Research in Community and Public Health Nursing

Original Articles

Effects of Anxiety on Health Related Quality of Life of the Elderly: Multiple Mediating Effects of Self-esteem and Social Support: Min Jeong Park, Mi Young Chung; J Korean Acad Community Health Nurs. 2020;31(1):24-33. Published online March 31, 2020; DOI: https://doi.org/10.12799/jkachn.2020.31.1.24

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Purpose
The purpose of this study was to examine the mediating effect of self-esteem and social support on the relationship between anxiety and health-related quality of life (HRQoL) in the elderly.
Methods
The Korea adult psycho-social anxiety survey data were collected from August to September 2015 by the Korea Institute for Health. The subjects were 1,035 elderly people who were aged 65 or older at the time of the data survey. The data were analyzed by t-test, chi-square, Pearson correlation coefficient, and parallel redundant mediated model for PROCESS macro using SPSS 23.0.
Results
They scored an average of 37.93±7.58 for anxiety, 28.59±3.45 for self-esteem, 17.25±4.11 for social support, and 0.88±0.11 for HRQoL. The direct effect of anxiety on HRQoL and the indirect effect of anxiety mediated with self-esteem and social support about HRQoL were statistically significant.
Conclusion
These results indicate that in order to increase the HRQoL of the elderly, it is necessary to develop an intervention program that focuses not only on reducing anxiety but also on improving self-esteem and social support.

Citations

Citations to this article as recorded by

Differences in the Effects of Work Environment on Health Problems and Satisfaction of Working Condition by Gender: The 6th Korean Working Conditions Survey
Chae Hyeseon, Park Sooin, Kim Insoo, Ko Myungsun
International Journal of Environmental Research and Public Health.2023; 20(19): 6824. CrossRef
Health-related quality of life measured with the EQ-5D-5L in critical care survivors: A cross-sectional study
Jiyeon Kang, Seonyoung Yun, Jiwon Hong
Intensive and Critical Care Nursing.2022; 72: 103252. CrossRef

The Death Anxiety and Depressive Symptoms among Poor Older Women in Rural Areas: The Moderating Effect of Social Support: Seung Joo Lim, Young Ko, Chun Mi Kim, Hung Sa Lee; J Korean Acad Community Health Nurs. 2017;28(4):440-449. Published online December 31, 2017; DOI: https://doi.org/10.12799/jkachn.2017.28.4.440

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Abstract PDF

PURPOSE
This study was conducted to identify the moderate effect of social support on the relationship between death anxiety and depressive symptoms among poor older women in rural areas.
METHODS
This was a secondary analysis of the data from 209 women who were participated in the intervention study to evaluate the effectiveness of depression prevention program. Data were collected between April and September 2012. The data were analyzed using moderate multiple regressions.
RESULTS
Among these poor older women, depressive symptoms were associated with death anxiety and social support. Self-esteem support had a moderating effect on the relationship between death anxiety and depressive symptoms.
CONCLUSION
The results indicate that the self-esteem support was effective in decreasing depressive symptoms and death anxiety in poor older women. In order to reduce their depression and make positive changes in their lives, self-esteem improvement programs are needed.

Citations

Citations to this article as recorded by

The influence of tai chi on the death anxiety of elderly people living alone: the chain mediating effect of social support and psychological capital
Jiali Zhou, Baoyuan Wu, Lining Su, Xiujie Ma
Frontiers in Psychology.2024;[Epub] CrossRef
Death anxiety, self‐esteem, and health‐related quality of life among geriatric caregivers during the COVID‐19 pandemic
Xia Zhao, Weihua Zhang, Yonggang Su, Yanping Song, Huaxin Si, Lifeng Zhu
Psychogeriatrics.2022; 22(2): 236. CrossRef
Death Depression Among Older Adults: A Concept Analysis Utilizing An Evolutionary Approach
Ameneh Yaghoobzadeh, Rebecca H. Lehto, Leila Mardanian Dehkordi, Mohammad Ali Cheraghi, Shahzad Pashaeipour
Research and Theory for Nursing Practice.2022; 36(3): 265. CrossRef
Cohort profile: Korean Urban Rural Elderly (KURE) study, a prospective cohort on ageing and health in Korea
Namki Hong, Kwang-Joon Kim, Su Jin Lee, Chang Oh Kim, Hyeon Chang Kim, Yumie Rhee, Yoosik Youm, Jin-Young Choi, Hyun-Young Park
BMJ Open.2019; 9(10): e031018. CrossRef

Factors Contributing to Non-suicidal Self Injury in Korean Adolescents: Mi Young Kim, Jung Ok Yu; J Korean Acad Community Health Nurs. 2017;28(3):271-279. Published online September 30, 2017; DOI: https://doi.org/10.12799/jkachn.2017.28.3.271

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15 Citations

Abstract PDF

PURPOSE
Non-Suicidal Self-Injury (NSSI), a highly prevalent behavior in adolescents, refers to the direct destruction of one's body tissue without suicidal intent. To date, the prevalence of adolescent self-injury in South Korea and its associated factors remain unknown. This study aims to determine the prevalence of self-injury in Korean adolescents as well as its associated factors.
METHODS
We assessed 717 middle school students by means of an anonymous self-report survey. Information about demographic characteristics, lifestyle, anxiety and depression, self-esteem, and parenting behavior was obtained. Data were analyzed using Ï‡Â² test, t-test and multiple logistic regression.
RESULTS
NSSI was reported by 8.8% of respondents. Univariate analyses showed associations of exposure to alcohol use, anxiety, depression, self-esteem, and parenting methods with self-injury. In multiple analyses, alcohol use, anxiety, and parental abuse were associated with lifetime self-injury.
CONCLUSION
The rate of NSSI in the South Korea was found to be lower than those of other countries. As our study suggests that alcohol use, anxiety, and parental abuse are associated with lifetime self-injury, health care providers at school should take these factors into account when developing prevention and intervention programs for adolescents.

Citations

Citations to this article as recorded by

Self-injury functions mediate the association between anxiety and self-injury frequency among depressed Chinese adolescents: sex differences
Yunhan Zhao, Xudong Zhao, Yongjie Zhou, Liang Liu
Frontiers in Psychiatry.2024;[Epub] CrossRef
Prevalence and associated factors of binge drinking among high school students in Acapulco, Mexico: a cross-sectional study
Abel Emigdio-Vargas, Arcadio Morales-Pérez, Elizabeth Nava-Aguilera, Alfonso Dávalos-Martínez, Nubia Blanco-García, Elia Barrera-Rodriguez, Liliana Morales-Nava, Neil Andersson
Drugs: Education, Prevention and Policy.2023; 30(6): 603. CrossRef
Correlation Between Defense Mechanisms and Parenting Style of Adolescents With Non-Suicidal Self-Injury
Yuan Xia, Benbo Wu, Zixue Zhang, Kefei Yang, Chuan'an Jiao, Xiaoqin Zhou
Journal of Psychosocial Nursing and Mental Health Services.2023; 61(11): 17. CrossRef
Adolescents’ Experiences of Non-Suicidal Self-Injury: An Interpretative Phenomenological Analysis Study
Jung A Ko, Ji Young Kim
Journal of Korean Academy of Nursing.2023; 53(5): 538. CrossRef
Adverse Childhood Experiences and Trends of Deliberate Self-Harm in Indonesian Adolescents
Devi Angelina Taminey Rawit, Firens Victor Tatipikalawan, Verina Christabela, Juniarta Juniarta, Novita Susilawati Barus
Psychiatry Nursing Journal (Jurnal Keperawatan Jiwa).2023; 6(1): 41. CrossRef
Association Among Self-Injury, Suicidal Tendency, and Personality and Psychological Characteristics in Korean Adolescents
Kyojin Yang, Si Young Kim, Hyejin Kim, Jun-Won Hwang
Psychiatry Investigation.2022; 19(1): 37. CrossRef
Perceptions of Knowledge, Attitudes, and Skills about Non-Suicidal Self-Injury: A Survey of Emergency and Mental Health Nurses
A. Asiri
THE NEW ARMENIAN MEDICAL JOURNAL.2022; (3): 28. CrossRef
Parenting behaviors, parenting styles, and non-suicidal self-injury in young people: a systematic review
Zhi Hui Fong, Wan Ning Charisse Loh, Ying Jie Fong, Hui Ling Michelle Neo, Tji Tjian Chee
Clinical Child Psychology and Psychiatry.2022; 27(1): 61. CrossRef
Global prevalence and characteristics of non-suicidal self-injury between 2010 and 2021 among a non-clinical sample of adolescents: A meta-analysis
Qingqing Xiao, Xiaozhen Song, Lijuan Huang, Dandan Hou, Xuehua Huang
Frontiers in Psychiatry.2022;[Epub] CrossRef
Perceptions of Knowledge, Attitudes, and Skills about Non-Suicidal Self-Injury: A Survey of Emergency and Mental Health Nurses
A. Asiri
THE NEW ARMENIAN MEDICAL JOURNAL.2022; (3): 28. CrossRef
Non‐suicidal self‐injury is associated with psychotic like experiences, depression, and bullying in Korean adolescents
Ju‐Yeon Lee, Honey Kim, Seon‐Young Kim, Jae‐Min Kim, Il‐Seon Shin, Sung‐Wan Kim
Early Intervention in Psychiatry.2021; 15(6): 1696. CrossRef
Self-Injurious Behavior in Community Youth
Yeonkyeong Son, Sojung Kim, Jong-Sun Lee
International Journal of Environmental Research and Public Health.2021; 18(4): 1955. CrossRef
Epidemiology and Determinants of Self-Injury Among High School Students in Iran: a Longitudinal Study
Soudabeh Marin, Mohammad Hajizadeh, Mohammad Hassan Sahebihagh, Hossein Nemati, Maryam Ataeiasl, Masoumeh Anbarlouei, Hadi Pashapour, Mahbobeh Mahmoodi, Asghar Mohammadpoorasl
Psychiatric Quarterly.2020; 91(4): 1407. CrossRef
Clinical Characteristics of Non-Suicidal Self-Injury and Suicide Attempts among Psychiatric Patients in Korea: A Retrospective Chart Review
Yubeen Bae, Yoanna Seong, Seok Hyeon Kim, Sojung Kim
Psychiatry Investigation.2020; 17(4): 320. CrossRef
Characteristics and Trends of Suicide Attempt or Non-suicidal Self-injury in Children and Adolescents Visiting Emergency Department
Harin Kim, Jeong Min Ryu, Hyo-Won Kim
Journal of Korean Medical Science.2020;[Epub] CrossRef

Analyzing Factors Affecting Cognitive Function in the Elderly using Computerized Neurocognitive Tests: Joohee Shim, Seung Wan Kang; J Korean Acad Community Health Nurs. 2017;28(2):107-117. Published online June 30, 2017; DOI: https://doi.org/10.12799/jkachn.2017.28.2.107

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2 Citations

Abstract PDF

PURPOSE
The purpose of this study is to examine the cognitive function in the elderly and to identify the influencing factors.
METHODS
The design of this study was descriptive research design. A total of 139 elderly people (aged 65 years and over) visiting the electroencephalogram (EEG) center in Seoul, Korea were evaluated. Data were assessed by self-administered questionnaires and CNS Vital Signs (CNSVS). Data were analyzed using SPSS Statistics 23.0 for Windows.
RESULTS
There were significant differences in the Korean Mini-Mental State Examination (K-MMSE), executive functions and reasoning according to education level. K-MMSE, visual memory and executive functions were different depending on the jobs. Age was highly correlated with cognitive function. In addition, stepwise multiple regression analyses showed that the factor significantly associated with reaction time and visual memory was depression. Depression and Trait-Anxiety had significant impacts on executive functions and K-MMSE.
CONCLUSION
CNSVS enabled the accurate and objective measurement of cognitive function. Therefore, this study provides useful data to improve cognitive function of the community-dwelling elderly. The results suggested that there is need for comprehensive interventional programs that manage cognitive impairment.

Citations

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Effects of an Eye-Tracking Linkage Attention Training System on Cognitive Function Compared to Conventional Computerized Cognitive Training System in Patients with Stroke
Sung-Jun Moon, Chan-Hee Park, Sang In Jung, Ja-Won Yu, Eun-Chul Son, Hye Na Lee, Hyeonggi Jeong, Sueun Jang, Eunhee Park, Tae-Du Jung
Healthcare.2022; 10(3): 456. CrossRef
A Longitudinal Study of Changes in Cognition Among Older Thais: Studying From the Kanchanaburi Demographic Surveillance System
Natchaphon Auampradit, Patama Vapattanawong, Sureeporn Punpuing, Malee Sunpuwan, Tawanchai Jirapramukpitak
Gerontology and Geriatric Medicine.2019;[Epub] CrossRef

The Effects of a Positive Psychology Improvement Program on Elders' Depression and Death Anxiety: Seung Joo Lim, Hung Sa Lee, Chun Mi Kim, Young Go; J Korean Acad Community Health Nurs. 2015;26(3):238-247. Published online September 30, 2015; DOI: https://doi.org/10.12799/jkachn.2015.26.3.238

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5 Citations

Abstract PDF

PURPOSE
This study was conducted to investigate the effects of a positive psychology improvement program on elders' depression and death anxiety.
METHODS
This was conducted as a quasi-experimental study with non-equivalent control group pretest-posttest design. The participants were community elders aged over 65 recruited by convenient sampling. A total of 94 elders (32 in the individual experimental group, 32 in the collective experimental group, and 30 in the control group) participated. Data were collected between April and September, 2012 and analyzed by using SPSS/WIN 21.
RESULTS
The individual and group approach experimental groups had significantly lower scores of depression than the control group after the treatment (F=7.50, p=.001). For death anxiety, however, only the individual experimental group had a significantly lower score compared to the control group (F=4.56, p=.013).
CONCLUSION
These results indicate that the positive psychology improvement program was effective in decreasing depression and death anxiety in the elderly. Therefore, the program needs to be applied in a customized way fittingly to the characteristics of the elderly in community, and individually and/or collectively according to its purposes.

Citations

Citations to this article as recorded by

Impact study on the Livelihood and Health Program at Workability Skills Training Foundation, Inc.
Sevillia S Felicen, Leonila M Adarlo
International Journal of Research Studies in Management.2022;[Epub] CrossRef
Aging and Positive Psychology
Ray Marks
Journal of Aging Research and Healthcare.2021; 4(1): 43. CrossRef
Effects of Positive Psychology-Based Program for the Depressed Pregnant Women
Hyeon Hee Shin, Yeong Hee Shin
Journal of The Korean Society of Maternal and Child Health.2021; 25(2): 109. CrossRef
Influence of Positive Psychological Capital and Death Awareness on Terminal Care Performance of Hematooncology Unit Nurses
Seo Yeon Jung, Jeong Hye Kim
The Korean Journal of Hospice and Palliative Care.2019; 22(2): 77. CrossRef
The Death Anxiety and Depressive Symptoms among Poor Older Women in Rural Areas: The Moderating Effect of Social Support
Seung Joo Lim, Young Ko, Chunmi Kim, Hung Sa Lee
Journal of Korean Academy of Community Health Nursing.2017; 28(4): 440. CrossRef

The Effects of a Death Preparing Education Program on Death Anxiety, Spiritual Well-being, and Meaning of Life in Adults: Me Ok Yoon; J Korean Acad Community Health Nurs. 2009;20(4):513-521. Published online December 31, 2009

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Abstract PDF: PURPOSE
The purpose of this study was to analysis the effect of death preparing education on death anxiety, spiritual well-being and meaning of life in adults.
METHODS
This study adopted the one group pre-posttest design. Data collection and intervention were performed from January 19 to 25, 2009. The participants were 30 adults (aged 20 or older) in Jeonju City. The death preparing education program consisted of five steps. Data were analyzed through paired t-test with the SPSS/WIN 12.0 program.
RESULTS
There were significant differences in death anxiety, spiritual well-being and meaning of life between before and after the death preparing education program.
CONCLUSION
The death preparing education program for adults was confirmed to be an effective intervention to lower death anxiety and to improve spiritual well-being and the meaning of life. Therefore, we look forward to the broad application of this program to adults.

The Effects of Aromatherapy and Hand Massage on Anxiety, Sleep, and Depression in the Female Aged at Residential Facilities: Sung Mi Kim; J Korean Acad Community Health Nurs. 2009;20(4):493-502. Published online December 31, 2009

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Abstract PDF: PURPOSE
This study adopted the non-equivalent control group pre-posttest design in order to examine the effects of aromatherapy and hand massage on anxiety, sleep, and depression in the female aged at residential facilities.
METHODS
This study was executed with the female aged at two residential facilities divided into an experimental group (n=35) and a control group (n=37). Data were collected by checking changes in the anxiety, sleep, and depression of the subjects who had received aromatherapy and hand massage ten times for two weeks. The data were analyzed using Chi-square test and ANCOVA (Analysis of Covariance).
RESULTS
The condition of anxiety and depression of the experimental group who had received aromatherapy and hand massage was significantly lower than that of the control group. Also, the condition of sleep of experimental group was significantly higher than that of the control group.
CONCLUSION
The aromatherapy and hand massage program had a positive effect on institutionalized elders' anxiety, sleep, and depression pattern.

The Effects of Danjeon Breathing Exercise on Vital Capacity, Physical Fitness, Anxiety and Depression among Older Adults: Kyung Sun Hyun, Jeong Sook Won, Won Ock Kim, Sang Sook Han, Ji A Lee; J Korean Acad Community Health Nurs. 2009;20(4):474-482. Published online December 31, 2009

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Abstract PDF: PURPOSE
The purpose of this study was to examine the effects of Danjeon Breathing Exercise (DBE) on vital capacity, physical fitness, anxiety and depression among older adults.
METHODS
This study employed the nonequivalent control group pretest-posttest design. The experimental group participated in a 12-week DBE program. Vital capacity and physical fitness were measured with a health measurement system (HELMAS). Anxiety and depression were measured with SCL-90-R-K. Data were collected from 37 community-dwelling older adults (experimental group=21, control group=16) in the Seoul metropolitan area. The data were analyzed by chi2-test, Mann-Whitney test and ANCOVA.
RESULTS
The experimental group taking DBE reported significant increases in flexibility than the control group, but differences in vital capacity and balance were not significant. Older adults taking DBE showed significant decreases in the anxiety and depression levels.
CONCLUSION
A DBE program may be a useful nursing intervention for older adults to improve their flexibility and to reduce anxiety and depression.

The Levels of Impacts of Events, Depression and Anxiety among Injured Workers: Chong Mi Chang, Nam Hee Choi, Hyun Sook Kang, Sun Hee Park; J Korean Acad Community Health Nurs. 2009;20(2):234-242. Published online June 30, 2009

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Abstract PDF: PURPOSE
The aim of this study was to investigate the impact of accidental events, depression, and anxiety among workers with industrial accidents in South Korea.
METHODS
The participants were 510 workers with industrial accidents. Data were collected by personal interviews with structured questionnaires for three months from August to October in 2005. For analyses, frequencies and means were utilized.
RESULTS
The participants' average age was 44.9 years, and about 91% of them were male. Also, they had a greater risk of poverty after being injured. The most frequent cause of accidents was fall (32.2%), and the most frequent injured body area was extremities (73.9%). For around a half of the participants, the treatment period was 12 months or shorter. The participants were at great risk of experiencing a negative impact due to events, depression, and anxiety.
CONCLUSION
It is necessary to develop: (a) strategies for injured workers to be financially stable during recuperation; and (b) supporting systems for them not to suffer and exacerbate mental health problems after being injured.

A Study on Health Behaviors, Health Status and Anxiety about Aging for the Elderly: Focused on the Elderly in Senior Center: Yoo Sun Shin, Eun Ha Kim; J Korean Acad Community Health Nurs. 2009;20(2):179-188. Published online June 30, 2009

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Abstract PDF: PURPOSE
This study is conducted to survey and examine the relationships among anxiety about aging, perceived health status and health promoting behaviors in the elderly, and to provide basic data for health promoting interventions that would improve their successful aging.
METHODS
Data in this study was collected from 333 elderly participants living in Busan. Descriptive statistics, t-test or ANOVA with Scheffe's test, Pearson's correlation coefficients and stepwise multiple regression were used for data analysis.
RESULTS
The major findings of this study were as follows. 1) The mean score of anxiety about aging was 2.67 +/- 0.30, perceived health status 2.46 +/- 0.37, and health promoting behavior 2.77 +/- 0.21. 2) There was a positive correlation between health promoting behavior and perceived health status (r = 267, p = .000). There was a negative correlation between anxiety about aging and health promoting behavior (r = -.163, p = .003). 3) Health-promoting behavior was significantly associated with perceived health and anxiety about aging, which explained 20.9% of variance in health-promoting behavior.
CONCLUSION
In order to promote perceived health status and to decrease anxiety about aging in the elderly, it is necessary to develop supporting interventions to decrease anxiety about aging.

The Effects of Aroma Inhalation on Nursing Students' Stress Response and Anxiety before Their First Clinical Practice: Hea Sook Lee; J Korean Acad Community Health Nurs. 2008;19(1):112-119. Published online March 31, 2008

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Abstract PDF: PURPOSE
The purpose of this study was to verify the effect of aroma inhalation on nursing students' stress responses and anxiety before their first clinical practice.
METHOD
Data were collected during the period from March 5 to March 10, 2007 at K College in a province. There were seventy eight subjects, 35 for the experimental group and 38 for the control group. Aroma oils used were lavender, peppermint and rosemary. Before and after the treatment, the severity of stress and anxiety were evaluated by VAS and a questionnaire. Data were analyzed by descriptive statistics, t-test and chi2-test with the SPSS program.
RESULT
The score of subjective stress (VAS) decreased significantly after aroma inhalation (p=.000), but status anxiety was not significantly different between the two groups (p=.649).
CONCLUSION
Aroma inhalation can be a useful intervention to reduce nursing student's stress before their first clinical practice.

Middle School Students' Addicted Use of Celluar Phone and their Psychosocial Characteristics: Hyun Kyung Son, Suk Hee Ahn, Hae Jung Lee; J Korean Acad Community Health Nurs. 2006;17(4):552-562. Published online December 31, 2006

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Abstract PDF: No abstract available.

The Effects of Aroma Foot Massage on the Anxiety, Pain and Sleep Satisfaction during Colonoscopy under Conscious Sedation: Myung Hee Kim, Ki Wol Sung; J Korean Acad Community Health Nurs. 2006;17(1):91-101. Published online March 31, 2006

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Abstract PDF: PURPOSE
This research is to know whether aroma foot massage has influence on the relief of anxiety and pain during colonoscopy under conscious sedation.
METHOD
This research was designed as a quasi-experiment of non-equivalent control group pretest-posttest. Data were collected from April 1 2005 to August 30 2005. The subjects were divided into three groups (control group, foot massage group and aroma foot massage group) with 30 persons each. Anxiety was evaluated with Visual Analogue Scale (VAS), blood pressure and pulse. Pain response was measured with VAS and non-verbal pain behavior score. Sleep satisfaction was measured with a graphic rating scale. Data were analyzed through Chi-square test, t-test and repeated measure ANOVA.
RESULTS
Systolic blood pressure, pulse, subjective anxiety and pain scores from the aroma foot massage group decreased significantly. Sleep satisfaction score of the aroma foot massage group increased significantly. Diastolic blood pressure from the aroma foot massage group did not decrease.
CONCLUSION
The results show that aroma foot massage with refined oils can increase sleep satisfaction and decrease anxiety and pain during colonoscopy under conscious sedation.

The Relation between Test Anxiety and Mental Health in Adolescents: Ji Yeong No; J Korean Acad Community Health Nurs. 2005;16(4):458-466. Published online December 31, 2005

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Abstract PDF: PURPOSE
The purpose of this study was to determine the relation between test anxiety and mental health in adolescents.
METHOD
The subjects were 450 students of two academic high schools in J City, who were selected through convenient sampling. Data were collected through a survey using a structured questionnaire from September 1st to 15th 2005. Collected data were analyzed using SPSS 10.0 for Windows through descriptive analysis, Pearson's Correlation Coefficient, t-test, ANOVA, Scheffe's test and stepwise multiple regression.
RESULT
The mean score of test anxiety was 2.40 (range:1.13-3.81) and that of mental health was 2.77 (range:0.64-5.03). A significant negative correlation was observed between test anxiety and mental health (r=-0.28, p=.000). Test anxiety was significantly different according to adolescents' general characters such as gender (t=-1.98, p=.048), grade (F=3.54, p=.030), school life satisfaction (F=10.73, p=.000) and relationship with the teacher (F=11.60, p=.000). Mental health was significantly different according to adolescents' general characters such as religion (t=2.14, p=.032) and school life satisfaction (F=4.13, p=.017). The most powerful predictor of mental health was test anxiety and it, combined with religion, accounted for 9.0% of variance in mental health in adolescents.
CONCLUSION
Test anxiety and mental health was found to be in a significant negative correlation with each other in adolescents. Therefore, nursing intervention programs for adolescents needs to reduce their test anxiety to improve their mental health.

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