The risk for early-adulthood anxiety and depressive disorders in adolescents with anxiety and depressive disorders

A Multi-Cohort Examination of the Independent Contributions of Maternal Childhood Adversity and Pregnancy Stressors to the Prediction of Children's Anxiety and Depression

Women's social experiences can have long-term implications for their offspring's health, but little is known about the potential independent contributions of multiple periods of stress exposures over time. This study examined associations of maternal exposure to adversity in childhood and pregnancy with children's anxiety and depression symptoms in a large, sociodemographically diverse sample. Participants were 1389 mother-child dyads (child age M = 8.83 years; SD = 0.66; 42% Black, 42% White; 6% Hispanic) in the ECHO-PATHWAYS Consortium's three U.S. pregnancy cohorts. Women reported their exposure to childhood traumatic events (CTE) and pregnancy stressful life events (PSLE). Children self-reported on their symptoms of anxiety and depression at age 8-9 years. Regression analyses estimated associations between maternal stressors and children's internalizing problems, adjusting for confounders, and examined child sex as a modifier. Exploratory interaction analyses examined whether geospatially-linked postnatal neighborhood quality buffered effects. In adjusted models, PSLE counts positively predicted levels of children's anxiety and depression symptoms ([ßAnxiety=0.08, 95%CI [0.02, 0.13]; ßDepression=0.09, 95%CI [0.03, 0.14]); no significant associations were observed with CTE. Each additional PSLE increased odds of clinically significant anxiety symptoms by 9% (95%CI [0.02, 0.17]). Neither sex nor neighborhood quality moderated relations. Maternal stressors during pregnancy appear to have associations with middle childhood anxiety and depression across diverse sociodemographic contexts, whereas maternal history of childhood adversity may not. Effects appear comparable for boys and girls. Policies and programs addressing prevention of childhood internalizing symptoms may benefit from considering prenatal origins and the potential two-generation impact of pregnancy stress prevention and intervention.

Functional role of frontal electroencephalogram alpha asymmetry in the resting state in patients with depression: A review

Depression is a psychological disorder that affects the general public worldwide. It is particularly important to make an objective and accurate diagnosis of depression, and the measurement methods of brain activity have gradually received increasing attention. Resting electroencephalogram (EEG) alpha asymmetry in patients with depression shows changes in activation of the alpha frequency band of the left and right frontal cortices. In this paper, we review the findings of the relationship between frontal EEG alpha asymmetry in the resting state and depression. Based on worldwide studies, we found the following: (1) Compared with individuals without depression, those with depression showed greater right frontal EEG alpha asymmetry in the resting state. However, the pattern of frontal EEG alpha asymmetry in the resting state in depressive individuals seemed to disappear with age; (2) Compared with individuals without maternal depression, those with maternal depression showed greater right frontal EEG alpha asymmetry in the resting state, which indicated that genetic or experience-based influences have an impact on frontal EEG alpha asymmetry at rest; and (3) Frontal EEG alpha asymmetry in the resting state was stable, and little or no change occurred after antidepressant treatment. Finally, we concluded that the contrasting results may be due to differences in methodology, clinical characteristics, and participant characteristics.

Differential effects of emotional valence on mnemonic performance with greater hippocampal maturity

The hippocampal formation (HF) facilitates declarative memory, with subfields providing unique contributions to memory performance. Maturational differences across subfields facilitate a shift toward increased memory specificity, with peripuberty sitting at the inflection point. Peripuberty is also a sensitive period in the development of anxiety disorders. We believe HF development during puberty is critical to negative overgeneralization, a common feature of anxiety disorders. To investigate this claim, we examined the relationship between mnemonic generalization and a cross-sectional pubertal maturity index (PMI) derived from partial least squares correlation (PLSC) analyses of subfield volumes and structural connectivity from T1-weighted and diffusion-weighted scans, respectively. Participants aged 9-14 yr, from clinical and community sources, performed a recognition task with emotionally valent (positive, negative, and neutral) images. HF volumetric PMI was positively associated with generalization for negative images. Hippocampal-medial prefrontal cortex connectivity PMI evidenced a behavioral relationship similar to that of the HF volumetric approach. These findings reflect a novel developmentally related balance between generalization behavior supported by the hippocampus and its connections with other regions, with maturational differences in this balance potentially contributing to negative overgeneralization during peripuberty.

Estimating the Long-Term Causal Effects of Attending Historically Black Colleges or Universities on Depressive Symptoms

Racism is embedded in society, and higher education is an important structure for patterning economic and health outcomes. Historically Black Colleges and Universities (HBCUs) were founded on antiracism while predominantly White institutions (PWIs) were often founded on white supremacy. This contrast provides an opportunity to study the association between structural racism and health among Black Americans. We used the National Longitudinal Study of Adolescent to Adult Health (Add Health) to estimate the long-term causal effect of attending an HBCU (vs. PWI) on depressive symptoms among Black students in the United States from 1994-2018. While we found no overall association with attending an HBCU (vs. PWI) on depressive symptoms, we found that this association varied by baseline mental health and region, and across time. For example, among those who attended high school outside of the South, HBCU attendance was protective against depressive symptoms 7 years later, and the association was strongest for those with higher baseline depressive symptoms. We recommend equitable state and federal funding for HBCUs, and that PWIs implement and evaluate antiracist policies to improve mental health of Black students.

Amygdala AVPR1A mediates susceptibility to chronic social isolation in females

Females are more sensitive to social exclusion, which could contribute to their heightened susceptibility to anxiety disorders. Chronic social isolation stress (CSIS) for at least 7 weeks after puberty induces anxiety-related behavioral adaptations in female mice. Here, we show that Arginine vasopressin receptor 1a ( Avpr1a )-expressing neurons in the central nucleus of the amygdala (CeA) mediate these sex-specific effects, in part, via projections to the caudate putamen. Loss of function studies demonstrate that AVPR1A signaling in the CeA is required for effects of CSIS on anxiety-related behaviors in females but has no effect in males or group housed females. This sex-specificity is mediated by AVP produced by a subpopulation of neurons in the posterodorsal medial nucleus of the amygdala that project to the CeA. Estrogen receptor alpha signaling in these neurons also contributes to preferential sensitivity of females to CSIS. These data support new therapeutic applications for AVPR1A antagonists in women.

Changes in the adult consequences of adolescent mental ill-health: findings from the 1958 and 1970 British birth cohorts

BACKGROUND

Adolescent mental health difficulties are increasing over time. However, it is not known whether their adulthood health and socio-economic sequelae are changing over time.

METHODS

Participants (N = 31 349) are from two prospective national birth cohort studies: 1958 National Child Development Study (n = 16 091) and the 1970 British Cohort Study (n = 15 258). Adolescent mental health was operationalised both as traditional internalising and externalising factors and a hierarchical bi-factor. Associations between adolescent psychopathology and age 42 health and wellbeing (mental health, general health, life satisfaction), social (cohabitation, voting behaviour) and economic (education and employment) outcomes are estimated using linear and logistic multivariable regressions across cohorts, controlling for a wide range of early life potential confounding factors.

RESULTS

The prevalence of adolescent mental health difficulties increased and their associations with midlife health, wellbeing, social and economic outcomes became more severe or remained similar between those born in 1958 and 1970. For instance, a stronger association with adolescent mental health difficulties was found for those born in 1970 for midlife psychological distress [odds ratio (OR) 1970 = 1.82 (1.65-1.99), OR 1958 = 1.60 (1.43-1.79)], cohabitation [OR 1970 = 0.64 (0.59-0.70), OR 1958 = 0.79 (0.72-0.87)], and professional occupations [OR 1970 = 0.75 (0.67-0.84), OR 1958 = 1.05 (0.88-1.24)]. The associations of externalising symptoms with later outcomes were mainly explained by their shared variance with internalising symptoms.

CONCLUSION

The widening of mental health-based inequalities in midlife outcomes further supports the need to recognise that secular increases in adolescent mental health symptoms is a public health challenge with measurable negative consequences through the life-course. Increased public health efforts to minimise adverse outcomes are needed.

Prediction of clinical anxious and depressive problems in mid childhood amongst temperamentally inhibited preschool children: a population study

Shy/inhibited young children are at risk for internalising difficulties; however, for many, this temperamental style does not result in mental health problems. This study followed a population-based sample of temperamentally inhibited preschool children into mid childhood to explore the aetiology of clinical-level anxious and depressive problems. Amongst inhibited preschool children, we aimed to predict each of clinical child anxiety and depressive problems in mid childhood from a broad range of potential risks (demographics, traumatic events and broader recent stressors, parents' well-being, and parenting practices). This study is based on data from a wider population trial of Cool Little Kids that recruited a representative sample of inhibited preschool children enrolled in their year before starting school. In 2011-2012, an inhibition screen was universally distributed to parents of children in their year before school (age 4 years) across eight diverse government areas in Melbourne, Australia. Participants were 545 parents of inhibited preschoolers (78% uptake, 545/703) who were followed to mid childhood (three annual waves 2015-2017, age 7-10 years) with 84% retention (456/545). Parents completed questionnaires spanning child ages 4-10 years, along with diagnostic interviews for child anxiety. Children also completed questionnaires in mid childhood. The questionnaires encompassed a variety of potential risks including sociodemographics, traumatic events, recent life stressors, parent wellbeing and parenting practices. In mid childhood, 57% (246/430) of inhibited preschoolers had a clinical level of anxiety problems while 22% (95/432) had depressive problems (by one or more sources). The aetiology analyses highlighted parent distress and parenting practices (overinvolved/protective, harsh discipline) as key predictors of inhibited preschoolers' internalising problems by mid childhood. Some high-risk families may not have participated. Child depression was not assessed with a diagnostic interview. The measures did not include every possible risk factor. The findings lend support to parenting programs for shy/inhibited young children that aim to prevent the development of anxiety and depression as they grow.

Efficacy and safety of serotonin reuptake inhibitors (SSRI) and serotonin noradrenaline reuptake inhibitors (SNRI) for children and adolescents with anxiety disorders: a systematic review and meta-analysis

PURPOSE

To assess the efficacy and safety of selective serotonin reuptake inhibitors (SSRIs) and selective noradrenaline reuptake inhibitors (SNRIs) in comparison with various control contingencies (e.g. pill placebo and cognitive behavioral treatment) for pediatric anxiety disorders. Additionally, we wanted to investigate whether serious adverse events or adverse events are more common with medication treatment compared with pill placebo.

MATERIALS AND METHODS

Studies were selected if they were randomized controlled trials evaluating SSRIs or SNRIs. Eligible studies included participants aged 17 years or younger. Eleven studies were included, with 2122 participants. Primary outcomes were (1) remission, (2) a continuous scale such as the Social Phobia and Anxiety Inventory for Children and (3) serious adverse events. We also calculated number needed to treat and number needed to harm.

RESULTS

SSRIs and SNRIs are an effective treatment of childhood anxiety disorders and are superior to pill placebo. While the risk of serious adverse events was low with SSRI/SNRI treatment, there was an increased risk of experiencing behavioral activation with SSRI/SNRI treatment.

CONCLUSION

SSRI and SNRI treatment is effective for childhood anxiety disorders, with positive effect of treatment outweighing the negative effects.

Parent-identified barriers to accessing exposure therapy: A qualitative study using process mapping

Background

Youth with anxiety and obsessive-compulsive disorder (OCD) rarely access exposure therapy, an evidence-based treatment. Known barriers include transportation, waitlists, and provider availability. Efforts to improve access to exposure require an understanding of the process that families take to find therapists, yet no prior studies have examined parents' perspectives of the steps involved.

Methods

Parents of children who have received exposure therapy for anxiety and/or OCD (N = 23) were recruited from a hospital-based specialty anxiety clinic where the majority of their children previously received exposure. Recruitment was ongoing until thematic saturation was reached. Parents completed questionnaires and attended an online focus group during which they were asked to describe each step they took-from recognizing their child needed treatment to beginning exposure. A process map was created and shown in real-time, edited for clarity, and emailed to parents for member checking. Authors analyzed process maps to identify common themes.

Results

Several themes emerged, as visually represented in a final process map. Participants identified a "search-outreach" loop, in which they repeated the cycle of looking for therapists, contacting them, and being unable to schedule an appointment due to factors such as cost, waitlists, and travel time. Parents often did not know about exposure and reported feeling guilty about their lack of knowledge and inability to find a suitable provider. Parents reported frustration that medical providers did not often know about exposure and sometimes dismissed parents' concerns. Participants emphasized the difficulty of navigating the mental health system; many reported that it took years to find an exposure therapist, and that the search was sometimes stalled due to fluctuating symptoms.

Conclusion

A common thread among identified barriers was the amount of burden placed on parents to find treatment with limited support, and the resultant feelings of isolation and guilt. Findings point to several directions for future research, such as the development of parent support groups for navigating the mental health system; enhancing coordination of care between medical and mental health providers; and streamlining referral processes.

A Pragmatic Randomized Controlled Trial Targeting Perfectionism in Young Adolescents

Perfectionism has adverse impacts on mental health and academic outcomes. We evaluated a 5-lesson classroom intervention for young adolescents delivered by teachers for impact on perfectionism, well-being, self-compassion, academic motivation and negative affect, at post-intervention and 3-month follow-up. Classes (N = 636 students, M _age = 13.68, SD = 0.60) were randomized to intervention (n = 343) or classes as usual (n = 293). Data were analyzed using linear mixed models adjusted for baseline observation and clustering. At post-intervention no differences were found between the groups. At 3-month follow-up, anxiety showed a significant increase in the control group with no increase in the intervention group (d = 0.23; 95% CI: 0.05, 0.40); females in the control group had a significant decrease in well-being from post-intervention to 3 month follow-up compared to the intervention group (d = 0.33; 95% CI: 0.08, 0.58); students with high levels of perfectionistic concerns in the intervention had significantly lower perfectionistic strivings at 3 month follow-up than the control group ((d = 0.34, 95% CI: 0.19, 0.49). This intervention shows promising results when delivered by teachers. Australian New Zealand Clinical Trials Registry (ANZCTR) Trial Number: ACTRN12621000457842 (April 19, 2021).

Supplementary Information

The online version contains supplementary material available at 10.1007/s12310-022-09540-3.

Psychological legacies of intergenerational trauma under South African apartheid: Prenatal stress predicts greater vulnerability to the psychological impacts of future stress exposure during late adolescence and early adulthood in Soweto, South Africa

BACKGROUND

South Africa's rates of psychiatric morbidity are among the highest in sub-Saharan Africa and are foregrounded by the country's long history of political violence during apartheid. Growing evidence suggests that in utero stress exposure is a potent developmental risk factor for future mental illness risk, yet the extent to which the psychiatric effects of prenatal stress impact the next generation are unknown. We evaluate the intergenerational effects of prenatal stress experienced during apartheid on psychiatric morbidity among children at ages 17-18 and also assess the moderating effects of maternal age, social support, and past household adversity.

METHODS

Participants come from Birth-to-Twenty, a longitudinal birth cohort study in Soweto-Johannesburg, South Africa's largest peri-urban township which was the epicentre of violent repression and resistance during the final years of the apartheid regime. Pregnant women were prospectively enrolled in 1990 and completed questionnaires assessing social experiences, and their children's psychiatric morbidity were assessed at ages 17-18.

RESULTS

Full data were available from 304 mother-child pairs in 2007-8. Maternal prenatal stress in 1990 was not directly associated greater psychiatric morbidity during at ages 17-18. Maternal age and past household adversity moderated the intergenerational mental health effects of prenatal stress such that children born to younger mothers and late adolescent/young adult children experiencing greater household adversity exhibited worse psychiatric morbidity at ages 17-18. Social support did not buffer against the long-term psychiatric impacts of prenatal stress.

CONCLUSIONS

Greater prenatal stress from apartheid predicted adverse psychiatric outcomes among children born to younger mothers and adolescents/young adults who experienced greater concurrent stress. Our findings suggest that prenatal stress may affect adolescent mental health, have stress-sensitising effects, and represent possible intergenerational effects of trauma experienced under apartheid in this sample.

Striatal Activity to Reward Anticipation as a Moderator of the Association Between Early Behavioral Inhibition and Changes in Anxiety and Depressive Symptoms From Adolescence to Adulthood

Importance

The early childhood temperament of behavioral inhibition (BI), characterized by inhibited and fearful behaviors, has been associated with heightened risk for anxiety and depression across the lifespan. Although several neurocognitive correlates underlying vulnerability to the development of anxiety among inhibited children have been identified, little is known about the neurocognitive correlates underlying vulnerability to the development of depression.

Objective

To examine whether blunted striatal activation to reward anticipation, a well-documented neurocognitive vulnerability marker of depression, moderates the association between early BI and the developmental changes in depression and anxiety from adolescence to adulthood.

Design, Setting, and Participants

Participants in this prospective longitudinal study were recruited at age 4 months between 1989 and 1993 in the US. Follow-up assessments extended into 2018 (age 26 years). Data were analyzed between September 2021 to March 2022.

Main Outcomes and Measures

BI was measured through an observation paradigm in infancy (ages 14 and 24 months). Neural activity to anticipated rewards during a monetary incentive delay task was measured using functional magnetic resonance imaging in adolescence (between ages 15-18 years; 83 individuals had usable data). Anxiety and depressive symptoms were self-reported across adolescence to young adulthood (ages 15 and 26 years; n = 108). A latent change score model, accounting for the interdependence between anxiety and depression, tested the moderating role of striatal activity to reward anticipation in the association between early BI and changes in anxiety and depressive symptoms. A region of interest approach limited statistical tests to regions within the striatum (ie, nucleus accumbens, caudate head, caudate body, putamen).

Results

Of 165 participants, 84 (50.1%) were female and 162 (98%) were White. Preliminary analyses revealed significant increases in anxiety and depressive symptoms across ages 15 to 26 years, as well as individual variation in the magnitude of changes. Main analyses showed that reduced activity in the nucleus accumbens to reward anticipation moderated the association between early BI and increases in depressive (β = -0.32; b = -4.23; 95% CI, -7.70 to -0.76; P = .02), and more depressive symptoms at age 26 years (β = -0.47; b = -5.09; 95% CI, -7.74 to -2.43; P < .001). However, there were no significant interactions associated with latent changes in anxiety across age nor anxiety at age 26 years. Activity in the caudate and putamen did not moderate these associations.

Conclusions and Relevance

Blunted reward sensitivity in the ventral striatum may be a developmental risk factor connecting an inhibited childhood temperament and depression over the transition to adulthood. Future studies should examine the efficacy of prevention programs, which target maladaptive reward processing and motivational deficits among anxious youths, in reducing risks for later depression.

Pediatric anxiety and daily fine particulate matter: A longitudinal study

Daily variations in ambient fine particulate matter (PM_2.5) could contribute to the morbidity of anxiety disorders in children and adolescents, but has not yet been studied longitudinally at a daily level. We tested this association using repeated weekly measures of anxiety symptom severity in a group of 23 adolescents with generalized anxiety disorder. After estimating ambient PM_2.5 concentrations using a validated model, we found that increased concentrations were significantly associated with increased anxiety symptom severity and frequency two, three, and four days later. PM_2.5 may be a novel, modifiable exposure that could inform population level interventions to decrease psychiatric morbidity.

A dual-system, machine-learning approach reveals how daily pubertal hormones relate to psychological well-being in everyday life

The two studies presented in this paper seek to resolve mixed findings in research linking activity of pubertal hormones to daily adolescent outcomes. In study 1 we used a series of Confirmatory Factor Analyses to compare the fit of one and two-factor models of seven steroid hormones (n = 994 participants, 8084 samples) of the HPA and HPG axes, using data from a field study (https://www.icpsr.umich.edu/web/ICPSR/studies/38180) collected over ten consecutive weekdays in a representative sample of teens starting high school. In study 2, we fit a Bayesian model to our large dataset to explore how hormone activity was related to outcomes that have been demonstrated to be linked to mental health and wellbeing (self-reports of daily affect and stress coping). Results reveal, first that a two-factor solution of adolescent hormones showed good fit to our data, and second, that HPG activity, rather than the more often examined HPA activity, was associated with improved daily affect ratios and stress coping. These findings suggest that field research, when it is combined with powerful statistical techniques, may help to improve our understanding of the relationship between adolescent hormones and daily measures of well-being.

Early exposure to flame retardants is prospectively associated with anxiety symptoms in adolescents: A prospective birth cohort study

BACKGROUND

Anxiety disorders emerge during childhood and adolescence and are frequently preceded by subsyndromal anxiety symptoms. Environmental toxicants, including gestational polybrominated diphenyl ether (PBDE) exposure, are associated with neuropsychiatric sequelae; however, the role of PBDEs as risk factors for anxiety in adolescence is unclear.

METHODS

Using data from the Health Outcomes and Measures of the Environment (HOME) Study, a prospective pregnancy and birth cohort enrolled from 2003 to 2006, we investigated the relationship between gestational serum PBDE concentrations and anxiety symptoms in adolescents (N = 236). We measured five PBDE congeners (PBDE-28, -47, -99, -100, and -153) at 16 ± 3 weeks of gestation and calculated their sum (∑PBDE). We assessed self-reported anxiety symptoms using the Screen for Child Anxiety Related Emotional Disorders (SCARED) and depressive symptoms using the Children's Depression Inventory (CDI-2) at age 12 years. We estimated the associations of maternal PBDE concentrations with child anxiety and depressive symptoms using multivariable linear regression and modified Poisson regression. Covariates included child sex, maternal race, maternal age at delivery, maternal marital status, maternal education, and household income at the 12-year study visit as well as maternal depressive and anxiety symptoms. Sensitivity analyses were performed to control for maternal lead and mercury at delivery.

RESULTS

After adjusting for predetermined covariates, each doubling in maternal PBDE concentrations was associated with increased SCARED scores (e.g., for ∑PBDE, SCARED total score, β = 1.6 95% confidence interval [CI]: 0.3-2.9, p = .019) and a nonsignificant increase in depressive symptoms (e.g., for CDI total score, β = .8, 95% CI: -0.2-1.8, p = .11).

CONCLUSIONS

Gestational serum PBDE concentrations just before mid-pregnancy and during a period of active cortical and limbic neurogenesis, synaptogenesis and myelogenesis may be a risk factor for developing anxiety symptoms in early adolescence.

The relationship between anxiety and depression under the pandemic: The role of life meaning

Introduction

COVID-19 is a stressor creating much anxiety for the general public, such as anxiety related to possible infection, social distancing, financial strain and uncertainty. As the scientific literature shows that there is an intimate relationship between anxiety and depression, it is important to ask whether anxiety is related to depression under the pandemic and whether spirituality indexed by life meaning can moderate the relationship between anxiety and depression. According to theories highlighting the importance of life meaning, relative to people with a higher level of life meaning, the relationship between anxiety and depression would be stronger in people with a lower level of life meaning.

Methods

Empirically, we collected data in two waves (i.e., before and after the first wave of COVID-19, respectively) from 4,981 adolescents recruited in Sichuan, China. Then, the 41-item "Screen for Child Anxiety Related Emotional Disorders" was employed to measure anxiety symptoms, 20-item "Center for Epidemiological Studies-Depression Scale" was utilized to examine depression symptoms, and the "Spirituality Subscale of the Chinese Positive Youth Development Scale" for assessing life meaning.

Results

We found that anxiety significantly predicted depression at each wave and across time. Second, controlling for Wave 1 depression scores, results showed that a drop in Wave 1 anxiety predicted a drop in depressive symptoms over time. Regarding the relationship between meaning in life and depression, spirituality indexed by meaning in life negatively predicted depression at each wave and over time, and predicted change in depression across time. Finally, multiple regression analyses showed that life meaning moderated the predictive effect of anxiety on depression.

Discussion

The findings support the thesis that spirituality serves as a protective factor for psychological morbidity in Chinese adolescents. The study also suggests the importance of helping adolescents to develop life meaning under COVID-19.

Review: Economic evidence of preventive interventions for anxiety disorders in children and adolescents - a systematic review

BACKGROUND

Anxiety disorders are common in children and youth. Also, in prevention, be it universal, selective or indicated, economic evaluation supports decision-making in the allocation of scarce resources. This review identified and summarised the existing evidence of economic evaluations for the prevention of anxiety disorders in children and adolescents.

METHODS

A systematic search was conducted on the EBSCO, Scopus, Web of Science, ProQuest, Cochrane and PubMed databases. We included studies that focused on children and adolescents under 18 years of age, aimed to prevent anxiety disorders and presented an incremental analysis of costs and effectiveness. A registered checklist was used that assessed the quality of the included articles.

RESULTS

The search yielded 1697 articles. Five articles were included in this review. Three were RCT-based, and two were model-based studies. Out of five included interventions, one was a universal school-based intervention, two selective interventions and two indicated interventions. Universal school-based prevention of anxiety was not cost-effective compared with usual teaching. Selective parent training and indicative child- and parent-focused CBT prevention were likely cost-effective compared with usual care or doing nothing.

CONCLUSION

Parent education and cognitive behaviour therapy interventions can be cautiously interpreted as being a cost-effective way of preventing anxiety in children and adolescents. However, the evidence is weakly related to cost-effectiveness as there are only a few studies, with relatively small sample sizes and short follow-ups.

The Relation Between the Paraphilias and Anxiety in Men: A Case-Control Study

Despite a multitude of theoretical views, it is still unclear how individuals develop and sustain paraphilic interests (e.g., sexual attraction to children, interest in non-consensual violence). It is also not clear from these views why many paraphilic interests, and especially many paraphilias and paraphilic disorders, are much more common in men than in women. One possible factor affecting male's higher rate of paraphilias is anxiety, because anxiety can potentiate sexual arousal in men. We speculated that paraphilic interests could develop when feelings of anxiety are recurrently generated by atypical sexual stimuli, and when that anxiety repeatedly potentiates sexual arousal, reinforcing sexual response to atypical stimuli. It follows that men with paraphilic interests are susceptible to anxiety disorders, because an anxiety disorder would facilitate the hypothesized developmental process. We conducted a retrospective file review of 1048 consecutive patients (944 male patients retained for analysis) referred to an outpatient sexual behavior clinic at a psychiatric hospital to investigate the link between paraphilias and anxiety. Male patients with a paraphilia had 1.64 greater odds than male patients without a paraphilia of having been diagnosed with an anxiety disorder, but they also had elevated rates of many other types of disorders. Therefore, there does not seem to be a specific link between paraphilias and anxiety in this sample. The discovery of a general link between the paraphilias and psychological disorders in men opens new avenues for studying the developmental origins and consequences of male paraphilic interests.

Exploring the association of interleukin polymorphisms with aggression and internalizing behaviors in children and adolescents

BACKGROUND

There is growing evidence that inflammation influences mental health. Blood interleukin levels, which regulate inflammation, have been linked to aggression and internalizing behaviors. We performed a hypothesis-driven genetic study to (1) evaluate the association of IL1B, IL2, and IL6 gene variants with aggression and internalizing behaviors and (2) explore gene-environment interactions with childhood adversity in a deeply phenotyped childhood-onset aggression sample including 255 cases and 226 controls of European ancestry.

METHODS

We evaluated the association of putative functional and tag SNPs within IL1B, IL2, and IL6 with aggression case status, parent-reported internalizing problems, self-reported anxiety symptoms, and self-reported depressive symptoms in our sample. We also performed exploratory GxE analyses within cases, testing for statistical interaction between interleukin SNP genotype and childhood adversity for depressive symptoms.

RESULTS

No significant association was observed between any of the interleukin SNPs and childhood-onset aggression. We observed association of IL6 variant rs2069827 with depressive symptoms (p = 7.15×10^-4 ), and trends for an interaction between severe childhood adversity and SNPs in IL1B and IL2 for depressive symptoms.

CONCLUSIONS

Our findings provide preliminary evidence that common variation in IL6 may be associated with depressive symptoms in children and adolescents, and that common variation in interleukin genes may sensitize individuals to the depressogenic effects of traumatic life experiences. Replication in independent samples is needed.

Comparison of the effectiveness of online supportive parenting intervention (SPACE) and timid to tiger program (FTTT) on childhood anxiety disorders and family accommodation with samples of Iranian parents

Studies have supported the effectiveness of the From Timid to a Tiger (FTTT) and Supportive Parenting for Anxious Childhood Emotions (SPACE) program in reducing childhood anxiety. This study is the first to compare the effectiveness of the two programs in the treatment of childhood anxiety disorder and reducing family accommodations levels. Parents of children aged 6 to 9 (n = 49, 49% boys) were randomly allocated to either FTTT (n 26) or SPACE (n = 23) groups, and each attended ten online sessions following the manuals of the interventions. Throughout the study, 9 participants dropped out, resulting in a total of 49 participants, and we performed statistical analyses based on data from these 49 participants. The assessment took place pre- and post-treatment and at a ten-week follow-up on parent-rated child anxiety and family accommodation measures. Analyses of variance (repeated measures) and gain scores were conducted to examine the data. The results indicated that both treatments approaches produced significant reductions in outcome measures, and the post-treatment gains of both treatments were maintained at a ten-week follow-up, though when considering the mean differences and effect sizes across the assessment scores and between groups, overall, the FTTT was significantly more effective in reducing child anxiety scores and family accommodation levels. Our results demonstrated that FTTT significantly outperformed the SPACE program in reducing childhood anxiety problems and family accommodation levels.

Effectiveness of an add-on guided internet-based emotion regulation training (E-TRAIN) in adolescents with depressive and/or anxiety disorders: study protocol for a multicenter randomized controlled trial

BACKGROUND

During adolescence, depressive and anxiety disorders are among the most common mental health disorders. Both disorders tend to persist, are predictive for other mental disorders, and are associated with severe impairment in diverse areas. Although Cognitive Behavioral Therapy (CBT) has proven to be an effective treatment, a considerable number of adolescents do not respond to CBT and residual symptoms often remain. Therefore, it is of great importance to improve treatment outcomes for depressed and/or anxious adolescents. Dysfunctional emotion regulation appears to be a transdiagnostic factor in the development and maintenance of aforementioned disorders. Enhancing emotion regulation skills may therefore reduce symptom severity. In light of this, we developed a guided internet-based emotion regulation training (E-TRAIN) that will be added to CBT. This study aims to evaluate the effectiveness of E-TRAIN + CBT compared to CBT alone on depressive and anxiety outcomes among adolescents with depressive and/or anxiety disorder.

METHODS

In this multicenter two-arm randomized controlled trial with parallel group design, we aim to include 138 adolescents, aged 13-19 years, referred for treatment and diagnosed with depressive and/or anxiety disorder. Participants will be allocated to either CBT or CBT + E-TRAIN. Assessments will take place at baseline, and at 3 (T1), 6 (T2) and 12 (T3) months after baseline. We will conduct multi-informant assessments: the adolescent, a parent/caregiver, and the CBT therapist will be asked to fill in questionnaires. The continuous primary outcome measure is self-reported depressive and anxiety symptoms at six months after baseline, measured with the RCADS25. Secondary outcome measures include anxiety or depression diagnosis based on a semi-structured clinical interview, emotion (dys) regulation, and parent-report measures of anxiety, depression and emotion (dys) regulation.

DISCUSSION

This study is the first randomized controlled trial to examine the additional value of a guided internet-based emotion regulation training to regular CBT in adolescents with depressive and/or anxiety disorders. If this intervention is effective, it can be implemented in mental health care and improve treatment for these young people.

TRIAL REGISTRATION

Registered on June 23, 2021 in The Netherlands Trial Register (NL9564). Retrospectively registered. Recruitment started in May 2021 and is ongoing.

Health-Related Fitness as a Predictor of Anxiety Levels Among School Adolescents: An observational cross-sectional study

Background

There is an inverse association between cardiorespiratory fitness and general anxiety levels in adolescents. Obesity also is associated with a higher risk of anxiety in this population. However, little is known about the association between other health-related fitness elements with anxiety symptoms in this population. The authors explored the relationship between health-related fitness and anxiety symptoms in a large sample of Brazilian youth.

Methods

This was an observational cross-sectional study with a sample comprised of 257 school adolescents, who were 136 girls (52.9%) and 121 boys (47.1%). The health-related fitness elements were evaluated by FitnessGram® test and anxiety levels by Multidimensional Anxiety Scale for Children - 39. Hierarchical regression analyses were used to determine the association between health-related fitness elements and anxiety symptoms in both sexes.

Results

In male adolescents, only the cardiorespiratory fitness was significantly associated with anxiety symptoms (F_{(1, 119)} = 6.472; P = 0.012; R² = 0.052; adjusted R² = 0.044). In turn, the anxiety symptoms showed an inverse small relationship with cardiorespiratory fitness (r = - 0.227; P < 0.01). However, in female adolescents, no association was found between health-related fitness elements and anxiety symptoms.

Conclusion

The level of cardiorespiratory fitness may represent a marker of anxiety in male adolescents.

A Randomised Crossover Trial of Behaviour Guidance Techniques on Children with Special Health Care Needs during Dental Treatment: The Physiological Variations

Passive immobilisation is regarded as able to potentially cause physical distress and intense anxiety manifestations. The study aims to investigate the physiological variations of children with special health care needs while using a Papoose board and a combination of basic behaviour guidance during dental treatment. This is a randomised crossover trial involving 90 children with special health care needs receiving standard dental care with two methods of behaviour guidance sequentially. Exposure A is a combination of tell-show-do, distraction, and positive reinforcement, while exposure B is passive immobilisation with a Papoose board. The subject child’s blood pressure, heart rate, and oxygen saturation level were measured at four different times during dental treatment. In total, 74 children’s physiological data were successfully collected with a mean age of 9.85 years (SD = 2.71). Further, 64.9% of the children were diagnosed with autism spectrum disorder, 12.2% with attention deficit hyperactivity disorder, 9.5% with intellectual disability, 8.1% with Down syndrome, 2.2% with global developmental delay, and 1.1% with dyslexia and cerebral palsy, respectively. The measurement of children’s blood pressure, heart rate, and oxygen saturation level with the application of a Papoose board or a combination of the basic behaviour guidance revealed no significant changes (p > 0.05). The use of a Papoose board is safe and has no discernible influence on the child’s physiological responses.

Mental health of Turkish medical students during the COVID-19 pandemic

BACKGROUND

The coronavirus disease emerged in 2019, spread in Turkey as all over the world rapidly. In this process, young people began to experience some mental problems due to the fear of contagion, as well as some changes in their lifestyles.

AIMS

In this study it is aimed to investigate anxiety and depression levels of medical school students and the factors associated with these mental problems.

METHOD

The forms were sent over the internet to the officials responsible for medical education at universities in various regions of Turkey. A total of 2,778 medical faculty students were included in the study. Students were asked to fill out the sociodemographic data form, the Patient Health Questionnaire - 9 (PHQ-9), and the Generalized Anxiety Disorder-7 (GAD-7) Test.

RESULTS

Students' 67.3% were female and 31.7% were male. About 90.2% of the students in the PHQ-9 scale had depressive symptoms in the major depressive disorder (MDD) dimension, and 44.5% in the GAD-7 scale had moderate/severe anxiety symptoms. Gender, being a preclinical student, history of psychiatric treatment in the past, currently receiving psychiatric treatment, death of someone due to pandemic, economic and health situation, perception of mental health were found associated with MDD and Moderate/Severe Anxiety symptoms. Students with Anxiety and MDD reported significantly more anxiety about contamination and negative beliefs about precautions' sufficiency.

CONCLUSIONS

It was determined that medical school students in our country showed anxiety and depression at a remarkable level during the pandemic. Examining the underlying causes of these high rates will be beneficial in terms of taking precautions during the long-term pandemic. In literature, there are a limited number of studies on this subject in our country, we believe that our study will be useful in future studies to determine the underlying causes of mental illnesses and what can be done to help students.

Is interpretation bias for threat content specific to youth anxiety symptoms/diagnoses? A systematic review and meta-analysis

Anxiety is the most common mental health problem in youth. Numerous studies have identified that youth anxiety is associated with interpretation bias or the attribution of threatening meaning to ambiguity. Interpretation bias has been proposed as a mechanism underlying the development and maintenance of pediatric anxiety. Theoretically, interpretation bias should be content-specific to individual youth anxiety symptom domains. However, extant studies have reported conflicting findings of whether interpretation bias is indeed content specific to youth anxiety symptoms or diagnoses. The present meta-analysis aimed to synthesize the literature and answer the question: is the relationship between interpretation bias and anxiety content specific? Search of PubMed and PsycINFO databases from January 1, 1960 through May 28, 2019 yielded 9967 citations, of which 19 studies with 20 comparisons and 2976 participants met eligibility criteria. Meta-analysis with random effects models was conducted to examine an overall effect (Pearson r) between anxiety domain and content-specific interpretation bias in single sample studies, and an overall effect size difference (Cohen's d) in studies comparing anxious to non-anxious youth. Results support a content specific correlation between interpretation bias and anxiety symptom domain in single sample studies (r = 0.18, p = 0.03). However, it is currently undetermined whether this relationship holds in studies that compare the relationship between content-specific interpretation bias and anxiety in anxious versus non-anxious youth. A variety of methodologic considerations across studies are discussed, with implications for further investigation of interpretation bias and youth anxiety.

Are fearful boys at higher risk for anxiety? Person-centered profiles of toddler fearful behavior predict anxious behaviors at age 6

Dysregulated fear (DF), the presence of fearful behaviors in both low-threat and high-threat contexts, is associated with child anxiety symptoms during early childhood (e.g., Buss et al., 2013). However, not all children with DF go on to develop an anxiety disorder (Buss and McDoniel, 2016). This study leveraged the data from two longitudinal cohorts (N = 261) to (1) use person-centered methods to identify profiles of fearful temperament, (2) replicate the findings linking DF to anxiety behaviors in kindergarten, (3) test if child sex moderates associations between DF and anxiety behaviors, and (4) examine the consistency of findings across multiple informants of child anxiety behaviors. We identified a normative fear profile (low fear in low-threat contexts; high fear in high-threat contexts), a low fear profile (low fear across both low- and high-threat contexts) and a DF profile (high fear across both low- and high-threat contexts). Results showed that probability of DF profile membership was significantly associated with child self-reported overanxiousness, but not with parent-reported overanxiousness. Associations between DF profile membership and overanxiousness was moderated by child sex such that these associations were significant for boys only. Additionally, results showed that probability of DF profile membership was associated with both parent-reported social withdrawal and observations of social reticence, but there were no significant associations with child self-report of social withdrawal. Results highlight the importance of considering person-centered profiles of fearful temperament across different emotion-eliciting contexts, and the importance of using multiple informants to understand associations with temperamental risk for child anxiety.

School-based supports and accommodations among anxious youth in treatment

Within pediatric anxiety, accommodation describes ways caregivers modify their behavior in an effort to alleviate distress shown by anxious youth. In schools, accommodation refers to school-based supports (SBS) placed to increase academic success for students with disabilities. The present study, using school documents provided at treatment, examined the types of SBS provided to youth (N = 76; ages 7-17; mean age 11.07; 47.4 % female) diagnosed with an anxiety disorder. SBS were rated by a panel of youth anxiety experts on the degree to which each SBS promoted (a) approach or (b) avoidance. School documents were coded for the presence of SBS and each SBS received a (a) total approach and (b) total avoidance score. Analyses revealed (a) approach and (b) avoidance promoting SBS were differentially associated with diagnostic status: youth with social anxiety disorder were more likely to be recommended SBS promoting avoidance and youth with a specific phobia were more likely to be recommended SBS promoting approach. Overall, the present study characterizes types of SBS being received by anxious youth and finds that SBS recommended to anxious youth vary in type and quality. Discussion considers the need for observations in schools to further address the merits/demerits of anxiety-related SBS.

Association between family financial decline due to COVID-19 and generalized anxiety disorder among Korean adolescents

BACKGROUND

COVID-19 has had a worldwide economic impact. A decline in family financial level can adversely affect adolescents' mental health. This study examined the association between perceived family financial decline due to COVID-19 and generalized anxiety disorder (GAD) among South Korean adolescents.

METHODS

Data from 54,948 middle and high school students from the 2020 Korea Youth Risk Behavior Survey were collected in this cross-sectional study. The effect of the perceived family financial decline due to COVID-19 related to GAD was analyzed using binary and multinomial logistic regression.

RESULTS

The relationship between perceived family financial decline due to COVID-19 and GAD was linear with increasing odds ratios and confidence intervals (the possibility of GAD, no financial decline: OR 1.00, mild: OR 1.11, CI 1.05-1.17, moderate: OR 1.30, CI 1.22-1.39, severe: OR 1.48, CI 1.34-1.63). Girls, low-income class, and living with family were vulnerable to GAD. GAD levels of mild, moderate, and severe were most likely to occur in each case of mild, moderate, and severe financial decline, respectively.

LIMITATIONS

As this is a cross-sectional study, causality is unknown. Because this study data was self-reported by adolescents, they may have been overestimated or underestimated.

CONCLUSION

GAD in adolescents is closely related to perceived decreased family finances due to COVID-19. The dose-response of GAD according to financial decline became gradually severe. Anxious adolescents were afraid of uncertain and adverse outcomes affecting them or their families. Therefore, there is a vital need to care for financially affected adolescents.

School wellbeing and psychological characteristics of online learning in families of children with and without hearing loss during the Covid-19 pandemic

This study investigated the psychological characteristics of online learning on Italian students with and without hearing loss (HL) and on their parents, who were forced into isolation during the Covid-19 pandemic. An online survey collected information on socio-demographic data and opinions concerning online learning from 61 children (mean age 11; 25 males, 36 females), including 43 with HL and also from their parents; additionally, school wellbeing and anxiety were assessed. The results showed that, in both the student and parent groups, no significant effect of HL on school wellbeing and anxiety was found. Additionally, in parents, State Anxiety was significantly higher than Trait Anxiety, suggesting one possible impact of lockdown on psychological wellbeing. Differences due to HL were observed and discussed in correlation analyses. The Authors believe that this study is the first contribution to the psychological evaluation of the impact of online learning on families with hearing-impaired children, from the perspective of a successful, inclusive didactic.

Family Socioeconomic Status and Internalizing Problem Behavior Among Chinese Adolescents: The Chain Mediation Effect of Academic Performance and Peer Conflict

This study aims to provide a new perspective on the relationship between family socioeconomic status (SES) and internalizing problem behavior (IPB) among adolescents. Many studies have focused on the relationship between family SES and IPB among adolescents; however, research on the underlying mechanism is still insufficient, and peer conflict has been ignored as a crucial social relationship factor for adolescents. This study identifies two new mediating variables and a chain mediating mechanism model between them. Using national longitudinal data from 2,467 adolescents aged 10–15 published in the China Family Panel Studies of wave 2018, this study found the following: (1) higher family SES can significantly reduce peer conflict and IPB among adolescents; (2) adolescents with better academic performance were less likely to be involved in peer conflict; (3) peer conflict mediated 30.41% of the relationship between family SES and adolescent’s IPB; and (4) there was a chain mediating mechanism, and the mediating effect of peer conflict was much stronger than the mediating effect of both academic performance and the chain mediation pathways. This is the first study to develop a chain mediation model to examine the roles of academic achievement and peer conflict in the relationship between family SES and IPB. These findings are significant in that they highlight the importance of providing adolescents with proper emotional de-escalation and peer conflict resolution strategies, contributing to the management of adolescent mental health in urban governance and rural development.

Anxiety problems in children and adolescents: a population-based cohort study on incidence and management in Dutch primary care

BACKGROUND

Due to a large strain on youth mental health care, general practice is suggested as an alternative treatment setting for children and adolescents with anxiety problems. However, research on the current management of these children and adolescents within general practice is scarce.

AIM

To investigate the incidence of coded anxiety in general practice using the International Classification of Primary Care (ICPC), and GPs' management of children and adolescents presenting with anxiety problems.

DESIGN AND SETTING

Population-based cohort study using electronic medical records of 51 212 children (aged 0-17 years) in primary care in the Rotterdam region between 1 January 2012 and 31 December 2018.

METHOD

Incidence of ICPC codes for anxiety were calculated, then the characteristics of children and adolescents consulting their GP with anxiety and the GPs' management were assessed qualitatively using quantitative content analysis.

RESULTS

Incidence of ICPC codes for anxiety in children and adolescents was 5.36 (95% confidence interval [CI] = 5.02 to 5.71) per 1000 person-years. Adolescent females had the highest incidence with 14.01 (95% CI = 12.55 to 15.58) per 1000 person-years. Of the 381 children and adolescents consulting their GP with an initial anxiety problem (median age 13.3 years, 40.4% male), GPs referred 59.3% to mental health care in the first year while 26.5% of children and adolescents were managed by a specialised practice nurse within general practice. Of the 381 children and adolescents, 10.5% received psychiatric medication during the first year, with the trend being for increased prescriptions during adolescence.

CONCLUSION

In general practice children and adolescents frequently received one of two ICPC codes for anxiety, especially adolescent females. Most presenting to their GP with anxiety problems are referred externally or seen by a specialised practice nurse within general practice.

The association between paternal depression and adolescent internalising problems: A test of parenting style as a mediating pathway

Whilst there is a large evidence base demonstrating the impact of maternal depression on the development of adolescent internalising problems, less is known about the association between paternal depression and adolescent internalising problems, and the mechanisms through which risk is conferred. This study examined the association between paternal depression and adolescent internalising problems, investigating parenting style as a pathway through which this association may be mediated. Participants included 4048 families taking part in the Growing Up in Ireland child cohort study. Self-report measures of paternal depression were completed when the study child was aged 9. Adolescents assessed paternal demandingness, responsiveness and autonomy granting at the age of 13. Adolescent internalising symptoms were measured at the age of 17/18 by the primary caregiver. A parallel multiple mediator model was used to test the total and specific indirect effects of the three parenting styles, whilst controlling for covariates and other mediators in the model. A direct effect of paternal depression on adolescent internalising problems was found (B = .051, 95% CI: 0.020, 0.083). However, no support for mediation via any of the paternal parenting styles (i.e., responsiveness, demandingness, or autonomy-granting) were found. These findings build on an emerging evidence-base demonstrating a specific direct association between paternal depression and adolescent internalising problems, and suggest that interventions ought to also target fathers suffering from depression to help reduce the risk of adolescent internalising problems.

Anxiety and Depression in a Non-Clinical Sample of Young Polish Adults: Presence of Meaning in Life as a Mediator

Early adulthood, between 18 and 25, is viewed as a decisive period of life for the prevention and treatment of anxiety and depression. Although the topic of their mutual relationship is well-known, little has been uncovered about the mechanism underlying this connection. To understand the indirect pathways between anxiety and depression, we chose the sense of meaning of life as a mediator because people's beliefs that their lives are or can be purposeful may protect against depression. The sample was composed of 277 Polish young adults. A small majority of the participants were women (58.8%). The mean age was M = 22.11 (SD = 1.72). We used in the research the Direct Behavior Rating-Scale Items Scale, the Meaning in Life Questionnaire, and the Brief Screen for Depression. Correlational analysis showed that, consistent with past findings, anxiety correlated positively with depression and searching for meaning. It was also negatively associated with presence of meaning. Moreover, depression was negatively linked to presence of meaning and positively with searching for meaning. Regression-based mediation analyses (PROCESS macro 3.4) proved that the relationship between anxiety and depression was mediated by presence of meaning in life, suggesting that having a sense of meaning may be a pathway by which feelings of tension relative to adverse events protect against depression.

Repetitive Negative Thinking Processes Account for Gender Differences in Depression and Anxiety During Adolescence

Rumination and worry are vulnerability factors involved in the early development of depression and anxiety during adolescence, particularly in girls. Current views conceptualize rumination and worry as transdiagnostic forms of repetitive negative thinking (RNT). However, most of research has analyzed them separately, without considering gender differences. We analyzed common and specific roles of rumination and worry in accounting for depressive and anxiety symptom levels overall and as a function of gender in adolescents (N = 159). Rumination and worry items were loaded into separate RNT factors. Girls showed a higher use of rumination and worry and higher levels of depression and anxiety than boys. Structural equation modeling supported that both RNT factors accounted for gender differences in symptom levels: rumination was the strongest mediator for depression and worry the strongest mediator for anxiety. Our findings support both general and specific contributions of RNT to account for affective symptomatology during adolescence, particularly in girls.

Increasing Trends in Mental Health Problems Among Urban Chinese Adolescents: Results From Repeated Cross-Sectional Data in Changsha 2016-2020

This study performed a repeated cross-sectional analysis to explore possible trends in mental health problems among Chinese adolescents over the years of 2016-2020. A total of 2,837 different seventh-grade students were surveyed in three waves from a junior high school in Changsha city, Hunan province in China (978 in 2016, 949 in 2019, and 910 in 2020) using the Mental Health Inventory of Middle School Students (MMHI-60). The results showed that obsessive-compulsive tendencies, interpersonal sensitivity, depression, anxiety, academic stress, and emotional disturbance problems were significantly increased in surveyed adolescents from 2016 to 2020. Moreover, positive rates of most of these problems were significantly higher in females than males, and were significantly increased in only females. These results highlight the importance of focusing on mental health problems among urban Chinese adolescents, especially among girls.

Time trends in treated incidence, sociodemographic risk factors and comorbidities: a Finnish nationwide study on anxiety disorders

BACKGROUND

There has been a lack of research about the time trends and socio-demographic risk factors for children and adolescents who receive treatment for anxiety disorders. This study aimed to fill these gaps in our knowledge by examining a nationwide sample of Finnish children and adolescents diagnosed in specialized healthcare settings.

METHODS

This study comprised national register data of all singleton children born in Finland from 1992-2006 who were diagnosed with anxiety disorders from 1998-2012. The changes in time trends in incidence were studied by dividing the study sample into three cohorts by birth years: 1992-1996, 1997-2001 and 2002-2006, who were followed up until the age of 20, 15 and 10 years, respectively. The 22,388 individuals with anxiety disorders were age and gender matched with 76,139 controls from the general population. Logistic regression was used to examine the socio-demographic risk factors and anxiety disorders in the entire sample. Comorbid disorders were examined in the oldest birth cohort (1992-1996 born).

RESULTS

Comparing the 1992-1996 and 2002-2006 cohorts showed that the cumulative incidence of treated anxiety disorders at the age of 10 increased from 0.3 to 1.2% among females and 0.46 to 1.9% among males. Subjects had higher likelihood for being diagnosed with an anxiety disorder if their mothers had low maternal socio-economic status class at birth (OR 1.53, 95% CI 1.45-1.61) compared to higher SES class, and marital status was single at the time of birth (OR 2.02, 95% CI 1.87-2.17) compared to married or in a relationship. They had lower risk of anxiety disorders diagnosis if born in rural (OR 0.82, 95% CI 0.79-0.86) or semi-urban areas (OR 0.79, 95% CI 0.76-0.82) when compared to urban residence. There was a wide range of psychiatric comorbidities, and unipolar depression was the most common (31.2%).

CONCLUSION

Anxiety disorders diagnosed by specialized Finnish services increased from 1998-2012 in both genders. This could indicate a real increase in overall anxiety disorders or an increase in treatment seeking. The findings on maternal socioeconomic status and single parenting improve the recognition of the environmental risk factors for anxiety disorders among children and adolescents.

Follow-up of the Cool Little Kids translational trial into middle childhood

BACKGROUND

Public health advocates have highlighted internalising problems as a leading cause of global burden of disease. Internalising problems (anxiety/depression) affect up to 20% of school-age children and can impact peer relations, school engagement and later employment and mortality. This translational trial aimed to determine whether a selective/indicated parenting group programme to prevent internalising distress in shy/inhibited preschool children had sustained effects in middle childhood. Translational design aspects were a brief parent-report screening tool for child inhibition offered universally across the population via preschools in the year before school, followed by an invitation to parents of all inhibited children to attend the parenting programme at venues in their local community.

METHODS

Design of the study was a randomised controlled trial. The setting was 307 preschool services across eight socioeconomically diverse government areas in Melbourne, Australia. Participants were 545 parents of inhibited four-year-old children of which 456 (84%) were retained during middle childhood (age of seven to 10 years). Early intervention was the Cool Little Kids parenting group programme, and control was 'usual care' access to available support services in the community. Primary outcomes were child anxiety and depression symptoms (parent and child report) and DSM-IV anxiety disorders (assessor masked). Secondary outcomes were parenting practices and parent mental health.

RESULTS

There was no significant difference in anxiety disorders between the intervention and control group during the three annual follow-ups of the cohort in middle childhood (2015 43% vs. 41%, 2016 40% vs. 36%, 2017 27% vs. 30%, respectively; p's > .05). There were also no significant differences in child anxiety or depression symptoms (by child or parent report), parenting practices or parent mental health, between the intervention and control group during middle childhood. However, a priori interaction tests suggested that for children with anxious parents, early intervention attenuated risk for middle childhood internalising problems.

CONCLUSIONS

An issue for population translation is low levels of parent engagement in preventive interventions. Initial effects of the Cool Little Kids parenting group programme in reducing shy/inhibited preschool children's internalising distress at school entry dissipated over time, perhaps due to low engagement. Future translational research on early prevention of internalising problems could benefit from screening preschool children in the population at higher risk (combining temperamental inhibition and parent distress) and incorporating motivational techniques to facilitate family engagement. Trial registration ISRCTN30996662 http://www.isrctn.com/ISRCTN30996662.

Fear conditioning and stimulus generalization in association with age in children and adolescents

The aim of the study was to investigate age-related differences in fear learning and generalization in healthy children and adolescents (n = 133), aged 8-17 years, using an aversive discriminative fear conditioning and generalization paradigm adapted from Lau et al. (2008). In the current task, participants underwent 24 trials of discriminative conditioning of two female faces with neutral facial expressions, with (CS+) or without (CS-) a 95-dB loud female scream, presented simultaneously with a fearful facial expression (US). The discriminative conditioning was followed by 72 generalization trials (12 CS+, 12 GS1, 12 GS2, 12 GS3, 12 GS4, and 12 CS-): four generalization stimuli depicting gradual morphs from CS+ to CS- in 20%-steps were created for the generalization phases. We hypothesized that generalization in children and adolescents is negatively correlated with age. The subjective ratings of valence, arousal, and US expectancy (the probability of an aversive noise following each stimulus), as well as skin conductance responses (SCRs) were measured. Repeated-measures ANOVAs on ratings and SCR amplitudes were calculated with the within-subject factors stimulus type (CS+, CS-, GS1-4) and phase (Pre-Acquisition, Acquisition 1, Acquisition 2, Generalization 1, Generalization 2). To analyze the modulatory role of age, we additionally calculated ANCOVAs considering age as covariate. Results indicated that (1) subjective and physiological responses were generally lower with increasing age irrespective to the stimulus quality, and (2) stimulus discrimination improved with increasing age paralleled by reduced overgeneralization in older individuals. Longitudinal follow-up studies are required to analyze fear generalization with regard to brain maturational aspects and clarify whether overgeneralization of conditioned fear promotes the development of anxiety disorders or vice versa.

Post-traumatic stress disorder, depression and the associated factors among children and adolescents with a history of maltreatment in Uganda

Worldwide, children who grow up under adverse conditions risk the development of mental health problems. However, reliable data on the estimated magnitude of mental disorders of PTSD, depression and their associated factors among maltreated children and adolescents in low- and middle-income-countries (LMICs) is still lacking. This study estimated the magnitude of PTSD, depression and the associated factors among the children and adolescents with ahistory of maltreatment in Southwestern Uganda.

METHODS

In this cross-sectional study, we assessed 232 children and adolescents on the prevalence of PTSD using Child PTSD Symptoms Scale for DSM-5 - Self-Report (CPSS-VSR) and Depression using the Center for Epidemiological Studies Depression Scale for Children (CES-DC). Predictor variables were taken from the Maltreatment and Abuse Chronology of Exposure- Paediatric Version (Pedi MACE). Logistic regressions analyses were selected for statistical modelling while odds-ratios were calculated to assess the strength of associations between the predictor and outcome variables.

RESULTS

In total, 140 (60%) participants fulfiled diagnostic criteria for PTSD and 91 (39%) for depression respectively. Predictor variables of PTSD were witnessing intimate partner violence (OR = 1.48, 95% CI: 1.19-1.83, p = <0.001), having lived in more than two homes (OR = 2.69, 95%CI: 1.34-5.41, p = .005), and being cared for by non-relatives (OR = 2.25; 95%CI: 2.26-223.9, p = .008). Variables predicting depression were witnessing intimate partner violence (OR = 1.30; 95%CI: 108-1.57, p = .006); being cared for by non-relatives (OR = 5.62, 95%CI: 1.36-23.1, p = .001) and being female (OR = .054, 95% CI: 0.30-1.00, p = .005).

CONCLUSION

Children living under adverse conditions are at a higher risk of developing PTSD and depression. We recommend interventions that aim at reducing adverse psychosocial stressors so as to improve or restore the children's mental health.Abbreviations: PTSD: Post traumatic stress disorder; LMICs: Low- and middle-income countries; IPV: Intimate partner violence; OVC: Orphans and vulnerable children.

Correlations between facial emotion processing and biochemical abnormalities in untreated adolescent patients with major depressive disorder: A proton magnetic resonance spectroscopy study

BACKGROUND

Studies show that disturbances of the fronto-striato-thalamic-cerebellar circuit could be correlated to facial emotion processing (FEP) biases in major depressive disorder (MDD). Nevertheless, the underlying mechanism of natural metabolism-emotion relationships in adolescent MDD remains unclear.

METHODS

Thirty-seven adolescent patients with MDD and 30 healthy controls completed FEP tasks using the Chinese Facial Affective Picture System (CAFPS). Proton magnetic resonance spectroscopy (¹H-MRS) was also used to obtain ratios of N-acetylaspartate (NAA) /creatine (Cr) and choline (Cho) /Cr ratios in the prefrontal cortex (PFC), anterior cingulate cortex (ACC), putamen, thalamus and cerebellum. Correlations between abnormal neurometabolic ratios and FEP were also computed.

RESULTS

Compared with the control group, the MDD group had significantly lower accuracy and perception intensity of happiness, and significantly higher accuracy of disgust and perception intensity of sad and fearful faces in FEP tasks. Compared to healthy controls, adolescent patients with MDD showed significantly lower NAA/Cr ratios in the left PFC, higher NAA/Cr ratios in the right thalamus, and higher Cho/Cr ratios in the right putamen, although there were no significant differences in metabolites in the ACC and cerebellum between two groups. In the MDD group, NAA/Cr ratios of the right thalamus were negatively correlated with happy reaction time and positively correlated with sad, anger, and fear intensity; Cho/Cr ratios in the right putamen were positively correlated with fear reaction time.

CONCLUSIONS

Our findings suggest that FEP bias may exist in adolescents with MDD, while the impairment of FEP may be associated with abnormal metabolites in the fronto-striato-thalamic circuit.

ENIGMA-anxiety working group: Rationale for and organization of large-scale neuroimaging studies of anxiety disorders

Anxiety disorders are highly prevalent and disabling but seem particularly tractable to investigation with translational neuroscience methodologies. Neuroimaging has informed our understanding of the neurobiology of anxiety disorders, but research has been limited by small sample sizes and low statistical power, as well as heterogenous imaging methodology. The ENIGMA-Anxiety Working Group has brought together researchers from around the world, in a harmonized and coordinated effort to address these challenges and generate more robust and reproducible findings. This paper elaborates on the concepts and methods informing the work of the working group to date, and describes the initial approach of the four subgroups studying generalized anxiety disorder, panic disorder, social anxiety disorder, and specific phobia. At present, the ENIGMA-Anxiety database contains information about more than 100 unique samples, from 16 countries and 59 institutes. Future directions include examining additional imaging modalities, integrating imaging and genetic data, and collaborating with other ENIGMA working groups. The ENIGMA consortium creates synergy at the intersection of global mental health and clinical neuroscience, and the ENIGMA-Anxiety Working Group extends the promise of this approach to neuroimaging research on anxiety disorders.

Bed nucleus of the stria terminalis and amygdala responses to unpredictable threat in children

Substantial evidence from studies in humans suggests the amygdala is pivotal for anxiety. Findings from animal models and translational studies suggests the bed nucleus of the stria terminalis (BNST) is also critical for anxiety and the anticipation of unpredictable threat in adults. However, it remains unknown whether the BNST is involved in unpredictable threat anticipation in children. Forty-two 8-10-year-olds completed resting-state functional magnetic resonance imaging (fMRI) scans and an unpredictable threat fMRI task in which they were trained to associate cues with images. Intrinsic connectivity analyses were performed to establish functional BNST and amygdala networks. BNST and amygdala activation to cues and images was tested. Significant findings were followed by task-based functional connectivity analyses. Children showed evidence for BNST and amygdala intrinsic connectivity that was similar to previous patterns observed in adults. In response to unpredictable cues relative to neutral face cues, children had a significant amygdala response but no response in the BNST. The amygdala, but not the BNST, also showed a significantly greater response to fear face images relative to neutral images. Thus, unpredictable threat activated the amygdala, but not BNST, in children. This finding is contrary to studies showing robust BNST activation to unpredictable threat in adults and may suggest that the BNST's role in threat processing emerges later in development.

Relationship between Early Maladaptive Schemas and Anxiety in Adolescence and Young Adulthood: A systematic review and meta-analysis

BACKGROUND

Early maladaptive schemas (EMS) are self-perpetuating dysfunctional cognitive structures that have been linked with youth psychological health and play a significant role in developing and maintaining psychological distress, including anxiety symptoms.

METHOD

The present meta-analysis synthesises the existing literature to evaluate the strength of association between EMS and anxiety symptoms among adolescents and young adults (aged 10-29 years). The systematic literature search was carried out in October 2019 using six different databases.

RESULTS

Our systematic search has identified 15 studies, comprising of 9515 participants (Mean age = 18.95, SD = 5.30). All the studies assessed were either cross-sectional or longitudinally designed. The random effect estimate for overall EMS with anxiety was r = 0.59 (95% Cl = 0.50 to 0.68, Z = 9.69, p < 0.0001), indicating a strong association between EMS and anxiety. When different schema domains were investigated separately, anxiety was shown to have significantly stronger associations with the schema domains of disconnection/rejection (r = 0.50), impaired autonomy/performance (r = 0.47) and other-directedness (r = 0.49). Further, females were found to have higher schemas of hypervigilance and other-directedness and associated anxiety symptoms compared to males.

LIMITATIONS

Meta-analytical results were limited to articles published in peer-reviewed journals in English language, inducing an upward publication bias and limiting the generalizability of the findings.

CONCLUSIONS

The findings highlight schemas related to disconnection/rejection, impaired autonomy/performance and other-directedness as particularly salient precursors of anxiety symptoms, providing evidence for clinicians to target these particular schemas during prevention, intervention, and management of anxiety disorder.

Preventing adolescent synaptic pruning in mouse prelimbic cortex via local knockdown of α4βδ GABAA receptors increases anxiety response in adulthood

Anxiety is increasingly reported, especially in adolescent females. The etiology is largely unknown, which limits effective treatment. Layer 5 prelimbic cortex (L5PL) increases anxiety responses but undergoes adolescent synaptic pruning, raising the question of the impact of pruning on anxiety. Here we show that preventing L5PL pruning increases anxiety in response to an aversive event in adolescent and adult female mice. Spine density of Golgi-stained neurons decreased ~ 63% from puberty (~ PND35, vaginal opening) to post-puberty (PND56, P < 0.0001). Expression of α4βδ GABA_A receptors (GABARs) transiently increased tenfold in L5PL at puberty (P < 0.00001), but decreased post-pubertally. Both global and local knockdown of these receptors during puberty prevented pruning, increasing spine density post-pubertally (P < 0.0001), an effect reversed by blocking NMDA receptors (NMDARs). Pubertal expression of the NMDAR-dependent spine protein kalirin7 decreased (50%, P < 0.0001), an effect prevented by α4 knock-out, suggesting that α4βδ-induced reductions in kalirin7 underlie pruning. Increased spine density due to local α4 knockdown at puberty decreased open arm time on the elevated plus maze post-pubertally (62%, P < 0.0001) in response to an aversive stimulus, suggesting that increases in L5PL synapses increase anxiety responses. These findings suggest that prelimbic synaptic pruning is necessary to limit anxiety in adulthood and may suggest novel therapies.