AUCTORES
Globalize your Research
Research Article
*Corresponding Author: Charlene L.M. Lam, Laboratory of Clinical Psychology and Affective Neuroscience, The University of Hong Kong, Hong Kong, China.
Citation: Min-rui Zhu., Cheuk-Hang Lam., Charlene L.M. Lam., (2023), Perceived Loneliness and Anxiety During Covid-19: A Moderated Mediation Model of Hope and Age, Psychology and Mental Health Care, 7(4): DOI:10.31579/2637-8892/221
Copyright: © 2023, Charlene L.M. Lam. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 29 March 2023 | Accepted: 12 June 2023 | Published: 18 June 2023
Keywords: perceived loneliness; hope, anxiety, age; covid-19 peritraumatic distress
Background: Hope has been identified as a psychological factor protecting against the negative impacts of anxiety and perceived loneliness. However, little is known about how the two factors of hope, namely agency thinking and pathway thinking, mitigate the negative psychological impacts of COVID-19 and how age might impact the relationship between perceived loneliness and anxiety. The current study aimed to examine the mediating effect of agency and pathway thinking between perceived loneliness and anxiety among young and older adults.
Methods: 154 participants (77 young adults; 77 old adults) were recruited during the fourth wave of COVID-19 in Hong Kong. They completed questionnaires on hope, perceived loneliness, anxiety and COVID-peritraumatic stress.
Results: Hope agency modulated the negative influence of perceived loneliness in younger adults compared to the older adults (b = -0.14, SE = 0.06, 95% CI [-0.28, -0.03]). Moreover, hope pathways modulated the COVID-19 peritraumatic distress in the younger adults compared with the older adults (b = -0.09, SE = 0.04, 95% CI [-0.19, -0.02]).
Conclusions: Different mental health strategies might be employed to reduce the negative impacts of perceived loneliness and anxiety related to COVID-19 in the younger and older populations.
The World Health Organization (WHO) declared the novel coronavirus outbreak (COVID-19) a global pandemic in March 2020 (WHO, 2020). Since its outbreak, numerous regions and countries have adopted strict social distancing policies in order to mitigate the spread and the negative impacts of the disease. Such policies and regulations, however, often undermined social interactions and led to social isolation to various degrees. Previous studies showed that levels of perceived loneliness have considerably increased among the general public during the outbreak (Cohn-Schwartz et al., 2022; Rogers et al., 2021).
Previous studies suggest that perceived loneliness has a bimodal distribution: younger and older adults reported higher levels of perceived loneliness (e.g., Hawkley & Cacioppo, 2010). Social distancing might have impacted the young and the old to various degrees. On the one hand, older adults might place more significance on the quality, rather than quantity, of their relationships and social engagements (Luong et al., 2011). On the other hand, social distancing made it harder for older adults to access family, friends, and social services on which they are often functionally dependent, specifically for those living in nursing homes (Hwang et al., 2020). Older adults may not be proficient in using virtual technology (e.g., video calls) for social connection (Armitage & Nellums, 2020; Hwang et al., 2020), making them more vulnerable to higher levels of perceived loneliness and mental distress during the pandemic. For younger adults, previous studies report that they are vulnerable to perceived loneliness and anxiety/depression during the pandemic (Loades et al., 2020). Younger adults might evaluate their social enjoyment and success based on the size of their social network and the number of social contacts (Wicken et al., 2021), both of which are directly impacted by social distancing.
Hope as a psychological buffer
Hope has been considered a psychological buffer against loneliness and anxiety (Muyan et al., 2016; Chang et al., 2019). Hope refers to an individual’s goal-oriented belief induced by agency thinking (i.e., the motivation to initiate and pursue goals) and pathway thinking (i.e., the perceived capacity to reach goals) (Snyder, 1994). Agency thinking, or hope agency, represents the willpower to achieve the expected outcome and reward, while pathway thinking, or hope pathways, involves concrete approaches and plans for the achievement of outcomes (Snyder, 2002). Previous research indicates that hope acts as a protective factor against anxiety and other mental outcomes (Carretta et al., 2014; Chang et al., 2016). Individuals with higher levels of hope demonstrated more adaptive emotional control and reported fewer anxious and depressive symptoms (Gallagher et al.,2021). Several studies have reported a negative association between perceived loneliness and hope during the pandemic (Bareket-Bojmel et al., 2021; Chang et al., 2019). For instance, perceived loneliness correlated negatively with hopeful thinking and acted as a mediator between social support and hope in a large sample of healthy adults from the U.K., the U.S., and Israel (Bareket-Bojmel et al., 2021). Lonely individuals reported higher scores in social inhibition and lower scores on hope and social network size compared to their non-lonely counterparts (Ypsilanti & Lazuras, 2022). However, findings of specific hope components (i.e., agency and pathways) on perceived loneliness and anxiety were limited and mixed. Most studies did not distinguish the two components when investigating hope as a construct and its relationship with other factors. Few studies reported that both hope agency and hope pathways were negatively associated with perceived loneliness (Chang et al., 2019; Ekas et al., 2016). Likewise, several studies suggested that hope agency, but not hope pathways, was a significant predictor of anxiety symptoms (Germann et al., 2018; May et al., 2015). On the contrary, only hope pathways effectively protected against anxiety in a group of high school students (Wang et al., 2017). As suggested by Chang et al. (2019), clarifying the contribution of each component of hope is important because it could avoid theoretical and empirical confusion compared to a single composite score. Such clarification not only refines the hope theory but also points to appropriate interventions that bolster hope through strategically facilitating agency thinking, pathway thinking, or both, when designing mental health programs for combatting the negative impacts of public health outbreaks such as COVID-19 in the future.To our knowledge, the findings about the effect of age on the relationship between hope, perceived loneliness and anxiety have not been fully investigated. Previous studies reported that hope is associated with emotion regulation and resilience that tend to increase with age (Losada-Baltar et al., 2021; Wickens et al., 2021). The current study aimed to elucidate the impact of hope and age on the relationship between perceived loneliness and anxiety during COVID-19 with the following objectives: 1) to examine the three relationships among hope (agency thinking and pathway thinking), perceived loneliness and anxiety; 2) to test whether hope mediated the relationship between perceived loneliness and anxiety, 3) to test the moderating effect of age, in which relationships vary across young adults and old adults (Figure 1). Based on the existing literature, we hypothesized that agency thinking and pathway thinking were negatively associated with anxiety and perceived loneliness; both agency thinking and pathway thinking mediated the relationship between perceived loneliness and anxiety; and 3) young adults with low hope were more likely to report high levels of anxiety compared to older adults.
Note. *Hope will be analyzed by agency and pathways subscales separately.
Figure 1: The proposed moderated mediation model.
One hundred and fifty-four healthy Chinese were recruited from local universities, communities, and elderly centers from March 2021 to May 2021. The inclusion criteria were: [1] either aged 18 to 25 or aged 65 to 85; [2] able to read Chinese. The exclusion criteria were: [1] with a present or history of Covid-19 diagnosis; [2] with a present or history of psychiatric or neurological illnesses. Studies have found that the infection and long COVID-19 symptoms are highly associated with an increase in
mental health problems (Magnúsdóttir et al., 2022; Robinson et al., 2022). The infection rate in Hong Kong was low during the data collection. Therefore, people with the infection were excluded to avoid the confounding effect. The sample comprised 77 young adults (Mage = 45.18, SD = 25.83, 50.6
The information on demographic variables is shown in Table 1.
| Demographic characteristics | Young adults (n = 77) | Old adults (n = 77) | Full sample (N = 154) |
| n (%) | n (%) | n (%) | |
| Gender | |||
| Male | 38 (49.4) | 42 (54.5) | 80 (51.9) |
| Female | 39 (50.6) | 35 (45.5) | 74 (48.1) |
| Education | |||
| No formal education | 0 (0) | 11 (14.3) | 11 (7.1) |
| Primary school | 0 (0) | 35 (45.5) | 35 (22.7) |
| Secondary school | 5 (6.5) | 31 (40.3) | 36 (23.4) |
| Bachelor degree or above | 72 (93.5) | 0 (0) | 72 (46.8) |
| Marital status | |||
| Unmarried | 77 (100) | 2 (2.6) | 79 (51.3) |
| Married | 0 (0) | 49 (63.6) | 49 (31.8) |
| Divorced/widowed | 0 (0) | 26 (33.8) | 26 (16.9) |
| Living arrangement | |||
| Alone | 5 (6.5) | 16 (20.8) | 21 (13.6) |
| Otherwise | 72 (93.5) | 61 (79.2) | 133 (86.4) |
| Presence of children | |||
| Yes | 0 (0) | 71 (92.2) | 71 (46.1) |
| No | 77 (100) | 6 (7.8) | 83 (53.9) |
| Employment | |||
| Studying | 66 (85.7) | 0 (0) | 66 (42.9) |
| Working | 7 (9.1) | 5 (6.5) | 12 (7.8) |
| Unemployed | 4 (5.2) | 0 (0) | 4 (2.6) |
| Retired | 0 (0) | 72 (93.5) | 72 (46.8) |
Table 1: Descriptive statistics.
The means, standard deviations and Pearson’s correlation matrix of each variable are shown in Table 2.
| Variable | M | SD | 1 | 2 | 3 | 4 |
| 1. Perceived loneliness | 42.20 | 9.57 | ||||
| 2. Hope (Agency) | 21.51 | 4.35 | -0.26** [-0.40, -0.11] | |||
| 3. Hope (Pathway) | 22.02 | 5.16 | -0.27*** [-0.41, -0.12] | 0.76*** [0.68, 0.82] | ||
| 4. Anxiety | 4.90 | 4.56 | 0.54*** [0.41, 0.54] | -0.07 [-0.23, 0.09] | -0.13 [-0.28, 0.03] | |
| 5. CPD | 11.66 | 8.17 | 0.58*** [0.47, 0.68] | -0.14 [-0.30, 0.01] | -0.18* [-0.33, -0.02] | 0.69*** [0.60, 0.77] |
Note. M = mean, SD = standard deviation. CPD: covid peritraumatic distress. Values in brackets indicate the 95% confidence interval. * p < .05, ** p < .01, *** p < .00
Perceived loneliness was positively associated with anxiety and covid peritraumatic distress, and negatively correlated with hope agency and pathways. Hope pathways were negatively correlated with covid peritraumatic distress (r = -0.18, p = .025). However, hope agency and hope pathways were not significantly associated with levels of anxiety and covid peritraumatic distress in the overall sample. In addition, young adults reported significantly higher levels of loneliness, anxiety and peritraumatic distress compared to the older adults (perceived loneliness: t(152) = 6.40, p < .001, d = 1.03, 95% CI [0.67, 1.38]; anxiety: t[146] = 8.24, p < .001, d = 1.33, 95% CI [-0.21, 0.42]; CPD: t[136] = 8.31, p < .001, d = 1.34, 95% CI [0.96, 1.72]), while they reported similar levels of agency and pathway thinkings (hope agency: t(146) = 1.51, p = .134, d = 0.24, 95% CI [-0.08, 0.56]; hope pathways: t[145] = 0.64, p > .05, d = 0.10, 95% CI [-0.21, 0.42]).
The mediating effect of hope on the relationship between perceived loneliness and anxiety is shown in Figure 2
Note. *** p < .001.
Figure 2: The mediation effect of hope agency on perceived loneliness and anxiety.
(hope agency) and Figure 3
Note. *** p < .001.
Figure 3: The mediation effect of hope pathways on perceived loneliness and anxiety.
(hope pathways). Concerning the model involving hope agency, perceived loneliness was positively associated with anxiety (β = 0.56, t = 7.95, p < .001), and had a significant negative effect on hope agency (β = -0.26, t = -3.35, p < .001). However, agency thinking was not significantly associated with the levels of anxiety (β = 0.09, t = 1.21, p > .05). There was no evidence for a mediating effect of hope agency on the relationship between perceived loneliness and anxiety (indirect effect = -0.02, SE = 0.02, 95% CI [-0.07, 0.02]). Similarly, there was no evidence for a mediating effect of hope pathways on the relationship between perceived loneliness and anxiety (indirect effect = -0.01, SE = 0.02, 95% CI [-0.06, 0.03]) in the whole sample.
Our results showed that the indirect effect of perceived loneliness on anxiety via hope agency was moderated by age (b = -0.14, SE = 0.06, 95% CI [-0.28, -0.03]). Specifically, the hope agency acted as a mediator in the young adults (b = 0.10, SE = 0.05, 95% CI [0.01, 0.22]), but not in the older adults (b = -0.04, SE = 0.04, 95% CI [-0.12, 0.01]). For young adults, higher levels of hope agency were associated with lower levels of anxiety (b = -0.41, p < .001), whereas for old adults, such a relationship was not significant (b = 0.06, p > .05) (Figure 4).
Figure 4: Anxiety at low vs. high hope agency for young and old adults.
Regarding the model involving hope pathways, both perceived loneliness × age and hope pathways × age was not significantly associated with anxiety. In other words, age did not buffer the mediating effect of hope pathways on the relationship between perceived loneliness and anxiety in the two age groups (young adults: b = 0.08, SE = 0.06, 95% CI [-0.04, 0.19]); old adults (b = -0.01, SE = 0.03, 95% CI [-0.08, 0.03]).
Hope agency did not mediate the relationship between perceived loneliness and CPD (young adults: b = 0.05, SE = 0.04, 95% CI [-0.01, 0.15]; old adults: b = 0.00, SE = 0.02, 95% CI [-0.03, 0.04]) in the whole sample. Interestingly, we found that hope pathways × age were significantly associated with covid peritraumatic distress, (b = -0.09, SE = 0.04, 95% CI [-0.19, -0.02]). Moreover, such mediation was only detected in young adults (b = 0.08, SE = 0.04, 95% CI [0.02, 0.17]), but not in the older adults (b = -0.01, SE = 0.02, 95% CI [-0.05, 0.02]). Further, the simple slope diagram (Figure 5)
Figure 5: CPD at low vs. high hope pathways for young and old adults.
illustrated that higher levels of hope pathways were associated with lower levels of CPD for young adults (b = -0.45, p < .001), whereas such a relationship was not significant for old adults (b = 0.04, p > .05).
The current study aimed to examine the mediating effect of agency thinking and pathway thinking between perceived loneliness and anxiety among young and older adults. Our results revealed that hope agency modulated the negative influence of perceived loneliness in younger adults compared to the older adults. Moreover, hope pathways modulated the reported covid-19 peritraumatic distress in the younger adults compared with the older adults.First of all, we found positive associations between loneliness and anxiety, and a negative association between loneliness and hope, which were in line with previous findings (e.g., Beutel et al., 2017; Okruszek et al., 2020). Consistent with other studies reporting young people were more negatively affected by the COVID-19 (e.g, Varma et al., 2021), young adults in our study reported higher levels of perceived loneliness and anxiety than older adults. Despite the reports of higher general distress, younger adults reported similar levels of hope agency and pathways as the older adults. To our knowledge, no previous studies examined the age difference in hope during COVID-19; our study suggested that hope might be a stable construct in young and old adult groups.
Despite the fact that neither pathway thinking nor agency thinking mediated the relationships between perceived loneliness and anxiety in the overall sample, our findings revealed specific roles of agency and pathway thinking in mitigating the negative impacts of COVID-19. Specifically, hope agency mediated the relationship between perceived loneliness and anxiety in young adults, and hope pathways mediated the relationship between perceived loneliness and peritraumatic distress in the young adults. In the original theory of Hope, Synder et al. (1991) proposed that both components of hope facilitate psychological adjustment. Our results showed that hope agency and pathways may have unequal contributions to anxiety and distress during COVID-19. Only
hope agency mediated the effect of perceived loneliness on anxiety in our young adult samples. It might imply that despite feeling lonely, younger adults with higher motivation to initiate or achieve a goal would result in lower anxiety. In fact, lacking motivation might be an important source of anxiety symptoms in young adults. Consistently, several studies have suggested the stronger involvement of hope agency on anxiety over hope pathways (Chang et al., 2016; Muyan & Chang, 2019). In contrast, the effect of perceived loneliness on COVID-19 peritraumatic distress, an index aimed to quantify pandemic-related acute stress reactions involving additional mental health factors, was mediated only by hope pathways. We conjecture that high pathway thinking, the perceived ability that a specific and concrete goal can be attained, might enable young adults to cope with stress more effectively. The null findings in old adults might be understood by their low requirements for social connections. In other words, the quarantine policies did not significantly undermine the fulfillment of their needs for social network nor changed their daily routine (Luong et al., 2011). Another possible explanation is the widespread adoption of digital technology for Hong Kong elderly. Although being inexperienced in using virtual technology could increase the vulnerability of feeling loneliness, such situation may not have applied to Hong Kong old adults. Yang et al. (2022) reported that around 70 percent of old adults have taken advantage of smartphones for social connections in 2021 (e.g., video calls with family members), which countered the negative impact caused by quarantine policies. Moreover, Philip et al. (2020) proposed a potential explanation that older adults generally have greater resilience, emotion regulation and coping strategies which provided better psychological responses during the pandemic.
Our study provides insight that hope could buffer the relationship between perceived loneliness and anxiety in young adults during COVID-19. The findings underscored the importance of hope, both agency and pathways thinking, in young adults to enhance their resilience in combatting COVID-related distress. Several hope-focused interventions suggested by previous studies could improve the hopeful thinking for young adults. Berg et al. (2020) developed an 8-week app-based program, focused on psychoeducation on hope-related skills (e.g., how to maintain motivations towards life goals) and addressed the enhanced mental well-being. Another brief single-session hope intervention conducted by Feldman and Dreher (2012) showed the greater hope of college students and facilitated their goal progress.In addition to specific hope intervention, problem-focused coping, aiming to resolve stressful situations with strategies such as reason identification, new skills learning, and implementation of alternative plans and approaches could also ameliorate the hope pathways (Folkman & Lazarus, 1985). What is worth mentioning, due to the interactive nature of the relationship between agency and pathways, the enhancement of either agency or pathways thinking should be another effective method to boost each other. For instance, distressed young adults who engage in such coping training should have more pathways to achieve goals and, as a result, gain more confidence and self-esteem (i.e., agency promotion). Lindsay et al. (2019) conducted a study about a 2-week smartphone-based mindfulness training, which reduced loneliness significantly and improved the feeling of social connectedness. Such training should be appropriate under the pandemic circumstance.Hope is also a crucial determinant of mental health for older adults although our study did not discover its mediation effect of hope among this group. Maintenance of a healthy hope level could prevent or lower the risk of other mental health problems. Two psychological interventions based on cognitive behavioral therapy (CBT) and life review are recommended to improve hope in older adults after a systematic review (Hernandez & Overholse, 2021). CBT facilitates goal-setting (e.g., breaking goals down into several manageable steps) and life review therapy enables one to recollect previously fulfilled particularized hopes to strengthen generalized hope.
The findings should be considered in light of several important limitations upon which future research can build. First, we conducted a cross-sectional study so inferences of any causality should be cautioned. Second, it is unclear if the present model is useful across other age groups (e.g., middle age group). We emphasized on young adults and older adults in our study because they are the two group psychologically more susceptible to the impact of the pandemic (Birditt et al., 2021). Future studies could consider including more age groups, so as to paint a more complete picture of the moderating effect of age. Third, the participants were recruited by the convenience sampling procedure, therefore the generalizability of our findings to other groups (e.g., old adults who live at home) might be limited. Given the null findings in the older adults group, further studies should attempt to use random sampling, particularly in the older population to unveil the relationships among hope, perceived loneliness and mental distress.
The COVID-19 pandemic will not be the last in our lifetime. Despite the current pandemic is nearly over, it is important to learn from the past such that we can be better prepared for the next pandemic. The present study highlights the importance of hope as an important psychological resource that we can enhance to help us manage through challenging situations. This internal psychological resource seems to play a more important role in younger adults compared to their older counterparts. Future work should focus on strategies to enhance hope in younger adults while further exploring other psychological resources that might help older adults to combat the next pandemic.
No potential conflict of interest was reported by the author(s).
Acknowledgement
The authors thank Ms. Tiffany Li for contributing her time and effort in the data collection of this project.
This project is supported by the State Key Laboratory of Brain and Cognitive Sciences Research Fund.
Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.
Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.
Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.
Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.
We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.
The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.
Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.
Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.
Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.
Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.
Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.
This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.
Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.
As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.
The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.
Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.
Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed. The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.
Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”
Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner
My Testimonial Covering as fellowing: Lin-Show Chin. The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews.
My experience publishing in Psychology and Mental Health Care was exceptional. The peer review process was rigorous and constructive, with reviewers providing valuable insights that helped enhance the quality of our work. The editorial team was highly supportive and responsive, making the submission process smooth and efficient. The journal's commitment to high standards and academic rigor makes it a respected platform for quality research. I am grateful for the opportunity to publish in such a reputable journal.
My experience publishing in International Journal of Clinical Case Reports and Reviews was exceptional. I Come forth to Provide a Testimonial Covering the Peer Review Process and the editorial office for the Professional and Impartial Evaluation of the Manuscript.
