Exposure traced in daily life: improvements in ecologically assessed social and physical activity following exposure-based psychotherapy for anxiety disorders

BACKGROUND

Although exposure-based cognitive-behavioral therapy for anxiety disorders has frequently been proven effective, only few studies examined whether it improves everyday behavioral outcomes such as social and physical activity.

METHODS

126 participants (85 patients with panic disorder, agoraphobia, social anxiety disorder, or specific phobias, and 41 controls without mental disorders) completed smartphone-based ambulatory ratings (activities, social interactions, mood, physical symptoms) and motion sensor-based indices of physical activity (steps, time spent moving, metabolic activity) at baseline, during, and after exposure-based treatment.

RESULTS

Prior to treatment, patients showed reduced mood and physical activity relative to healthy controls. Over the course of therapy, mood ratings, interactions with strangers and indices of physical activity improved, while reported physical symptoms decreased. Overall results did not differ between patients with primary panic disorder/agoraphobia and social anxiety disorder. Higher depression scores at baseline were associated with larger changes in reported symptoms and mood ratings, but smaller changes in physical activity CONCLUSIONS: Exposure-based treatment initiates increased physical activity, more frequent interaction with strangers, and improvements in everyday mood. The current approach provides objective and fine-graded process and outcome measures that may help to further improve treatments and possibly reduce relapse.

Anxiety symptoms and associated factors among school students after 2 years of the COVID-19 pandemic: a cross-sectional study in Zhejiang Province, China

OBJECTIVES

To ascertain the prevalence and associated factors of anxiety symptoms among middle and high school students in Zhejiang after 2 years of the COVID-19 pandemic.

DESIGN

A school-based cross-sectional study.

SETTING

30 counties/districts in Zhejiang Province, China.

PARTICIPANTS

27 019 students attending middle and high schools.

OUTCOME MEASURES

Anxiety symptoms were assessed using the Generalised Anxiety Disorder 7-item scale (GAD-7). A total score of 10 or more is considered indicative of anxiety symptoms.

RESULTS

The overall prevalence (95% CI) of anxiety symptoms was 14.2% (13.4 to 15.0), higher among girls (18.6%, 95% CI: 17.5 to 19.7) than boys (10.2%, 95% CI: 9.5 to 10.9) (p<0.001), higher among rural students (15.1%, 95% CI: 14.1 to 16.2) than urban students (12.5%, 95% CI: 11.6 to 13.4) (p<0.001). Older age (14-15 years, OR=1.25, 95% CI: 1.09 to 1.44; ≥16 years, OR=1.32, 95% CI: 1.07 to 1.63), being girls (OR=1.76, 95% CI: 1.58 to 1.96), living in rural areas (OR=1.14, 95%CI: 1.01 to 1.29), poor academic performance (OR=1.20, 95% CI: 1.03 to 1.41), alcohol drinking (OR=1.15, 95% CI: 1.01 to 1.30), inadequate fruits (OR=1.31, 95% CI: 1.19 to 1.45) and vegetables intake (OR=1.32, 95% CI: 1.10 to 1.57), insomnia (sometimes, OR=2.14, 95% CI: 1.93 to 2.38; often/always, OR=4.73, 95% CI: 4.03 to 5.56), loneliness (sometimes, OR=2.97, 95%CI: 2.59 to 3.41; often/always, OR=8.35, 95% CI: 7.20 to 9.69), sadness (OR=2.51, 95% CI: 2.25 to 2.79) and physical fight (OR=1.29, 95% CI: 1.13 to 1.48) were positively associated with anxiety symptoms, while studying at vocational high school (OR=0.61, 95% CI: 0.49 to 0.75), coming from family with middle income (OR=0.76, 95% CI: 0.64 to 0.89), being physically active 3-7 days weekly (OR=0.85, 95% CI: 0.75 to 0.95) were negatively associated with anxiety symptoms.

CONCLUSION

Anxiety symptoms prevailed among middle and high school students in China. A variety of factors, containing sociodemographic factors, lifestyle behaviours, mental health, academic performance and physical fight should be taken in consideration in addressing prevention and intervention of anxiety symptoms.

Hypertension, socioeconomic status and depressive and anxiety disorders: a cross-sectional study of middle-aged and older Chinese women

OBJECTIVES

To investigate the association of hypertension with depressive and anxiety disorders in middle-aged and older Chinese women, and to further assess whether the association was influenced by socioeconomic status (SES).

DESIGN

Nationwide cross-sectional study.

SETTING

Six provinces of the eastern, central and western regions of China.

PARTICIPANTS

Women aged 40-70 years were included by a multistage stratified random cluster sampling in 2018 (N=9900).

PRIMARY OUTCOME MEASURES

Depressive and anxiety disorders were measured by the Patient Health Questionnaire-9 and the Generalized Anxiety Disorder-7, respectively. Logistic regression models were used to evaluate the OR and 95% CI for hypertension and the odds of depressive and anxiety disorders.

RESULTS

18.5% of participants reported having hypertension; 20.9% and 15.3% of women experienced depressive and anxiety disorders, respectively. After adjusting for potential confounders, women diagnosed with hypertension were more likely to have depressive (OR=1.27, 95% CI 1.11 to 1.45) and anxiety disorders (OR=1.48, 95% CI 1.28 to 1.71) than those without hypertension. Stratified analyses demonstrated that hypertension was significantly associated with higher odds of depressive disorders in women living in rural areas (OR=1.34, 95% CI 1.13 to 1.59), with lower levels of education (OR=1.28, 95% CI 1.12 to 1.46) and with average monthly household income <¥3000 (OR=1.33, 95% CI 1.12 to 1.59), while hypertension was significantly correlated with increased odds of anxiety disorders in women living in urban (OR=1.41, 95% CI 1.12 to 1.79) and rural areas (OR=1.53, 95% CI 1.27 to 1.84), with lower levels of education (OR=1.47, 95% CI 1.27 to 1.70), and with average monthly household income <¥3000 (OR=1.45, 95% CI 1.20 to 1.75) and ≥¥3000 (OR=1.49, 95% CI 1.18 to 1.86).

CONCLUSIONS

Hypertension was associated with increased odds of depressive and anxiety disorders among middle-aged and older women, especially in those with low SES. Effective strategies and actions for identification and management of hypertension and depressive and anxiety disorders are needed.

Grey matter structural alterations in anxiety disorders: a voxel-based meta-analysis

Anxiety disorders (ADs) are a group of prevalent and destructive mental illnesses, but the current understanding of their underlying neuropathology is still unclear. Employing voxel-based morphometry (VBM), previous studies have demonstrated several common brain regions showing grey matter volume (GMV) abnormalities. However, contradictory results have been reported among these studies. Considering that different subtypes of ADs exhibit common core symptoms despite different diagnostic criteria, and previous meta-analyses have found common core GMV-altered brain regions in ADs, the present research aimed to combine the results of individual studies to identify common GMV abnormalities in ADs. Therefore, we first performed a systematic search in PubMed, Embase, and Web of Science on studies investigating GMV differences between patients with ADs and healthy controls (HCs). Then, the anisotropic effect-size signed differential mapping (AES-SDM) was applied in this meta-analysis. A total of 24 studies (including 25 data sets) were included in the current study, and 906 patients with ADs and 1003 HCs were included. Compared with the HCs, the patients with ADs showed increased GMV in the left superior parietal gyrus, right angular gyrus, left precentral gyrus, and right lingual gyrus, and decreased GMV in the bilateral insula, bilateral thalamus, left caudate, and right putamen. In conclusion, the current study has identified some abnormal GMV brain regions that are related to the pathological mechanisms of anxiety disorders. These findings could contribute to a better understanding of the underlying neuropathology of ADs.

Effectiveness, acceptability, and completeness and quality of intervention reporting of psychological interventions for people with dementia or mild cognitive impairment: protocol for a mixed-methods systematic review

INTRODUCTION

Mental health difficulties such as anxiety and depression have negative impacts on psychological well-being and are common in people with dementia and mild cognitive impairment. However, access to psychological treatments is limited. This mixed-method systematic review will: (1) examine the effectiveness of psychological interventions to improve mental health and psychological well-being in people with dementia or mild cognitive impairment; (2) examine the effectiveness of these psychological interventions to improve mental health and psychological well-being in informal caregivers; (3) examine potential clinical and methodological moderators associated with effectiveness; (4) explore factors associated with the acceptability of psychological interventions from the perspective of key stakeholders; and (5) examine the completeness and quality of intervention reporting.

METHODS AND ANALYSIS

Electronic databases (ASSIA, CENTRAL, CINAHL, EMBASE, PsycINFO and MEDLINE) will be systematically searched and supplemented with expert contact, reference and citation checking, and grey literature searches. If possible, we will conduct a meta-analysis to examine the overall effectiveness of psychological interventions to improve mental health and psychological well-being in people with dementia or mild cognitive impairment and their informal caregivers; and examine potential clinical and methodological moderators associated with effectiveness. We will conduct a deductive framework synthesis, informed by the theoretical framework of acceptability, to explore factors associated with the acceptability of psychological interventions from the perspective of key stakeholders. In accordance with Joanna Briggs Institute guidance, we will adopt a convergent segregated approach to data synthesis and integration of quantitative and qualitative findings. We will examine the completeness and quality of intervention reporting according to the Template for Intervention Description and Replication checklist and guide.

ETHICS AND DISSEMINATION

No primary data will be collected, and therefore, ethical approval is not required. Results will be disseminated through a peer-reviewed publication, academic conferences, and plain language summaries.

PROSPERO REGISTRATION NUMBER

CRD42023400514.

Relationship between mental health, sleep status and screen time among university students during the COVID-19 pandemic: a cross-sectional study

OBJECTIVE

On 20 July 2021, after the outbreak of COVID-19 at Nanjing Lukou International Airport, several universities started closed management and online teaching. This had a large impact on students' daily life and study, which may lead to mental health problems. The purpose of this study is to study the effect of screen time on mental health status of university students and the possible mediating effect of sleep status.

METHODS

This was a cross-sectional study. A web-based questionnaire survey was employed that included demographic characteristics, sleep status and mental health status (depression, anxiety and loneliness). The Pittsburgh Sleep Quality Index scale was used to assess sleep status, while the Centre for Epidemiologic Studies Depression (CES-D) scale, Generalised Anxiety Disorder-7 (GAD-7) scale and Emotional versus Social Loneliness Scale (ESLS) were used to assess depression, anxiety and loneliness, respectively. Linear and logistic regression models were developed and adjusted for confounding factors, and finally the mediating effects were tested using the Karlson-Holm-Breen method.

RESULTS

Finally, 1070 valid questionnaires were included. Among these, 604 (56.45%) indicated depressive symptoms (CES-D score ≥16) and 902 (84.30%) indicated anxiety symptoms (GAD-7 score ≥10). The mean ESLS score (for loneliness) was 26.51±6.64. The relationship between screen time and depressive symptoms (OR 1.118, 95% CI 1.072 to 1.166) and anxiety symptoms (OR 1.079, 95% CI 1.023 to 1.138) remained significant after adjusting for confounding factors. Meanwhile, sleep status plays an intermediary role in screen time and mental health status (depression and anxiety) and accounts for 13.73% and 19.68% of the total effects, respectively. We did not find a significant association between screen time and loneliness.

CONCLUSION

During the outbreak of COVID-19, screen time is inevitably prolonged among university students. There is a relationship between mental health and screen time, and sleep status plays a mediating role.

Effectiveness of a universal personalized intervention for the prevention of anxiety disorders: Protocol of a randomized controlled trial (the prevANS project)

Background

To date, all preventive anxiety disorders interventions are one-fit-all and none of them are based on individual level and risk profile. The aim of this project is to design, develop and evaluate an online personalized intervention based on a risk algorithm for the universal prevention of anxiety disorders in the general population.

Methods

A randomized controlled trial (RCT) with two parallel arms (prevANS vs usual care) and 1-year follow-up including 2000 participants without anxiety disorders from Spain and Portugal will be conducted.The prevANS intervention will be self-guided and can be implemented from the prevANS web or from the participants' Smartphone (through an App). The prevANS intervention will have different intensities depending on the risk level of the population, evaluated from the risk algorithm for anxiety: predictA. Both low and moderate-high risk participants will receive information on their level and profile (risk factors) of anxiety disorders, will have access to stress management tools and psychoeducational information periodically. In addition, participants with a moderate-high risk of anxiety disorders will also have access to cognitive-behavioral training (problem-solving, decision-making, communication skills, and working with thoughts). The control group will not receive any intervention, but they will fill out the same questionnaires as the intervention group.Assessments will be completed at baseline, 6 and 12-month follow-up. The primary outcome is the cumulative incidence of anxiety disorders. Secondary outcomes include depressive and anxiety symptoms, risk probability of anxiety disorders (predictA algorithm) and depression (predictD algorithm), improvement in physical and mental quality of life, and acceptability and satisfaction with the intervention. In addition, cost-effectiveness and cost-utility analyses will also be carried out from two perspectives, societal and health system, and analyses of mediators and moderators will also be performed.

Discussion

To the best of our knowledge, prevANS study will be the first to evaluate the effectiveness and cost-effectiveness of a personalized online intervention based on a risk predictive algorithm for the universal prevention of anxiety disorders.

Trial registration

ClinicalTrials.gov: NCT05682365.

Attentional Control Accounts for the Association Between Anxiety Sensitivity and Sleep Efficiency in Clinic-Referred Youth

Youth with anxiety disorders report difficulty falling asleep and returning to sleep after sleep onset (i.e., poor sleep efficiency). Anxiety sensitivity, the excessive attention to physical symptoms of anxiety and their threatening interpretations, has been linked to poor sleep efficiency. We tested a conceptual model wherein attentional control, attentional focusing and attentional shifting would account for the relationship between anxiety sensitivity and poor sleep efficiency. 255 youths (6-17 years old, 78% Hispanic/Latino) who presented to a university-based research clinic completed measures on anxiety sensitivity, sleep, and attentional control. Poorer sleep efficiency was significantly correlated with higher anxiety sensitivity and lower attentional control, attentional focusing, and attentional shifting. Higher anxiety sensitivity was significantly correlated with lower attentional control and attentional focusing. Attentional control and attentional focusing, not attentional shifting, accounted for the relationship between anxiety sensitivity and poor sleep efficiency. These findings identify attentional control and attentional focusing as variables that may explain the association between anxiety sensitivity and sleep efficiency in youth.

Distraction versus focusing during VR exposure therapy for acrophobia: A randomized controlled trial

BACKGROUND AND OBJECTIVES

The therapeutic mechanisms of exposure therapy are not well understood. Research suggests that focusing on the most feared aspect might not be necessary, and that distraction with a low cognitive load (e.g., conversation) might enhance exposure. We aimed at systematically testing the efficacy of exposure therapy with focusing vs. conversational distraction, hypothesizing that distracted exposure would yield superior effects.

METHODS

Thirty-eight patients with acrophobia (specific phobia of heights; clinician-determined) (free from relevant somatic or other mental disorders) were randomly assigned (1:1) to one virtual reality (VR) session of either focused (n = 20) or distracted exposure (n = 18). This monocentric trial took place at a psychiatric university hospital.

RESULTS

Both conditions resulted in a significant reduction of acrophobic fear and avoidance, and a significant increase of self-efficacy (primary outcome variables). However, condition did not have a significant effect on any of these variables. Effects were stable at four-week follow-up. Heart rate and skin conductance level indicated significant arousal, but did not differ between conditions.

LIMITATIONS

Eye-tracking was unavailable, nor did we assess emotions other than fear. Power was limited due to sample size.

CONCLUSIONS

A balanced exposure protocol combining attention to fear cues with conversational distraction, while not being superior, might be as effective as focused exposure for acrophobia, at least during the initial stages of exposure therapy. These results support previous findings. This study demonstrates how VR can be exploited for therapy process research, as VR supports dismantling designs and the incorporation of online process measures.

Brain activation during fear extinction recall in unmedicated patients with obsessive-compulsive disorder

Specific brain activation patterns during fear conditioning and the recall of previously extinguished fear responses have been associated with obsessive-compulsive disorder (OCD). However, further replication studies are necessary. We measured skin-conductance response and blood oxygenation level-dependent responses in unmedicated adult patients with OCD (n = 27) and healthy participants (n = 22) submitted to a two-day fear-conditioning experiment comprising fear conditioning, extinction (day 1) and extinction recall (day 2). During conditioning, groups differed regarding the skin conductance reactivity to the aversive stimulus (shock) and regarding the activation of the right opercular cortex, insular cortex, putamen, and lingual gyrus in response to conditioned stimuli. During extinction recall, patients with OCD had higher responses to stimuli and smaller differences between responses to conditioned and neutral stimuli. For the entire sample, the higher the response delta between conditioned and neutral stimuli, the greater the dACC activation for the same contrast during early extinction recall. While activation of the dACC predicted the average difference between responses to stimuli for the entire sample, groups did not differ regarding the activation of the dACC during extinction recall. Larger unmedicated samples might be necessary to replicate the previous findings reported in patients with OCD.

Blended Care Therapy for Depression and Anxiety: Outcomes across Diverse Racial and Ethnic Groups

BACKGROUND

Studies have reported positive outcomes of blended care therapy (BCT), which combines face-to-face care with internet modules. However, there is insufficient evidence of its effectiveness across racial and ethnic groups. This study evaluated outcomes of a BCT program, which combined video psychotherapy with internet cognitive-behavioral modules, across race and ethnicity.

METHODS

Participants were 6492 adults, with elevated anxiety (Generalized Anxiety Disorder-7 [GAD-7] ≥ 8) and/or depression (Patient Health Questionnaire-9 [PHQ-9] ≥ 10) symptoms, enrolled in employer-offered BCT. Changes in anxiety (GAD-7) and depression (PHQ-9) symptoms during treatment were evaluated using individual growth curve models. Interaction terms of time with race and ethnicity tested for between-group differences. Treatment satisfaction was assessed using a Net Promoter measure (range = 1 (lowest satisfaction) to 5 (greatest satisfaction)).

RESULTS

Participants' self-reported race and ethnicity included Asian or Pacific Islander (27.5%), Black or African American (5.4%), Hispanic or Latino (9.3%), and White (47.2%). Anxiety symptoms decreased during treatment (p < 0.01), with greater reductions among Hispanic or Latino participants compared to White participants (p < 0.05). Depressive symptoms decreased across treatment (p < 0.01), with significantly greater decreases among some racial and ethnic groups compared to White participants. Declines in anxiety and depressive symptoms slowed across treatment (p's < 0.01), with statistically significant differences in slowing rates of depressive symptoms across some racial and ethnic groups. Among participants with responses (28.45%), average treatment satisfaction ranged from 4.46 (SD = 0.73) to 4.67 (SD = 0.68) across race and ethnicity (p = 0.001). Racial and ethnic differences in outcomes were small in magnitude.

CONCLUSIONS

BCT for anxiety and depression can be effective across diverse racial and ethnic groups.

Incidence and risk factors for anxiety disorders in young adults: A population-based prospective cohort study

Anxiety disorders are among the most common psychiatric disorders in the general population. Our objective was to describe the cumulative incidence and risk factors of anxiety disorders, including obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD), in a follow-up of young adults over a five-year period. This is a prospective cohort conducted in two waves. The first took place from 2007 to 2009, in which 1,560 young adults aged between 18 and 24 years were evaluated using the Mini-International Neuropsychiatric Interview (MINI). Subjects were invited to participate in the second wave, which wave took place from 2012 to 2014, where 1,244 young adults were evaluated using the MINI-Plus. Our findings showed a cumulative incidence of 10.9% for any anxiety disorder, 6.5% for generalized anxiety disorder, 6.0% for agoraphobia, 2.0% for OCD, 1.6% for panic disorder, 1.1% for social anxiety and 0.7% for PTSD. Being female and having had a depressive episode were risk factors to develop any anxiety disorder. We observed a high cumulative incidence of anxiety disorders in a population-based sample of young adults. Our data highlights the importance of the early identification of these disorders as this could lead to early illness detection, early illness management and a reduced burden of disease.

Virtual reality interventions for the treatment of anxiety disorders: A scoping review

BACKGROUND

& Objectives: Virtual Reality (VR) refers to an artificial, immersive three-dimensional environment with interactive sensory stimuli. VR is typically incorporated into the psychotherapeutic process as a means of providing exposure therapy. The objectives of this scoping review were to synthesize the most up-to-date evidence on the outcomes, acceptability, and side effects of VR interventions for treating anxiety disorders in adults.

METHODS

This scoping review is grounded in the methodological framework of Arksey and O'Malley (2005). The databases searched were PubMed, EMBASE, Web of Science, PsycINFO, and ProQuest Dissertations and Theses.

RESULTS

The search process identified 112 unique citations. 52 (46%) of the eligible articles examined participants with specific phobias, 25 (22%) with PTSD, 21 (19%) with social anxiety disorder, 12 (10%) with panic disorder with or without agoraphobia, and 3 (3%) with generalized anxiety disorder. VR interventions often led to statistically significant and meaningful reductions in symptoms for people with anxiety disorders. Additionally, they were acceptable to clients and associated with minimal side effects for all types of anxiety disorders, except for Combat-Related PTSD in Vietnam veterans.

LIMITATIONS

Limitations included the fact that the studies in this review were of varying quality, and that articles in languages other than English and French were excluded.

CONCLUSION

VR interventions appeared to be a viable alternative to conventional exposure therapy. Future research should include more male participants and have a stronger emphasis on acceptability and side effects. Increased traction for VR interventions for generalized anxiety disorder and panic disorder is also important.

Integrated behavioral treatments for comorbid anxiety and substance use disorders: A model for understanding integrated treatment approaches and meta-analysis to evaluate their efficacy

INTRODUCTION

Substance use disorders (SUD) and anxiety disorders are highly comorbid, and this comorbidity is associated with poor clinical outcomes. Emerging research in the last decade has shifted from addressing these problems separately to the development and evaluation of behavioral treatments that integrate care for anxiety disorders (or elevated symptoms of anxiety) and SUD.

METHODS

An extensive literature search revealed a sufficient number of studies (K=11) to conduct a meta-analysis comparing the efficacy of integrated SUD/anxiety disorder behavioral treatment to SUD treatment alone on substance use and anxiety symptom outcomes. Randomized clinical trials including those with SUD and either anxiety disorders or elevations in constructs implicated in the maintenance of anxiety disorder/SUD comorbidity were included. This study meta-analyzes the effects of these studies.

RESULTS

Integrated treatments outperformed SUD treatments alone on both substance use and anxiety outcomes, with small to moderate effects favoring integrated treatments. There was no significant heterogeneity across studies in the primary analyses, such that moderator analyses to identify variables that yielded differential patterns of effect sizes were not conducted.

DISCUSSION

Integrated treatments for SUD/anxiety disorders demonstrate an incremental but significant and clinically meaningful improvement over SUD treatment alone for SUD/anxiety disorder comorbidity. Implications for future research and clinical practice paradigm shifting are discussed.

Effectiveness of unified protocol for trans diagnostic treatment in children with anxiety disorders: A randomized control trial

BACKGROUND

The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Children (UP-C) is a theory-derived approach that can target the common underlying processes, such as the cognitive, emotional, and behavioral processes in emotional disorders in children aged 8-12 years. This study aimed to investigate UP-C's efficacy in treating children's anxiety disorders compared to cognitive behavior therapy (CBT).

MATERIALS AND METHODS

In this randomized control trial (RCT), with pre-test, post-test, and follow-up, 34 participants aged 8-12 with anxiety disorders were selected through the restricted randomization method and allocated to intervention (UP-C) or control (CBT) groups by random allocation rule. UP-C group consisted of 15 weekly individual sessions, and CBT included 16 weekly individual sessions. The Emotion Regulation Questionnaire for Children and Adolescents (ERQ-CA) and The Screen for Child Anxiety Related Disorders (SCARED-71) were completed in the pre-test, post-test, and three-month follow-up stages. The data of participants were analyzed using the repeated measure analysis of variance. A P- value under. 05 was regarded as significant.

RESULTS

Based on the repeated measures ANOVA, UP-C, and CBT significantly reduced anxiety symptoms (P = .002) and emotional suppression (P = .032). Moreover, UP-C and CBT significantly increased emotion regulation (P = .000) and cognitive reappraisal (P = .000).

CONCLUSION

The individual UP-C can be effective as anxiety-oriented CBT in treating anxiety disorders. Also, in the three months follow-up, the UP-C's effects were more stable and progressive than the CBT.

COVID-19 anxiety and related factors amid adjusted epidemic prevention policies: a cross-sectional study on patients with late-life depression in China

OBJECTIVES

To explore the prevalence and associated factors of COVID-19 anxiety in patients with late-life depression (LLD) during the adjustment of epidemic prevention policies in China.

DESIGN

Cross-sectional study.

SETTING

The data analysed in this study were collected from seven regions in China between November 2022 and January 2023.

PARTICIPANTS

A total of 1205 patients with LLD (aged 60-78 years) participated in the survey. They completed a social demographic assessment and the Chinese version of the five-point Coronavirus Anxiety Scale (CAS).

PRIMARY OUTCOME MEASURES

The primary outcome was the anxiety level of the participants. Patients were categorised into two groups based on their anxiety levels, one with anxiety and one without, according to CAS scores.

RESULTS

The prevalence of COVID-19 anxiety in depressed older adults was 47.3%. Regression analysis revealed that the average COVID-19 anxiety score was significantly higher among females (AOR: 2.177, 95% CI 1.201 to 3.947), widowed individuals (AOR: 3.015, 95% CI 1.379 to 6.591), patients residing at a distance from healthcare facilities (AOR: 3.765, 95% CI 1.906 to 7.438), and those who frequently experienced worry (AOR: 1.984, 95% CI 1.111 to 3.543). Conversely, the anxiety score was significantly lower among divorced individuals (AOR: 0.491, 95% CI 0.245 to 0.988), those aged 70 years and above (AOR: 0.117, 95% CI 0.064 to 0.213), patients without difficulty obtaining medication (AOR: 0.027, 95% CI 0.007 to 0.097), those living with family members (AOR: 0.080, 95% CI 0.022 to 0.282) or in nursing homes compared with those living alone (AOR: 0.019, 95% CI 0.004 to 0.087).

CONCLUSION

Women with LLD who are widowed, live far from healthcare facilities, and are prone to excessive worry are more likely to experience anxiety. It is advisable to implement appropriate preventive measures and provide psychosocial support programmes for this vulnerable group during the COVID-19 pandemic.

Prevalence of psychological distress and associated factors among patients undergoing comprehensive genomic profiling testing: protocol for a multicentre, prospective, observational study

INTRODUCTION

Since May 2019, comprehensive genomic profiling (CGP) has been covered by Japan's health insurance system for patients with solid tumours that have progressed on standard chemotherapy, rare tumours or tumours of unknown primary origin. Although CGP has the potential to identify actionable mutations that can guide the selection of genomically matched therapies for patients with advanced cancer and limited treatment options, less than 10% of patients benefit from CGP testing, which may have a negative impact on patients' mental status. The aim of this study is to investigate the prevalence of psychological distress and associated factors among patients with advanced cancer who are undergoing CGP testing across Japan.

METHODS AND ANALYSIS

This multicentre, prospective cohort study will enrol a total of 700 patients with advanced cancer undergoing CGP testing. Participants will be asked to complete questionnaires at three timepoints: at the time of consenting to CGP testing (T1), at the time of receiving the CGP results (T2; 2-3 months after T1) and 4-5 months after T2 (T3). Primary outcome is the prevalence of depression as measured by the Patient Health Questionnaire-9 at the three timepoints. Secondary outcomes are the prevalence of anxiety and Quality of Life Score. Associated factors with psychological distress will also be examined, including knowledge about CGP, attitudes, values and preferences towards CGP, satisfaction with oncologists' communication and patient characteristics as well as medical information including CGP test results and genomically matched therapies if provided. The prevalence of depression and anxiety will be estimated using the unadjusted raw rates observed in the total sample. Longitudinal changes in measures will be explored by calculating differences between the timepoints. Multivariate associations between variables will be examined using multiple or logistic regression analysis depending on the outcomes to adjust for confounders and to identify outcome predictors.

ETHICS AND DISSEMINATION

This study was approved by the Institutional Review Board of the National Cancer Center Japan on 5 January 2023 (ID: 2022-228). Study findings will be disseminated through peer-reviewed journals and conference presentations.

TRIAL STATUS

The study is currently recruiting participants and the enrolment period will end on 31 March 2025, with an expected follow-up date of 31 March 2026.

TRIAL REGISTRATION NUMBER

UMIN000049964.

Association between anxiety and depression and all-cause mortality: a 50-year follow-up of the Population Study of Women in Gothenburg, Sweden

OBJECTIVES

This study aimed to examine the association between anxiety disorders and/or major depression disorder (ADs/MDD) and all-cause mortality in a 50-year perspective and to examine specific risk and health factors that may influence such an association.

DESIGN

Observational population study, 1968-2019.

SETTING

The Population Study of Women in Gothenburg, Sweden (PSWG).

PARTICIPANTS

In 1968-1969, 899 (out of 1462) women from PSWG were selected according to date of birth for a psychiatric investigation, including diagnostic evaluation. Eight hundred (89%) were accepted. Twenty-two women were excluded. Of the 778 included, 135 participants (17.4 %) had solely ADs, 32 (4.1%) had solely MDD and 25 (3.2%) had comorbid AD/MDD.

PRIMARY AND SECONDARY OUTCOME MEASURES

Associations between ADs, MDD, comorbid AD/MDD and all-cause mortality with adjustments for potential confounding factors. Differences between the groups concerning health and risk factors and their association with mortality.

RESULTS

In a fully adjusted model, ADs were non-significantly associated with all-cause mortality (HR 1.17, 95% CI 0.98 to 1.41). When examining age during risk time as separate intervals, a significant association between mortality and AD was seen in the group of participants who died at the age of 65-80 years (HR 1.70, 95% CI 1.26 to 2.29). In the younger or older age interval, the association did not reach significance at the 95% level of confidence. Among confounding factors, smoking and physical activity were the strongest contributors. The association between smoking and mortality tended to be further increased in the group with ADs versus the group without such disorders (HR 2.10, 95% CI 1.60 to 2.75 and HR 1.82, 95% CI 1.56 to 2.12, respectively).

CONCLUSIONS

This study suggests potential links between ADs, age and mortality among women with 50 years of follow-up, but does not provide definitive conclusions due to the borderline significance of the results.

Psychiatric comorbidities in women with cardiometabolic conditions with and without ADHD: a population-based study

BACKGROUND

Leveraging a large nationwide study of Icelandic women, we aimed to narrow the evidence gap around female attention-deficit/hyperactivity disorder (ADHD) and cardiometabolic comorbidities by determining the prevalence of obesity, hypertension, type 2 diabetes, and cardiovascular diseases among women with ADHD and examine the association between cardiometabolic conditions and co-occurring ADHD with anxiety and mood disorders, alcoholism/substance use disorder (SUD), self-harm, and suicide attempts.

METHODS

We conducted a cross-sectional analysis of the nationwide, all-female, population-based SAGA Cohort Study (n = 26,668). To ascertain diagnoses and symptoms, we used self-reported history of ADHD diagnoses, selected cardiometabolic conditions and psychiatric disorders, and measured current depressive, anxiety, and PTSD symptoms through appropriate questionnaires (PHQ-9, GAD-7, and PCL-5). We calculated age-adjusted prevalences of cardiometabolic conditions by women's ADHD status and estimated adjusted prevalence ratios (PR) and 95% confidence intervals (CI), using modified Poisson regression models. Similarly, we assessed the association of cardiometabolic conditions and co-occurring ADHD with current psychiatric symptoms and psychiatric disorders, using adjusted PRs and 95% CIs.

RESULTS

We identified 2299 (8.6%) women with a history of ADHD diagnosis. The age-adjusted prevalence of having at least one cardiometabolic condition was higher among women with ADHD (49.5%) than those without (41.7%), (PR = 1.19, 95% CI 1.14-1.25), with higher prevalence of all measured cardiometabolic conditions (myocardial infarctions (PR = 2.53, 95% CI 1.83--3.49), type 2 diabetes (PR = 2.08, 95% CI 1.66-2.61), hypertension (PR = 1.23, 95% CI 1.12-1.34), and obesity (PR = 1.18, 95% CI 1.11-1.25)). Women with cardiometabolic conditions and co-occurring ADHD had, compared with those without ADHD, substantially increased prevalence of (a) all measured mood and anxiety disorders, e.g., depression (PR = 2.38, 95% CI 2.19-2.58), bipolar disorder (PR = 4.81, 95% CI 3.65-6.35), posttraumatic stress disorder (PR = 2.78, 95% CI 2.52-3.07), social phobia (PR = 2.96, 95% CI 2.64-3.32); (b) moderate/severe depressive, anxiety, and PTSD symptoms with PR = 1.76 (95% CI 1.67-1.85), PR = 1.97 (95% CI 1.82-2.12), and PR = 2.01 (95% CI 1.88-2.15), respectively; (c) alcoholism/SUD, PR = 4.79 (95% CI 3.90-5.89); and (d) self-harm, PR = 1.47 (95% CI 1.29-1.67) and suicide attempts, PR = 2.37 (95% CI 2.05-2.73).

CONCLUSIONS

ADHD is overrepresented among women with cardiometabolic conditions and contributes substantially to other psychiatric comorbidities among women with cardiometabolic conditions.

First Onset in Adulthood of Mental Disorders: Exposure to War vs. Non-war Childhood Adversities: A National Study

Background

There is evidence that some childhood trauma increases the risk of the first onset of mental disorders and for the first time into adulthood. There are no studies that assessed whether exposure to war has this delayed long-term effect.

Objectives

To fill this gap by investigating the comparative roles of war and non-war trauma on the first onset of adulthood mood and anxiety disorders.

Methods

A nationally representative sample of 2,857 Lebanese was assessed using the World Health Organization Composite International Diagnostic Interview 3.0. with the onset of exposure to trauma and of first onset of mood and anxiety disorders.

Results

Non-war childhood traumata especially those belonging to family malfunctioning continue to exert their effect for the first time well beyond their occurrence as they were the most universal predictors for adult onset of both mood and anxiety disorders. War trauma during childhood predicted mood anxiety and mood (anxiety only in males) only below age 18 y. war childhood trauma predicts the first onset of mood and anxiety disorders before age 18 y in females, but only anxiety in males.

Conclusion

Childhood traumata are not equal in predicting the first onset of mood and anxiety disorders into adulthood. Family malfunctioning looks to carry the longest such risk and war more of shorter immediate effects. This might change though with re-exposure to war in adulthood which might unravel dormant vulnerability.

Taste receptor type 1 member 3 enables western diet-induced anxiety in mice

BACKGROUND

Accumulating evidence supports that the Western diet (WD), a diet high in saturated fat and sugary drinks, contributes to the pathogenesis of anxiety disorders, which are the most prevalent mental disorders worldwide. However, the underlying mechanisms by which WD causes anxiety remain unclear. Abundant expression of taste receptor type 1 member 3 (TAS1R3) has been identified in the hypothalamus, a key brain area involved in sensing peripheral nutritional signals and regulating anxiety. Thus, we investigated the influence of excessive WD intake on anxiety and mechanisms by which WD intake affects anxiety development using wild-type (WT) and Tas1r3 deficient (Tas1r3-/-) mice fed a normal diet (ND) or WD for 12 weeks.

RESULTS

WD increased anxiety in male WT mice, whereas male Tas1r3-/- mice were protected from WD-induced anxiety, as assessed by open field (OF), elevated plus maze (EPM), light-dark box (LDB), and novelty-suppressed feeding (NSF) tests. Analyzing the hypothalamic transcriptome of WD-fed WT and Tas1r3-/- mice, we found 1,432 genes significantly up- or down-regulated as a result of Tas1r3 deficiency. Furthermore, bioinformatic analysis revealed that the CREB/BDNF signaling-mediated maintenance of neuronal regeneration, which can prevent anxiety development, was enhanced in WD-fed Tas1r3-/- mice compared with WD-fed WT mice. Additionally, in vitro studies further confirmed that Tas1r3 knockdown prevents the suppression of Creb1 and of CREB-mediated BDNF expression caused by high levels of glucose, fructose, and palmitic acid in hypothalamic neuronal cells.

CONCLUSIONS

Our results imply that TAS1R3 may play a key role in WD-induced alterations in hypothalamic functions, and that inhibition of TAS1R3 overactivation in the hypothalamus could offer therapeutic targets to alleviate the effects of WD on anxiety.

Persistence of extensively trained avoidance is not elevated in anxiety disorders in an outcome devaluation paradigm

BACKGROUND

A habitual avoidance component may enforce the persistence of maladaptive avoidance behavior in anxiety disorders. Whether habitual avoidance is acquired more strongly in anxiety disorders is unclear.

METHODS

Individuals with current social anxiety disorder, panic disorder and/or agoraphobia (n = 62) and healthy individuals (n = 62) completed a devaluation paradigm with extensive avoidance training, followed by the devaluation of the aversive outcome. In the subsequent test phase, habitual response tendencies were inferred from compatibility effects. Neutral control trials were added to assess general approach learning in the absence of previous extensive avoidance training.

RESULTS

The compatibility effects indicating habitual control did not differ between patients with anxiety disorders and healthy controls. Patients showed lower overall approach accuracy, but this effect was unrelated to the compatibility effects.

CONCLUSIONS

In this study, anxiety disorders were characterized by reduced approach but not stronger habitual avoidance. These results do not indicate a direct association between anxiety disorders and the acquisition of pervasive habitual avoidance in this devaluation paradigm.

The Mind-Body Problem in the Context of Neuropsychiatric Symptoms in Patients with Coronavirus Disease 2019

Objective

This study is to determine the possible pathophysiological parameters associated with the development of anxiety and impaired consciousness in patients with acute coronavirus disease (COVID-19).

Methods

Descriptive pathophysiological and pathopsychological data was collected from 89 patients hospitalized due to COVID-19 across 7 infectious hospitals, where 14 trainees in psychiatry and neurology collected data from December 2020 to June 2021. Contingency tables and logistic regression analyses were made to reveal associations and to detect predictors of patients' states of anxiety or impaired consciousness.

Results

Anxiety and impaired consciousness were observed in 28 patients (31.50%); 22 (25.00%) presented with anxiety symptoms, and 7 (7.90%) had impaired consciousness. The degree of their association was low (Fisher's exact = 0.675 (df = 1), P = .495). Different pathophysiological mechanisms were shown to determine the development of anxiety or impaired consciousness within COVID-19. Predictors of anxiety were oxygen saturation (OR = 1.26; 95% CI, 1.04-1.54; P = .021), cardiovascular disorders (OR = 0.14; 95% CI, 0.04-0.52; P = .003), disorders of the nervous system (OR = 0.05; 95% CI, 0.01-0.84; P = .038), and urogenital system (OR = 0.13; 95% CI, 0.02-0.87; P = .035). The predictive power of the model was 80.23% (P ≤ .001). The development of impaired consciousness was associated with age (OR = 1.11; 95% CI, 1.01-1.21; P = .025) and C-reactive protein level (OR = 1.02; 95% CI, 0.99-1.04; P = .060), and the predictive power of the model was 94.52% (P ≤ .001).

Conclusion

The prevalence of psychopathological disorders associated with acute COVID-19 was high: n = 28 (31.50%) for anxiety and impaired consciousness. Moreover, a 1.00% increase in the saturation index was associated with a 1.3-fold increase in the patient's risk of developing anxiety. Thus, anxiety symptoms may be considered within a personality rather than an infectious-inflammatory response to COVID-19.

Explaining paranoia: cognitive and social processes in the occurrence of extreme mistrust

BACKGROUND

Paranoia-incorrectly thinking that others are deliberating trying to harm you-causes distress, undermines social interactions and leads to withdrawal. It presents across multiple psychiatric diagnoses.

OBJECTIVE

The primary aim was to determine the extent that cognitive and social processes may explain paranoia. The secondary aim was to identify explanatory factors that distinguished paranoia and social anxiety.

METHODS

10 382 UK adults, quota sampled to match the population for age, gender, ethnicity, income and region, participated in a non-probability survey. All participants completed a paranoia measure and assessments of cognitive and social processes. Structural equation modelling was conducted.

FINDINGS

2586 (24.9%) participants described being mistrustful of other people. 1756 (16.9%) participants wanted help to trust more. 66.7% of variance in paranoia was explained by a model comprising (in descending order of importance): within-situation defence behaviours, negative images, negative self-beliefs, discrimination, dissociation, aberrant salience, anxiety sensitivity, agoraphobic distress, worry, less social support, agoraphobic avoidance, less analytical reasoning and alcohol use. All explanatory factors were associated with paranoia and social anxiety. Ten factors were more closely associated with paranoia than social anxiety, including discrimination, hallucinations, negative images, aberrant salience and alcohol use. Nine factors were more closely associated with social anxiety, including less positive self-belief, an external locus of control, worry and less analytical reasoning.

CONCLUSIONS

Multiple causes are likely to be involved in paranoia. Cognitive and social processes may explain a high degree of paranoia.

CLINICAL IMPLICATIONS

Multiple clear targets for intervention to reduce paranoia are identified.

Association of breastfeeding with mental disorders in mother and child: a systematic review and meta-analysis

BACKGROUND

Breastfeeding has long been associated with numerous benefits for both mothers and infants. While some observational studies have explored the relationship between breastfeeding and mental health outcomes in mothers and children, a systematic review of the available evidence is lacking. The purpose of this study is to systematically evaluate the association between breastfeeding and mental health disorders in mothers and children.

METHODS

We systematically searched MEDLINE and EMBASE from inception to June 2, 2023. The inclusion criteria consisted of all studies evaluating links between breastfeeding and development of mental health disorders in children and mothers. Risk of bias was assessed using the Newcastle-Ottawa Scale (NOS) while grading of Recommendations Assessment, Development and Evaluation (GRADE) was used to assess the certainty of evidence. A random-effects meta-analysis was used if possible, to estimate the odds ratio for the association between breastfeeding and mental health outcomes. The Mantel-Haenszel method was utilised for pooling ORs across studies. Study heterogeneity was assessed using the I2 statistic.

RESULTS

Our review identified twenty-one original study. Of these, 18 focused on the association between breastfeeding and child health, assessing depressive disorders, schizophrenia, anxiety disorders, eating disorders and borderline personality disorder. Three studies evaluated the associations between breastfeeding and maternal mental health disorders. Three studies looking at outcomes in children showed no significant association between breastfeeding and occurrence of schizophrenia later in life (OR 0.98; 95% CI 0.57-1.71; I2 = 29%). For depressive disorders (5 studies) and anxiety disorders (3 studies), we found conflicting evidence with some studies showing a small protective effect while others found no effect. The GRADE certainty for all these findings was very low due to multiple limitations. Three studies looking at association between breastfeeding and maternal mental health, were too heterogeneous to draw any firm conclusions.

CONCLUSIONS

We found limited evidence to support a protective association between breastfeeding and the development of mental health disorders in children later in life. The data regarding the association between breastfeeding and maternal mental health beyond the postnatal period is also limited. The methodological limitations of the published literature prevent definitive conclusions, and further research is needed to better understand the relationship between breastfeeding and mental health in mothers and children.