Mental and Social Health Commons^™

Efficacy And Safety Of Behavioural Activation On Depression In People With Co-Occurring Non-Communicable Diseases: Systematic Review And Meta-Analysis, Engida Yisma, Kuda Muyambi, Sandra Walsh, Shwikar Othman, Richard Gray, Kuan Liung Tan, Mary Steen, Martin Jones

Research outputs 2022 to 2026

Background People with non-communicable diseases (NCDs) have a higher prevalence of comorbid depression than the general population. While previous research has shown that behavioural activation is effective for general depression, its efficacy and safety in treating depression associated with NCDs remains unclear. Aims To compare the efficacy and safety of behavioural activation against comparators in reducing depression symptoms in people with NCDs. Method We searched six databases from inception until 30 March 2023 (updated 23 September 2024) for randomised controlled trials (RCTs) comparing behavioural activation with comparators for depression in people with NCDs. Risk of bias was assessed using the …

Mental Health In Preprofessional And Professional Circus Artists: A Narrative Review, Melanie I. Stuckey, Stephanie Greenspan, Joanna Nicholas, Veronique Richard, Janine H. Stubbe, Fleur E.C.A. Van Rens

Research outputs 2022 to 2026

Mental health has received little attention in preprofessional and professional circus despite the performance demands, cognitive skill, and emotional labor required. This review aimed to consolidate the literature, identify research gaps, and guide practice priorities for mental health in preprofessional and professional circus artists. A narrative review of the literature was conducted based on the International Olympic Committee’s 2019 consensus statement for mental health in elite athletes. Articles reported on mental health symptoms and disorders (n = 13) and interventions (n = 3) in preprofessional and professional circus contexts. Circus artists may experience more symptoms of depression, anxiety, fatigue, and …

Improving Mental Health Referral Systems In Rural Australia: Co-Design Study With Health Professionals And Consumers, Kate Bartel, Asini Malinka Siriwardene, Paul Worley, Kim Pearce, Niranjan Bidargaddi, Bronwin Patrickson, Simon Moody, Sharon Wingard, Martin Jones, Brian Mckenny, Darryl Cameron, Sharon Lawn, Amy E. Mendham

Research outputs 2022 to 2026

Background: In rural Australia, geographical isolation, limited resources, and complex health care navigation create significant barriers to mental health care access. Mental health care professionals and organizations often work in segregation, exacerbating existing barriers. Digital technology provides an opportunity to improve communication between providers and streamline workflows while supporting a diverse range of consumers. Objective: This co-design study aimed to identify rural community needs and explore digital solutions to enhance mental health service delivery pathways. Methods: Using a design-thinking methodology, we conducted focus groups and workshops with 17 participants (7 consumers and caregivers and 10 health care professionals) from a …

Qualitative Evaluation Of A Physical Activity Motivation Intervention At A Residential Substance Use Disorder Treatment Facility, Sascha Thal, Nikos Ntoumanis, Stephen Bright, Eleanor Quested, Dominika Kwasnicka, Min Maung, Bronwyn Myers

Research outputs 2022 to 2026

Background: Research on physical activity (PA) interventions for individuals with substance use disorders (SUDs) has yielded mixed findings regarding impact on substance use, mental health, and physical health. Low motivation, a common barrier in this population, can limit intervention effectiveness. This study evaluated the perceived effectiveness, feasibility, and acceptability of a motivational group intervention designed to enhance PA motivation among residents of a SUD treatment facility in Western Australia. Methods: Semi-structured interviews were conducted with 10 intervention participants and five treatment facility stakeholders (n = 15). Data were analysed using inductive reflexive thematic analysis. Results: This generated five key themes: …

Dementia Awareness Raising Forum: Improving Attitudes Towards People Living With Dementia, Sheridan T. Read, Rosemary Saunders, Matthew A. Albrecht, Ravani Duggan

Research outputs 2022 to 2026

Stigma surrounding dementia is a significant issue affecting individuals and communities leading to discrimination towards those living with the condition. However, the changing paradigm in dementia support to living well with dementia can reduce this stigma and improve community attitudes. A community initiative aimed to address this evaluated the impact of a two-hour education forum involving 92 community members. Presentations from experts, including a person with dementia, addressed dementia-related human rights issues and initiatives to live well with dementia. Attendees completed the new Dementia Community Attitudes Questionnaire (DCAQ) aligned with the evolving paradigm of living well with dementia before and …

The Development Of A Family-Led Novel Intervention For Delirium Prevention And Management In The Adult Intensive Care Unit: A Co-Design Qualitative Study, Gideon U. Johnson, Amanda Towell-Barnard, Christopher Mclean, Beverley Ewens

Research outputs 2022 to 2026

Aim: The aim of this study was to codesign a Family Members’ Voice Reorientation Intervention (FAMVR) for delirium prevention and management in critically ill adult patients through collaborative process with previous patients, families, and clinical staff. Background: Delirium is a common consequence of intensive care admission, and there is limited evidence to support family-led interventions to prevent or minimise delirium in intensive care. People with lived experience of intensive care are seldom involved in codesigning delirium prevention and management interventions despite the identified benefits of their involvement in delirium care. Design: Codesign qualitative study. Methods: The process of co-designing was …

Mental Health Support Workers Perspectives On Barriers To And Facilitators Of The Effective Delivery Of Their Roles: A Systematic Review And Meta-Aggregation, Martha Njuguna, Irene Ngune, Yvonne Middlewick

Research outputs 2022 to 2026

Mental health support workers (MHSWs) are an important workforce within the mental health care system. Research shows that support services delivered by MHSWs are effective at improving the outcomes of individuals with mental illness. However, there is also literature suggesting that this group of workers are facing many challenges in their roles. This qualitative systematic review sought to explore, analyze and synthesize available primary research literature on the experiences of MHSWs with the aim of identifying the barriers to and facilitators of effective delivery of their roles. An electronic search of Medline, CINAHL, PsycINFO, and Web of Science was conducted …

Supporting People Bereaved By Suicide In The South West Region Of Western Australia: Report, Colleen M. Carlon

Research outputs 2022 to 2026

This paper reports on the practices of service providers in working with people and communities bereaved by suicide in regional contexts. For people bereaved by suicide experiences of grief, trauma and stigma and the questioning of why someone has died create a complex mix of need and emotion that can leave people vulnerable to complicated grief and poor physical and mental health. These effects may also be exacerbated by stigma in social and communal contexts. As such experiences of suicide grief are different to other forms of grief and loss, effectively supporting people and communities bereaved by suicide requires knowledge …

Comusichiamo. First Language, Life-Soundtracks And Storytelling To Support The Cultural Wellbeing Of Migrants Living With Dementia, Simone Marino, Loretta Baldassar

Research outputs 2022 to 2026

This study, located at the intersection of anthropology, ageing, music therapy and dementia, explores the value of music, life-storytelling and first language, to support the cultural identity and wellbeing of people from culturally and linguistically diverse backgrounds living with dementia in Australia. It uses participant observation, the collection of oral histories and ‘life soundtracks’ to co-create a song with older Italian migrants and their families. This paper presents the first case study which informed the development of the music engagement program we call Comusichiamo (let’s make music together). The case study shows that the co-creation of a culturally tailored song, …

Knowledge, Attitude, And Practice Of Care Providers Toward Non-Pharmacological Intervention For Managing Behavioural And Psychological Symptoms In Australian Aged Care Residents With Dementia: A Cross-Sectional Survey, Hunduma Dinsa Ayeno, Mustafa Atee, Gizat M. Kassie, Tuan Anh Nguyen

Research outputs 2022 to 2026

Objectives: This study aimed to assess the knowledge, attitude, and practice of the healthcare professionals and paid caregivers toward non-pharmacological interventions (NPIs) for managing behavioural and psychological symptoms of dementia (BPSD) in Australian residential aged care homes (RACHs). Methods: A cross-sectional, online survey was completed by RACH staff and physicians over the period 6 March-31 August 2023. Descriptive statistics were used to present the results. Results: Ninety-six respondents participated (41.7% aged 35–54 years, 80.2% female, 38.5% nurses). While 50–65% of the respondents were extremely familiar with 15 of NPIs, only 22% believed there was a sufficient funding for their implementation, …

Prevalence And Profile Of New Zealand Osteopaths Treating People Experiencing Headaches And Migraines, Ana Paula Antunes Ferreira, Brett Vaughan, Jerry Draper-Rodi, Lee Muddle, Loïc Treffel, Cindy Mcintyre, Michael Fleischmann, Francesco Cerritelli, Kesava Kovanur Sampath, Amie Steel

Research outputs 2022 to 2026

To describe the prevalence and profile of NZ osteopaths treating people experiencing headaches and migraines. This study is the first to describe this practice. Manual and manipulative therapy interventions are commonly sought by individuals experiencing headaches or migraines. Evidence supports the use of manual therapy as part of the management of headache and migraine disorders. Osteopaths are health professionals who provide care for individuals experiencing headaches and migraines. However, there is a lack of data concerning the profile of osteopaths treating these conditions, in addition to their diagnostic and management strategies. The Osteopathy Research Connect-New Zealand (ORC-NZ), a practice-based research …

Implementation Of A Coach-Supported Mhealth Intervention For Dementia Prevention In China: A Qualitative Study Among Chinese Participants And Coaches In The Prodemos Trial, Jinxia Zhang, Marieke P. Hoevenaar-Blom, Xuening Jian, Haifeng Hou, Siqi Ge, Carol Brayne, Esmé Eggink, Melanie Hafdi, Mingyue He, Guohua Wang, Wenzhi Wang, Wei Zhang, Yueyi Yu, Yixuan Niu, Jihui Lyu, Libin Song, Wei Wang, Youxin Wang, Eric P. Moll Van Charante, Manshu Song

Research outputs 2022 to 2026

Background Modifiable risk factors have been linked to 45% of dementia cases. Mobile health (mHealth) interventions targeting lifestyle-related risk factors with remote coaching have the potential to reach underserved high-risk populations globally. To date, little is known about the implementation of such interventions in China. Methods Fifty semi-structured interviews were conducted with 14 participants and 11 health coaches involved in the PRODEMOS trial. This trial investigated whether a coach-supported mHealth application intervention can reduce dementia risk in people aged 55–75 years with multiple risk factors. Interviews were conducted three months and 12–18 months into the intervention, focusing on implementation outcomes …

Prevalence And Risk Factors Of Postpartum Depression Among Postnatal Mothers With Hypertensive Disorders Of Pregnancy In A Developing Country, Wina Ivy Ofori Boadu, Enoch Odame Anto, Edmund Mintah Wiafe, Michael Nyantakyi, Joseph Frimpong, Emmanuel Ekow Korsah, Ezekiel Ansah, Afia Agyapomaa Kwayie, Elizabeth Aboagye, Christian Obirikorang, Emmanuel Timmy Donkoh, Kwame Ofori Boadu

Research outputs 2022 to 2026

Background: Postpartum depression is a public health issue affecting both maternal well-being and child development. While it is the most common mental health disorder following childbirth, data on its prevalence and associated risk factors in developing countries, including Ghana, remains limited. Objectives: This study determined the prevalence of postpartum depression and identified its associated risk factors among pregnant women who developed hypertensive disorders of pregnancy at the Adabraka Polyclinic in the Greater Accra Region of Ghana. Design: This study was a hospital-based cross-sectional study. Methods: This hospital-based cross-sectional study was conducted on 159 postnatal mothers who delivered between March 31, …

She Speaks: Amplifying Women's Voices For Wellbeing, Narelle Lemon

Reports accepted as research outputs

Executive Summary

The SheSpeaks project successfully transformed how 223 Western Australian women understand and practice self-care, demonstrating  that targeted wellbeing literacy interventions can create lasting change  in women’s relationship with their own wellbeing. Funded by the Women’s Grants for a Stronger Future program, this innovative initiative combined evidence-based workshops with authentic podcasting to challenge the pervasive cultural narrative that positions women’s self-care as selfish  or impossible.

Childhood Exposure To Interparental Physical Violence And Adult Cardiovascular Disease, Cancan Cui, Lin Liu, Haibin Li, Yitian Qi, Jiayin Song, Ning Han, Zhijia Wang, Xinyun Shang, Chen Sheng, Lois Balmer, Zhiyuan Wu

Research outputs 2022 to 2026

Importance: Childhood adverse experiences have been linked with long-term risk of cardiovascular disease (CVD), yet the transgenerational associations between interparental behaviors and CVD remain poorly understood. Objectives: To explore the association between exposure to childhood interparental physical violence and the subsequent risk of CVD and to examine whether the association is modified by adult depressive symptoms. Design, Setting, and Participants: This population-based cohort study included data from the China Health and Retirement Longitudinal Study (CHARLS), an ongoing study recruiting individuals aged 45 years or older, dated between June 1, 2011, and December 31, 2020, with a follow-up duration of 9 …

Prevalence And Management Of Depressive Symptoms In Coronary Heart Disease Patients And Relationship With Cardiovascular Prognosis: A Prospective Cohort Study, Yewei Pan, Yequn Chen, Shenglin Wu, Pengxiang Ying, Zishan Zhang, Xuerui Tan, Jinxiu Zhu

Research outputs 2022 to 2026

Aims: Depressive symptoms are comorbid with coronary heart disease (CHD). There is a controversial debate about whether screening and intervention for depressive symptoms could improve cardiovascular prognosis. This study characterizes the prevalence, characteristics, cardiovascular prognosis and management need of depressive symptoms among CHD patients. Methods: CHD patients were recruited between November 18, 2020 and November 26, 2021. Depressive symptoms were evaluated with the Patient Health Questionnaire (PHQ-9). During the 12-month follow-up, cardiovascular disease (CVD) was the endpoint. Time-to-event data were estimated by Kaplan-Meier curves and Cox models. Results: Of 582 patients (25% women), 21.0% had mild depressive symptoms, and 7.5% …

Protocol To Implement And Evaluate A Culturally Secure, Strength-Based, Equine-Assisted Learning Program, "Yawardani Jan-Ga" (Horses Helping), To Support The Social And Emotional Wellbeing Of Australian Aboriginal Children And Young People, Juli Coffin, Sharmila Vaz, Cheryl Kickett-Tucker, Helen Milroy, Craig Olsson, Meg Kirby, Lesley Nelson, Rob Mcphee, Donna Cross

Research outputs 2022 to 2026

Australian Aboriginal people experience stressors from inequalities across crucial social determinants, including deep and entrenched disadvantage and exclusion. The impact of unaddressed historical issues is pervasive and intergenerational. The disproportionate rates of Aboriginal youth suicide, juvenile detention and imprisonment highlight the inadequacy of existing social and emotional wellbeing programs and services for Aboriginal children and young people. There is increasing recognition in Australia that aligning social and emotional wellbeing interventions with Western values and conceptions of mental health is one of the main barriers to service uptake among Aboriginal people. This suggests fundamental questions remain unanswered about what type of …

Family Members’ Experiences With Depression Through The Lens Of Frank's Illness Narratives, Amanda Cole, Julie Ann Pooley, Lisa Whitehead

Research outputs 2022 to 2026

Background: Depression impacts around 300 million people worldwide and places significant strain on families who care for relatives with chronic mental health conditions. This strain can lead to substantial burdens and affect the mental health and well-being of family members. Aim: This study explores family members’ experiences with depression through the lens of Frank's illness narratives. Methods: Employing a narrative inquiry approach, interviews were conducted with eight family members of adults diagnosed with major depressive disorder. The data were analysed through the lens of Frank's illness narratives. Findings: Family members’ experiences revealed a complex interplay of narratives that reflected the …

The Impact Of Elder Abuse Training On Subacute Health Providers And Older Adults: Study Protocol For A Randomized Control Trial, Marina G. Cavuoto, Simona Markusevska, Catriona Stevens, Patricia Reyes, Gianna Renshaw, Micah D.J. Peters, Briony Dow, Peter Feldman, Andrew Gilbert, Elizabeth Manias, Duncan Mortimer, Joanne Enticott, Claudia Cooper, Josefine Antoniades, Brenda Appleton, Sigrid Nakrem, Meghan O’Brien, Joan Ostaszkiewicz, Marion Eckert, Cheryl Durston, Bianca Brijnath

Research outputs 2022 to 2026

Background: Elder abuse often goes unreported and undetected. Older people may be ashamed, fearful, or otherwise reticent to disclose abuse, and many health providers are not confident in asking about it. In the No More Shame study, we will evaluate a co-designed, multi-component intervention that aims to improve health providers’ recognition, response, and referral of elder abuse. Methods: This is a single-blinded, pragmatic, cluster randomised controlled trial. Ten subacute hospital sites (i.e. clusters) across Australia will be allocated 1:1, stratified by state to a multi-component intervention comprising a training programme for health providers, implementation of a screening tool and use …

Culturally Responsive, Trauma-Informed, Continuity Of Care(R) Toolkits: A Scoping Review, Ellen Mcevoy, Storm Henry, Maedeh Aboutalebi Karkavandi, Jillian Donnelly, Madeleine Lyon, Natalie Strobel, Jacqui Sundbery, Helen Mclachlan, Della Forster, Thiago Melo Santos, Simone Sherriff, Rhonda Marriott, Catherine Chamberlain

Research outputs 2022 to 2026

Background: Models of care that are culturally responsive, trauma-informed and provide continuity of care(r), are important components of care for Aboriginal and Torres Strait Islander parents during the broad perinatal period (pregnancy to 2 years after birth; first 1000 days). Many health services do aim to incorporate these concepts in care provision, but often focus on only one.

Aim: To identify practical toolkits that guide implementation of culturally responsive care, trauma-informed care, or continuity of care(r) in the perinatal period, and map the key elements.

Methods: A scoping review was conducted. Relevant databases and grey literature were searched to identify …

Healthy Community Healthy Mind: An Evidence-Based Culturally Sensitive Aboriginal Child And Adolescent Mental Health Program, Shane Murphy, Kirra Roberts

Journal of the Australian Indigenous HealthInfoNet

This brief report describes an area of promising practice and a model of care that encapsulates the intersection of non-Indigenous methods and Aboriginal and Torres Strait Islander ways of knowing, being, and doing. The Ballarat and District Aboriginal Cooperative (BADAC) Aboriginal Child and Adolescent Mental Health Program provides evidence-based mental health practice integrating the cultural knowledge and lived experience of Aboriginal staff, clients, and families. The program focus is on building trust with community and clients. This paper presents the outcomes from the first year of the program. Data from referral and assessment processes and outcomes for the young people …

Fostering Physical Activity Motivation At Substance Use Disorder Treatment Facilities: A Qualitative Study Grounded In Self-Determination Theory, Sascha Thal, Chloe Graham, Nikos Ntoumanis, Bronwyn Myers, Stephen Bright, Jocelyn Jones, Eleanor Quested

Research outputs 2022 to 2026

Background and aims: Studies have found inconclusive results for the effects of physical activity (PA) interventions on substance use, mental health, and physiological health of people experiencing substance use disorders (SUDs). To improve PA interventions for individuals with SUDs, a deeper understanding of the underlying motivational processes is imperative. This study employs self-determination theory as a framework to explore factors impacting PA motivation in SUD treatment contexts. Methods: A qualitative research design utilising semi-structured interviews explored the experiences and perspectives of five people with lived or living experience of SUD treatment and five stakeholders within SUD treatment facilities across Western …

Codesigning A Clinical Prediction Model For Aboriginal Perinatal Mental Health Using Glassbox Ai And Aboriginal Wisdom And Lived Experience, Guanjin Wang, Hachem Bennamoun, Wai Hang Kwok, Rhonda Marriott, Roz Walker, Jayne Kotz

Research outputs 2022 to 2026

Perinatal mental health is vital for mothers, infants, and families. Aboriginal mothers, despite their strengths, face greater mental health disparities due to colonisation and trauma. Traditional screening methods lack cultural sensitivity. The Baby Coming You Ready (BCYR) program offers a culturally sensitive assessment with promising pilot results. To support health professionals, an AI solution using the Explainable Boosting Machine (EBM) is proposed, trained with Aboriginal lived experiences. This model identifies maternal protective and risk factors, offering interpretable predictions for holistic culturally sensitive care.

Violence And Abuse Towards Grandparent Kinship Carers In Informal Kinship Care Context, Hajara Bentum, Vicki Banham, Kwadwo Adusei-Asante

Research outputs 2022 to 2026

Violence and abuse by grandchildren towards their grandparent kinship carers is an important but under-researched issue. Research evidence on the perceived legitimacy of aged-related myths, beliefs, and witchcraft accusations against older people, especially grandparents, in Ghana and Africa suggest that violence and abuse against grandparent kinship carers could be common. This study explored the types of violence or abuse experienced by grandparent kinship carers, and the meanings grandparents associate with the abuse. Thirty-one grandparents were recruited from four communities in Ghana following a horizontal network sampling approach and interviewed using a qualitative in-depth narrative storytelling strategy. Analysis of the narratives …

The Palliative Care Service Enhancement Program: Specialised Palliative Care Services For People With Behaviours And Psychological Symptoms Of Dementia In Australia, Mustafa Atee, Thomas Morris, Daniel Whiting, Marie Alford

Research outputs 2022 to 2026

No abstract provided.

Artificial Intelligence In Perinatal Mental Health Research: A Scoping Review, Wai Hang Kwok, Yuanpeng Zhang, Guanjin Wang

Research outputs 2022 to 2026

The intersection of Artificial Intelligence (AI) and perinatal mental health research presents promising avenues, yet uncovers significant challenges for innovation. This review explicitly focuses on this multidisciplinary field and undertakes a comprehensive exploration of existing research therein. Through a scoping review guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework, we searched relevant literature spanning a decade (2013–2023) and selected fourteen studies for our analysis. We first provide an overview of the main AI techniques and their development, including traditional methods across different categories, as well as recent emerging methods in the field. Then, through our …

Family Members’ Experiences Of ‘Living Well’ With A Family Member With Depression, Amanda Cole, Julie Ann Pooley, Vivien Kemp, Lisa Whitehead

Research outputs 2022 to 2026

Background: With the high and growing prevalence of depression worldwide, there is an increasing number of families assuming the role of caregivers for family members with mental health conditions such as depression. Aim: The aim of this study was to explore how family members describe and perceive the experience of living well with a family member living with depression. Methods: Narrative inquiry was used to elicit stories from eight participants who lived with an adult family member diagnosed with depression. Narrative and thematic analysis were used. Findings: Participants described the experience of living well through the themes of ‘times of …

Exercise As A Non-Pharmacological Intervention For The Management Of Sleep Disturbance In Primary Brain Tumour Survivors And Their Caregivers: A Study Protocol Of A Clinical Trial, Jason A. Martin, Nicolas H. Hart, Natalie Bradford, Fiona Naumann, Mark B. Pinkham, Elizabeth P. Pinkham, Justin J. Holland

Research outputs 2022 to 2026

Background: Sleep disturbance is a highly prevalent and impactful symptom experienced by those adversely affected by primary brain tumours. Despite this, there is a lack of literature exploring appropriate options for the management of sleep disturbance in these populations. As such, more holistic and patient-centred approaches to address sleep disturbance are needed. Exercise presents itself as a viable option for managing sleep disturbances given its numerous health benefits, minimal costs, and acceptability, though the feasibility of its use in the context of primary brain tumours is unknown. Methods: Primary brain tumour survivors and their caregivers will enrol and participate in …

Understanding Mental Wellbeing Of Family Day Care Educators In Australia: A Mixed Methods Study, Theresa Rayfield

Theses: Doctorates and Masters

Family Day Care (FDC) is an essential service within the Australian early childhood education and care sector. FDC educators support Australian families who require convenience, flexibility, and versatility in the education and care of their children. FDC educators’ mental wellbeing (MWB) is vital to ensure optimal education and care is provided, however this is often overlooked by educators. This research aimed to gauge Australian FDC educators’ MWB, identify factors positively or negatively affecting MWB and strategies employed to maintain and support MWB.

Primarily, a cross-sectional quantitative questionnaire measuring MWB and ten predictor variables determining relationship with food, food insecurity, alcohol …

The Caregiving Role Influences Suboptimal Health Status And Psychological Symptoms In Unpaid Carers, Monique Garcia, Zheng Guo, Yulu Zheng, Zhiyuan Wu, Ethan Visser, Lois Balmer, Wei Wang

Research outputs 2022 to 2026

Background: Suboptimal Health Status (SHS) is the physical state between health and disease. This study aimed to fill in the knowledge gap by investigating the prevalence of SHS and psychological symptoms among unpaid carers and to identify SHS-risk factors from the perspective of predictive, preventive and personalised medicine (PPPM). Methods: A cross-sectional study was conducted among 368 participants who were enrolled from Australia, including 203 unpaid carers as cases and 165 individuals from the general population as controls. SHS scores were measured using SHSQ-25 (Suboptimal Health Status Questionnaire-25), whilst psychological symptoms were measured by DASS-21 (Depression, Anxiety and Stress Scale-21). …