiety, additional support may be needed from both parents and other professionals such as an athletic trainer or sports psychologist.

The demand on athletes today goes beyond the sport they are playing. Again, the pressure put on athletes by their family, friends and coaches affects their mental state as well. For most athletes, this pressure results in anxiety that can cause the athlete to make a mistake. In more extreme cases, the athlete can have a complete breakdown. In some situations, the anxiety becomes serious enough that they take their own life. Luckily, athletic trainers are becoming more familiar with the signs that lead to anxiety and can provide support to these athletes. Athletic trainers work with the athlete, the coach, and a sports psychologist to help the athlete understand why certain thoughts and feelings develop and then help them implement strategies to minimize the same. (Quinn, 2019). This team of professionals helps the athlete to reduce performance anxiety before the event, during the event, and after the event. Before the event, the athlete and trainer focus on recognizing that pre-game nerves are normal and

they practice visualization or positive self-talk strategies. (Quinn, 2019). In order to reduce anxiety during the event, the trainer and athlete work to place the focus on being present in the moment rather than the outcome of the game. After the event or game, they review the athlete’s performance with a focus on the positive, acknowledge those things that hindered performance, and continue to develop a training program that mimics game-like conditions. (Quinn, 2019). While athletic trainers play a significant role in the management of sports-related performance anxiety, the athlete must first recognize and acknowledge that they have a need.

Do you perform well during practice but fall short in a game? Do you feel nervous or fearful prior to a game? When the coach calls you up from the bench, does your heart begin to race and your palms begin to sweat? If the answer is yes, you might suffer from sports-related performance anxiety. As a student athlete who suffers from anxiety, I understand these feelings and encourage you to seek the support of your family, coach and athletic trainers.

The thought of joining a gym can cause anxieties to surface in some people. If this statement rings true for you, you’re not on your own. Many of us get worried or scared when they go to the gym. Gym’s like Energybase are working hard to create inclusive spaces where people have an environment and support network to overcome these issues.

Some of the reasons why people get anxious about going to the gym include:

• Feeling intimidated by other gym members
• Believing that you can’t exercise due to feelings about lack of personal fitness
• Cultural and/or religious attitudes and beliefs
• Body shape and/or size
• Existing mental health conditions such as anxiety, depression or body dysmorphia

Gym anxiety is very real and it can be experienced by anyone. It does not discriminate between gender, size, strength, or how physically fit you are. If going to the gym leaves you feeling self-conscious or zaps your confidence to the point that you don’t want to go, read on, we can help.

Feeling intimidated about going to gym

Many people feel intimidated when they go to the gym, but it’s not just other people at the gym that can make a person feel lost or inadequate. The physical spaces can be intimidating too. Big open spaces lined with mirrors and complex fitness equipment are all aspects of modern gyms that can magnify fitness fear and gym anxiety.

It’s understandable why so many people have reservations about going to a gym. Let’s look at some of these in more detail:

Why Gyms Can Be Intimidating

It’s very normal for people to feel nervous when going to the gym and when we look at how many gyms work, it’s easy to understand why.

Big rooms – Many gyms are designed in an open plan style. This means that the workout areas feel cavernous and can become quite crowded. There are often lots of windows and mirrors too. Some people can feel like they are being stared at in big gyms.

Complicated machinery -Trying not to look stupid or confused when attempting to use gym equipment is a very real fear for many people. Whether it’s cross trainer machines, an exercise bike or a confusing weights bench… all that equipment can be hard to master if you’ve never used them before.

Proficient exercisers – Many gyms have their regular members who know that particular gym very well. Although some of them can be very helpful, others can be a little impatient or rude to new members. If you’re new to exercising in the gym, this can feel unwelcoming. It is also intimidating if you are unsure about the right gym etiquette.

Personal fitness anxiety

For people that are worried about their bodies and how capable they are, gyms can become places of fear and anxiety. An important aspect of feeling happy and comfortable when exercising is having the peace of mind that you are actually improving your body rather than harming it.

Before embarking on your fitness journey, talk to a health care professional and ask their advice on whether you should be exercising in a gym. If at any point, you start to feel anxious or concerned about your general health during a gym session, take a break and talk to a staff member.

Am I too overweight to join a gym?

If you think that your weight might be a problem, talk to a doctor before you start to exercise at the gym. It’s a rational fear to have, but your doctor might be able to give you some good tips on what exercises to do. Your weight won’t actually stop you from exercising but it’s always a great idea to check with your doctor first.

The swimming pool is a good place to start. At EnergyBase we have a full size pool Swimming requires gentle but continuous movement and is virtually a ‘no-impact’ exercise. It takes the weight off of your joints and allows for improved blood circulation throughout the body.

Swimming is fantastic as you’re able to control the intensity and length of your exercise session. It’s also a great way to measure your progress too. Start with small distances and gradually increase your lengths as you get fitter and more confident in your own abilities.

An existing mental health issue stopping me from exercising

Going to the gym can cause anxiety to surface, but it might also relate to an existing mental health issue. This pre-existing issue might then act as a catalyst in bringing up new mental health problems such as an increase in anxiety or depression. This is perfectly normal and completely understandable.

If you feel like this, it’s really important to seek help. Talking to a friend might be a first step but seeking professional assistance through your doctor or a private service could really help you to look after your mental health.

Does exercise help with mental health issues?

The good news is that exercise can actually promote positive mental health. Increased physical exercise has been found to improve mood, increase energy levels, and encourage quality sleep. During exercise, endorphins are released and stress hormones like cortisol are suppressed giving our mind and body a natural boost.

Doctors often recommend exercise to patients suffering with mental health issues. This is because exercise helps to promote a healthy lifestyle, both mentally and physically.

The physical and mental benefits of exercise can include :

• Reduces risk of developing depression
• Reduces risk of developing anxiety
• Helps to build strong bones and muscles
• Aids in brain health and memory
• Avoiding type 2 diabetes
• Protects against heart disease and strokes
• Reduces risk of developing types of cancers
• Prevents early death

How can I deal with gym anxiety?

Here are seven quick tips to help overcome gym anxiety and get the most out of your exercise session:

Find a gym that has private areas – Some gyms have female-only rooms. Others have areas that aren’t as visible to passers-by. If you are self-conscious, find an environment where you feel as comfortable as possible. At Energybase…

Use a PT – Personal trainers are there to support you as well as offer guidance around what to do at the gym. They are great at being positive and motivating people in the gym so if you want to gain confidence, talk to a personal trainer. At Energybase, we have a team of personal trainers that specialise in different areas of fitness. They’re there to help you get the most from your gym session.

Bring a friend or fitness mentor – If you don’t want to use a personal trainer, bring a friend. Overcoming gym anxiety can be about working on your focus and confidence. An encouraging friend or mentor makes a fantastic gym-going partner. You can encourage and motivate them and hopefully, they’ll return the favour.

Exercise during off-peak hours – If you can, training during quieter times in the gym will help you feel less self-conscious and more focused on your exercise routine. At Energybase…

Start slow – Whether it’s a set of exercises or a particular machine that you feel comfortable using, start slow. Don’t be too ambitious when it comes to your exercise sessions. When you start to feel more confident in the gym you can increase your activity. The Energybase gym is staffed by fitness professionals that can guide and instruct you when you first start to exercise in the gym.

Set achievable targets – Working towards realistic goals is advisable whether you’re a seasoned gym-goer or new to gym-based exercise. Hitting those targets will increase confidence and deliver a lovely shot of adrenaline. Achieving your goals is a great way to feel good about going to the gym. Energybase personal trainers can help you to set up an action plan of how to set and achieve your fitness goals.

We hope that this article encourages you to see fitness and the gym as tools that can improve your physical and mental well-being. Share it with your friends and fellow fitness buddies.

Energybase gym & pool

Energybase is a gym and swimming pool operated by Student Central for the benefit of those that work, study and live in Bloomsbury.

We have different memberships available depending on whether you’re a student or non-student.

Our facilities include a 53 station fitness suite, 33 metre swimming pool, up to 50 classes per week, remedial treatments, a sports hall and a multi-purpose studio. Membership of Energybase includes unlimited use of the fitness suite, swimming pool and classes.

Contact us today to learn more about our gym, book a tour or speak to one of the team.

Social anxiety is the dread of social circumstances that include association with others. The uneasiness and nervousness of being contrarily judged and assessed by others is called social anxiety. The physical symptoms of social anxiety include Muscle tension, rapid heartbeat, Stomach trouble and inability to catch breath etc. (Teng, Gao, Huang, & Poon, 2019). Moreover, the role of social anxiety for the body shame is very significant and symptom of these are the fear of judgment based on one’s appearance and it is linked to the social anxiety and body dysmorphic disorder and isolations of individuals etc. (Gilbert, 2014).

Body shaming is the practice of making critical, potentially humiliating comments about a person’s body size or weight. An example of body shaming is telling a child that they are ‘too fat.’ An example of body shaming is when thin women are told they are ‘too skinny’ (Weingarden, Renshaw, Tangney, & Wilhelm, 2016). Moreover, Body-related guilt is a negative emotion that involves remorse and regret in reference to a specific behavior related to the physical self that is perceived as undesirable Guilt is a valuable emotion, because it helps to maintain your ties to the people in your community.

Shame and guilt belong to the self-related and self-evaluating emotions which constitute a peculiarity of human development. To the best of our knowledge, even higher developed animals know neither shame nor guilt (Chen, Teng, & Zhang, 2013). Previous research demonstrated that attractive people are more welcome in social interactions and are more likely to have the opportunity to build relationships with others (Kroplewski, Szcześniak, Furmańska, & Gójska, 2019). However, People with social anxiety disorder “may have few or no social or romantic relationships, making them feel powerless, alone, or even ashamed,” the association reports. Without someone in your life to share the experiences, the experiences often seem empty, and these feelings feed any type of social anxiety issues. Apart from this, lowered self-esteem may put person at risk of later social anxiety, having an anxiety disorder can also make you feel worse about yourself. In this way, these two afflictions interact to continue a negative cycle. A self-esteem is defined as a person’s overall sense of self-work or personal value (Barker & Galambos, 2003).

There are many group of disorders but specifically eating disorders considered as abnormal eating attitudes of individuals that becomes a reason of significant disturbance in maintenance of healthy body weight and also shows that these become a reason of serious health problems including death as well (Kircaburun, Griffiths, & Billieux, 2019). It is reported that the dimensions of self-esteem considered as therapeutic methods and diagnostic by considering their determined mediating role (Rashid, Saddiqua, & Naureen, 2011). Apart from this, eating disorders among individuals with a negative measurement of family function that can be minimized only when individual is agreed with oneself, when he has the ability to command on new task, point out the affections received from the others and last when it has their own internal integrity. According to these all points are considered as effects by taking survey of 160 people at the age from 18 to 47 years (Jones & Moore; Rashid et al., 2011).

Shame is a universal emotion rooted in the need for attachment to others. This emotion arises in the social context when individuals believe that others see or evaluate them as inferior, inadequate, defective or unattractive (Rashid et al., 2011. Therefore, shame can be conceptualized as a functional defensive response to social threats. activated to attenuate its negative social consequences (e.g., rejection, social criticism and ostracism) Shame motivates striving or working hard to correct one’s behaviors or features and thus to appear desirable and be accepted by others Body image has been identified as a salient source of shame because it represents a dimension of the self that can be easily assessed and evaluated by others (Peplau, 1982). Body image was defined as the picture that one has in mind of the size, form and shape of body and the feelings one has about these characteristics (Porter, Zelkowitz, Gist, & Cole, 2019). Furthermore, body image comprises cognitive (thoughts and beliefs about the body), perceptual, affective (feelings about one’s own body), behavioral and social components, and so the development of body image is influenced by events affecting the body, as well as relationships with others, self-esteem and socialization (Lynch, Heil, Wagner, & Havens, 2008).In this sense, the display of a valued body image by others plays an important role in the interplay with others and in one’s self-evaluations.

There is a recognized need to further study the mechanisms that may explain body image difficulties in men, few studies have focused on that. Given the pervasive and negative impact of body image shame and negative body attitudes, it is considered that research should focus on the analysis of potential factors and mechanisms involved in these difficulties to inform the development of prevention and intervention programmers on these areas. Also, considering the aforementioned impact of early memories with peers and shame on eating psychopathology and body image concerns (Lynch et al., 2008).

People, often women, are sexually objectified in modern society such that their bodies are regarded as objects to be looked at, evaluated, and sexually exploited by others. Sexual objectification occurs frequently, often through interpersonal encounters (Cacioppo et al., 2002) and media portrayals. According to the objectification theory (Furnham, Badmin, & Sneade, 2002), frequent experiences of sexual objectification will coax women into internalizing a third-party self-perspective as some women come to see themselves through a sexually objectifying lens, a process termed as self-objectification (Hrabosky et al., 2009). Women who sexually objectify themselves attach great importance to their physical appearance and habitually monitor their outward appearance from an observer’s perspective (i.e., body surveillance; Lindberg et al. 2006).

In clinical literature, it is clearly shows that body shame is considered as major reason for the body dysmorphic disorder (BDD). However, the studies effects of body shame with respect to its effect on the BDD (Hrabosky et al., 2009). It is due to the researchers mainly focus to study the body shame with respect to eating of individual and weight-based content. Secondly, researchers considered body shame is due to the shame felt by individual when someone point out the flaws of one’s body parts (Ko, 2010). A body-focused shame model that is more related to person’s shame experience within BDD and concluded that shame is deeply painful emotion that person only felt when person figure out the bad part of his body (Porter et al., 2019).

It is found from that obesity is not considered for the effect of mental disorders. But it has significant negative effects on psychological behaviors of individuals and that becomes a reason of increasing rates of mental disorders in the obese populations (Hrabosky et al., 2009). In additions, these are considered as a heterogeneous group with respect to the individual psychological well-being. It is also become a reason of higher rate of psychopathology. In order to face these problems, author developed his own model that received need for the easy-to-administer etc. (Gilbert, 2000). And author concluded that there are many reasons of individual to feel bodily shame and guilt that related to over-weight persons etc.

So far, the focus of previous researches was on the studying the effect of body shame with respect to eating disorders. For example, (Teng et al., 2019) reports suggest that eating disorders increasing especially among women from the non-Western ethnic origins. Thus, contradiction from previous research, in this paper, the main aim of the study is to discuss the body shame of individual with respect to all the concerns parameters and also point out the parameters that are the main reasons of social anxiety and isolation of individuals. For that, we conduct a survey and analysis its respect with respect to culture behavior of individuals etc.

Introduction

The main goal of educators of English as a second language (ESL) is to enhance the English language proficiency of non-native English speakers. The acquisition of the English language has been a necessity, taking into account that competent users of the language provide advantages, especially in education and employment particularly in the Philippines (Incirci, Turan & Öztürk, 2018). English in the country is used extensively in the daily lives of Filipinos, and it has already established new norms that were shaped by present sociocultural and sociolinguistic contexts of this generation (Alamis, 2008). But learning a second language (L2), English, may be inhibited by many factors, and one of the most emotive of these is ‘language learning anxiety’ (LLA) (Cao, 2011; Fergina, 2010; Gopang, Bughio, MacIntyre & Gardner, 1994 & Ohata, 2005). MacIntyre and Gardner (1989) defined language anxiety as the “feeling of tension” learners experience as they learn a second or foreign language. This tension is often felt in common linguistic activities such as listening and conversing with the use of the L2. Many local studies have presented the negative effects of this particular type of anxiety (eg. Gomari & Lucas, 2013; Lucas, Miraflores & Go, 2011; Macayan, Quinto, Otsuka, & Cueto, 2018; Orbeta & San Jose, 2013). The visible symptoms observed by these studies include “sweating, palpitations, trembling, apprehension, worry, fear, threat, difficult concentration, forgetfulness, freezing, going blank, and avoidance behavior (Kráľová, 2016, p. 19)”. These symptoms were induced mostly by public speaking in the classroom with the L2.

Although many would argue the underlying positive effects of LLA (eg. Chang et al., 2017; Incirci et al., 2018; Macayan et al., 2018; Trang, Moni & Baldauf Jr, 2013), most, if not all, of the studies about LLA have presented its debilitating nature, and many ESL learners are admittedly hindered by it. This paper aims to uncover and analyze the underlying causes and influencing factors that give rise to LLA among ESL learners. But in order to understand the various causes and contributing factors, we need to take into consideration that there are two approaches in viewing the concept of LLA which was introduced by Horwitz and Young (1991), as cited in Kráľová (2016) namely: 1) Transfer approach; 2) Unique Approach.

The first approach sees LLA as a manifestation of more general types of anxiety. Language anxiety may be manifested due to many situational factors (MacIntyre & Gardner, 1989). The second one views LLA as a distinctive form of anxiety correlated with language performance but not to other forms of anxiety. This sees LLA as a separate form of anxiety centered on language learning that was brought about by the combinations of external factors (Horwitz et al.,1986).

Causes and accompanying factors of LLA in learning ESL

A number of studies about LLA in the Philippines utilized Horwitz et al.’s (1986) Foreign Language Classroom Anxiety Scale (FLCAS) (eg. Alico, 2015, Barabas, 2013; Cao, 2011; Gomari & Lucas, 2013; Lucas et al., 2011; Macayan et al., 2018; Orbeta & San Jose, 2013). It was designed to assess the level of LLA on a specific learning environment. Under this were three primary factors: 1) Communication apprehension; 2) Test Anxiety; 3) Fear of Negative Evaluation.

Communication apprehension is related to the fear of a person to orally communicate. It is usually connected with their perception of judgment from an audience and their perceived self-image (Cao, 2011; Lucas et al., 2011). The next factor which is test anxiety pertains to the impractical thoughts and demands learners put onto themselves during tests to avoid disappointment caused by failure (Lucas et al., 2011). Lastly, the fear of negative evaluation can be described as the tendency of backing out of evaluative situations because of their fear of criticisms. This anxiety can arise from any evaluative environments, most likely in a classroom where the teacher continuously monitors and evaluates the L2 learners (Cao, 2011).

Furthermore, Kráľová (2016) introduced the causal relationship of various lingual and extra-lingual variables with LLA. Lingual variables are related to the system of language while extra-lingual factors are more concerned with the language learning process itself.

Lingual factors

Lingual factors can be subdivided into intra-lingual and inter-lingual. Intra-lingual factors result from the system of a second or foreign language itself while inter-interlingual factors are from the convergence of two language systems, in this case between English and the various Filipino native languages (Kráľová, 2009).

Some studies have presented that the typological distance between the first language and English (L2) increases the tendency of anxiety (e.g. Kráľová, 2016; Alico, 2015). Participants have pointed out difficulties in certain language topics like verb use and subject-verb agreement (Alico, 2015) which are the examples of the intervention of intra-lingual factors that inhibits their ESL learning. There also exists an interference between English and their first language (one of the inter-lingual factors) this is because the structure, including lexis and syntax, of their native languages differs from the conventions followed in the English language (Alico & Guimba, 2015).

Extra-lingual Factors

Most of the studies believed that extra-lingual factors contribute more to the learner’s anxiety. Many studies from the past have iterated factors falling in this category as stated by Young (1991). She tried to classify these factors and came up with six general sources of language anxiety namely: 1) Personal and Interpersonal related anxiety; 2) Learner’s beliefs about language learning; 3) Instructor’s beliefs about language teaching; 4) Instructor-learner interaction; 5) Language testing.

First, Personal and interpersonal related issues are likely the most talked about, hence the most common source of anxiety as reported by most studies. These issues include competitiveness, low self-esteem, communication apprehension, social anxiety, and anxiety specifically arising from language learning (Ghodke, 2015). Respondents from a study conducted in Panabo City, Davao del Norte also presented apprehension contributed to the poor oral performance of ESL learners (Orbeta & San Jose, 2018). As reported in the study conducted by Alico (2015), participants and respondents from the Meranao tribe, a Muslim minority group in Marawi City, together with members of the Manobo and Subanen natives from Surigao and Agusan Provinces have shared their issue of short-term memory, mental block, and pessimism towards ESL learning. Additionally, they have attested their feelings of inferiority, how they would tend to sulk and undermine their capabilities, projecting their low self-esteem. This type of projection was also contributed by their personal beliefs that they are not good enough, and this self-perceived incompetence is part of the next source of anxiety.

Second, Learners’ beliefs about language learning pertain to the usual pessimistic concerns of ESL learners, like in the correctness of their utterances of the language, the belief of necessarily speaking in an excellent accent, and the belief that there are people who are more able in learning a new language than others (Young, 1991). These are to name some of the unrealistic beliefs of an ESL learner. These are ought to be simple thoughts or perceptions can incite frustrations, for example, if they believe that proper pronunciation is the most important, failure to attain that goal can build up stress that can accumulate over the course of the learner’s learning process. Participants in a study said that they naturally lack the intelligence to excel in English and doubt their capabilities to answer correctly to language-related questions (Alico, 2015; Alico & Guimba, 2015). When these beliefs and reality converge, more or less, anxiety will be the result.

Third, Instructor beliefs about language teaching, on the other hand, focus on the beliefs of the language teachers in teaching ESL (Young, 1991). For instance, if a teacher believes that authoritative and teacher-centered approach is the best way to teach ESL, that would be a further source of LLA. The idea that the learning of ESL students lies on the instructors themselves to set up an environment they see fit can cause potential complications for the learners. ESL teachers should also consider a bilingual teaching environment, utilizing the prominent mother tongue of the students to ease up their learning of the L2 (Bernardo & Gaerlan, 2011), this is to consider that not all students can catch up to a purely English approach.

Fourth, Instructor-learner interactions are more concerned with the manner the teacher corrects the students. Incorrect or harsh response from the instructors can be perceived negatively by the learners and can arise adverse consequences towards their outlook in learning ESL (Ghodke, 2015). A native speaker as a teacher can cause LLA, since the teacher may lack sensitivity towards the learning process of ESL learners. Additionally, the methods and teaching styles of instructors are potential sources of LLA. The tendency of ‘style wars’ or incompatibility of the teacher’s teaching and student’s learning styles may arise and pose more issues to the student’s anxiety (Lucas et al., 2011)¬¬.

Fifth, Classroom procedures can induce anxiety in the form of typical classroom activities especially speech related ones in front of a group (Ghodke, 2015; Young, 1991). Oral presentations have been the greatest enemy for those who are intensely affected by LLA. Anxiety also stems from writing activities, and participants have stated that they felt anxious during delayed feedback of their papers (Macayan et al., 2018). Motivation can be a great avenue for students to cope with classroom activities that cause anxiety. There should be an active engagement from teachers and counselors in the classroom procedures to promote intervention programs that can help boost the motivation of students especially in cases of the members of minority groups (Alico, 2015).

Anxiety can also stem from Language testing which is under the previously stated factor of test anxiety. This happens when anxious learners put too much pressure and impractical demands on themselves for a test (Lucas et al., 2011). Some test formats produce more anxiety than others especially if the students find it unfamiliar or ambiguous (Young, 1991), and considering also the time pressure. Furthermore, anxiety also arises when students study for hours just to find out that their tests assess different materials or the tests focus on experiences they can’t even relate. Additional causes under testing are the stress induced by the high expectations of the parents (Alico & Guimba, 2015). These high expectations of the parents seem to be salient in an Asian context, and it is observed in some Filipino families (Calaguas, 2013), and it is even a popular subject in memes across social media platforms by Filipino netizens.

So far, these identified factors are only limited in the context of the classroom or the educational system. Little research has been done to address anxiety stemming from non-classroom environments (Horwitz, 2010). A study by Guntzviller, Yale, & Jensen (2016) tried to address this issue and found out the variations in their results between different cultural and linguistic settings. This implies that the root of LLA goes in deep within its hosts’ cultural identity, making it more challenging to understand from one case to another.

Discussion and Conclusion

The causes and effects of LLA among language learners, including the information presented above are still matters for debate, due to the fact of conflicting studies done from the past few decades. Truly LLA is a multifaceted issue and a complex phenomenon that cannot be directly described or defined (Fergina, 2010; Kráľová, 2016). Even by narrowing down the scope, particularly focusing on the causes and accompanying factors of LLA to ESL learners, there still exists a degree of complication in understanding a focal point.

The dictionary defines a ‘cause’ as a condition that produces an effect, while a contributing ‘factor’ is a condition that influences the effect by increasing a phenomenon’s likelihood, accelerating the effect in time, affecting the severity of the consequences, etc. (cause, 2019; factor, 2019). The main difference between the two is that when a cause is taken away, it will also eliminate its effect. This is contrary when a factor is taken away. A dilemma emerges with these two distinct terms. According to Horwitz et al. (1986), the terms presented previously: communication apprehension, test anxiety, and fear of negative evaluation are ‘factors’ that affect LLA, but other more recent studies (eg. Berowa, (2018); Gomari & Lucas, 2013; Lucas et al., 2011) have presented it to be ‘causes’ of LLA. Moreover, others (eg. Macayan et al., 2018; Marcial, 2016) introduced them to be certain types of LLA because they perceived it with a unique approach. Even some (eg. Young, 1991, 1994) who view it in a transfer approach believed that Horwitz et al.’s ‘factors’ are also effects from other sources of anxiety. All of these studies have presented their own pieces of evidence for their chosen claim, and more recent studies have provided us with supplementary details including the present social context in relation to the situation-specific factors.

In relation to this, it can be said that the causes, factors and even the effects of LLA have this interchangeable relationship with each other. This multiplicity in nature can be the answer to this “chicken or the egg” dilemma, and can also exemplify how complex this matter really is. Orbeta and San Jose (2013) also share this belief and conducted their study with this concept in mind. Furthermore, this idea could be extended to the sources cited by Young (1991) which were more generalized in Young (1994) into three: LLA associated with the learner, the teacher, and the institution. Some of these sources have manifested the elements established by Horwitz et al. (1986) as consequences and causes of LLA. For example, Personal and interpersonal related issues cause communication apprehension to the participants coming from minority groups (Alico, 2015), and Language testing induces test anxiety among ESL learners (Alico & Guimba, 2015).

Looking at LLA with the transfer approach, test anxiety, unrelated to language, can also be a cause for LLA, especially during evaluations and language tests. Fear of negative evaluation, unrelated to language, inhibits the ESL learners to do good in oral presentations (Kráľová, 2016). This just proves that any element can be both a cause and a contributing factor, and even an effect in various cases of LLA.

In addition, this multiplicity approach would also mean that if one would act upon one of these elements because he believes it as a cause, this would not necessarily result to the elimination of the debilitating effects of LLA. There is still the tendency that the particular element he believed as a cause may just be a factor or just one of the many causes that induced the LLA. This would make every case somewhat unique, thus this does not guarantee a direct solution to address this multivariate issue.

K-12 program has been implemented in the country for quite some time now, and it has been very clear in promoting the importance of the development of English proficiency of young Filipinos to better prepare them for the global stage (Okabe, 2013). Since our bilingual educational system pushes students to believe that they need English to accomplish their scholastic endeavors, the system itself becomes a hotspot for LLA while they learn ESL. The implication of this study is that by understanding the roots of this phenomenon, new strategies can be formulated to fight off the problem which is needed because LLA greatly affects the agenda for the improvement of ESL in the Philippine education. In turn, further revisions accounting LLA on the country’s educational reform can provide future learners with a better system that allows them to acquire the necessary language skills with optimal proficiency.

Given the perplexing nature of LLA, one of the ways for students to cope against this issue is to remove the idea of total eradication of the anxiety from the table, instead, the focus should be on minimizing its effects and to devise innovative strategies against the effects of LLA. Since most of the studies are only focused on the factors inside the four corners of a classroom, further studies should be conducted to determine the playing factors outside the scope of a learning environment or the educational system so that these factors can also be addressed. One of the angles that can be explored is the involvement of family matters and local norms in the students’ anxiety since the formation of one’s ideals and beliefs are greatly influenced by socio-cultural norms and family ties (Marshall, 2001). The involvement of these factors in the Philippine context is not surprising since Filipinos are known to be family-oriented and the country has a diverse set of cultures from different regions (Morillo, Capuno & Mendoza, 2013).

Overcoming this problem would be a great feat for the future of our educational system, this would promote an efficient environment in the country for language learners, that would gradually allow the country to produce more competent and fluent English Speakers (Macayan et al., 2018).

This essay will examine and analyse the historical, cultural, structural and critical factors that may have contributed to anxiety and depression, through utilising the sociological imagination framework. Firstly, the definition and prevalence of anxiety and depression will be delved into on a national and global scale, which will highlight the important nature of the issue. The historical perspective of anxiety and depression will then be explored by assessing how events such as colonisation have been key contributors to this health issue. Cultural trends and practices including social media and child marriages will be investigated, as well as the impact that it has on anxiety and depression. Additionally, key structures and organisations including school life, will be closely studied to determine the effect of academic stress on anxiety and depression. Finally, a critical perspective will be applied, discussing biological factors surrounding mental health and possible interventions to combat this issue. Thus, through sociological analysis, it will be argued that historical, cultural and structural factors have contributed to anxiety and depression as a public health issue.

Anxiety and depression are often identified by medical professionals as potentially debilitating conditions that can affect one’s physical and mental health (Lifeline Australia, 2020). Anxiety and depression have become increasingly more prevalent within Australian society. This is demonstrated by statistics delivered by the Australian Bureau of Statistics (ABS), which revealed that 3.2 million Australians have an anxiety related condition, an increase from 11.2% in 2014-2015 (Australian Bureau of Statistics, 2018). Similarly, the number of people suffering from depression increased from 8.9% in 2014-2015 to 10.4% which is equivalent to 1 in 10 people (Australian Bureau of Statistics, 2018). Globally, more than 300 million people suffer from depression, whilst 25% will be affected by a mental health condition at some time in their lives (Roberts, 2018). The prevalence of anxiety and depression within our society is a significant issue as people with depression are three times more likely to commit suicide, as well as three times more likely to engage in violent crimes (Department of Health and Human Services 2014; Fazel et al. 2015). Depression and anxiety have an immense economic impact, as the World Health Organisation in 2019 (WHO), estimated that these two disorders cost the global economy up to $1 trillion US dollars each year. This notably impacts people’s quality of life, places strain on health care systems and services, and thus generates detrimental consequences to society. The importance of good mental health is once again highlighted by WHO as they emphasise “there is no health without mental health” (World Health Organisation 2004, p.10). It has been reiterated that anxiety and depression affect a large number of people, communities and economies both directly and indirectly.

Colonisation is a historical event in history that has played a significant role in the occurrence of anxiety and depression present in Indigenous communities. Indigenous individuals are still to date experiencing overwhelming feelings of trauma and grief as a direct result of this historical event (Lavalle & Poole, 2009). All of these factors are thereby linked to depression, anxiety and suicide. Colonisation has created a feeling of emptiness within Indigenous people “with respect to their identity,” due to being forcefully separated from the “fundamental essential elements of Aboriginal life” (Brown et al. 2012, p.7). The intergenerational effects of this occurrence are brought to light by Cynthia C. Wesley-Esquimaux as she states that,“present indigenous communities are a direct legacy of their traumatic past” (2002, p.7). Lifeline Australia has revealed that the suicide rate for Indigenous Australians in 2015 was more than double the national rate, which currently sits at 12.6 per 100,000 people. This is a direct reflection on the impact that colonisation still has on anxiety and depression in current Indigenous populations. Land reclamations, environmental dispossession, racism, the stolen generations and segregation of Indigenous people to other civilians have all been incidences caused as a direct consequence of colonial practices. This, in turn, has contributed to a “denigration of identity,” as well as in addition to feelings of “grief, anger, hopelessness and helplessness” (Lavallee & Poole 2009, p.274). A study conducted in 2012 investigating depression amongst Aboriginal men, concluded that participants viewed their depression as a “loss of connection to social and cultural features of Aboriginal life,” correlated to the legacy of colonialism (Brown et al. 2012, p.1). Additionally, a statement from a participant in the study also revealed the destructive impact of colonisation, particularly its effects on mental health. The man explained how “in the old days…there was probably no depression prior to White man’s influence” (Brown et al. 2012, p.5). This was in stark contrast to today’s society where he felt there are “two lots of rules, no respect, [and] hardly any culture” (Brown et al. 2012, p.5). Therefore, it has been demonstrated that colonisation and colonial practices significantly place Indigenous communities and individuals at a higher risk of anxiety and depression.

Cultural trends and practices including social media and child marriages, have proven to have dreadful consequences on mental health in adolescents and children. It is clear that social media platforms have swiftly become an integral part of young people’s lives, with 90% of adolescents aged between 13-17 in America adolescents utilising social media (Lenhart, 2015). It is interesting to note that the prevalence of anxiety and depression in young people has increased by up to 70% from 1998 to 2017 (Keles, McCrae & Grealish, 2019). Previous studies hold social media primarily accountable for this phenomenon. According to a study that evaluated 467 participants aged 11-17 years old, 47% were categorised as anxious, whilst 21% were regarded as depressed (Woods & Scott, 2016). Similarly, it was discovered in a 2018 study conducted that, “How emotionally and behaviourally attached an individual is to social media” needs to be taken into consideration when assessing the relationship between anxiety and depression and social media use (Shensa et al. 2019, p.117). Actions such as overlooking important responsibilities and relationships have been identified as consequences of social media, which may lead to depression and anxiety (Shensa et al., 2019). Another cultural practice that has been identified as having an impact on anxiety and depression for young individuals is child marriage. Victims of child marriage are subject to significant levels of abuse, forced sexual relations, and the denial of freedom. Many feel as if though “there is no one to trust or speak to about their situation,” leading to profound feelings of anxiety and depression (Mwachindalo n/d p.1). It is estimated that this custom affects over 60 million girls globally, with Niger having the highest rate of child marriage in the world, with over 75% of children aged between 15-19 already married (John, Edmeades & Murithi, 2019). The most considerable implication of child marriage is domestic violence, which includes sexual and emotional abuse. Qualitative data derived from a study undertaken in Nigeria and Ethiopia has presented how child marriage leads to “significant emotional distress and depression” (John, Edmeades & Murithi 2019 p.5). It was additionally discovered that, “Child brides were more likely than those who marry later to be stressed and anxious” (John, Edmeades & Murithi 2019 p.6). When a young girl is wedded to an older man it “creates an inequitable power imbalance” which allows the man to feel in ownership “to her attention, body and reproductive capacity” (Mwachindalo n/d p1). According to the International Council of Research On Women (ICRW), married adolescents are at a higher risk of domestic violence in comparison to women who marry later. It has been proven that women experiencing domestic violence are at a substantially higher risk of developing a range of mental health disorders, including depression and anxiety. Specifically, the likelihood of acquiring depression was 2.7 times greater, and anxiety four times more (Trevillion et al. 2012).

School institutions are an integral structure in society, however recent evidence has suggested that academic stress can increase the prevalence of anxiety and depression. Several medical professionals have articulated their concerns in regard to education being a primary source of stress for high school and university students. A study undertaken in India demonstrated that academic stress and examination related anxiety “was positively related to psychiatric problems” (Deb, Strodl & Sun 2015, p.29). The gravity of this issue is yet again emphasised by the amount of hospitalisations and suicides due to school related mental illness. The study highlights that many adolescents “are referred to hospital psychiatric units, exhibiting symptoms of depression and anxiety,” and tragically 6.23 students everyday in India commit suicide as a result of academic stress (Deb, Strodl & Sun 2015, p.29). These results are similarly replicated in other studies globally including America where it has been concluded that, “Within the past 7 years the likelihood that a college student will suffer from depression has doubled” (Howard 2006, p.92). Survey results from The Journal of the American Medical Association unveiled that 45% of students felt “so depressed” that they “could barely function” (Howard 2006, p.93). It has been suggested by researchers that this particular generation is more susceptible to mental health issues as a result of academic stress, due to certain traits that millennials possess (Howard, 2006). This includes the fact that millennials are high achievers, with many experiencing constant pressure from their families to be successful. In their pursuits to achieve the “trophy kid status” they experience extreme stress and burnout (Howard 2006, p.95). If one does not accomplish their goals this can translate to feelings of defeat, as well as depression. Overall, expectations from parents as well as being a high achiever can cause academic stress, which increases the probability of developing anxiety and depression.

Whilst all the factors discussed in the essay thus far do contribute to anxiety and depression, they are not the sole reason. Anxiety and depression are often caused by a range of factors combined. Although psychosocial factors contribute to this issue, biological causes play a key role also which have not been recognised enough. When diagnosing such disorders, classification systems are used. However, such methods assume that, “One hat fits all” as it does not take into consideration “the enormous depth, breadth and variances in mental illness” as well as “the individuality and complexities of the sufferers” (Parliament of Australia 2006, section. 5.6-5.13) This led to Wilhelm Greisinger developing the biomedical model for mental illness which states that, “Mental disorders are caused by biological abnormalities” and that biological treatment is recommended (Deacon 2013, p.847). Current treatments, including medication, cognitive behavioural therapy and changes to diet and exercise, do not emphasise as strong as a biological focal point as they should. Even though medication is used to treat chemical imbalances, “Approximately half of psychotropic drug prescriptions are written for individuals without a psychiatric diagnosis” (Deacon 2013, p.847). This reinforces the fact that current diagnostic methods are not catered well enough to the individual and are far too subjective. After reflecting on this issue, it can be inferred that an “increased investment in neuroscience” will improve current diagnostic and treatment methods by offering “biological tests” and specific “pharmacological treatments” (Deacon 2013, p.847). A study conducted by Verma, Kaur & David in 2012 proposes a blood test to diagnose depression to determine ethanolamine phosphate levels, as people with depression typically have less in their blood. It has shown to have led to a correct diagnosis 82% of the time, and thus should be strongly considered as a future diagnostic tool (Verma, Kaur & David, 2012). Similarly, anxiety disorder should be diagnosed using neuro-imaging, as it has been emphasised by researchers that there are significant changes in brain anatomy when anxiety is present (Maron & Dutt, 2017). These methods would benefit rural Indigenous communities, university students, as well as countries where child marriages take place. This will additionally allow medical physicians to make a more knowledgeable decision regarding the referral of a patient to a psychiatrist. It will act as a guide for “conducting clinical interviews” as well as “assess[ing] the response to interventions” (Parliament of Australia 2006, chapter 5). Although the biological analysis of anxiety and depression is essential to developing more personalised and effective treatments, it is still crucial to obtain qualitative psychological data and combine them together to improve the outcomes of these disorders.

It has been reinforced throughout this essay through the sociological imagination as a framework, that historical, structural and cultural influences have impacted upon depression and anxiety. It was identified how colonisation has played a role in the current prevalence of anxiety and depression. Cultural aspects of society including social media and child marriages were discussed as contributors to this issue. Additionally, school life was recognised as a structural factor that may influence anxiety and depression, in particular academic stress. Upon reflection, a critical analysis of all factors discussed was incorporated, and innovative measures including personalised biological treatment was examined. The implication of the concept created by C.Wright Mills widely known as the ‘sociological imagination’ is essential for both individuals in the health industry and societies to understand so that they able to analyse the issue from an array of perspectives. This, in turn, will allow medical professionals to be able to effectively view global societal issues through a sociological framework.

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The Meaning of Anxiety

The importance of Anxiety as an influence in life is increasingly recognized. Manifestations with modern-day challenge of Anxiety are being meditated in literature, the arts, or even science. In behavioral and clinical sciences, theoretical and empirical hobby in tension parallels the famous difficulty. Anxiety is found as a central idea in almost all theories of persona and it has seemed as a principal reason of insomnia, immoral and sinful acts. Research on Anxiety has dramatically increased within the past two decades. Much of this research has been targeted round investigations of gaining knowledge of and notion. While fear and covert tension have always been part of man’s bag, reputedly it didn’t grow to be an explicit hassle till the twentieth century.

May(1950), in his book The Meaning of Anxiety, affords an analysis of basic historical and cultural traits in Western Civilization that have contributed to making anxiety a salient traits of our times. To the volume that social and cultural factors undermine private protection and create issues for someone in setting up his psychological identity. Anxiety is distinguishable from other unpleasant stated including anger, grief, or sorrow via it’s combination of phenomenological and physiological qualities. These gave anxiety a special “character of unpleasure” which, although is tough to explain, seemed “ to possess a specific be aware of its own”. According to Freud, there are forms of Anxieties- Objective and Neurotic Anxiety.

Objective Anxiety was appeared as synonymous with fear had a complex inner response to anticipated damage and damage from a few external risk.

External chance ——> belief of danger ——> objective anxiety

Neurotic anxiety, like objective tension, turned into characterized via feelings of apprehension and physiological arousal. But it differed from objective anxiety as in that the source of the risk that evoked it was inner in preference to external, and this source became not consciously perceived because it become repressed. So, neurotic tension was the historical fabricated from an aversive conditioning system which worried instinctual impulses and repression usually going on in formative years.

Internal impulses ——-> external risk(punishment) ——-> objective tension ——-> repression ——-> partial breakdown ——-> derivatives of internal impulses ——-> neurotic tension.

Anxiety Disorders represent one in every of the most not unusual styles of baby psychopathology. Studies with network samples endorse around 8- 12% of youngsters meet diagnostic standards for a few form of tension disorder. Anxiety Disorders are present in a whole lot of paperwork in kids like separation tension, social phobia, panic disorder, etc. Child tension problems are associated with with a number of negative outcomes in phrases of social, scholastic and private adjustment. Furthermore, there is evidence to signify that if early life tension disorders are left untreated, they may persist through childhood and adulthood.

The maximum not unusual type of tension in kids is Social Anxiety Disorder. Social Anxiety Disorder, additionally known as social phobia means social tension affects your lifestyles and forestalls you from taking part in ordinary social activities in your non-public or work lifestyles. A few symptoms are immoderate sweating, a pounding rapid heartbeat, nausea, shaking, blushing and stammering may be annoying for a person with social tension disorder considering the fact that these signs reinforce emotions of embarrassment and fear. An inability to control the signs and symptoms often leads to frustration, hopelessness, isolation and in the end despair. People with social phobia also have a history of being bullied, rejected or ignored. Such experiences have an effect on their self esteem and self esteem which results in depression later in existence. There’s a cycle while social anxiety and depression co occur. It starts with uncontrollable anxiety. To avoid the physical emotional, psychological effects, youngsters withdraw themselves from others.

Now we’re going to look into depression motive with the aid of anxiety in kids/youth.

Teen melancholy is a extreme intellectual health trouble that reasons a persistent feeling of disappointment and loss of hobby in activities. It affects how a person thinks, feels and behaves. It can reason emotional, functional, and bodily problems. Issues which includes peer stress, academic expectations and changing bodies can carry loads of issues for teens. But for a few teens, the lows are more than just transient emotions- they’re a symptom of melancholy. Emotional signs of despair in a teen can be feelings of disappointment, frustration, irritated mood, low self-esteem, etc. Whereas, behavioral signs and symptoms of despair in teens can be tiredness, insomnia or snoozing too much, modifications in appetite, etc. Estimates from a look at a posted country that up to 15% of youngsters and teenagers have a few symptoms of melancholy.

Research has located that 1/2 of all lifetime mental health disorders emerge by means of age 14 and three quarters through the age of 24. Moreover, mental contamination contributes to 45% of the worldwide burden of disease amongst the ones aged 10 to 24vyears. Mental Health disorders also placed individuals prone to self damage and suicide. One 1/3 of all deaths among younger human beings is because of suicide or self damage. Data from the Australian Bureau of Statistics National Survey of Mental Health and Wellbeing indicates that simply over one in 4 younger Australians aged sixteen to 24 had experienced a intellectual disorder inside the preceding 12 months. The record at the Second Australian Child and Adolescent Survey of Mental Health and Wellbeing, because of its methodology, did now not consider the intellectual fitness of Aboriginal and Torres Strait Islander young humans, however, the studies have concluded that one 0.33 of the younger humans have reported high or very excessive stages of psychological distress. Social and emotional wellbeing(SEWB) refers to a multidimensional idea of health which besets mental health with other domains of fitness and wellbeing, inclusive of connection to country. Given the severe, lengthy-lasting influences that mental health disorders may have on young people and people around them, it is important that powerful mental fitness offerings are in region and that they’re relevant and effortlessly accessible for younger people.

Each year, following ethics approval from State and Territory Education Departments and Catholic Education Offices to technique secondary school principals throughout Australia, online surveys are disbursed to schools across the nation. The survey normally runs from April to August every year.

In 2017 – 18, one in five(20.1%) or 4.eight million Australians had a intellectual or behavioral condition. Overall, intellectual conditions were more common amongst women than adult males. Unlike many other conditions, the percentage of humans with intellectual situations does not growth with age. Almost one in 3 women aged 15-24 years had a mental fitness condition, whereas simply one in 5 men of an equal age had a mental health disorder.

In 2017 – 18, 3.2 million Australians had an tension associated condition. This became a growth from 2014 – 15. The increase in rates of tension – associated conditions changed into mostly in the younger age groups.

To decide a diagnosis and check for associated compilations, you may have a physical exam, lab tests, and a mental evaluation. Sometimes it’s tough decide which intellectual infection can be the purpose for your intellectual contamination. Interventions may be implemented straight away and extensively with existing expertise and technology.

Prevention of early life intellectual trouble :

Adequate care during being pregnant and around childbirth prevents mind and intellectual issues. Psychosocial interventions via instructors and counsellors can prevent despair, competitive behaviors among students.

Suicide Prevention:

Mental fitness specialists can start codes of behavior for the mass media to make certain that they do no glamorize times of suicide.

Prevention of alcohol-associated problems:

Higher taxes on alcoholic liquids uniformly can deliver down the intake levels which results in vast reduction.

Depression:

We are conscious that even excessive – profits countries suffer from despair which is not identified. Early identity manner extra effective treatment. Depressive issues can be treated successfully with commonplace and cheaper drug treatments in maximum of the cases.

There isn’t any particular reason that is contributing to the increase in intellectual fitness problems nowadays among youth. Different reasons of different background have an effect on as a collection to mental health issues. The biggest reason being in recent times is stress. Stress additionally takes place for many motives like social stress, academic stress and own family strain. But all of it could be avoided gradually. Awareness of intellectual health problems can genuinely help children with intellectual fitness issues.

Introduction:

In everyday life, there are many different factors and experiences which shape the way we think, act and behave in our present life. Intrinsically, a person’s mental health is dependent on their life involvements and the enjoyments they have such as intimate relationship with partner, healthy self-esteem, sense of belonging, etc. Another aspect which affects the mental health of human beings is the physical aspect of life, which is associated with nutritional diet, sufficient sleep, etc. In any case, all these are part of one major idea; happiness and level of wellbeing of an individual. Having limited happiness and accomplishing less in life can lead an individual to stop caring after their health; both mentally and physically. This influences people to fall under the category of having a disorder of anxiety and depression. Anxiety and depression can come to anyone at any given moment and as it is common, it is just as much as a terminal disease, as it is now one the leading deaths of teenagers and adults. Anxiety and depression all have different levels of severity according to the patient, it can be mild or life threatening. To find the level of the illness, many medical institutes use a simple questionnaire which is titled, The Hospital Anxiety and Depression scale, or also known as ‘HADS’.

This paper attempts to first identify what HADS is and its origin. Not only this but many different studies from psychologists will be used to investigate the accuracy of the hospital anxiety depression scale when diagnosing patients. Furthermore, the reliability and creditability of the hospital anxiety depression scale will be questioned as many similar methods of identifying mental disorders can lead to over and under diagnosis. Therefore, this brings the research question of this essay: “To what extent is the hospital anxiety depression scale an accurate measure in assessing the mental and depression levels of patients?”

Different sources of articles, papers, books, psychological studies and literature are included in this paper. Bocéréan and Spinhoven’s studies and findings will also be embedded into this paper. Furthermore, Nowak and Bjelland will be used to ensure the reliability and validity of the HADS.

To reduce the effect of This paper did not consider the other factors such as gender, age, background/ethnicity and credibility of the participants that could also affect the HADS to give false information. Further research is suggested to make to study precise and legally binding to a more versatile of people.

What is it:

Hospital anxiety and depression scale (HADS) set out and created by Zigmond and Snaith. This was done in 1983 and since then, many doctors find this method useful as it is extremely economical and efficient to use. The scale is utilised to determine how powerful is the depression and anxiety level of the patient. The HADS is structured in a questionnaire format which consists of fourteen questions and collects raw and original data. To maintain equality, the HADS involves seven questions targeted against anxiety and seven question towards depression. This makes sure that the patient who might be undergoing the test, does not get overwhelmed with many questions towards one disorder than the other. Patients with the potential of having depression and anxiety have the chance of being affected by the questions and if the test takes along, it can lead to emotional trauma. This is why HADS is reliable as well because the test contains short and sharp questions which could be completed and ready to be analysed within 3 to 5 minutes. The importance of this scale is because, before the HADS, doctors could not separate if the patient had mental illness or if they were suffering from somatic illness. This includes physical sicknesses such as fatigue, insomnia, hypersomnia. The HADS was viewed as a medical breakthrough as it was extremely beneficial to distinct against somatic issues to anxiety or depression. It was extremely advantageous to doctors as it was fairly easy to use and understand.

As it is a questionnaire, the process does not have to be conducted in a laboratory or clinical setting which makes it suitable to use in many places. However, the “H” in HADS stands for hospital, indicating that the test can only be done in a particular type of location. To test this theory, many studies have been consisted throughout the world, by many psychologists. The outcome from their studies imply that the test can be professionally done by psychiatrist or it can be self-evaluated. To its nature, many psychologists find this questionnaire to be valid and reliable to use from both methods. As it is a scale, doctors and analysers can use it to test how severe the anxiety and depression is in the patient. As many copies and alterations of the scale exist on the internet, HADS is only available in hard copies to reduce the risk of unreliable, invalid diagnosis.

When conduction the HADS test correctly, it can accurately supply information on how dangerous the anxiety and depression in a person. The factor that is impressive about the HADS, is that it is extremely time efficient and can be completed multiple times at once.

Scientists and psychologists do not only use the HADS, they also use DCM (the Diagnostic and Statistical Manual of Mental Disorders) which has a similar purpose as the HADS: used to identify the symptoms of mental illness and diagnose an individual with mental disorders. Another handbook is extremely similar to the DCM which is the ICM. The difference is that ICM can be used

internationally while DCM is only for Americans. CSMD is also invented for Chinese and patients from Hong Kong. The reason why many different types of diagnostic handbooks is created is because doctors forget to include the cultural differences of people which can affect the mental disorders of a person. This is why doctors prefer to use the HADS as it expectable to use for almost everyone. Currently, there are 78 translations of the HADS in different languages. The HADS can be used in western countries and non-western countries. This makes it exceptionally easier for doctors if language acts like a barrier because many people from non-western countries can not understand English. The nature of HADS has multiple different translations, which allows the method not to be restricted. This is where the DCM, CSMD fall short as it is not useable for everyone. HADS is very commonly used by many people including professionals and patients but the reason why psychologists prefer DCM and other handbooks is because not only does it help with diagnosis, but it helps the assessor to identify the symptoms as well. HADS does not have this ability or capability to recognise the symptoms as it just predicts on how threatening the anxiety and depression in a person.

First study: A validation study of the Hospital Anxiety and Depression Scale (HADS) in a large sample of French employees

Aim:

In France and many different parts of Europe, HADS Is used throughout many hospital and medical infrastructures, but it has never been tested in a large sample size. Therefore, the HADS became invalid to be generalisable to a large population. The aim of this study was to produce data operating the HADS within a large population and demonstrate the reliable of the test subjects based on their age and occupation (Bocéréan 2014). The outcome of the study will determine if HADS can be used for people with different ages and jobs while also predicting if there is a clear correlation between age and occupation of a person.

Participants:

The participants were all based in France to take out other cultural bias between the participants. The test subject’s jobs came from 19 major French companies (Bocéréan 2014). To make the test more generable, the participants came from 32 different French towns. The workers occupations ranged from working in: Nuclear (6.3%), Telecommunications (17.5%), Audio-visual (9.8%), Construction (9.7%), Pharmaceutical (4.4%), Banking (7.2%), Cosmetics (6.5%), Aeronautical (7.5%), Petroleum (14.6%), Electronics (8%) and Other (8.5%) (Bocéréan 2014). The employees took and answered the questionnaire as a part of their biennial occupation medical examination. The experiment was conducted in 2011 and contained 20993 employees meaning the experiment had a large sample of test subjects (Bocéréan 2014).

Findings:

The results indicated that women scored higher than men for anxiety and depression. A correlation was also found that as the ages increased in the test subjects, so did their scores meaning more predominant to have depression and/or anxiety. This could mean anxiety and depression could start to build up through life. Occupational status such as engineers and managers had the least average score compared to the sample population. (Bocéréan 2014).

Conclusion:

The results of the questionnaire were coherent though most of the participants with few being outliers. Even if the outcome showed outliers, overall, the HADS test is an appropriate method to notice or find symptoms of anxiety and/or depression in a large population with many different types of jobs and occupations (Bocéréan 2014). From this study, HADS is proven to be suitable to detect the early stages of depression or anxiety. Not only this, but the test could also predict if a participant requires more further treatment, regarding anxiety and depression. However, it is suggested that only a medically certified specialist can diagnose people with anxiety and depression (Bocéréan 2014).

Second Study: A validation study of the Hospital Anxiety and Depression Scale (HADS) in different groups of Dutch subjects

Aim:

As the first study had spotted a correlation in age and their score in HADS, another study was conducted in the Dutch community to further understand and test the reliability of the HADS. The experiment had a second purpose; to establish the existence of depression and anxiety in various age groups.

Participants:

In total, the experiment, the age group ranged from 18 and upwards. In total, the test had 6165 people participating (Spinhoven 1997). The groups were spread out into 6 different sections: a random sample of young adults (18yr-65yr, 199 participants), a random sample of elderly subjects (57yr to 65yr, 1901 participants), random sample of elderly subjects (66yr, 3293 participants), a sample of consecutive general medical out-patients with unexplained somatic symptoms (169 participants) and finally, a sample of consecutive psychiatric out-patients (491 participants) (Spinhoven 1997).

Findings:

The results had found that the anxiety and depression are very intensely associated as the proof of the two-factor solution was uncovered from the experiment (Spinhoven 1997). The test showed that the results that the age groups did little effect to their respected HADS scores (Spinhoven 1997). The experimenters suggest that instead of age, the correlation was found positive predictive value and the sensitivity(Spinhoven 1997). This helped to find any hints of psychiatric disorder in humans; subscales include depression and anxiety (Spinhoven 1997).

Conclusion:

HADS was found to be extremely reliable to identify the starting symptoms of depression and anxiety. The results indicated that age might not have a correlation with a person being diagnosed with anxiety or depression which is the opposite results from the first study. Therefore, it is still unclear whether age has a correlation with participants HADS score.

Third Study: The validity of the Hospital Anxiety and Depression Scale.

Aim:

This study attempts to investigate the wording and structure of the Hospital Anxiety and Depression Scale (HADS). As many psychologists and doctors might be concerned about potential, negative feedback from the literature of the HADS, the study will also further investigate the extent of validity of the HADS.

Participants:

The study required no living subjects. However, to gather data for the study, 747 identified papers that were used the HADS. (Bjelland 2002).

Method:

The past papers were analysed and were investigated and evaluated on the following questions: How are the factor structure, discriminant validity and the internal consistency of HADS? How does HADS perform as a case finder for anxiety disorders and depression? How does HADS agree with other self-rating instruments used to rate anxiety and depression? (Bjelland 2002). All of these questions were all designed to question on the language used in the HADS while using the Cronbach’s alpha scale to measure on how accurate are both factors in the scale(Bjelland 2002).

Results:

The outcome of the results indicated a good correlation between depression and anxiety. The papers from which have been used for HADS, showed that two subscales (anxiety and depression) are work together. To understand the values given from this study, the numbers are compared against the Cronbach’s Alpha and the strength of the value Is given by the Internal Consistency:

Cronbach’s Alpha Internal Consistency

a ≥ 0.9 Excellent

0.9 > a ≥ 0.8 Good

0.8 a ≥ 0.7 Acceptable

0.7 > a ≥ 0.6 Questionable

0.6 > a ≥ 0.5 Poor

0.5 > a Unacceptable

The values were given by the two-factor solution test were proven to be at a ‘good’ consistency (Bjelland 2002). The subscales in HADS had a very strong correlation. When measuring the correlations for anxiety, the values ranged from 0.68 to 0.93 (Bjelland 2002). This gave the average of .83 which is a good consistency (Bjelland 2002). Depression was also very similar to these results from latter subscale as the values for correlation ranged from 0.67 to 0.90 (Bjelland 2002). This gave the mean of 0.82 which again is a good consistency (Bjelland 2002). The values were given by the sensitivity of the question and how specifically it targets the issue (anxiety and depression). The values and sensitivity and how specific HADS questions are when talking about the two subclasses, were provided by the General Health Questionnaire (GHQ) (Bjelland 2002).

Conclusion:

Shown from the GHQ, HADS was proven to have a statistical, good correlations for both anxiety and depression as when sensitivity and specifically targeted questions were involved. This study also includes that the HADS was sufficient in judging the Severity of depression and anxiety in all sorts of people in the normal community including somatic, psychiatric and common patients (Bjelland 2002).

However, as proven from the other studies that HADS is reliable and valid in detecting the early or sever symptoms of anxiety and depression. Not only this but, some studies have also noticed the correlation between the two subclasses to be related and similar. As accurate the HADS may seem, there was a study that which shows that the HADS was proven to be inaccurate. This study was testing the HADS with patients which already have a somatic disease.

Forth Study: Accuracy of the Hospital Anxiety and Depression

Scale for Identifying Depression in Chronic Obstructive Pulmonary Disease Patients.

Aim:

This study attempts to investigates the HADS when there is a large sample of participants when already diagnosed with a somatic, respiratory related disease. Many hospitals and doctors have approved of the use HADS in general patients which is why this study targets patients who are already diagnosed with a critical illness. (Nowak 2014).

Participants:

The patients were enlisted as potential participants from October 2009 to June 2013(Nowak 2014). The participants will be patients who are infected by the Chronic Obstructive Pulmonary disease. The reason behind this is because this physical disease hinders normal breathing and even with medical studies advancing, there is still no treatment found for the chronic respiratory disease (Pietrangelo 2018 ).According to science, having diseases makes the patient more vulnerable to another psychological illnesses such as anxiety and depression(Helper 2016 ). The participants were aged from 40 to 75(Nowak 2014). The average age of the participants was 62.5. Initially, for the experiment, there was 348 patients infected from COPD were considered to be adequate to participate but only 259 results got collected(Nowak 2014). The loss of 89 participants happened for numerous reasons such as, some didn’t attend (8), refusal to participate (71), language barrier (6) and insufficient data collection (4) (Nowak 2014). From this batch of patients, past information has been researched upon them and it was recorded that 29 out of 259 (11.2%) were already diagnosed with depression (Nowak 2014). The primary care physicians of the patients were the people responsible for the diagnosis of depression. The diagnosis occurred by using the 10th edition of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) (Nowak 2014). Not only this but 10 of the 29 patients (35% out of the sample of depressed participants) (3.86% out of census) depression was severe as they required prescribed antidepressants as medications. (Nowak 2014).

Method:

The participants were tested in multiple procedures ranging from a self- report questionnaire to having investigators ask the patients question in an interview style (Nowak 2014). Not only this, but their clinical records were also pulled to examine their conditions (Nowak 2014). This was the preliminary procedure to understand the patient before continuing the method.

To ensure reliability of the testing, the assessment was only performed by either physicians who specialise in the respiratory system and treating lung related diseases such as lung cancer, tuberculosis or in this case COPD or trained professionals who were chosen to be the study investigators (Nowak 2014).

Results:

The experiment used multiple methods of statistical testing such as the Independent sample -tests, Mann-Whitney test, and Chi-Square to figure out if the HADS was significant enough to find and diagnose patients with depression or anxiety if already diagnosed with COPD(Nowak 2014). The statistical testing were all done with the significance level of 0.05 and all the tests were proven to show that there was no significant difference between depressed and nondepressed patients suffering from reportorial disease respectfully (Nowak 2014). Although, the HADS wasn’t successful in this aspect of the study, it was able to detect a trend; participants who were already battling depressing scored a much higher score than participants who weren’t diagnosed with depression before the assessment(Nowak 2014). This trend carried out though the depression subclass in HADS and the final HADS score.