Various psychological, biological, and social factors make people vulnerable to mental health problems. These precursory factors as mental distress, are not sufficient alone for diagnosing a mental disorder but are recognised as risks to mental health. There has been no screening tool available in Mongolia that is adequately validated for mental health screening and neuropsychiatric functions of the brain. Therefore, we aimed to translate and validate the hospital anxiety and depression scale (HADS) to identify potential mental distress in healthy people. The HADS is reliable, valid, and practical for identifying the most common psychological disturbances. This nationwide comparative observational study for the validity of a self-reported measure was conducted between June and December 2020. One thousand ninety-four participants were randomly selected, aged 13-75, mean age was 37.7±13.7 years old, 60.9% were females, 63.9% were married. HADS total score was 13.0±5.7, HADS anxiety (HADS-A) score was 6.8±3.6, and HADS depression (HADS-D) score was 6.0±3.1 for the original two-factor model. The external reliability was good in the whole scale, and both subscales using the Intraclass Correlation Coefficient (0.872, 0.837, and 0.801 for the HADS-T, HADS-A, and HADS-D, respectively). Cronbach's alpha value was 0.776, 0.756, and 0.582, respectively, for the HADS-T, HADS-A, and HADS-D, indicating an acceptable internal consistency for the entire scale but marginal reliability for the HADS-D subscale. The reliability of both the two-factor and three-factor structures of the HADS was confirmed using confirmatory factor analysis with a satisfactory model fit on a separate sample. In conclusion, the Mongolian version of the HADS can be considered a valid and reliable measurement tool for various scientific and clinical practices in the general population.

Obstructive sleep apnea (OSA) disrupts sleep. This study examined factors related to OSA severity. A cross-sectional, prospective, hospital-based study was conducted with 205 patients who underwent polysomnography (PSG). Demographic, anthropometric, clinical, PSG, and sleep quality assessment data were analyzed. Participants (N = 205) were classified into four groups based on apnea–hypopnea index (AHI); no OSA (AHI < 5/h; N = 14), mild (mOSA, 5 < AHI < 15/h; N = 50), moderate (modOSA, 15 < AHI < 30/h; N = 41), severe (sOSA, 30 < AHI < 60/h; N = 50), and very severe (vsOSA, AHI ≥ 60; N = 50). Men had more severe OSA than women (p < 0.001). Anthropometric characteristics differed with OSA severity (p < 0.001). OSA patients had decreased sleep quality and increased excessive daytime sleepiness (EDS). Body mass index (BMI), neck/waist circumference, and blood pressure (BP) differed between groups (p < 0.001). Patients with vsOSA had the highest Mallampati grades (p < 0.001). Multiple linear regression indicated that OSA severity was related to gender and sleep quality. PSG parameters (oxygen saturation, systolic BP, and arousal/respiratory arousal) were strongly related to OSA severity. In conclusion, about half of study-referred patients had severe/very severe OSA; these groups were predominantly obese men with high BP. OSA severity associated with high BP, BMI, waist circumference, and neck circumference.

Communication via the sense of touch has long been perceived as an important aspect of human development, social comfort, and well-being. Human somatosensory system has in fact two tactile sub-modalities, one providing the well-recognized discriminative touch input to the brain, and the second–the affective or emotional input. C-tactile system is hypothesized to represent the neurobiological substrate for affective and rewarding properties of touch. Lower relationship quality is associated with lower resilience to stressors and can lead to increased vulnerability to mental health disorders. Based on the existing work, we know that social touch can increase well-being and lower state-anxiety. Our goal was to prove content validity for the Mongolian version with the factor structure of the original English version of the TEAQ. We translated, and adapted TEAQ for Mongolian language version. Original TEAQ-117 items were used in the pilot study. In the present study, enrolled 204 participants, age varied between 18 and 57 years (26.9±8.8), 57.8% were female. Validated TEAQ-57 items English version was used, and Exploratory factor analysis confirmed 55 items with 6 component structure. Confirmatory factor analysis demonstrated good consistency and homogeneity of the 6 factor structure of the TEAQ, and satisfactory model fit. Several subscales of the TEAQ revealed positive correlations on quality of life domains, in contrast negative correlations with anxiety and depression. In conclusion, analysed Mongolian version of the TEAQ-55 is a reliable and valid assessment tool of experiences and attitudes towards touch, and similar to component structure for different cultures (Validated British TEAQ-57, and TEAQ-37 RUS). We expected that Mongolian version of the TEAQ might be a helpful tool for screening mental health issues and researchers.

Improving knowledge, attitudes, and practices toward COVID-19 is critical to control the infection rate of the pandemic successfully. Mongolia declared a state of emergency in January 2020 but no study was performed on public adherence to centralised measures and awareness of the pandemic in Mongolia. This study aimed to determine knowledge, attitudes, and practices (KAP) toward COVID-19 in the general population, especially regarding the extent to which KAP has contributed to the control measures before local COVID-19 outbreaks. The study was conducted between July and October 2020, when the pandemic was limited to internationally imported cases. We adapted a structured KAP questionnaire that was used to survey residents of Wuhan, China, during the initial outbreak of the pandemic. Participants aged between 13 and 65 years (n=1324, mean age=39.79±14.8), 73.2% were women, and 27.2% held a bachelor's degree or above. The results suggested that 81.9% of the participants had sufficient knowledge about the transmission, symptoms, treatment, and prevention of the disease. In the multiple linear regression, an increase in age and education contributed positively to a high knowledge score (p<0.05, p<0.001, respectively). The majority of the participants (96.2% - 96.5%) had compliance with the measures to control COVID-19 spread with good practices (82.4% - 93.1%) toward COVID-19 prevention. In the binary logistic regression analyses, the COVID-19 knowledge score was associated with a higher likelihood of optimistic attitudes and preventive practices (OR: 0.617 - 0.845). In conclusion, despite the sufficient knowledge toward the COVID-19 pandemic among the general population of Mongolia, a relatively low level of optimistic attitudes and appropriate practices compared to other populations may negatively impact preventing the outbreak in the society. Health education programs aimed at improving COVID-19 knowledge will be helpful to minimise local epidemic growth and the current government measures such as lockdowns, quarantines, and travel restrictions.

The Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) are standardized self-report tools for screening depressive and anxiety disorders, respectively. While they have been validated in various cultural contexts, their psychometric properties have not been thoroughly evaluated in Mongolia. This study aimed to validate the PHQ-9 and GAD-7 among young adults in Mongolia, ensuring their reliability and efficacy in assessing mental health. A cross-sectional study was conducted with 1,391 young adults (aged 17-29 years). Tests for internal consistency, test-retest reliability, and validity were performed, including exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Convergent validity and cut-off scores were assessed using the Hospital Anxiety and Depression Scale (HADS). Results: Both the PHQ-9 and GAD-7 demonstrated excellent internal consistency (Cronbach’s alpha=0.913 and 0.895, respectively) and good test-retest reliability over time (ICC=0.637 for PHQ-9; ICC=0.782 for GAD-7). Factor analyses confirmed their unidimensional structures, explaining 59.1% and 61.5% of variance, respectively. Unidimensional models showed acceptable goodness-of-fit indices, with RMSEA values of 0.051 for PHQ-9 and 0.047 for GAD-7, indicating a close-to-good fit for both models. Strong correlations were observed between PHQ-9 and GAD-7 scores with HADS scores (p<0.001), indicating good convergent validity. Observed cut-off scores yielded high sensitivity and specificity in this sample population. The final Mongolian versions of the questionnaires exhibited robust psychometric properties. The PHQ-9 and GAD-7 were validated as reliable instruments for screening depression and anxiety among medical students in Mongolia. These findings improve the capacity for early identification and intervention in mental health among this population. However, further research should address limitations related to gender representation and the need for assessment in diverse settings.

Anxiety and depression are among the most common mental disorders and are strongly associated with reduced quality of life (QOL). In this cross-sectional study, we examined the associations of anxiety and depression with four QOL domains, namely, physical, psychological, social, and environmental, among Mongolian adults, and tested whether sleep quality mediates these relationships. Although previous Mongolian studies have examined anxiety, depression, and sleep, none of them have tested sleep quality as a mediator of their effect on QOL. A total of 534 adults completed the Hospital Anxiety and Depression Scale (HADS), the World Health Organization Quality of Life–BREF self-report measure (WHOQOL-BREF), and the Pittsburgh Sleep Quality Index (PSQI), each previously translated and validated for the Mongolian population. Associations were assessed using Pearson correlations and multiple regressions, and indirect effects were estimated through mediation analysis. Higher anxiety and depression scores were significantly associated with lower QOL across all domains (p < .001). Poor sleep quality, reported by 43% of participants, was associated with higher anxiety and depression and lower QOL. Mediation analyses showed that sleep quality partially mediated the associations between anxiety/depression and QOL, most strongly in the physical and environmental domains. These findings indicate that sleep quality is a modifiable factor that may be targeted to reduce the impact of psychological distress on well-being. Culturally adapted interventions addressing both mental health and sleep may yield meaningful public health benefits in Mongolia.