A systematic review of reviews on the prevalence of anxiety disorders in adult populations

Comparison of networks of loneliness, depressive symptoms, and anxiety symptoms in at-risk community-dwelling older adults before and during COVID-19

Network analysis provides an innovative approach to examining symptom-to-symptom interactions in mental health, and adverse external conditions may change the network structures. This study compared the networks of common risk factors and mental health problems (loneliness, depressive symptoms, and anxiety symptoms) in community-dwelling older people before and during COVID-19. Older adults (aged ≥ 60) at risk for depression were recruited through non-governmental organizations. Loneliness, depressive symptoms and anxiety symptoms were measured using the three-item Loneliness Scale (UCLA-3), nine-item Patient Health Questionnaire (PHQ-9), and seven-item Generalized Anxiety Disorder Scale (GAD-7), respectively. Data from 2549 (before) and 3506 (during COVID-19) respondents were included using propensity score matching. Being restless (GAD-7-item5) was most central, indicated by Expected Influence, in both pre and during COVID-19 networks despite low severity (mean score). The network during COVID-19 had higher global strength and edge variability than the pre-pandemic network, suggesting easier symptom spread and potentially more complex symptom presentation. In addition, feeling isolated from others (UCLA-3-item3) had stronger connections with feeling worthless/guilty (PHQ-9-item6) and anticipatory anxiety (GAD-7-item7) during COVID-19 than before. These findings may enhance our knowledge of the symptom structure of common mental health problems and the impacts of the pandemic. Targeting central symptoms may offer novel preventive strategies for older people.

How Do Mental Disorders and Combinations of Disorders Affect the Odds of Injuries and Poisoning?

ABSTRACT

Injuries and poisoning are associated with mental disorders. The association may be stronger if comorbid mental illness is involved. This study explores whether selected mental disorders (stress, anxiety, depression, attention deficit hyperactivity disorder [ADHD], bipolar, obsessive-compulsive disorder [OCD], schizophrenia) are associated with injuries and poisoning and if the presence and frequency of comorbid mental illness affect these associations. Analyses utilize medical claims data for adult employees of a large corporation during 2017-2021. Approximately half or more of the index mental disorders experience comorbid mental illness. Odds of injury and poisoning are significantly greater for each mental disorder and tend to be significantly greater when comorbid mental illness exists ( vs . the mental disorder alone), especially for the associations involving poisoning. Schizophrenia alone and in combination with other mental illness has the strongest associations with injury and poisoning. OCD is only associated with injury and poisoning, and ADHD is only associated with poisoning, if accompanied by comorbid mental illness.

Maternal antenatal mental health and its associations with perinatal outcomes and the use of healthcare services in children from the NINFEA birth cohort study

To investigate the associations between maternal mental health disorders before and during pregnancy and perinatal outcomes and child healthcare utilization between 6 and 18 months of age. Among the 6814 mother-child pairs from the Italian Internet-based NINFEA birth cohort, maternal depression, anxiety, and sleep disorders diagnosed by a physician before and during pregnancy were assessed through self-reported questionnaires completed during pregnancy and 6 months after delivery. Perinatal outcomes (preterm birth, birth weight, small for gestational age, congenital anomalies, and neonatal intensive care unit (NICU)) and children's healthcare utilization (emergency department (ED) visits, hospitalizations, and outpatient visits) were reported by mothers at 6 and 18 months postpartum. We used regression models adjusted for maternal age, education, parity, country of birth, region of delivery, and household income. Maternal mental health disorders were not associated with perinatal outcomes, except for depression, which increased the risk of offspring admission to NICU, and anxiety disorders during pregnancy, which were associated with preterm birth and lower birth weight. Children born to mothers with depression/anxiety disorders before pregnancy, compared to children of mothers without these disorders, had an increased odds of a visit to ED for any reason (odds ratio (ORadj) = 1.26, 95% confidence interval (CI): 1.02-1.54), of an ED visit resulting in hospitalization (ORadj = 1.75, 95%CI: 1.27-2.42), and of planned hospital admissions (ORadj = 1.55, 95%CI: 1.01-2.40). These associations with healthcare utilization were similar for mental disorders also during pregnancy. The association pattern of maternal sleep disorders with perinatal outcomes and child healthcare utilization resembled that of maternal depression and/or anxiety disorders with these outcomes.   Conclusion: Antenatal maternal mental health is a potential risk factor for child-health outcomes and healthcare use. Early maternal mental health interventions may help to promote child health and reduce healthcare costs. What is Known: • Poor maternal mental health affects pregnancy outcomes and child health, and children of mothers with mental health conditions tend to have increased healtcare utilization. • Parents with poor mental health often face challenges in caring for their children and have less parenting self-efficacy, which could potentially lead to frequent medical consultations for minor health issues. What is New: • Maternal pre-pregnancy mental disorders were not associated with preterm birth, low birth weight, SGA, and congenital anomalies, except for depression, which increased the risk of offspring admission to NICU. Anxiety disorders during pregnancy were associated with lower birth weight and an increased odds of preterm birth. • Maternal depression and/or anxiety and sleep disorders, both before and during pregnancy, were associated with an increase in children's healthcare utilization between 6 and 18 months of life.

The effectiveness of mindfulness for the management of anxiety in the nursing staff: Systematic review and meta-analysis

A systematic review with meta-analysis following Joanna Briggs Institute recommendations. It aimed to determine the effectiveness of mindfulness for the management of anxiety symptoms in the nursing staff and stress as a secondary outcome. The databases searched were MEDLINE, Embase, LILACS, CINAHL, Web of Science, Scopus and Psycinfo. Search was conducted in October 2022. Independent reviewers used standardized methods to research, track, and code the included studies. Data meta-analysis was performed using random effects models. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) was used as an approach to assess the quality and certainty of evidence in research studies. The review examined the effectiveness of mindfulness on nursing staff in 13 studies. The meta-analysis revealed a statistically significant decrease in anxiety and stress after treatment, with an average reduction of 0.36 in anxiety and 0.48 in stress. The results emphasizes the possibility of mindfulness being an effective intervention to the management of anxiety and stress in nursing staff. However, the studies analyzed presented limitations in the design and sampling in the development of the intervention, which impact the conclusive statements about the effectiveness of mindfulness and the generalization of the results. The implications to the nursing field involve adopting evidence-based research and practices to improve the well-being and quality of life of nursing professionals, as well as strengthening the evidence base surrounding mindfulness interventions in nursing practice. This may lead to changes in healthcare policies, care practices, and recognition of the importance of nurses' well-being for effective healthcare delivery.

Effectiveness of a Mental Health Chatbot for People With Chronic Diseases: Randomized Controlled Trial

BACKGROUND

People with chronic diseases tend to experience more mental health issues than their peers without these health conditions. Mental health chatbots offer a potential source of mental health support for people with chronic diseases.

OBJECTIVE

The aim of this study was to determine whether a mental health chatbot can improve mental health in people with chronic diseases. We focused on 2 chronic diseases in particular: arthritis and diabetes.

METHODS

Individuals with arthritis or diabetes were recruited using various web-based methods. Participants were randomly assigned to 1 of 2 groups. Those in the treatment group used a mental health chatbot app (Wysa [Wysa Inc]) over a period of 4 weeks. Those in the control group received no intervention. Participants completed measures of depression (Patient Health Questionnaire-9), anxiety (Generalized Anxiety Disorder Scale-7), and stress (Perceived Stress Scale-10) at baseline, with follow-up testing 2 and 4 weeks later. Participants in the treatment group completed feedback questions on their experiences with the app at the final assessment point.

RESULTS

A total of 68 participants (n=47, 69% women; mean age 42.87, SD 11.27 years) were included in the analysis. Participants were divided evenly between the treatment and control groups. Those in the treatment group reported decreases in depression (P<.001) and anxiety (P<.001) severity over the study period. No such changes were found among participants in the control group. No changes in stress were reported by participants in either group. Participants with arthritis reported higher levels of depression (P=.004) and anxiety (P=.004) severity than participants with diabetes over the course of the study, as well as higher levels of stress (P=.01); otherwise, patterns of results were similar across these health conditions. In response to the feedback questions, participants in the treatment group said that they liked many of the functions and features of the app, the general design of the app, and the user experience. They also disliked some aspects of the app, with most of these reports focusing on the chatbot's conversational abilities.

CONCLUSIONS

The results of this study suggest that mental health chatbots can be an effective source of mental health support for people with chronic diseases such as arthritis and diabetes. Although cost-effective and accessible, these programs have limitations and may not be well suited for all individuals.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04620668; https://www.clinicaltrials.gov/study/NCT04620668.

Ketamine's Amelioration of Fear Extinction in Adolescent Male Mice Is Associated with the Activation of the Hippocampal Akt-mTOR-GluA1 Pathway

Fear-related disorders, including post-traumatic stress disorder (PTSD), and anxiety disorders are pervasive psychiatric conditions marked by persistent fear, stemming from its dysregulated acquisition and extinction. The primary treatment for these disorders, exposure therapy (ET), relies heavily on fear extinction (FE) principles. Adolescence, a vulnerable period for developing psychiatric disorders, is characterized by neurobiological changes in the fear circuitry, leading to impaired FE and increased susceptibility to relapse following ET. Ketamine, known for relieving anxiety and reducing PTSD symptoms, influences fear-related learning processes and synaptic plasticity across the fear circuitry. Our study aimed to investigate the effects of ketamine (10 mg/kg) on FE in adolescent male C57 BL/6 mice at the behavioral and molecular levels. We analyzed the protein and gene expression of synaptic plasticity markers in the hippocampus (HPC) and prefrontal cortex (PFC) and sought to identify neural correlates associated with ketamine's effects on adolescent extinction learning. Ketamine ameliorated FE in the adolescent males, likely affecting the consolidation and/or recall of extinction memory. Ketamine also increased the Akt and mTOR activity and the GluA1 and GluN2A levels in the HPC and upregulated BDNF exon IV mRNA expression in the HPC and PFC of the fear-extinguished mice. Furthermore, ketamine increased the c-Fos expression in specific brain regions, including the ventral HPC (vHPC) and the left infralimbic ventromedial PFC (IL vmPFC). Providing a comprehensive exploration of ketamine's mechanisms in adolescent FE, our study suggests that ketamine's effects on FE in adolescent males are associated with the activation of hippocampal Akt-mTOR-GluA1 signaling, with the vHPC and the left IL vmPFC as the proposed neural correlates.

Alcohol Consumption Is a Coping Mechanism for Male Patients with Severe Anxiety Disorders Treated with Antidepressants Monotherapy

Background: Anxiety disorders are prevalent mental health conditions often accompanied by various comorbidities. The association between anxiety and liver disease, as well as fluctuations in blood sugar levels, highlights the importance of carefully evaluating patients with anxiety undergoing antidepressant therapy. The aim of this study was to conduct a comparative assessment of liver function and blood glucose levels in patients diagnosed with anxiety disorders while considering potential gender-specific differences. Methods: An analysis was conducted over a 24-month period. This study included 88 patients diagnosed with anxiety disorders, with symptoms severe enough to require hospitalization, aged 18 or older, undergoing antidepressant monotherapy, without any additional pathologies. Liver enzymes (AST, ALT, GGT), AST/ALT ratio, and blood glucose levels were measured and compared. Results: While no significant differences were found between antidepressant classes, increased GGT levels were observed in men older than 40 years compared to women of the same age, suggesting that alcohol consumption may be a coping mechanism for anxiety. This gender difference was not observed among young patients. Conclusions: Early detection of alcohol consumption is essential in patients with anxiety disorders in order to prevent alcohol-related liver damage and to adjust the management of both conditions accordingly.

A systematic review of pre-injury anxiety disorder and post-concussion outcomes in youth and young adult athletes

Pre-injury anxiety disorder may be a risk factor for poor outcomes following sportsrelated concussion. A systematic review was performed to characterize the relationship between pre-injury anxiety disorder and post-concussion symptom presentation and recovery time after sports-related concussions among children, adolescents, and young adults. A PRISMA-compliant literature search was conducted in Ovid MEDLINE, PsycINFO, EMBASE, and Scopus for articles published up to 25 January 2024. The initial query yielded 1358 unique articles. Articles that analyzed the relationship between pre-injury anxiety disorder and post-concussion symptoms and recovery time were included. A final cohort of 11 articles was extracted, comprising a total of 8390 study participants, of whom 921 had a history of pre-injury anxiety disorder. Pre-injury anxiety disorder was associated with prolonged time to return to sports activity and an increased incidence of physical, emotional, cognitive, and sleep-related symptoms. While the results of this review suggest an association between pre-injury anxiety disorder and post-concussion symptoms and recovery time, future studies should be more stringent regarding standardized anxiety disorder definitions, longitudinal assessment of post-concussion symptoms, anxiety disorder subtypes, and anxiety treatment history.

Normal isn't normal: On the medicalization of health

BACKGROUND

This study investigated the proportion of the U.S. population classified as healthy based on 10 common indicators, examined in two ways: (1) above or below (in the healthy direction) the sample median (termed "normal"), and (2) below diagnostic cut-off points for clinical caseness or high risk (termed "ideal").

METHODS

Data are from the 2017-March 2020 round of the National Health and Nutrition Examination Survey (NHANES). Sample sizes ranged from 3,956 to 8,961 for respective health indicators, with a total of 3,102 respondents for two weighted multi-item measures described below. Measures included the Alameda 5 health behaviors (smoking, drinking exercising, sleeping, and body mass index) and five standard biomarkers (systolic and diastolic blood pressure, resting heart rate, fasting glucose, and total cholesterol). Besides point prevalences for the normal and ideal categories for each indicator, we also calculated the proportion healthy for all 10 indicators, again calculated both ways, termed "meta-normal" and "meta-ideal."

RESULTS

The prevalence of meta-normality was 1.05%, suggesting that hardly any adult Americans are completely healthy according to population norms. Findings for meta-ideality showed that while most Americans are not clinical cases for any respective indicator, only 5.55% met the official criteria for being healthy according to all 10 indicators.

CONCLUSION

Most Americans appear healthy according to nearly all key health indicators and biomarkers, according to "normal" or "ideal" criteria. However, the proportion healthy according to all measures is extremely small. Relatively few U.S. adults are completely healthy according to clinical criteria (meta-ideal), and even fewer are completely healthy according to population norms (meta-normal). Results are interpreted through sociological writing on medicalization.

Network pharmacology combined with molecular docking and experimental verification to elucidate the effect of flavan-3-ols and aromatic resin on anxiety

This study investigated the potential anxiolytic properties of flavan-3-ols and aromatic resins through a combined computational and experimental approach. Network pharmacology techniques were utilized to identify potential anxiolytic targets and compounds by analyzing protein-protein interactions and KEGG pathway data. Molecular docking and simulation studies were conducted to evaluate the binding interactions and stability of the identified targets. Behavioral tests, including the elevated plus maze test, open field test, light-dark test, actophotometer, and holeboard test, were used to assess anxiolytic activity. The compound-target network analysis revealed complex interactions involving 306 nodes and 526 edges, with significant interactions observed and an average node degree of 1.94. KEGG pathway analysis highlighted pathways such as neuroactive ligand-receptor interactions, dopaminergic synapses, and serotonergic synapses as being involved in anxiety modulation. Docking studies on EGCG (Epigallocatechin gallate) showed binding energies of -9.5 kcal/mol for MAOA, -9.2 kcal/mol for SLC6A4, and -7.4 kcal/mol for COMT. Molecular dynamic simulations indicated minimal fluctuations, suggesting the formation of stable complexes between small molecules and proteins. Behavioral tests demonstrated a significant reduction in anxiety-like behavior, as evidenced by an increased number of entries into and time spent in the open arm of the elevated plus maze test, light-dark test, open field center activity, hole board head dips, and actophotometer beam interruptions (p < 0.05 or p < 0.01). This research provides a comprehensive understanding of the multi-component, multi-target, and multi-pathway intervention mechanisms of flavan-3-ols and aromatic resins in anxiety treatment. Integrated network and behavioral analyses collectively support the anxiolytic potential of these compounds and offer valuable insights for future research in this area.

The association between schizophrenia and increased Covid-19 mortality in a cohort of over 2 million people in Brazil

OBJECTIVE

To determine clinical outcomes and mortality risk factors related to mental disorders in a cohort of hospitalized patients with Covid-19 in Brazil.

METHODS

This retrospective cohort study used a Brazilian database called the Sistema de Vigilância Epidemiológica da Gripe (Influenza Epidemiological Surveillance System) to analyze patients aged = 18 years who were hospitalized with Covid-19 between 2020 and 2022. The exposure of interest was mental disorders (anxiety, depression, schizophrenia, and bipolar disorder) identified through self-report. The primary outcome was in-hospital mortality. Covariates included demographic and clinical characteristics. Descriptive statistics, t-tests, chi-square tests, and binary logistic regression were used to analyze the data.

RESULTS

A cohort of 2,124,285 patients was included in the analysis, with 23,246 individuals (1.1%) self-reporting mental disorders, of which depression was the most prevalent (52.3%). The mortality rate of patients with mental disorders was 30.8%. Age, sex, region, dyspnea, low oxygen saturation, and comorbidities were associated with a higher mortality risk, as was schizophrenia (adjusted OR: 1.68; 95%CI 1.54-1.81).

CONCLUSIONS

Individuals with schizophrenia had a greater likelihood of Covid-19-related death than those without mental health conditions. These findings underscore the significant effect of serious mental disorders on Covid-19 mortality.

Validity and reliability of anxiety literacy (A-Lit) and its relationship with demographic variables in the Iranian general population

Introduction

Anxiety disorder is one of the most common mental disorders. This cross-sectional research aimed to determine anxiety literacy (A-Lit) psychometric properties among the Iranian population in 2022.

Methods

This research was conducted on 690 people in Iran in 2022. In this study, people were selected by proportional stratified sampling, and the validity and reliability of the A-Lit designed by Griffiths were assessed. Validity of A-Lit was assessed by face validity, content validity, and confirmatory factor analysis. Reliability of A-Lit was evaluated by the McDonald's omega coefficient, Cronbach's alpha coefficient, and test- retest. In analytical sections, the tests of One-way ANOVA, Chi-squared test, and independent samples t-test were used.

Results

The rates of S-CVI/Ave and CVR for A-Lit were 0.922 and 0.774, respectively. In confirmatory factor analysis, three items were deleted because the factor loading was less than 0.4, and goodness-of-fit indexes (Some of goodness-of-fit indexes: χ2/df = 4.175, GFI: 0.909, RMSEA = 0.068, PCFI = 0.745, AGFI = 0.883) were confirmed as the final model with 19 items. For all items, the Cronbach's alpha coefficient was 0.832, the McDonald's omega coefficient was 0.835, and the intraclass correlation coefficient was 0.874. According to the results of this study, 1.3% (n = 9) did not answer any questions correctly and 8.4% (n = 58) were able to answer 1-6 questions correctly. Approximately 72% (n = 495) were able to answer 7-12 questions, and eventually only 18.6% (n = 128) were able to answer 13 questions and more. There was a significant relationship between sex, age group, occupation status, marital status, and get information related to mental illness with A-Lit level (p < 0.05).

Conclusion

The Persian version of A-Lit was confirmed with 19 items, and this scale is a reliable tool for measuring A-Lit in the general population. The results also showed that a few people have a higher level of anxiety literacy and that educational and intervention programs need to be designed and implemented for the public population.

Associations of chronotype with anxiety, depression and insomnia among general adult population: A cross-sectional study in Hubei, China

BACKGROUND

The relationship between chronotype and anxiety, depression, and insomnia was inconsistent. We aimed to assess the association between chronotype and mental health and the potential moderating effect of age and socioeconomic status (SES).

METHODS

A multi-stage sampling cross-sectional study with 12,544 adults was conducted. Chronotype, anxiety, depression, and insomnia were investigated by 5-item Morning and Evening, 7-item Generalized Anxiety Disorder, 9-item Patient Health, and the 7-item Insomnia Severity Index Questionnaires. Logistic regression was conducted.

RESULTS

The predominant chronotype was morning chronotype (69.2 %), followed by 27.6 % intermediate and 3.2 % evening chronotype. The prevalence of anxiety, depression, and insomnia was 0.7 %, 1.9 %, and 9.6 %, respectively. Compared with intermediate chronotype, morning chronotype participants had a lower risk of anxiety (OR = 0.28,95%CI:0.18-0.44), depression (OR = 0.54,95%CI:0.41-0.72) and insomnia (OR = 0.67,95%CI:0.58-0.77), while evening chronotype participants had a higher risk of depression (OR = 1.98,95%CI:1.06-3.71) but not anxiety or insomnia. Interactions between chronotype with age and SES on insomnia (Pinteraction < 0.05) were found. A more profound association between morning chronotype and insomnia was observed in <65 years participants (OR = 0.59,95%CI:0.50-0.71) and those with monthly household income ≥10,000yuan (OR = 0.21,95%CI:0.12-0.35), compared with their counterparts.

LIMITATIONS

The cross-sectional design limited causal conclusions. Only adults were included; the findings could not be generalized to children.

CONCLUSIONS

The morning chronotype might be protective for anxiety, depression, and insomnia, while the evening chronotype might be a risk factor for depression. Future studies are needed to assess the efficacy of chronotype-focused intervention for mental health. Insomnia prevention efforts should pay more attention to the elderly and those with lower incomes.

Placebo Effects Are Small on Average in the 7.5% CO2 Inhalational Model of Generalized Anxiety

BACKGROUND

Anxiety disorders are highly prevalent and socio-economically costly. Novel pharmacological treatments for these disorders are needed because many patients do not respond to current agents or experience unwanted side effects. However, a barrier to treatment development is the variable and large placebo response rate seen in trials of novel anxiolytics. Despite this, the mechanisms that drive placebo responses in anxiety disorders have been little investigated, possibly due to low availability of convenient experimental paradigms. We aimed to develop and test a novel protocol for inducing placebo anxiolysis in the 7.5% CO2 inhalational model of generalized anxiety in healthy volunteers.

METHODS

Following a baseline 20-minute CO2 challenge, 32 healthy volunteers were administered a placebo intranasal spray labelled as either the anxiolytic "lorazepam" or "saline." Following this, participants surreptitiously underwent a 20-minute inhalation of normal air. Post-conditioning, a second dose of the placebo was administered, after which participants completed another CO2 challenge.

RESULTS

Participants administered sham "lorazepam" reported significant positive expectations of reduced anxiety (P = .001), but there was no group-level placebo effect on anxiety following CO2 challenge post-conditioning (Ps > .350). Surprisingly, we found many participants exhibited unexpected worsening of anxiety, despite positive expectations.

CONCLUSIONS

Contrary to our hypothesis, our novel paradigm did not induce a placebo response, on average. It is possible that effects of 7.5% CO2 inhalation on prefrontal cortex function or behavior in line with a Bayesian predictive coding framework attenuated the effect of expectations on subsequent placebo response. Future studies are needed to explore these possibilities.

Objectification and body esteem: age group patterns in women's psychological functioning

OBJECTIVES

Sexual objectification is related to negative outcomes for young adult women, but whether sexual objectification operates similarly for women in mid-life or older adulthood is less clear. Our aim was to assess self-objectification and sexually objectifying experiences for women in two different age groups, 18-27 and 48-90 and, further, test the relationship between objectification and psychological functioning. Based on objectification theory, we hypothesized that young adults would report higher self-objectification and sexually objectifying experiences compared to women in the older group. We further expected that these age differences would be related to body esteem and psychological functioning.

METHODS

We surveyed 218 women regarding their sexually objectifying experiences and self-objectification, as well as body esteem, global self-esteem, and mood/anxiety, all outcomes theoretically expected to be related to sexual objectification and self-objectification.

RESULTS

Sexually objectifying experiences and self-objectification were correlated with lower body esteem, lower global self-esteem, and higher mood/anxiety symptoms. Further, older women reported lower objectification and better psychological functioning. Tests of serial mediation showed that the relationship between age and two outcomes (self-esteem and mood/anxiety symptoms) was mediated by self-objectification and body esteem, while the model using experiences of sexually objectifying experiences was not supported.

CONCLUSION

Older women differed from younger women in the impact of self-objectification. We discuss these outcomes referencing age patterns and objectification theory.

A single session of a beach volleyball exergame did not improve state anxiety level in healthy adult women

This study evaluated the acute effect of the exergame Kinect Sports® beach volleyball on state anxiety level in adult women. Thirty healthy adult women (age: 21 [4] years, body mass: 54.70 [19.50] kg, height: 1.61 ± 0.05 m, and body mass index: 21.87 [5.76] kg/m2, data are expressed as median [interquartile range] and as the mean ± standard deviation) were assigned to play an exergame of beach volleyball in singleplayer mode session (intervention session) for ~ 30 min using the Xbox 360 Kinect® or remained seated (control session). State anxiety was evaluated before and after the intervention and control sessions through the State-Trait Anxiety Inventory. State anxiety obtained in both sessions (exergame and control) was classified as intermediate before (median: 36.00 [IQR: 4.75] and mean = 38.73 ± 7.23, respectively) and after (mean: 34.86 ± 6.81 and mean: 37.66 ± 8.44, respectively). Friedman test found no time significant effect on state anxiety of the sessions (χ2 [3] = 6.45, p-value = 0.092, Kendall's W = 0.07 "trivial"). In conclusion, the present study showed that there were no significant differences in the state anxiety level after an acute session of the exergame beach volleyball.

The Psychometric Properties of the Arabic Version of the Anxiety and Preoccupation About Sleep Questionnaire (APSQ)

Background

Insomnia disorder is a common health condition; it has a role in increasing the possibility of developing other psychological disorders, including anxiety and depression. Anxiety and preoccupation with sleep are two examples of common cognitive factors that contribute to the development of chronic insomnia; thus, it is important to have a tool that assesses worry in insomnia. There is no comprehensive psychiatric measure to assess anxiety and preoccupation with sleep in Arabic. We conducted this study to translate, adapt, and validate the Arabic version of the Anxiety and Preoccupation about Sleep Questionnaire (APSQ), providing a reliable psychometric tool to assess concerns regarding sleep within Arabic-speaking communities.

Methods

The translation process of the scale involved several steps, including forward and backward translation. A cross-sectional study was conducted using an online survey completed by 523 participants from various Arabic-speaking countries. Psychometric analysis was performed utilizing the R software, including internal consistency, test-retest reliability, and confirmatory factor analysis. In addition, convergent and divergent against the Athens insomnia scale (AIS) and general anxiety disorder (GAD) were conducted.

Results

The Arabic-translated form of the APSQ expresses excellent internal consistency with a value of 0.91 for both Cronbach's α and McDonald's ω. The test-retest reliability of a subsample showed an excellent coefficient of 0.93 (p<0.01). A good fit of the APSQ was observed by CFI = 0.93, TLI = 0.91, SRMR = 0.05, and RMSEA = 0.1. Convergent and divergent against AIS and GAD showed statistically significant correlations of 0.85 (p<0.01) and 0.69 (p<0.01), respectively. Our sample showed a mean APSQ score of 31.28 ± 8.31, and the mean age was 23.62 ± 7.5.

Conclusion

The Arabic APSQ is reliable and valid for measuring anxiety and preoccupation with sleep in Arabic countries. Using translated APSQ for clinical diagnosis and research is currently trustworthy.

A step-by-step and data-driven guide to index gender in psychiatry

Beyond sex as a binary or biological variable, within-sex variations related to sociocultural gender variables are of increasing interest in psychiatric research to better understand individual differences. Using a data-driven approach, we developed a composite gender score based on sociodemographic and psychosocial variables showing sex differences in a sample of psychiatric emergency patients upon admission (N = 1708; 39.4% birth-assigned females; mean age = 40 years; age standard deviation = 14). This gender score was extracted from a confirmatory factor analysis (CFI = 0.966; RMSEA = 0.044, SRMR = 0.030) and could predict a person's birth-assigned sex with 67% accuracy. This score allowed the further identification of differences on impulsivity measures that were absent when looking solely at birth-assigned sex. Female birth-assigned sex was also associated with higher rates of mood and personality disorder diagnoses, while higher feminine gender scores were related to higher proportions of anxiety and mood disorder diagnoses. By contrast, male birth-assigned sex and higher masculine gender scores were associated with higher proportions of psychotic and substance use disorder diagnoses. Patients with undifferentiated gender scores (i.e., scoring between masculine and feminine threshold defined by terciles) were more represented in the psychotic disorder group. Considering both sex and gender in psychiatric research is essential and can be achieved even when using secondary data to index gender comprised of demographic and psychosocial variables.

Demand management processes to improve access to cognitive-behavioral therapies for anxiety disorders: a grounded theory study

Introduction

Anxiety disorders are impactful mental health conditions for which evidence-based treatments are available, notably cognitive-behavioral therapies (CBTs). Even when CBTs are available, demand-side factors limit their access, and actors in a position to perform demand management activities lack a framework to identify context-appropriate actions.

Methods

We conducted a constructivist grounded theory study in Quebec, Canada, to model demand management targets to improve access to CBTs for anxiety disorders. We recruited key informants with diverse experiences using purposeful, then theoretical sampling. We analyzed data from 18 semi-directed interviews and 20 documents through an iterative coding process centered around constant comparison.

Results

The resulting model illustrates how actors can target clinical-administrative processes fulfilling the demand management functions of detection, evaluation, preparation, and referral to help patients progress on the path of access to CBTs.

Discussion

Modeling clinical-administrative processes is a promising approach to facilitate leveraging the competency of actors involved in demand management at the local level to benefit public mental health.

The effectiveness of transdiagnostic cognitive behavioural therapy for anxiety disorders: the role of and impact of comorbid depression

Transdiagnostic Cognitive Behaviour Therapy (tCBT), an intervention designed to be applicable across multiple diagnoses, was introduced to improve limitations in traditional therapy such as cost and access to trained therapists. It has been established as an effective and efficacious treatment for anxiety disorders, though there has been little research focussed on the role of depression. The current study investigated the role of comorbid depression during tCBT for anxiety disorders in primary care settings as an outcome and a moderator of anxiety outcomes. Results of multi-level ANOVAs indicated no significant difference in anxiety outcomes regardless of whether there was a comorbid depression diagnosis in the tCBT condition, and that individuals with a comorbid depression diagnosis experienced significantly greater reduction in anxiety severity than those without. Depression symptom severity decreased to a significantly greater extent in the tCBT condition than in TAU when the outcome measure of Patient Health Questionnaire was utilised as the outcome measure, but this was not mirrored when the Clinician Severity Rating was utilised as the outcome measure. This study provides preliminary support for the effectiveness of Transdiagnostic Cognitive Behaviour therapy for those with both a principal anxiety disorder and comorbid depression in symptom reduction.

Prevalence of generalized anxiety disorder among patients attending medicine outpatient department in a tertiary care center: A cross-sectional study

Background

Generalized anxiety disorder is commonly underdiagnosed and undertreated in medical settings.

Aim

The objectives of this study were to determine the prevalence and correlates of generalized anxiety disorder among patients presenting to medicine outpatient department in a tertiary care centre.

Materials and Methods

A cross-sectional observational study was conducted among the patients visiting the outpatient department of General Medicine in a tertiary care teaching hospital. Sociodemographic and clinical parameters were collected using a structured pro forma. All patients were administered Generalized Anxiety Disorder-7 (GAD-7) to screen for the presence of generalized anxiety disorder. Patients who score 10 or more underwent a semi-structured evaluation using a generalized anxiety disorder module of Structured Clinical Interview for DSM-IV Axis I disorders.

Results

Two hundred and fifty patients were recruited for the study. The mean age of the participants was 40.66 ± 12.8 years. More than one-fourth of them had diabetes mellitus and about one-fifth of the participants had systemic hypertension and hypothyroidism. Thirty five (14%) participants screened positive on GAD-7 scale. On detailed evaluation using SCID-I, 19 (7.6%) participants were confirmed to have a generalized anxiety disorder. Female gender was associated with the presence of GAD.

Conclusion

One in thirteen patients presenting to the medicine outpatient department were found to have generalized anxiety disorder. Female patients had a greater prevalence of generalized anxiety disorder compared to male patients.

Evaluating the effects of counterconditioning, novelty-facilitated, and standard extinction on the spontaneous recovery of threat expectancy and conditioned stimulus valence

Extinction training has proved effective to diminish the expectancy of the aversive unconditioned stimulus (US). However, the negative valence of the conditioned stimulus (CS) may still stay intact. In fact, several studies have suggested that the CS negative valence may be a factor that promotes the return of fear. Our study focuses on the role of changes in the CS valence as a potential mechanism to reduce the spontaneous recovery of threat expectancies. To do that, we evaluated counterconditioning (CC), a technique aimed to reduce the CS negative valence by paring it with a positive stimulus and compared its efficacy to that of a novelty-facilitated extinction (NFE) and a standard extinction interventions. Using a 2-day protocol, participants first learned the relationship between a figure and an aversive sound, using a differential conditioning paradigm, and were then randomly assigned to one of three different groups. For the CC group, CS+ or cue A was paired with a positive US. The standard extinction group was exposed to cue A alone. For a third NFE group, cue A was followed by a neutral US. Finally, on the second day, spontaneous recovery was tested. Our findings did not provide evidence to suggest that CC could be more effective to prevent or reduce the return of threat expectancies or influence valence ratings when compared with NFE and standard extinction.

Generalized anxiety disorder and associated factors in primary health care workers in Minas Gerais, Brazil

BACKGROUND

The COVID-19 pandemic had direct and indirect impacts on public health, also affecting the mental health of the population.

OBJECTIVE

To analyze symptoms of generalized anxiety disorder (GAD) and associated factors, in primary health care (PHC) professionals.

METHODS

Cross-sectional and analytical study conducted with professionals who work in the Primary Health Care (PHC) of the Northern health macro-region of the state of Minas Gerais, Brazil. Data collection was carried out through an online, self-administered questionnaire, made available from August 27, 2021, to October 30, 2021 using the Google Forms tool. The questionnaire included sociodemographic questions as well as questions related to the history of anxiety and work during the pandemic. To assess anxiety symptoms, the General Anxiety Disorder-7 (GAD-7) instrument was used. Data treatment consisted of descriptive analysis of the variables, bivariate analysis followed by multivariate Poisson Regression with robust variance.

RESULTS

702 health professionals participated in the study and the general prevalence of GAD was 32.2%. Current anxiety symptoms were self-reported by 37.6% of the participants. In the final model, the associated factors identified were: female sex (PR = 1.82; 95% CI = 1.17-2.84; p = 0.007), previous symptoms (PR = 1.58; 95% CI = 1.19-2.10; p = 0.002) and (PR = 2.68; 95% CI = 2.00-3.62; p < 0.001) current self-reported anxiety.

CONCLUSION

The results show the need to implement actions in mental health promotion and anxiety prevention, through the dissemination of information about mental health care, health education activities, encouraging the adoption of healthy habits and professional monitoring when necessary.

Elevated Plus Maze for Assessment of Anxiety and Memory in Rodents

The elevated plus maze is the most widely used paradigm to evaluate anxiety-associated behavioral alterations in rodent models of central nervous system (CNS) disorders. Unconditioned aversive behavior for open and elevated areas is a measure of anxiety and can be assessed by the plus maze. Plus maze consists of perpendicularly arranged open arms and closed arms crossed in the middle with a central platform. Rodents are allowed to explore the maze between the open and closed arms. The number of entries and time spent in the open arms and the closed arms are used as indicators for the anxiety nature of the animals. Transfer latency is a memory indicator that measures the amount of time it takes to move an animal from an open arm to a closed arm. This chapter describes the pretest conditions, materials required, and protocol for the conductance and evaluating the results for the anxiety and cognition-related behavior in rodents.

Dietary Inflammatory Potential, Inflammation-Related Lifestyle Factors, and Incident Anxiety Disorders: A Prospective Cohort Study

It is unclear whether diet-associated inflammation is related to the development of anxiety disorders. We aimed to investigate the association between energy-adjusted dietary inflammatory index (E-DII) scores and the incidence of anxiety disorders, and explore the joint effects of E-DII scores with other inflammatory lifestyles in enhancing anxiety risk. In the UK Biobank Study of 96,679 participants, baseline E-DII scores were calculated from the average intake of at least two 24 h dietary recalls. Multivariable-adjusted Cox models were used to evaluate the associations between E-DII scores and the incidence of total anxiety disorders, and primary types and subtypes; additive and multiplicative interactions of a pro-inflammatory diet and seven inflammatory lifestyles were examined. After a median follow-up of 9.4 years, 2785 incident cases of anxiety disorders occurred. Consuming a pro-inflammatory diet was significantly associated with a higher risk of total anxiety disorders (HRQ4vsQ1 = 1.12, 95% CI = 1.00-1.25), and positive associations were consistently identified for primary types and subtypes of anxiety disorders, with HRs ranging from 1.08 to 1.52, and were present in women only. Both additive and multiplicative interactions of current smoking and a proinflammatory diet on total anxiety risk were identified. A proinflammatory diet was associated with a higher incidence of anxiety disorders, and current smoking may synergize with a proinflammatory diet to promote anxiety risk, particularly among women.

Effectiveness of electroacupuncture on anxiety: a systematic review and meta-analysis of randomized controlled trials

This systematic review and meta-analysis aimed to comprehensively evaluate the effectiveness of electroacupuncture (EA) for patients with anxiety. Randomized controlled trials (RCTs) on the treatment of anxiety by EA up to November 2022 were searched and collected from nine databases. Hamilton Anxiety Rating Scale (HAMA), self-rating anxiety scale (SAS), and adverse reactions were used as outcome indicators. The quality of relevant articles was evaluated using the Cochrane Collaboration's risk of bias tool. The quality of evidence for each outcome was classified as "low risk," "unclear risk," or "high risk." RevMan 5.0 was used for data analysis. A total of 633 articles were identified from nine electronic databases; 37 RCTs were included, which measured anxiety changes by using EA alone compared to the control group. For the main outcome, EA significantly reduced the HAMA score [Mean difference (MD):-1.13 (95% CI:-2.55-0.29), I2:80%], and the quality of evidence was moderate. EA significantly reduced the SAS score (MD:-3.47 (95% CI,-6.57--0.36), I2:88%), and the quality of evidence was moderate. Our meta-analysis shows that EA reduces HAMA and SAS. This study suggests that EA can relieve anxiety. For various uses, additional research is needed on its effect when combined with other treatments.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=345658, identifier (CRD42022345658).

Relation among, trait anxiety, intolerance to uncertainty and early maltreatment experiences on fear discrimination learning and avoidance generalization online task

BACKGROUND AND OBJECTIVES

Early aversive experiences, which have been associated with elevated anxiety and intolerance of uncertainty (IUS), may contribute negatively to fear conditioning learning. The aim of the present study was to analyze the relation among individual differences in childhood maltreatment experiences, trait anxiety, and IUS in adulthood; and to determine how these variables could affect fear learning discrimination and avoidance generalization.

METHODS

We adapted an avoidance procedure in an online fear learning task. Two pictures of different lamp colors (CS+) were first associated with two aversive images (US), while a third color was not (CS-). Next, clicking a button during one CS + could effectively avoid the US (CS + av), but not during the other (CS + unav). Finally, avoidance generalization was tested to lamp colors that were between CS- and CS + av (safety dimension) and CS + av and CS + unav (avoidability dimension). With a sample of 67 participants, we measured ratings of relief, expectancy, and anxiety, as well as button presses and individual differences (STAI, IUS and MAES).

RESULTS

Aversive early experiences were positively related to trait anxiety and intolerance of uncertainty. The results of the task further suggested that maltreatment experience contributes to be more attentive to aversive signals, which could be implicated in leading to difficulties in discrimination learning.

LIMITATIONS

Online experiments implies some loss of control over subjects and environment that can threaten internal validity. Likewise, the commitment of participants may be low.

CONCLUSIONS

Results suggest that early aversive experience and anxiety could contribute to the development of IUS, which likely contributes to the development of avoidance behavior.

A cognitive-behavioral skills building program improves mental health and enhances healthy lifestyle behaviors in nurses and other hospital employees

BACKGROUND

Mental health outcomes in nurses have historically indicated a greater prevalence of anxiety, depression, and suicide than the general population. It is vital to provide programming for healthcare workers to gain the necessary skills to reduce burnout and improve their mental and physical health.

AIMS

The aims of this study were to evaluate mental health outcomes and healthy lifestyle beliefs and behaviors among nurses and other hospital employees who completed MINDBODYSTRONG, a cognitive-behavioral skill building program.

METHODS

A pre-experimental, pre- and poststudy design was used to examine mental health and well-being outcomes among 100 hospital personnel who participated in MINDBODYSTRONG, a program designed to improve coping and resiliency and decrease stress, anxiety, and depressive symptoms. Outcomes measured included healthy lifestyle behaviors, healthy lifestyle beliefs, anxiety, depression, stress, and burnout.

RESULTS

One hundred hospital personnel, including 93 nurses, completed the pre- and post-survey. Among all participants, post- MINDBODYSTRONG scores for healthy lifestyle beliefs (p = .00; Cohen's d = 0.52) and healthy lifestyle behaviors (p = .00; Cohen's d = -0.74) increased significantly with medium effects, while depression (p = .00; Cohen's d = -0.51), anxiety (p = .00; Cohen's d = -0.54), stress (p = .00; Cohen's d = -0.33), and burnout (p = .00; Cohen's d = -0.37) decreased significantly with small and medium effects. The program produced even stronger positive effects on mental health outcomes for participants who started the study with higher levels of depression and anxiety.

LINKING EVIDENCE TO PRACTICE

Anxiety, depression, stress, and burnout decreased significantly postintervention. Participants also significantly improved their healthy lifestyle beliefs and behaviors with the MINDBODYSTRONG program. MINDBODYSTRONG is an effective program that reduces anxiety, depression, burnout, and stress and improves healthy lifestyle beliefs and behaviors in hospital-based clinicians. It is of utmost importance to provide evidence-based programs to improve mental resiliency and decrease stress, anxiety, burnout, and depressive symptoms, which will ultimately improve the safety and quality of health care.

Prevalence of mental disorders among older Australians: Contrasting evidence from the 2020-2021 National Study of Mental Health and Wellbeing among men and women and the Health In Men Data Linkage Study

OBJECTIVE

To determine the prevalence of common mental disorders among older Australians included in the Health In Men Data Linkage Study and compare those with the results of the 2020-2021 National Study of Mental Health and Wellbeing (NSMHW).

METHOD

We used longitudinal record linkage to estimate the prevalence of mental disorders from age 65 years in a random sample of 38173 Australian men aged 65-85 years living in the Perth metropolitan region. Outcome was the proportion of participants affected by depressive episodes or dysthymia, bipolar disorder, anxiety disorder, psychotic disorder and alcohol use disorder.

RESULTS

Prevalence estimates for participants aged 65-69, 70-74, 75-79, 80-84 and ≥85 years were 0.9%, 2.0%, 3.6%, 5.8% and 12.6% for depressive, 0.2%, 0.3%, 0.4%, 0.4% and 0.7% for bipolar, 0.1%, 0.5%, 1.3%, 2.2%, 6.9% for anxiety, 0.2%, 0.4%, 0.5%, 0.4% and 0.6% for psychotic and 1.2%, 1.7%, 2.1%, 2.2% and 4.2% for alcohol use disorders.

CONCLUSIONS

In contrast to the NSMHW, our data indicate that the prevalence of depressive and anxiety disorders increases with age, particularly among the older old. We conclude that the NSMHW should not be relied upon to guide planning or policies to address the mental health needs of older Australians.

The prevalence of anxiety in adult endocrinology outpatients: A systematic review and meta-analysis

INTRODUCTION

Anxiety disorders and anxiety symptoms are common mental disorders in the medically unwell and have significant impacts on patients' quality of life and engagement with psychiatric and medical services. Several systematic reviews have examined the prevalence of anxiety in specific endocrinology settings with estimates varying significantly from study to study. No meta-analysis has examined anxiety rates across the endocrinology outpatient setting. The aim of this meta-analysis is to provide endocrinologists with a precise estimate of the prevalence of anxiety - and impacting factors - in their outpatient clinics.

METHOD

PubMed, Embase, Cochrane and PsycINFO databases and Google Scholar were searched to identify studies that assessed anxiety prevalence in endocrinology outpatients published up to 23 January 2023. This was part of a larger systematic review search of anxiety prevalence in common medical outpatient clinics. Data characteristics were extracted independently by two investigators. Studies of patients 16 years and older and representative of the clinic were included. The point prevalence of anxiety or anxiety symptoms was measured using validated self-report questionnaires or structured interviews. Risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Checklist. Pooled estimates were analysed under the random-effects model and subgroup analyses on relevant variables were conducted under a mixed-effects model. Heterogeneity was assessed using the I2 statistic.

RESULTS

Fifty-nine studies with a total of 25,176 participants across 37 countries were included in this study. The overall pooled prevalence of anxiety or anxiety symptoms was 25·1% (95%CI 21·4-29·2; 6372/25,176; n = 59). Subgroup analyses revealed no difference in prevalence between outpatients with diabetes mellitus compared to other grouped endocrine disorders. Generalized Anxiety Disorder (GAD) was the most frequent clinical diagnosis 11·7% (95%CI 8·1-16·7; I2=87·93%; 443/4604; n = 17), while panic disorder was significantly higher in the non-diabetes group 9·5% (95%CI 5·9-14·9; I2=57·28%; 56/588; n = 8), compared to the diabetes group 5·2% (95%CI 3·7-7·3; I2=32·18%; 184/3669; n = 6). Estimates of prevalence were higher when assessed with a self-report scale 32·4% (95%CI 25·6-40·0; I2=96·06%; 1565/4675; n = 21) compared to diagnostic interview 17·6% (95%CI 12·2-24·7; I2=94·39%; 636/5168; n = 21). Outpatients in developing countries had higher rates of anxiety than those in developed countries. Female diabetes patients reported higher rates of anxiety compared to males.

CONCLUSION

Our study provides evidence that anxiety occurs frequently amongst endocrinology outpatients and at a higher rate than is estimated in the general population. Given the impact anxiety has on patient outcomes, it is important that effective management strategies be developed to support endocrinologists in identifying and treating these conditions in their outpatient clinics.

Shaping Memories Via Stress: A Synaptic Engram Perspective

Stress modulates the activity of various memory systems and can thereby guide behavioral interaction with the environment in an adaptive or maladaptive manner. At the cellular level, a large body of evidence indicates that (nor)adrenaline and glucocorticoid release induced by acute stress exposure affects synapse function and synaptic plasticity, which are critical substrates for learning and memory. Recent evidence suggests that memories are supported in the brain by sparsely distributed neurons within networks, termed engram cell ensembles. While the physiological and molecular effects of stress on the synapse are increasingly well characterized, how these synaptic modifications shape the multiscale dynamics of engram cell ensembles is still poorly understood. In this review, we discuss and integrate recent information on how acute stress affects synapse function and how this may alter engram cell ensembles and their synaptic connectivity to shape memory strength and memory precision. We provide a mechanistic framework of a synaptic engram under stress and put forward outstanding questions that address knowledge gaps in our understanding of the mechanisms that underlie stress-induced memory modulation.

Global Prevalence of Anxiety in Adult Cardiology Outpatients: A Systematic Review and Meta-analysis

Anxiety and anxiety disorders are associated with adverse cardiovascular outcomes, and reduced quality of life. Despite this, no comprehensive study on the global prevalence of anxiety symptoms and disorders among adult cardiology outpatients exists. This systematic review and meta-analysis aims to provide cardiologists with a precise estimate of the prevalence of anxiety in their outpatient clinics. PubMed, Embase, Cochrane and PsycINFO databases and Google Scholar were searched from database inception to January 23, 2023. Data characteristics were extracted independently by 2 investigators. Ninety-three studies, n = 36,687 participants across 31 countries, were included. Global prevalence of anxiety symptoms/disorders was 28.9% (95%CI 25.7-32.4; 8927/36, 687; I2 = 97.33; n = 93). The highest rates were found in patients presenting with hypertension, 43.6%. Subgroup analyses revealed higher prevalence estimates when using self-report screening compared to gold-standard diagnostic interview. When using diagnostic interview, the highest rates were reported in outpatients with undifferentiated chest pain/palpitations, 19·0%. Panic disorder was the most frequent diagnosis 15.3%, and rates were significantly higher in patients with undifferentiated chest pain/palpitations compared to ischemic heart disease. Higher rates of anxiety were found in studies of outpatients from developing countries, and female outpatients tended to have higher rates compared to males. Anxiety occurred frequently among cardiology outpatients and at a higher rate than estimated in the general population. Given the impact anxiety has on patient outcomes, it is important that effective identification and management strategies be developed to support cardiologists in identifying and treating these conditions in their clinics.

Yoga-based interventions may reduce anxiety symptoms in anxiety disorders and depression symptoms in depressive disorders: a systematic review with meta-analysis and meta-regression

OBJECTIVE

To summarise the effect of mind-body exercises on anxiety and depression symptoms in adults with anxiety or depressive disorders.

DESIGN

Systematic review with meta-analysis and meta-regression.

DATA SOURCES

Five electronic databases were searched from inception to July 2022. Manual searches were conducted to explore clinical trial protocols, secondary analyses of clinical trials and related systematic reviews.

ELIGIBILITY CRITERIA

Randomised clinical trials evaluating qigong, tai chi or yoga styles with anxiety or depression symptoms as the outcomes were included. No intervention, waitlist or active controls were considered as control groups. The risk of bias and the certainty of the evidence were assessed. Meta-analyses, meta-regressions and sensitivity analyses were performed.

RESULTS

23 studies, comprising 22 different samples (n=1420), were included. Overall, meta-analyses showed yoga interventions were superior to controls in reducing anxiety symptoms in anxiety disorders. Furthermore, yoga-based interventions decreased depression symptoms in depressive disorders after conducting sensitivity analyses. No differences between groups were found in the rest of the comparisons. However, the certainty of the evidence was judged as very low for all outcomes due to concerns of high risk of bias, indirectness of the evidence, inconsistency and imprecision of the results. In addition, there was marked heterogeneity among yoga-based interventions and self-reported tools used to evaluate the outcomes of interest.

CONCLUSION

Although yoga-based interventions may help to improve mental health in adults diagnosed with anxiety or depressive disorders, methodological improvements are needed to advance the quality of clinical trials in this field.

PROSPERO REGISTRATION NUMBER

CRD42022347673.

Anxiety in Parkinson's Patients: What's Timing Got to Do with It?

Background: Parkinson's Disease (PD) affects over 10 million people worldwide. Many PD patients experience comorbid anxiety disorders, which have been correlated with reduced quality of life and can manifest at any time during the course of PD, including prior to motor symptom onset. Purpose: Prior work has demonstrated that patients diagnosed with depression following a PD diagnosis are less likely to receive depression treatment, but no such study has been conducted for anxiety. Research Design: A cross-sectional analysis of secondary electronhic health record data was conducted. Study Sample: Data was obtained through Optum® de-identified Electronic Health Record dataset, using ICD-9 and ICD-10 diagnosis codes to determine PD status and comparing index date of anxiety and PD diagnoses to classify patients by relative time of diagnosis. Data Analysis: Multivariate logistic regression was performed to assess factors associated with receipt of mental health treatment. Results: Of PD patients with anxiety, 52% documented a diagnosis of anxiety prior to PD. Overall, 69% documented some treatment, with 79% of those diagnosed with anxiety prior to PD receiving some treatment compared to 59% of those diagnosed with anxiety on or after PD (P < 0.001). Conclusion: Patients with PD and subsequent anxiety diagnoses are less likely to receive treatment. Further study could explore reasons for variations in mental health care within the context of an existing PD diagnosis.

Sexual differentiation of neural mechanisms of stress sensitivity during puberty

Anxiety disorders are a major public health concern and current treatments are inadequate for many individuals. Anxiety is more common in women than men and this difference arises during puberty. Sex differences in physiological stress responses may contribute to this variability. During puberty, gonadal hormones shape brain structure and function, but the extent to which these changes affect stress sensitivity is unknown. We examined how pubertal androgens shape behavioral and neural responses to social stress in California mice (Peromyscus californicus), a model species for studying sex differences in stress responses. In adults, social defeat reduces social approach and increases social vigilance in females but not males. We show this sex difference is absent in juveniles, and that prepubertal castration sensitizes adult males to social defeat. Adult gonadectomy does not alter behavioral responses to defeat, indicating that gonadal hormones act during puberty to program behavioral responses to stress in adulthood. Calcium imaging in the medioventral bed nucleus of the stria terminalis (BNST) showed that social threats increased neural activity and that prepubertal castration generalized these responses to less threatening social contexts. These results support recent hypotheses that the BNST responds to immediate threats. Prepubertal treatment with the nonaromatizable androgen dihydrotestosterone acts in males and females to reduce the effects of defeat on social approach and vigilance in adults. These data indicate that activation of androgen receptors during puberty is critical for programming behavioral responses to stress in adulthood.

Psychometric Properties of the Persian Version of Social Anxiety Scale for Social Media Users (SAS-SMU)

Objective: Social anxiety refers to an excessive concern or fear about social situations. It seems that social media, which has become one of the most popular and effective tools for communication today, can be one of the contexts of social anxiety. Due to the lack of a Persian instrument to assess social anxiety in the context of social networks, the current study was undertaken to analyze the psychometric criteria of the Iranian version of the Social Anxiety Scale for Social Media Users (SAS-SMU). The SAS-SMU is a 21-item questionnaire designed by Alkis and colleagues (2017) to measure social anxiety emerging from the social media platforms. Method : In this study, a total of 842 participants within the age range of 11 to 82 years old (mean age 33.11 ± 12.134), 59% female) answered the questions in an online survey. The original version of the scale was translated into Persian using the back translation procedure. All participants completed a Demographic Questionnaire, the SAS-SMU, and the Beck Anxiety Inventory. In order to analyze the collected data, internal and external consistency, factor analysis, construct validity, and confirmatory factor analysis (CFA) were examined. A significance level of less than 0.05 was considered to determine statistical significance. Results: Four subscales were obtained from the exploratory factor analysis (SCA, PCA, IA, and SEA), which were confirmed by the confirmatory factor analysis. Cronbach's alpha for internal consistency was found to be 0.931 for the total scale and 0.920, 0.846, 0.901, 0.828 for SCA, PCA, IA, and SEA, respectively. In addition, the test-retest scores of 30 participants (interval: between 2 to 3 weeks) for all four subscales (SCA = 0.641, PCA = 0.773, IA = 0.688, SEA = 0.727) indicated acceptable stability of the questionnaire over time. Conclusion: This study validates the Persian version of the SAS-SMU for use in studies in the field of psychological problems related to social media and online communications.

Is Increasing Diet Diversity of Animal-Source Foods Related to Better Health-Related Quality of Life among Chinese Men and Women?

Diet plays a crucial role in regulating individuals' lifestyles and is closely related to health. The intake of animal-sourced foods (ASF) provides the human body with high-quality protein and various micronutrients. This study aimed to investigate whether the diversity of animal foods has a positive impact on the health-related quality of life (HRQoL) among residents. The data came from the Shaanxi baseline survey of the Northwest Chinese Regional Ethnic Cohort Study, which recruited more than 100 thousand participants aged 35 to 74 from five provinces between June 2018 and May 2019. A total of 39,997 participants in Shaanxi (mean age: 50 years; 64% women) were finally included in this current study. The animal source food diet diversity score (ASFDDS) was established based on the frequency of consuming pork, mutton, beef, poultry, seafood, eggs, pure milk, and yogurt. The physical component score (PCS) and mental component score (MCS), ranging from 0 to 100 on the 12-Item Short Form Survey (SF-12), were used to assess participants' HRQoL. Better PCS/MCS was defined as scores higher than the 90th percentile. The results showed that men had a higher intake of ASF and ASFDDS than women. After adjusting for potential confounders, compared with those who never or rarely consumed animal foods, the likelihood of having better PCS and MCS increased by 16% (OR = 1.16, 95%CI: 1.01-1.34) and 24% (OR = 1.24, 95%CI: 1.03-1.448), respectively, in men with an ASFDDS ≥ 2. In women, a 34% increase (OR = l.34, 95%CI: 116-l.54) likelihood for better PCS was observed for an ASFDDS ≥ 2, but no association was observed for MCS. Increasing each specific animal source's food intake was associated with better PCS after adjusting for all covariates. However, for MCS, positive associations were only observed in seafood consumption among men and eggs among women. Restricted cubic splines showed a substantial dose-response association between intake frequency of animal-source foods and PCS, both in men and women. The study suggests that a diverse intake of animal-sourced foods can potentially improve the HRQoL of Chinese adults.

Changes in anxiety in the general population over a six-year period

BACKGROUND

Anxiety is a frequent condition in patients and in the general population. The aim of this study was to investigate changes in anxiety over time and to test several psychometric properties of the Generalized Anxiety Disorder Screener (GAD-7) from a longitudinal perspective.

METHODS

The GAD-7 was included in an examination with two waves, six years apart. The study sample (n = 5355) was comprised of representatively selected adults from the general population with a mean age of 57.3 (SD = 12.3) years.

RESULTS

During the 6-year time interval, anxiety increased significantly from 3.28 ± 3.16 (t1) to 3.66 ± 3.46 (t2). Confirmatory factor analyses proved the longitudinal measurement invariance of the GAD-7. Reliability of the GAD-7 was established both for the cross-sectional and the longitudinal perspective. The test-retest correlation was r = 0.53, and there were no substantial sex or age differences in these coefficients of temporal stability. The mean changes in anxiety were similar for males and females, and there was no linear age trend in the changes measured by the GAD-7. Changes in anxiety over the 6-year period were correlated with changes in satisfaction with life (r = -0.30), bodily complaints (r = 0.31), and the mental component of quality of life (r = -0.48).

CONCLUSION

The GAD-7 is a suitable instrument for measuring changes in anxiety. Age and gender have only minor significance when interpreting change scores.

Anxiety in Response to Sustaining Spinal Cord Injuries and Disorders: When Should Clinicians Be Concerned?

OBJECTIVE

To recommend a cut-off score for the brief 2-item Generalized Anxiety Disorder (GAD-2) measure for persons with spinal cord injuries/disorders (PwSCI/D) and to estimate anxiety occurrence within this population using the full 7-item Generalized Anxiety Disorder (GAD-7).

DESIGN

Multicenter retrospective analyses.

SETTING

One inpatient rehabilitation center and 2 community sites for PwSCI/D.

PARTICIPANTS

PwSCI/D 18 years or older (N=909) were included for analysis using retrospectively collected GAD-2 and GAD-7 data.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURE(S)

Occurrence of anxiety symptoms were compared using cut-off scores of ≥8 and ≥10 on the GAD-7. A cut-off score recommendation for the GAD-2 was determined using ROC curve, and sensitivity and specificity analyses.

RESULTS

Occurrence of anxiety symptoms was 21% using a GAD-7 cut-off of ≥8 and 15% using a cut-off of ≥10. Analyses indicated optimal sensitivity for a GAD-2 score of ≥2 when a GAD-7 cut-off of ≥8 was used.

CONCLUSIONS

Anxiety occurrence is elevated among PwSCI/D compared with the general population. For PwSCI/D, it is recommended that a cut-off score of ≥2 is used for the GAD-2 to maximize sensitivity and that a threshold of ≥8 is used for the GAD-7 to ensure the maximum number of individuals presenting with symptoms of anxiety are recognized for diagnostic interview. Study limitations are discussed.

The Association of Cytomegalovirus and Allostatic Load by Country of Birth and Length of Time in the United States

BACKGROUND

Cytomegalovirus (CMV) is a highly prevalent virus with a worldwide distribution. It typically remains dormant in most individuals until reactivation. Immunocompromised states are known to be potential causes for CMV reactivation. Current research has shown a link in the decline of immigrant health among those living in the US for an extended period, though the impact of CMV on this is not clear.

METHODS

This study investigated the association between country of birth, duration of US residency, allostatic load, and latent cytomegalovirus infection (CMV IgG) in a sample of US adults aged 20-49. The data utilized for our analysis was obtained from the National Health and Nutrition Examination Survey (NHANES) conducted between 2001 and 2004. Allostatic load, an index measuring the cumulative physiological strain on the body as it strives to regain stability in the presence of chronic stress, provided a valuable approach to assess stress within the context of CMV exposure. Logistic regression modeling was employed to estimate odds ratios and confidence intervals for the analysis. The chi-square test of association and Cramer's V statistic were used to assess the correlation among categorical variables, while Pearson's correlation coefficient was applied to evaluate the relationship between continuous variables. The results revealed that individuals born outside the US and those with less than 20 years of residency in the US exhibited significantly higher proportions of positive CMV IgG compared to individuals born in the US. Specifically, individuals born outside the US had more than triple the odds of CMV IgG when adjusting for the AL index (OR = 3.69, p-value = 0.0063). A similar trend was observed when examining AL risk based on the duration of US residency. Furthermore, age and sex were identified as significant predictors (p-value < 0.05) of AL risk, considering the individual's country of birth. In summary, the findings of this study significantly enhance our comprehension of the intricate interplay between cytomegalovirus (CMV) and allostatic load (AL). The investigation sheds light on how CMV and AL interact within specific demographic contexts, providing valuable insights into the underlying risk factors for CMV infection.

Concurrent validity of the anxiety symptom-scale compared to two well-being scales: results from the Lolland-Falster health study

OBJECTIVE

To examine the concurrent validity of the Anxiety Symptom-scale against two well-being scales, the Cantril Ladder (CL) and World Health Organization Well-Being Index (WHO-5), to test the algorithm defining anxiety against these scales, and identify cut-off points for the Anxiety Symptom-scale sum score.

SUBJECTS

14,405 adult respondents completing all psychometric questions in the Lolland Falster Health Study.

METHOD

Receiver operating characteristic analyses comparing Anxiety Symptom-scale WHO-5 and CL.

RESULTS

2.5% of respondents had an anxiety disorder (3% female and 2% male) according to the Anxiety Symptom-scale algorithm. The area under the curve (AUC) was 0.87 for CL and 0.90 for WHO-5 (using inverse scores), indicating high concordance with anxiety disorder as identified by the scale. A score solely ≥2 on item 10 is a relevant cut off to low wellbeing. Anxiety disorder covers a broad range on the scale's sum score, with 3 to 4 indicating low well-being in this population sample and a sensitivity of 0.85 - 0.99 against CL and WHO-5.

CONCLUSION

The Anxiety Symptom-scale is a sensitive and valid instrument for the identification of patients in low well-being with symptoms of anxiety. A score ≥2 on the functional impact (Item 10) of all symptoms is a relevant indicator of anxiety associated with low well-being in this sample. A higher Anxiety Symptom-scale sum score is coherent with lower well-being, though without specific cut-off points. Further validation of the Anxiety Symptom-scale in a clinical setting is recommended.

Assessment of depression and anxiety in young and old with a question-based computational language approach

Middle aged adults experience depression and anxiety differently than younger adults. Age may affect life circumstances, depending on accessibility of social connections, jobs, physical health, etc, as these factors influence the prevalence and symptomatology. Depression and anxiety are typically measured using rating scales; however, recent research suggests that such symptoms can be assessed by open-ended questions that are analysed by question-based computational language assessments (QCLA). Here, we study middle aged and younger adults' responses about their mental health using open-ended questions and rating scales about their mental health. We then analyse their responses with computational methods based on natural language processing (NLP). The results demonstrate that: (1) middle aged adults describe their mental health differently compared to younger adults; (2) where, for example, middle aged adults emphasise depression and loneliness whereas young adults list anxiety and financial concerns; (3) different semantic models are warranted for younger and middle aged adults; (4) compared to young participants, the middle aged participants described their mental health more accurately with words; (5) middle-aged adults have better mental health than younger adults as measured by semantic measures. In conclusion, NLP combined with machine learning methods may provide new opportunities to identify, model, and describe mental health in middle aged and younger adults and could possibly be applied to the older adults in future research. These semantic measures may provide ecological validity and aid the assessment of mental health.

Efficacy and safety of non-pharmacological therapy under the guidance of TCM theory in the treatment of anxiety in patients with myocardial infarction: A protocol for systematic review and meta-analysis

BACKGROUND

With the increasing pressures of modern life and work, combined with a growing older population, the incidence of comorbid anxiety and myocardial infarction (MI) is increasing. Anxiety increases the risk of adverse cardiovascular events in patients with MI and significantly affects their quality of life. However, there is an ongoing controversy regarding the pharmacological treatment of anxiety in patients with MI. The concomitant use of commonly prescribed selective serotonin reuptake inhibitors (SSRIs) and antiplatelet medications such as aspirin and clopidogrel may increase the risk of bleeding. Conventional exercise-based rehabilitation therapies have shown limited success in alleviating anxiety symptoms. Fortunately, non-pharmacological therapies based on traditional Chinese medicine (TCM) theory, such as acupuncture, massage, and qigong, have demonstrated promising efficacy in treating MI and comorbid anxiety. These therapies have been widely used in community and tertiary hospital settings in China to provide new treatment options for patients with anxiety and MI. However, current studies on non-pharmacological TCM-based therapies have predominantly featured small sample sizes. This study aims to comprehensively analyze and explore the effectiveness and safety of these therapies in treating anxiety in patients with MI.

METHOD

We will systematically search six English and four Chinese databases by employing a pre-defined search strategy and adhering to the unique rules and regulations of each database to identify studies that fulfilled our inclusion criteria, to qualify for inclusion, patients must be diagnosed with both MI and anxiety, and they must have undergone non-pharmacological TCM therapies, such as acupuncture, massage, or qigong, whereas the control group received standard treatments. The primary outcome measure will be alterations in anxiety scores, as assessed using anxiety scales, with secondary outcomes encompassing the evaluations of cardiopulmonary function and quality of life. We will utilize RevMan 5.3 to conduct a meta-analysis of the collected data, and subgroup analyses will be executed based on distinct types of non-pharmacological TCM therapies and outcome measures.

RESULTS

A narrative summary and quantitative analysis of the existing evidence on the treatment of anxiety patients with MI using non-pharmacological therapies guided by Traditional Chinese Medicine theory.

CONCLUSION

This systematic review will investigate whether non-pharmacological interventions guided by TCM theory are effective and safe for anxiety in patients with MI, and provide evidence-based support for their clinical application.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42022378391.

Sex, anxiety and the interplay with physiological variables of stress: a clinical study of patients about to undergo bronchoscopy

Women often report more anxiety than men, but there are divergent results regarding the putative correlation between physiological variables, such as cortisol, blood pressure and heart rate and the experienced emotional states. The aim of the present study was to evaluate sex differences in anxiety, and the relation to serum cortisol, blood pressure and heart rate. We used data from two pooled studies with participants from the same population (N = 405) facing a real-life stressor, bronchoscopy, as part of examination for lung cancer. At admission, blood pressure and heart rate were recorded, and a blood sample was taken for analysis of serum cortisol. Participants then completed Spielberger's State Trait Anxiety Inventory (STAI). Patients had elevated anxiety measured with STAI state compared to relevant age and sex stratified norm scores. Women had significantly higher STAI state score than men (M = 44.9, SD = 13.2 vs M = 36.2, SD = 10.7; t(403) = 7.25, p < 0.001). Mean serum cortisol, systolic blood pressure and heart rate showed no significant sex difference. There was a weak but significant correlation between state anxiety and heart rate and cortisol but none between blood pressure and anxiety. This study adds an important confirmation of sex differences in anxiety in a real-life setting, where women report significantly more anxiety than men do. However, the physiological markers only show a weak link with experienced anxiety, and exhibit no sex differences.

mGluR5 in hippocampal CA1 pyramidal neurons mediates stress-induced anxiety-like behavior

Pharmacological manipulation of mGluR5 has showed that mGluR5 is implicated in the pathophysiology of anxiety and mGluR5 has been proposed as a potential drug target for anxiety disorders. Nevertheless, the mechanism underlying the mGluR5 involvement in stress-induced anxiety-like behavior remains largely unknown. Here, we found that chronic restraint stress induced anxiety-like behavior and decreased the expression of mGluR5 in hippocampal CA1. Specific knockdown of mGluR5 in hippocampal CA1 pyramidal neurons produced anxiety-like behavior. Furthermore, both chronic restraint stress and mGluR5 knockdown impaired inhibitory synaptic inputs in hippocampal CA1 pyramidal neurons. Notably, positive allosteric modulator of mGluR5 rescued stress-induced anxiety-like behavior and restored the inhibitory synaptic inputs. These findings point to an essential role for mGluR5 in hippocampal CA1 pyramidal neurons in mediating stress-induced anxiety-like behavior.

Psychometric Properties and Factorial Structure of Postpartum-Specific Anxiety Scale (PSAS) Within Arabic Language in a Palestinian Context

BACKGROUND

The Postpartum-Specific Anxiety Scale (PSAS) is an international measure designed to evaluate anxiety experienced by mothers in the postpartum period from one day to six months; the scale was translated into Arabic and validated within Palestinian context to test postpartum anxiety among Palestinian women.

AIMS

The current study aimed to test the psychometric properties and the factorial structure within the Arabic language in a Palestinian context using confirmatory factor analysis (CFA). The sample of this study consisted of 475 Palestinian women recruited from health centers in the West Banks of Palestine using a convenience sample. 61% were of ages 20-30 years and 39% percent ages 31-40 years.

FINDINGS

The PSAS showed good validity and reliability indicators in assessing postpartum anxiety within Palestinian context. Results of CFA showed a stable construct of a four-factor structure in assessing postpartum anxiety among Palestinian mothers: (1) competence and attachment anxieties, (2) infant safety and welfare anxieties, (3) practical baby care anxieties and (4) psychosocial adjustment to motherhood, which is consisting with the original four-factor structure of the scale.

CONCLUSIONS

The PSAS showed good validity indicators within Palestinian context. Therefore, it is recommended to conduct similar studies with clinical and non-clinical groups in the Palestinian society. The PSAS can be a useful measure to assess anxiety levels among women during the postpartum months; which will enable mental health providers to provide psychological interventions for mothers whose anxiety levels are high.

Group-based active artistic interventions for adults with primary anxiety and depression: a systematic review

OBJECTIVES

This systematic review examined the potential benefit of all group-based performing arts interventions for primary anxiety and/or depression.

SETTING

Scholarly literature from any country or countries globally.

DATA SOURCES

Three key bibliographic databases, Google Scholar and relevant citation chasing.

PRIMARY AND SECONDARY OUTCOME MEASURES

Depression and/or anxiety symptom severity, well-being, quality of life, functional communication or social participation.

RESULTS

Database searches returned a total of 63 678 records, of which 56 059 remained following dededuplication. From these database searches, a total of 153 records proceeded to full-text screening. These were supplemented by 18 additional unique full-text screening records from Google Scholar searches and citation chasing (12% of total). From a total of 171 records at the full-text screening stage, 12 publications (7%) were eligible for inclusion in this systematic review, each reporting on a separate study. Published from 2004 to 2021, these studies involved a total of 669 participants with anxiety and/or depression from nine countries and covered five broad artistic modalities: dance, music therapy, art therapy, martial arts and theatre. Dance was the most studied artistic modality (five studies), while there were three studies on art therapy, two on music therapy and one each on martial arts and theatre. The evidence was clearest for a benefit of arts therapies on depression and/or anxiety symptoms.

CONCLUSIONS

This systematic review addresses all group-based active arts interventions in a focused population of primary anxiety and/or depression. The evidence suggests that the arts may be a useful therapeutic medium in this population. However, a substantial limitation of the evidence base is the lack of studies directly comparing different artistic modalities. Moreover, not all artistic modalities were assessed for all outcome domains. Therefore, it is not currently possible to determine which artistic modalities are most beneficial for which specific outcomes.

Inappropriate Medications Use and Polypharmacy among Older Adults with Anxiety Disorder

BACKGROUND

Elderly with mental health conditions usually use multiple medications, which predisposes them to inappropriate use of medications, which is defined as medications that should be avoided due to their risk; this outweighs their benefit given that safer alternatives are available. This study aimed to examine potentially inappropriate medication use among older patients with anxiety disorder.

METHODS

This study used a cross-sectional retrospective study design using twelve months of data extracted from the Electronic Health Record (EHR) database for older adults diagnosed with anxiety disorder and treated in the ambulatory care setting. Potentially inappropriate medications (PIMs) use was evaluated using the 2019 Beers criteria. Descriptive statistics were used to describe the sample. Pearson's chi-square tests (for categorical variables) and t-tests (for continuous variables) were utilized to measure the differences in independent variables between patients with and without PIMs. Binary logistic regression was used to examine the associations between PIMs use and identify potential factors for PIMs use among older adults with anxiety disorder. Analyses were performed using the Statistical Analysis Software version 9.4 (SAS^® 9.4).

RESULTS

The study sample includes 371 older adults (age ≥ 65 years) with anxiety disorder; their average age was (72.1 ± 5.8) years. PIMs use was highly prevalent among older adults with anxiety (66.6%). About 35.6% of the study sample used one PIM, 22.6% used two PIMs, and 8.4% used three PIMs. The most frequently prescribed PIMs were NSAIDs and gastrointestinal agents. The adjusted regression analysis found that PIMs use was less likely among men than women. In addition, PIMs use was more likely among women with diabetes, cancer, and polypharmacy.

CONCLUSIONS

Future studies on strategies and interventions rationing PIMs use in older adults with anxiety disorder are necessary given the high prevalence of PIMs and polypharmacy within this population.

Remotely and collaboratively evaluating a campus-based therapy dog program during the COVID-19 pandemic

The COVID-19 pandemic adversely affected the wellbeing of university students and adults in general, emphasizing the need for mental health programming that was compliant with physical distancing mandates. The present evaluation investigated mental health and social connection within the context of COVID-19 by remotely evaluating a virtual animal-assisted activity at the University of Saskatchewan - PAWS Your Stress. The purpose of this article is to outline our evaluation methods and findings, while calling specific attention to the collaborative strategies that were implemented within a remote, time-sensitive context. The evaluation findings revealed that remote animal-assisted programming can facilitate connections with humans and animals, and promote multiple mental health benefits, despite the lack of physical interaction with the animals. Our lessons learned indicate that remote program logic modelling workshops are feasible when suited to audience demographics. Further, our experience suggests that the Most Significant Change technique (a qualitative, participatory, storytelling method that elicits outcome data) can be useful in time-restricted evaluations, and the necessity of central steps in the process may vary depending on evaluation goals. This project has implications for future evaluation work, by demonstrating the effective use of remote methods that allowed for successful stakeholder collaboration.

Impaired fear memory in a rat model of the Brain-Derived Neurotrophic Factor Val66Met polymorphism is reversed by chronic exercise

The brain-derived neurotrophic factor (BDNF) Val66Met polymorphism is associated with reduced activity-dependent BDNF release in the brain and has been implicated in fear and anxiety disorders, including post-traumatic stress disorder. Exercise has been shown to have benefits in affective disorders but the role of BDNF Val66Met remains unclear. Male and female BDNF Val66Met rats were housed in automated running-wheel cages from weaning while controls were housed in standard cages. During adulthood, all rats underwent standard three-day fear conditioning testing, with three tone/shock pairings on day 1 (acquisition), and extinction learning and memory (40 tones/session) on day 2 and day 3. Expression of BDNF and stress-related genes were measured in the frontal cortex. Extinction testing on day 2 revealed significantly lower freezing in response to initial cue exposure in control Met/Met rats, reflecting impaired fear memory. This deficit was reversed in both male and female Met/Met rats exposed to exercise. There were no genotype effects on acquisition or extinction of fear, however chronic exercise increased freezing in all groups at every stage of testing. Exercise furthermore led to increased expression of Bdnf in the prefrontal cortex of females and its isoforms in both sexes, as well as increased expression of FK506 binding protein 51 (Fkpb5) in females and decreased expression of Serum/glucocorticoid-regulated kinase (Sgk1) in males independent of genotype. These results show that the Met/Met genotype of the Val66Met polymorphism affects fear memory, and that chronic exercise selectively reverses this genotype effect. Chronic exercise also led to an overall increase in freezing in all genotypes which may contribute to results.