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Family Strain, Depression, and Somatic Amplification in Adults with Chronic Pain. Int J Behav Med 2019; 26:427-436. [DOI: 10.1007/s12529-019-09799-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Aragonès E, Rambla C, López-Cortacans G, Tomé-Pires C, Sánchez-Rodríguez E, Caballero A, Miró J. Effectiveness of a collaborative care intervention for managing major depression and chronic musculoskeletal pain in primary care: A cluster-randomised controlled trial. J Affect Disord 2019; 252:221-229. [PMID: 30986737 DOI: 10.1016/j.jad.2019.04.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 02/07/2019] [Accepted: 04/06/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Depression and chronic musculoskeletal pain commonly occur as comorbid conditions, which increases their negative effects on health outcomes. The objective of this study was to assess the effectiveness of the DROP (DepRessiOn and Pain) programme designed for the management of major depression and chronic musculoskeletal pain in primary care. METHODS A cluster-randomised controlled trial was carried out between June 2015 and December 2017 with 328 patients with major depression and chronic musculoskeletal pain, randomly allocated to either intervention arm or usual care arm. The intervention included care management, optimised management of depression, and a psychoeducational programme. Outcomes were monitored using blinded interviews over a 12-month period. TRIAL REGISTRATION NCT02605278 (ClinicalTrials.gov). RESULTS After 12 months, 274 patients were evaluated (83.5% participation). The severity of depression (Hopkins Symptom Checklist score) was 0.23 points lower in the intervention arm [1.11 vs. 1.34; CI95% = -0.42 to -0.04]. Intervention arm's response rate to antidepressant treatment was 18.9% higher [39.6% vs. 20.7%; OR = 2.74; CI95% = 1.12-6.67] and its remission rate for depression was 9.0% higher [20.1% vs. 11.1%; OR = 2.13; CI95% = 0.94-4.85] compared to the usual care arm. There were no significant differences between the two arms in terms of pain severity (Brief Pain Inventory severity score) [6.23 vs. 6.66; difference = -0.39; CI95% = -1.13-0.35] or pain response rate [18.7% vs. 18.5%; OR = 1.02; CI95% = 0.46-2.26]. LIMITATIONS This is a pragmatic study, and poor adherence to the programme by patients and physicians was a main limitation. CONCLUSION The programme improves clinical outcomes for depression, although no clinical benefits were seen for pain.
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Affiliation(s)
- Enric Aragonès
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain; Atenció Primària Camp de Tarragona, Institut Català de la Salut, Tarragona, Spain.
| | - Concepció Rambla
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain; Atenció Primària Camp de Tarragona, Institut Català de la Salut, Tarragona, Spain
| | - Germán López-Cortacans
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain; Atenció Primària Camp de Tarragona, Institut Català de la Salut, Tarragona, Spain
| | - Catarina Tomé-Pires
- Atenció Primària Camp de Tarragona, Institut Català de la Salut, Tarragona, Spain; Unit for the Study and Treatment of Pain - ALGOS, and Research Center for Behavior Assessment (CRAMC), Department of Psychology, Universitat Rovira i Virgili, Tarragona, Spain; Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Tarragona, Spain
| | - Elisabet Sánchez-Rodríguez
- Unit for the Study and Treatment of Pain - ALGOS, and Research Center for Behavior Assessment (CRAMC), Department of Psychology, Universitat Rovira i Virgili, Tarragona, Spain; Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Tarragona, Spain
| | - Antonia Caballero
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain; Atenció Primària Camp de Tarragona, Institut Català de la Salut, Tarragona, Spain
| | - Jordi Miró
- Unit for the Study and Treatment of Pain - ALGOS, and Research Center for Behavior Assessment (CRAMC), Department of Psychology, Universitat Rovira i Virgili, Tarragona, Spain; Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Tarragona, Spain
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Brettschneider C, Bleibler F, Hiller TS, Konnopka A, Breitbart J, Margraf J, Gensichen J, König HH. The allocation of resources in the care for patients with panic disorder in Germany: an excess cost analysis informing policy and science. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2019; 17:9. [PMID: 31061640 PMCID: PMC6487058 DOI: 10.1186/s12962-019-0177-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 04/15/2019] [Indexed: 11/10/2022] Open
Abstract
Background Panic disorder is a mental disorder of high prevalence, which frequently co-occurs with agoraphobia. There is a lack of studies measuring excess costs of panic disorder patients with and without agoraphobia. We compared costs of panic disorder patients with or without agoraphobia with costs of the anxiety-free population in Germany. Methods Primary data from a cluster-randomized trial of adults suffering from panic disorder (n = 419) and from a representative survey of the German general population (N = 5005) were collected between 2012 and 2014. Missing data from the cluster-randomized trial were first imputed by multiple imputation using chained equations and subsequently balanced with the data from the survey by Entropy Balancing. The societal perspective was chosen. Excess costs were calculated by generalized linear models and two-part-models. Results Entropy Balancing led to an exact match between the groups. We found 6-month total excess costs of 3220€ (95% CI 1917€–4522€) for panic disorder patients without agoraphobia and of 3943€ (95% CI 2950€–4936€) for patient with agoraphobia. Panic disorder patients with or without agoraphobia had significantly higher costs for psychotherapy, general practitioners, general hospital stays and informal care Indirect costs accounted for approximately 60% of the total excess costs. Conclusions Panic disorder with or without agoraphobia is associated with significant excess costs. Agoraphobia changes the pattern of resource utilization. Especially indirect costs are relevant. Agoraphobia influences resource utilization in the inpatient sector. Trial registration ISRCTN64669297
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Affiliation(s)
- Christian Brettschneider
- 1Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Florian Bleibler
- 1Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Thomas S Hiller
- 2Institute of General Practice & Family Medicine, Jena University Hospital, Friedrich-Schiller-University, Bachstrasse 18, 07743 Jena, Germany
| | - Alexander Konnopka
- 1Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Jörg Breitbart
- 2Institute of General Practice & Family Medicine, Jena University Hospital, Friedrich-Schiller-University, Bachstrasse 18, 07743 Jena, Germany
| | - Jürgen Margraf
- 3Mental Health Research and Treatment Center, Ruhr-University Bochum, Massenbergstrasse 9-13, 44787 Bochum, Germany
| | - Jochen Gensichen
- 2Institute of General Practice & Family Medicine, Jena University Hospital, Friedrich-Schiller-University, Bachstrasse 18, 07743 Jena, Germany.,4Institute of General Practice and Family Medicine, University Hospital of Ludwig-Maximilians-University Munich, Pettenkoferstraße 10, 80336 Munich, Germany
| | - Hans-Helmut König
- 1Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
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Abstract
PURPOSE OF REVIEW Anxiety disorders are among the most common mental disorders with a lifetime prevalence of over 20%. Clinically, anxiety is not thought of as a homogenous disorder, but is subclassified in generalized, panic, and phobic anxiety disorder. Anxiety disorders are moderately heritable. This review will explore recent genetic and epigenetic approaches to anxiety disorders explaining differential susceptibility risk. RECENT FINDINGS A substantial portion of the variance in susceptibility risk can be explained by differential inherited and acquired genetic and epigenetic risk. Available data suggest that anxiety disorders are highly complex and polygenic. Despite the substantial progress in genetic research over the last decade, only few risk loci for anxiety disorders have been identified so far. This review will cover recent findings from large-scale genome-wide association studies as well as newer epigenome-wide studies. Progress in this area will likely require analysis of much larger sample sizes than have been reported to date. We discuss prospects for clinical translation of genetic findings and future directions for research.
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Responsibilization and recovery: shifting responsibilities on the journey through mental health care to social engagement. SOCIAL THEORY & HEALTH 2019. [DOI: 10.1057/s41285-019-00097-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Meints SM, Edwards RR. Evaluating psychosocial contributions to chronic pain outcomes. Prog Neuropsychopharmacol Biol Psychiatry 2018; 87:168-182. [PMID: 29408484 PMCID: PMC6067990 DOI: 10.1016/j.pnpbp.2018.01.017] [Citation(s) in RCA: 246] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 01/18/2018] [Accepted: 01/29/2018] [Indexed: 12/12/2022]
Abstract
The biopsychosocial model of pain dominates the scientific community's understanding of chronic pain. Indeed, the biopsychosocial approach describes pain and disability as a multidimensional, dynamic integration among physiological, psychological, and social factors that reciprocally influence one another. In this article, we review two categories of studies that evaluate the contributions of psychosocial factors to the experience of chronic pain. First, we consider general psychosocial variables including distress, trauma, and interpersonal factors. Additionally, we discuss pain-specific psychosocial variables including catastrophizing, expectations, and pain-related coping. Together, we present a diverse array of psychological, social, and contextual factors and highlight the need to consider their roles in the development, maintenance, and treatment of chronic pain conditions.
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Affiliation(s)
- S M Meints
- Department of Anesthesiology, Pain Management Center, Brigham and Women's Hospital, Harvard Medical School, Chestnut Hill, MA, USA.
| | - R R Edwards
- Department of Anesthesiology, Pain Management Center, Brigham and Women's Hospital, Harvard Medical School, Chestnut Hill, MA, USA
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Homish GG, Hoopsick RA, Heavey SC, Homish DL, Cornelius JR. Drug use and hazardous drinking are associated with PTSD symptoms and symptom clusters in US Army Reserve/National Guard Soldiers. Am J Addict 2018; 28:22-28. [PMID: 30548523 DOI: 10.1111/ajad.12829] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 09/27/2018] [Accepted: 11/17/2018] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND AND OBJECTIVES There is strong evidence of the association between Posttraumatic Stress Disorder (PTSD) symptoms and substance use. Previous work has found sex differences in these associations. With revisions to the DSM, it is important to understand how overall PTSD symptoms and the new symptom clusters relate to substance use among Reserve/Guard soldiers-a high risk group. METHODS Data are from the baseline assessment of Operation: SAFETY (Soldiers and Families Excelling Through the Years), a longitudinal study of US Army Reserve/National Guard (USAR/NG) soldiers (N = 389 males, N = 84 females). We examined associations between current substance use (drug use, hazardous drinking, and smoking) and overall PTSD symptoms, and symptom clusters. Additionally, we examined PTSD by sex interactions. RESULTS Greater overall PTSD symptoms were associated with higher odds of drug use (OR = 1.08; 95%CI: 1.05, 1.12) and hazardous drinking (OR = 1.04; 95%CI: 1.02, 1.07). Greater individual symptom cluster scores were associated with higher odds of drug use (ps < .001) and hazardous drinking (ps < .01). Interaction models revealed no differences in these associations on the basis sex (ps > .05). There were no associations between PTSD symptoms or symptom clusters on smoking (ps > .05). DISCUSSION AND CONCLUSION Soldiers experiencing PTSD symptoms are reporting current drug and hazardous alcohol use, suggestive of self-medication. SCIENTIFIC SIGNIFICANCE It is imperative to consider the impact of PTSD on substance use broadly, as this work shows that overall symptoms and symptom clusters have an impact on male and female USAR/NG soldiers. (Am J Addict 2019;28:22-28).
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Affiliation(s)
- Gregory G Homish
- Department of Community Health and Health Behavior, State University of New York at Buffalo, 3435 Main Street, Buffalo 14214, New York.,Departments of Pediatrics and Family Medicine, State University of New York at Buffalo, 3435 Main Street, Buffalo 14214, New York
| | - Rachel A Hoopsick
- Department of Community Health and Health Behavior, State University of New York at Buffalo, 3435 Main Street, Buffalo 14214, New York
| | - Sarah Cercone Heavey
- Department of Community Health and Health Behavior, State University of New York at Buffalo, 3435 Main Street, Buffalo 14214, New York
| | - D Lynn Homish
- Department of Community Health and Health Behavior, State University of New York at Buffalo, 3435 Main Street, Buffalo 14214, New York
| | - Jack R Cornelius
- Department of Psychiatry, University of Pittsburgh, 3811 O'Hara Street, Pittsburgh 15213, Pennsylvania
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Frohlich JR, Rapinda KK, Schaub MP, Wenger A, Baumgartner C, Johnson EA, O'Connor RM, Vincent N, Blankers M, Ebert DD, Hadjistavropoulos H, Mackenzie CS, Keough MT. Efficacy of an Online Self-Help Treatment for Comorbid Alcohol Misuse and Emotional Problems in Young Adults: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2018; 7:e11298. [PMID: 30389649 PMCID: PMC6238101 DOI: 10.2196/11298] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 07/17/2018] [Accepted: 07/17/2018] [Indexed: 01/19/2023] Open
Abstract
Background Alcohol misuse and emotional problems (ie, depression and anxiety) are highly comorbid among Canadian young adults. However, there is a lack of integrated, accessible, and evidence-based treatment options for these young adults. Objective The main goal of this study is to develop and test the efficacy of an integrated, online self-help program designed to target both alcohol misuse and emotional problems. Methods A two-arm randomized controlled trial design will be used to compare the efficacy of the online integrated treatment to a psychoeducational control group. A target sample of 214 participants will be recruited and randomly assigned to either condition. The integrated treatment will last 8 weeks, and participants will work through 12 modules. Modules will incorporate content based on principles of cognitive behavioral therapy and motivational interviewing. Participants in the control group will receive links to psychoeducational resources and will have access to the full treatment after follow-up. The primary outcome will be the number of Canadian standard drinks consumed in the week leading up the assessment. Secondary outcomes of interest include symptoms of depression, anxiety, alcohol-related problems, quality of life, and use of other drugs. Assessments will be completed at 3 time-points: at baseline, at the end of treatment (ie, 8 weeks), and at follow-up (ie, 24 weeks). Upon completion, data will be analyzed using generalized linear mixed models. Results Data collection began in June 2018 and will continue until January 2020. Final study results will be submitted for publication by July 2020. Conclusions Currently, there are no integrated treatments designed to target alcohol misuse and the range of emotional problems experienced by young adults. This research stands to provide an effective, accessible (ie, Web-based), and feasible option to treat the many struggling young adults in this country. Trial Registration ClinicalTrials.gov ID NCT03406039; https://clinicaltrials.gov/ct2/show/NCT03406039 (Archived by WebCite at http://www.webcitation.org/72fDefnrh) Registered Report Identifier PRR1-10.2196/11298
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Affiliation(s)
- Jona R Frohlich
- Department of Psychology, University of Manitoba, Winnipeg, MB, Canada
| | - Karli K Rapinda
- Department of Psychology, University of Manitoba, Winnipeg, MB, Canada
| | - Michael P Schaub
- Swiss Research Institute for Public Health and Addiction, University of Zurich, Zurich, Switzerland
| | - Andreas Wenger
- Swiss Research Institute for Public Health and Addiction, University of Zurich, Zurich, Switzerland
| | - Christian Baumgartner
- Swiss Research Institute for Public Health and Addiction, University of Zurich, Zurich, Switzerland
| | - Edward A Johnson
- Department of Psychology, University of Manitoba, Winnipeg, MB, Canada
| | - Roisin M O'Connor
- Department of Psychology, Concordia University, Montreal, QC, Canada
| | - Norah Vincent
- Clinical Health Psychology, University of Manitoba, Winnipeg, MB, Canada
| | - Matthijs Blankers
- Arkin Mental Health Care, University of Amsterdam, Amsterdam, Netherlands.,Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, Netherlands.,Academic Medical Center, Department of Psychiatry, University of Amsterdam, Amsterdam, Netherlands
| | - David D Ebert
- Department of eMental Health, University of Erlangen-Nuremberg, Erlangen, Germany
| | | | - Corey S Mackenzie
- Department of Psychology, University of Manitoba, Winnipeg, MB, Canada
| | - Matthew T Keough
- Department of Psychology, University of Manitoba, Winnipeg, MB, Canada
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Which mental disorders are associated with the greatest impairment in functioning? Soc Psychiatry Psychiatr Epidemiol 2018; 53:1265-1276. [PMID: 29959451 DOI: 10.1007/s00127-018-1554-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 06/14/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE The objective of this study is to estimate the comparative associations of mental disorders with three measures of functional impairment: the Global Assessment of Functioning (GAF); the number of days in the past 12 months of total inability to work or carry out normal activities because of emotions, nerves, or mental health (i.e., days out of role); and a modified version of the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0). METHODS Secondary data analysis of the linked Mental Health Surveillance Study and the National Survey on Drug Use and Health (n = 5653), nationally representative population surveys conducted in the United States. Generalized linear models assessed the independent effects of mental disorders on each measure of functional impairment, controlling for mental disorder comorbidity, physical health disorders, and sociodemographic factors. RESULTS The results varied across measures of functional impairment. However, mood disorders generally tended to be associated with the greatest functional impairment, anxiety disorders with intermediate impairment, and substance use disorders with the least impairment. All 15 disorders were significantly associated with the GAF score in multiple regression models, eight disorders were significantly associated with the WHODAS score, and three disorders were significantly associated with days out of role. CONCLUSIONS Our results highlight the value of complementary measures of functional impairment.
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González-Blanch C, Fernando Hernández-de-Hita, Muñoz-Navarro R, Ruíz-Rodríguez P, Medrano LA, Moriana JA, Cano-Vindel A. Domain-specific associations between disability and depression, anxiety, and somatization in primary care patients. Psychiatry Res 2018; 269:596-601. [PMID: 30205353 DOI: 10.1016/j.psychres.2018.09.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 07/26/2018] [Accepted: 09/03/2018] [Indexed: 10/28/2022]
Abstract
This study explores the associations between different disability domains and the most prevalent symptoms of mental disorders in primary care patients (i.e. depression, anxiety, and somatization). A total of 1241 participants from 28 primary care centres completed self-report measures of depression, anxiety, and somatization. This same sample also completed the Sheehan Disability Scale (SDS) to assess functional impairment in work, social life, and family life domains. Associations between the symptoms and each disability domain were examined using hierarchical regression analyses. Depression emerged as the strongest predictor of all three disability domains. Somatization was associated only with the work domain, and anxiety was associated only with the family life domain. Clinical symptoms explained a greater proportion of the variance than sociodemographic variables. In primary care patients, depression, anxiety and somatizations were associated with distinct domains of disability. Early provision of effective treatments in the primary care setting may be crucial to reduce the societal burden of common mental disorders.
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Affiliation(s)
- César González-Blanch
- Mental Health Centre, University Hospital Marqués de Valdecilla- IDIVAL. Santander, Spain.; Faculty of Health Sciences, Universidad Europea del Atlántico, Santander, Spain.
| | | | - Roger Muñoz-Navarro
- Department of Basic Psychology, Faculty of Psychology, University of Valencia, Valencia, Spain
| | | | | | - Juan Antonio Moriana
- Department of Psychology, University of Córdoba/Maimónides Institute for Research in Biomedicine of Córdoba-IMIBIC/Reina Sofía University Hospital, Spain
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Abstract
In this article, we examine the process of recovery in people who have undertaken treatment for mental health problems, based on interviews with 34 participants. We describe their experiences through the lens of social capital, focusing on the social networks and relationships within which they are embedded and which they utilise to give purpose and meaning to their lives. The accounts give sense of movement from relationships, institutions and networks which were provided through their engagement with services towards relationships outside the health care system which were more freely chosen and which provided a sense that they were able to achieve recognition and make a contribution. The latter included activities such as art, theatre and sport. The relationships and institutions with which they were engaged via the statutory services were described as burdensome and inappropriate, whereas those which were freely chosen appeared more emancipatory and positively constitutive of identity. We have called this latter experience one of 'intentional social capital' because the participants were deliberately choosing and orienting to these networks and were able to derive pleasure and a sense of self from them. The findings have implications for how we see the situation of people recovering from mental health problems inasmuch as professional attitudes and practices could usefully be extended to more fully recognise and encourage wider patterns of social engagement and fulfilment occurring outside the limited contribution of clinical definitions and clinical interventions.
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Rhon DI, Greenlee TA, Marchant BG, Sissel CD, Cook CE. Comorbidities in the first 2 years after arthroscopic hip surgery: substantial increases in mental health disorders, chronic pain, substance abuse and cardiometabolic conditions. Br J Sports Med 2018; 53:547-553. [DOI: 10.1136/bjsports-2018-099294] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2018] [Indexed: 02/05/2023]
Abstract
ObjectivesWe aimed to identify the rate of seven comorbidities (mental health disorders, chronic pain, substance abuse disorders, cardiovascular disorders, metabolic syndrome, systemic arthropathy and sleep disorders) that occurred within 2 years after hip arthroscopy.MethodsData from individuals (ages 18–50 years) undergoing arthroscopic hip surgery between 2004 and 2013 were collected from the Military Health System (MHS) Data Repository (MDR). The MDR captures all healthcare encounters in all settings and locations for individuals within the MHS. Person-level data over 36 months were pulled and aggregated. Seven comorbidities related to poor outcomes from musculoskeletal disorders (mental health disorders, chronic pain, substance abuse disorders, cardiovascular disorders, metabolic syndrome, systemic arthropathy and sleep disorders) were examined 12 months prior and 24 months after surgery. Changes in frequencies were calculated as were differences in proportions between presurgery and postsurgery.Results1870 subjects were identified (mean age 32.24 years; 55.5% men) and analysed. There were statistically significant increases (p<0.001) proportionally for all comorbidities after surgery. Relative to baseline, cases of mental health disorders rose 84%, chronic pain diagnoses increased 166%, substance abuse disorders rose 57%, cardiovascular disorders rose by 71%, metabolic syndrome cases rose 85.9%, systemic arthropathy rose 132% and sleep disorders rose 111%.ConclusionsMajor (potentially ‘hidden’) clinical comorbidities increased substantially after elective arthroscopic hip surgery when compared with preoperative status. These comorbidities appear to have been overlooked in major studies evaluating the benefits and risks of arthroscopic hip surgery.Level of evidencePrognostic, level III.
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Interactive effects of Traumatic Brain Injury and Anxiety Sensitivity Cognitive Concerns on Post-traumatic Stress among Active Duty Soldiers. COGNITIVE THERAPY AND RESEARCH 2018; 41:902-910. [PMID: 30220753 DOI: 10.1007/s10608-017-9863-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Wijers IGM, Ayala A, Rodriguez-Blazquez C, Rodriguez-Laso A, Rodriguez-Rodriguez V, Forjaz MJ. Rasch Analysis and Construct Validity of the Disease Burden Morbidity Assessment in Older Adults. THE GERONTOLOGIST 2018; 58:e302-e310. [PMID: 30219906 DOI: 10.1093/geront/gnx061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Indexed: 11/12/2022] Open
Abstract
Purpose of the Study The Disease Burden Morbidity Assessment (DBMA) is a self-report questionnaire in which participants rate the disease burden caused by a number of medical conditions. This paper studies the measurement properties of the DBMA, using Rasch analysis. Design and Methods We used data of 1,400 community-dwelling adults aged 50 years and older participating in the Ageing in Spain Longitudinal Study, Pilot Survey (ELES-PS). Test of fit to the Rasch model, reliability, unidimensionality, response dependency, category structure, scale targeting, and differential item functioning (DIF) were studied in an iterative way. Construct validity of the linear measure provided by the Rasch analysis was subsequently assessed. Results To achieve an adequate fit to the Rasch model, all items were rescored by collapsing response categories. Reliability (Person Separation Index) was low. The scale was unidimensional and neither response dependency nor relevant DIF were found. The linear measure had a correlation of -0.48 with physical functioning, -0.47 with perceived health, 0.32 with depression, and -0.24 with quality of life (QoL) and displayed satisfactory known-groups validity by sex and age groups. Relative precision analysis showed that the linear measure discriminated better between age groups than the original raw score, but for sex no difference was found. Implications Despite some limitations, support was found for the validity of the DBMA in older adults. Its linear scores may be useful to assess strategies aimed at improving the QoL of patients with multimorbidity. More research is needed in a hospital-based sample.
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Affiliation(s)
- Irene G M Wijers
- Department of Preventive Medicine and Quality Management, General University Hospital Gregorio Marañón, Madrid, Spain
| | - Alba Ayala
- National School of Public Health, Carlos III Institute of Health and REDISSEC, Madrid, Spain
| | | | - Angel Rodriguez-Laso
- Biomedical Research Foundation of the University Hospital of Getafe, Madrid, Spain
| | | | - Maria João Forjaz
- National School of Public Health, Carlos III Institute of Health and REDISSEC, Madrid, Spain
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Ouyang P, Sun W. The association between depressive symptoms and fall accidents among middle-aged and elderly people in China. Environ Health Prev Med 2018; 23:42. [PMID: 30185143 PMCID: PMC6123963 DOI: 10.1186/s12199-018-0735-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 08/26/2018] [Indexed: 11/17/2022] Open
Abstract
Background Depressive symptoms are a worldwide health problem. However, the research about the effect of depressive symptoms on the fall among the Chinese mid-aged and elderly people is lacking. Therefore, this study aims to investigate the association between depressive symptoms and fall accidents among middle-aged and elderly people in China. Methods This study was conducted based on 12,527 sets of data from China Health and Retirement Longitudinal Survey (CHARLS). The 2011 depressive symptoms data and the 2013 fall data were chosen for this study. The depressive symptom-related data was assessed by the Chinese version of Center for Epidemiologic Studies Depression scales (CES-D). Individuals were divided into subgroups according to gender (male or female), age (45–59, middle-aged or ≥ 60, elderly people), and residence (rural or urban). The odds ratios (ORs) were compared between subgroups using multivariable logistic regression analysis method. Results The adjusted OR value (OR = 1.19 [95% CI 1.07–1.33]) shows there is a significant association between depressive symptoms and subsequent fall accidents. The ORs of the female, elderly people, rural, and urban subgroups are 1.31 (95% CI 1.11–1.55), 1.24 (95% CI 1.08–1.43), 1.17 (95% CI 1.02–1.33), and 1.25 (95% CI 1.04–1.49), respectively, which reveals that this association is also statistically significant in these subgroups. Conclusions This study shows that there is a significant association between depressive symptoms and their subsequent fall accidents among the Chinese middle-aged and elderly people.
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Affiliation(s)
- Peng Ouyang
- School of Management, Harbin Institute of Technology, 92 West Dazhi Street, Nan Gang District, Harbin, Heilongjiang Province, People's Republic of China.
| | - Wenjun Sun
- School of Management, Harbin Institute of Technology, 92 West Dazhi Street, Nan Gang District, Harbin, Heilongjiang Province, People's Republic of China
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Wampold BE, Flückiger C, Del Re AC, Yulish NE, Frost ND, Pace BT, Goldberg SB, Miller SD, Baardseth TP, Laska KM, Hilsenroth MJ. In pursuit of truth: A critical examination of meta-analyses of cognitive behavior therapy. Psychother Res 2018; 27:14-32. [PMID: 27884095 DOI: 10.1080/10503307.2016.1249433] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE Three recent meta-analyses have made the claim, albeit with some caveats, that cognitive-behavioral treatments (CBT) are superior to other psychotherapies, in general or for specific disorders (e.g., social phobia). METHOD The purpose of the present article was to examine four issues in meta-analysis that mitigate claims of CBT superiority: (a) effect size, power, and statistical significance, (b) focusing on disorder-specific symptom measures and ignoring other important indicators of psychological functioning, (c) problems inherent in classifying treatments provided in primary studies into classes of treatments, and (d) the inclusion of problematic trials, which biases the results, and the exclusion of trials that fail to find differences among treatments. RESULTS When these issues are examined, the effects demonstrating the superiority of CBT are small, nonsignificant for the most part, limited to targeted symptoms, or are due to flawed primary studies. CONCLUSION Meta-analytic evidence for the superiority of CBT in the three meta-analysis are nonexistent or weak.
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Affiliation(s)
- Bruce E Wampold
- a Department of Counseling Psychology , University of Wisconsin-Madison , Madison , WI , USA.,b Research Institute, Modum Bad Psychiatric Center , Vikersund , Norway
| | | | - A C Del Re
- d VA Palo Alto Health Care System , Palo Alto , CA , USA
| | - Noah E Yulish
- a Department of Counseling Psychology , University of Wisconsin-Madison , Madison , WI , USA
| | - Nickolas D Frost
- a Department of Counseling Psychology , University of Wisconsin-Madison , Madison , WI , USA
| | - Brian T Pace
- e Department of Educational Psychology , University of Utah , Salt Lake City , UT , USA
| | - Simon B Goldberg
- a Department of Counseling Psychology , University of Wisconsin-Madison , Madison , WI , USA
| | | | | | - Kevin M Laska
- h VA Salt Lake City Health Care System , Salt Lake City , UT , USA
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Feingold D, Brill S, Goor-Aryeh I, Delayahu Y, Lev-Ran S. The association between severity of depression and prescription opioid misuse among chronic pain patients with and without anxiety: A cross-sectional study. J Affect Disord 2018; 235:293-302. [PMID: 29660645 DOI: 10.1016/j.jad.2018.04.058] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 03/08/2018] [Accepted: 04/05/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND In light of the increased rates of Prescription Opioid (PO) misuse and associated mortality in several developed countries in recent years, efforts have been made to identify populations who may be at increased risk for misuse of POs. Though the association between depression and PO misuse among pain patients is well documented, little is known regarding the effects of severity of depression on rates of misuse. In this study we explored rates of PO misuse among chronic pain patients screening positive for depression according to level of severity. METHODS Participants included chronic pain patients receiving POs (N = 554). All participants were screened for depression using the Patient Health Questionnaire (PHQ-9; cut-off scores of 5, 10, 15, and 20 for mild, moderate, moderate-severe and severe depression, respectively) and for opioid misuse using the Current Opioid Misuse Measure (COMM). Logistic regression analyses controlling for additional sociodemographic and clinical factors were conducted. RESULTS Participants who screened positive for depression were at significantly increased odds to screen positive for opioid misuse (Adjusted Odds Ratio (AOR) = 3.63; 95% Confidence Interval (CI) = 1.71-7.7) compared to those without depression. Severity of depression was significantly associated with increased odds for opioid misuse for moderate (AOR = 3.71; 95% CI = 1.01-13.76), moderate-severe (AOR = 6.28; 95% CI = 1.6-24.57) and severe (AOR = 14.66; 95% CI = 3.28-65.52) depression but not among those who screened positive for mild depression (AOR = 1.49; 95% CI = 0.39-5.68). LIMITATIONS Cross-sectional study. CONCLUSIONS Our results highlight the need to properly asses and address level of severity of co-morbid depression among chronic pain patients receiving POs.
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Affiliation(s)
- Daniel Feingold
- Ariel University, Ariel, Israel; Dual Diagnosis Clinic, Lev-Hasharon Medical Center, Pardesiya, Israel.
| | - Silviu Brill
- Pain Center, Sourasky Medical Center, Tel Aviv, Israel
| | | | - Yael Delayahu
- Department of Dual Diagnosis, Abarbanel Mental Health Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shaul Lev-Ran
- Dual Diagnosis Clinic, Lev-Hasharon Medical Center, Pardesiya, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Muench C, Schwandt M, Jung J, Cortes CR, Momenan R, Lohoff FW. The major depressive disorder GWAS-supported variant rs10514299 in TMEM161B-MEF2C predicts putamen activation during reward processing in alcohol dependence. Transl Psychiatry 2018; 8:131. [PMID: 30006604 PMCID: PMC6045574 DOI: 10.1038/s41398-018-0184-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 03/13/2018] [Accepted: 05/11/2018] [Indexed: 01/25/2023] Open
Abstract
Alcohol dependence (AD) frequently co-occurs with major depressive disorder (MDD). While this comorbidity is associated with an increase in disease burden, worse treatment outcomes, and greater economic costs, the underlying neurobiology remains poorly understood. A recent large-scale GWAS of MDD has identified a locus in the TMEM161B-MEF2C region (rs10514299) as a novel risk variant; however, the biological relevance of this variant has not yet been studied. Given previous reports of disrupted reward processing in both AD and MDD, we hypothesized that rs10514299 would be associated with differences in striatal BOLD responses during reward/loss anticipation in AD. DNA samples from 45 recently detoxified patients with AD and 45 healthy controls (HC) were genotyped for rs10514299. Participants performed the Monetary Incentive Delay task in a 3-Tesla MRI scanner. Effects of rs10514299 on striatal activation during anticipation of high/low reward/loss were investigated. Furthermore, we examined associations between rs10514299 and lifetime AD diagnosis in two independent clinical samples [NIAAA: n = 1858 (1123 cases, 735 controls); SAGE: n = 3838 (1848 cases, 1990 controls)], as well as its association with depression severity in a subsample of individuals with a lifetime AD diagnosis (n = 953). Patients carrying the T allele showed significantly greater putamen activation during anticipation of high reward (p = 0.014), low reward (at trend-level; p = 0.081), high loss (p = 0.024), and low loss (p = 0.046) compared to HCs. Association analyses in the NIAAA sample showed a trend-level relationship between rs10514299 and a lifetime AD diagnosis in the European American subgroup (odds ratio = 0.82, p = 0.09). This finding was not replicated in the SAGE sample. In the NIAAA sample, the T allele was significantly associated with greater depression symptom severity in individuals with a lifetime AD diagnosis (β = 1.25, p = 0.02); this association was driven by the African American ancestry subgroup (β = 2.11, p = 0.008). We show for the first time that the previously identified MDD risk variant rs10514299 in TMEM161B-MEF2C predicts neuronal correlates of reward processing in an AD phenotype, possibly explaining part of the shared pathophysiology and comorbidity between the disorders.
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Affiliation(s)
- Christine Muench
- Section on Clinical Genomics and Experimental Therapeutics, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA
| | - Melanie Schwandt
- Office of the Clinical Director, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA
| | - Jeesun Jung
- Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA
| | - Carlos R Cortes
- Clinical NeuroImaging Research Core, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA
| | - Reza Momenan
- Clinical NeuroImaging Research Core, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA
| | - Falk W Lohoff
- Section on Clinical Genomics and Experimental Therapeutics, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA.
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Huffman AL, Bromberg JE, Augustson EM. Lifetime Depression, Other Mental Illness, and Smoking Cessation. Am J Health Behav 2018; 42:90-101. [PMID: 29973314 PMCID: PMC6050019 DOI: 10.5993/ajhb.42.4.9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objectives In this study, we attempt to elucidate the relationship between lifetime mental illness (LMI), particularly a depression diagnosis, and smoking cessation. Methods Data were drawn from a previous study and include LMI, demographics, mood, and smoking cessation outcomes. We evaluated the relationship between multiple LMIs and smoking cessation at 7 months post-intervention, and depression in combination with another LMI. Results At 7 months, the adjusted odds of cessation for those with one LMI, including depression, were 0.74 (p = .102), and for those with 2+ LMIs, 0.69 (p = .037), both in comparison with participants who reported no history of LMI. Among those with 2+ LMIs, the adjusted odds of cessation for those with a depression diagnosis were 0.34 (p = .007) compared to those whose multiple LMIs did not include depression. Conclusions Among smokers seeking cessation treatment, those who had 2+ LMIs were at greater risk of relapse, an effect particularly marked in smokers with depression. This study adds to the literature examining the potential impact of LMI on smokers' ability to quit by considering the potential impact of 2+ LMIs and highlights the potential impact of depression as a risk factor for continued smoking.
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Thorpe K, Jain S, Joski P. Prevalence And Spending Associated With Patients Who Have A Behavioral Health Disorder And Other Conditions. Health Aff (Millwood) 2018; 36:124-132. [PMID: 28069855 DOI: 10.1377/hlthaff.2016.0875] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
People with multiple medical conditions are a growing and increasingly costly segment of the U.S. POPULATION Despite the co-occurrence of physical and behavioral health comorbidities, the US health care system tends to treat these conditions separately rather than holistically. To identify opportunities for population health improvement, we examined the treated prevalence of and health care spending on behavioral health disorders, by the number of coexisting physical disorders, among noninstitutionalized adults. The vast majority (85 percent) of spending was attributed to treatment of the physical comorbidities. Only 15 percent was attributed to treatments of the behavioral disorders; of these, a primary diagnosis of depression was most common, seen in 57 percent of the sample. These findings suggest the potential to improve outcomes and reduce spending by applying collaborative care models more broadly. Policies should promote payment and delivery reforms that advance the integration of behavioral health and primary care.
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Affiliation(s)
- Ken Thorpe
- Ken Thorpe is the Robert W. Woodruff Professor and Chair of the Department of Health Policy and Management, Rollins School of Public Health, at Emory University, in Atlanta, Georgia
| | - Sanjula Jain
- Sanjula Jain is a doctoral student in health services research and health policy, Rollins School of Public Health, Emory University
| | - Peter Joski
- Peter Joski is a senior associate in the Department of Health Policy and Management, Rollins School of Public Health, Emory University
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Sanchez N. Suitability of the National Health Care Surveys to Examine Behavioral Health Services Associated with Polycystic Ovary Syndrome. J Behav Health Serv Res 2018; 45:252-268. [PMID: 27966057 PMCID: PMC5869872 DOI: 10.1007/s11414-016-9543-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The National Institutes of Health, Office of Disease Prevention, has described polycystic ovary syndrome (PCOS) as a major public health problem for women in the USA. This study examines the suitability of the National Health Care Surveys, collected by the Centers for Disease Control and Prevention, to understand patient demographics and behavioral health services associated with PCOS-related medical visits. Data were from the 2005-2010 National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey. PCOS-related medical visits were identified using the International Classification of Diseases, 9th Revision, Clinical Modification code 256.4. Items on mental health and health education ordered or provided did not meet the National Center for Health Statistics criteria necessary to produce reliable national estimates (i.e., at least 30 unweighted records and a relative standard error <30%). Findings underscore the need to strengthen national surveillance to further understand behavioral health care for patients with PCOS.
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Affiliation(s)
- Ninive Sanchez
- School of Social Work, University of Missouri, 712 Clark Hall, Columbia, MO, 65211, USA.
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Psychometric Properties of the Spanish Version of the Panic Disorder Severity Scale. THE SPANISH JOURNAL OF PSYCHOLOGY 2018; 21:E5. [PMID: 29573755 DOI: 10.1017/sjp.2018.6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The Panic Disorder Severity Scale (PDSS) is a well-established measure of panic symptoms but few data exist on this instrument in non north-American samples. Our main goal was to assess the psychometric properties (internal consistency, test re-test reliability, inter-rater reliability, convergent and divergent validity) and the factor structure of the Spanish version. Ninety-four patients with a main diagnosis of panic disorder were assessed with the Spanish version of PDSS, the Anxiety Sensitivity Index-3 (ASI-3), the Panic and Agoraphobia Scale (PAS), the Beck Anxiety Inventory (BAI), the Beck Depression Inventory-II (BDI-II) the PDSS self-rating form and the Clinical Global Impression-Severity scale (CGI). The Spanish PDSS showed acceptable internal consistency (α = .74), excellent test-retest (total score and items 1-6: α > .58, p .90) and medium to large convergent validity (r = .68, 95% CI [.54, .79], p < .01; r = .80, 95% CI [.70, .87], p < .01; r = .48, 95% CI [.28, .67], p < .01; BAI, PAS and ASI-3 total scores respectively). Data on divergent validity (BDI-II total score: r = .52, 95% CI [.34, .67], p < .01) suggest some need for refinement of the PDSS. The confirmatory factor analysis suggested a two-factor modified model for the scale (nested χ2 = 14.01, df = 12, p < .001). The Spanish PDSS has similar psychometric properties as the previous versions and is a useful instrument to assess panic symptoms in clinical settings in Spanish-speaking populations.
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Rapinesi C, Kotzalidis GD, Ferracuti S, Girardi N, Zangen A, Sani G, Raccah RN, Girardi P, Pompili M, Del Casale A. Add-on high frequency deep transcranial magnetic stimulation (dTMS) to bilateral prefrontal cortex in depressive episodes of patients with major depressive disorder, bipolar disorder I, and major depressive with alcohol use disorders. Neurosci Lett 2018; 671:128-132. [PMID: 29454034 DOI: 10.1016/j.neulet.2018.02.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 02/07/2018] [Accepted: 02/13/2018] [Indexed: 01/18/2023]
Abstract
BACKGROUND Dorsolateral prefrontal cortex (DLPFC) is critically involved in mood and alcohol use disorders. OBJECTIVE We aimed to investigate the safety of intervention with add-on bilateral prefrontal high-frequency deep transcranial magnetic stimulation (dTMS) and between-group differences in treatment response in patients with different types of depressive episodes, including major depressive episodes in the course of major depressive disorder (MDD), bipolar disorder, type I (BD-I), and MDD with alcohol use disorder (MDAUD). METHODS We conducted a 6-month open-label study, involving 82 patients with DSM-5 Depressive Episode. Of these, 41 had diagnosis of MDD, 20 BD-I, and 21 MDAUD. All patients received standard drug treatment and add-on dTMS over the bilateral DLPFC with left prevalence for four weeks, with five sessions in each week. We rated mood state with the Hamilton Depression Rating Scale (HDRS) at baseline, one-month, and six-month follow-up visits. RESULTS Mean total HDRS scores dropped from 22.8 (SD = 5.9) at baseline to 10.4 (SD = 3.6) at 1 month, to 10.0 (SD = 4.5) at 6 months, while response/remission were 70.73% (N = 58) and 19.51% (N = 16) at 1 month and 76.83% (N = 63) and 32.93% (27) at 6 months, respectively, with no between-group differences. No patient experienced any side effects. CONCLUSIONS High-frequency DLPFC dTMS was well tolerated and did not significantly differ on improvement of depression in MDD, BD-I, and MDAUD.
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Affiliation(s)
- Chiara Rapinesi
- Neurosciences, Mental Health, and Sensory Organs (NESMOS) Department, Faculty of Medicine and Psychology, Sapienza University; Sant'Andrea Hospital, Rome, Italy.
| | - Georgios D Kotzalidis
- Neurosciences, Mental Health, and Sensory Organs (NESMOS) Department, Faculty of Medicine and Psychology, Sapienza University; Sant'Andrea Hospital, Rome, Italy
| | - Stefano Ferracuti
- Department of Neurology and Psychiatry, Sapienza University; Sant'Andrea Hospital, Rome, Italy
| | - Nicoletta Girardi
- Neurosciences, Mental Health, and Sensory Organs (NESMOS) Department, Faculty of Medicine and Psychology, Sapienza University; Sant'Andrea Hospital, Rome, Italy; Unit of Psychiatry, "Umberto I" University Hospital, Rome, Italy
| | - Abraham Zangen
- Department of Life Sciences, Ben Gurion University of the Negev, Be'er Sheva, Israel
| | - Gabriele Sani
- Neurosciences, Mental Health, and Sensory Organs (NESMOS) Department, Faculty of Medicine and Psychology, Sapienza University; Sant'Andrea Hospital, Rome, Italy; Lucio Bini Center, Aretæus Onlus, Rome, Italy
| | - Ruggero N Raccah
- ATID Ltd Advanced Technology Innovation Distribution, Rome, Italy
| | - Paolo Girardi
- Neurosciences, Mental Health, and Sensory Organs (NESMOS) Department, Faculty of Medicine and Psychology, Sapienza University; Sant'Andrea Hospital, Rome, Italy; Lucio Bini Center, Aretæus Onlus, Rome, Italy
| | - Maurizio Pompili
- Neurosciences, Mental Health, and Sensory Organs (NESMOS) Department, Faculty of Medicine and Psychology, Sapienza University; Sant'Andrea Hospital, Rome, Italy
| | - Antonio Del Casale
- Neurosciences, Mental Health, and Sensory Organs (NESMOS) Department, Faculty of Medicine and Psychology, Sapienza University; Sant'Andrea Hospital, Rome, Italy
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Strawn JR, Vollmer LL, McMurray KM, Mills JA, Mossman SA, Varney ST, Schroeder HK, Sah R. Acid-sensing T cell death associated gene-8 receptor expression in panic disorder. Brain Behav Immun 2018; 67:36-41. [PMID: 28736033 PMCID: PMC5696091 DOI: 10.1016/j.bbi.2017.07.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 07/18/2017] [Accepted: 07/19/2017] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND While disruption of acid-base homeostasis has been pathoetiologically implicated in panic disorder (PD), the mechanism by which pH imbalance is translated to panic pathophysiology is poorly understood. Recently, in a translational rodent model of PD, we reported a role of microglial acid sensing G-protein coupled receptor, T cell death associated gene-8 (TDAG8) in panic-associated behavior and physiology. However, the clinical validity of the TDAG8 receptor has not been investigated. OBJECTIVE To assess TDAG8 in PD, we evaluated TDAG8 receptor expression in adolescents and young adults with PD and healthy comparison subjects. METHODS Relative expression of TDAG8 mRNA was determined in peripheral blood mononuclear cells from patients with PD, and compared to expression in healthy subjects. Linear models were utilized to evaluate the relationship between TDAG8 expression and panic disorder symptom severity scale (PDSS) score as well as other potential explanatory variables (e.g., CRP, body mass index, sex, age). Models were refined based on the estimated parameter significance, evidence of omitted variable bias and Bayesian/Akaike information criteria. RESULTS Relative to healthy comparison subjects (n=17), expression of TDAG8 mRNA was significantly increased in patients with PD (n=15) (1.60±0.65 vs. 1.01±0.50, p=0.008). TDAG8 mRNA expression predicted PD symptom severity in a fixed effect model incorporating age and sex (p=0.003). CONCLUSIONS Collectively, our results suggest greater TDAG8 expression in patients with PD compared to healthy subjects, and directly link TDAG8 expression and the severity of the PD symptoms. Further investigation of the TDAG8 receptor in panic pathophysiology is warranted.
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Affiliation(s)
- Jeffrey R. Strawn
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, College of Medicine, Cincinnati, OH 45237,Cincinnati Children's Hospital Medical Center, Department of Psychiatry, Cincinnati, Ohio, 45219
| | - Lauren L. Vollmer
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, College of Medicine, Cincinnati, OH 45237
| | - Katherine M.J. McMurray
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, College of Medicine, Cincinnati, OH 45237
| | - Jeffrey A. Mills
- Carl Lindner College of Business, University of Cincinnati, Cincinnati, OH
| | - Sarah A. Mossman
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, College of Medicine, Cincinnati, OH 45237
| | - Sara T. Varney
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, College of Medicine, Cincinnati, OH 45237
| | - Heidi K. Schroeder
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, College of Medicine, Cincinnati, OH 45237
| | - Renu Sah
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, College of Medicine, Cincinnati, OH 45237,Neuroscience Graduate Program, University of Cincinnati, Cincinnati, OH 45219,VA Medical Center, Cincinnati, OH 45220
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The Influence of Exposure to Natural Disasters on Depression and PTSD Symptoms among Firefighters. Prehosp Disaster Med 2017; 33:102-108. [PMID: 29223176 DOI: 10.1017/s1049023x17007026] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Introduction Firefighters represent an important population for understanding the consequences of exposure to potentially traumatic stressors. Hypothesis/Problem The researchers were interested in the effects of pre-employment disaster exposure on firefighter recruits' depression and posttraumatic stress disorder (PTSD) symptoms during the first three years of fire service and hypothesized that: (1) disaster-exposed firefighters would have greater depression and PTSD symptoms than non-exposed overall; and (2) depression and PTSD symptoms would worsen over years in fire service in exposed firefighters, but not in their unexposed counterparts. METHODS In a baseline interview, 35 male firefighter recruits from seven US cities reported lifetime exposure to natural disaster. These disaster-exposed male firefighter recruits were matched on age, city, and education with non-exposed recruits. RESULTS A generalized linear mixed model revealed a significant exposure×time interaction (e coef =1.04; P<.001), such that depression symptoms increased with time for those with pre-employment disaster exposure only. This pattern persisted after controlling for social support from colleagues (e coefficient=1.05; P<.001), social support from families (e coefficient=1.04; P=.001), and on-the-job trauma exposure (coefficient=0.06; e coefficient=1.11; P<.001). Posttraumatic stress disorder symptoms did not vary significantly between exposure groups at baseline (P=.61). CONCLUSION Depression symptoms increased with time for those with pre-employment disaster exposure only, even after controlling for social support. Posttraumatic stress disorder symptoms did not vary between exposure groups. Pennington ML , Carpenter TP , Synett SJ , Torres VA , Teague J , Morissette SB , Knight J , Kamholz BW , Keane TM , Zimering RT , Gulliver SB . The influence of exposure to natural disasters on depression and PTSD symptoms among firefighters. Prehosp Disaster Med. 2018;33(1):102-108.
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Davis EC, Rotheram-Borus MJ, Weichle TW, Rezai R, Tomlinson M. Patterns of Alcohol Abuse, Depression, and Intimate Partner Violence Among Township Mothers in South Africa Over 5 Years. AIDS Behav 2017; 21:174-182. [PMID: 29027039 PMCID: PMC5839633 DOI: 10.1007/s10461-017-1927-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Alcohol is a major contributor to the global burden of disease. In South Africa, alcohol abuse is hypothesized to correlate with women's HIV status, mental health, and partner relationships over time. All pregnant women in 12 urban, low-income, Cape Town neighborhoods were interviewed at baseline, post-birth, and at 6, 12, 36, and 60 months following delivery with retention rates from 82.5 to 94%. Women were assessed for any alcohol use, problematic drinking, depression, intimate partner violence, and HIV status. Prior to pregnancy discovery and 5 years after giving birth, alcohol use was 25.8 and 24.7%, respectively. Most women decreased their alcohol use during pregnancy. Twenty-one percent reported alcohol use on two or more assessments, and only 15% of the mothers drinking alcohol at 5 years were also drinking at baseline. Mothers with depression had a higher likelihood of drinking alcohol compared to mothers who were not depressed only at baseline and 6 months post-birth. Mothers who experienced IPV had more than twice the likelihood of drinking alcohol compared to non-IPV mothers at all assessments. HIV positive mothers were more likely to drink alcohol compared to mothers without HIV prior to pregnancy discovery and at 5 years post-birth. These longitudinal trends in alcohol use among young women in South Africa represent a large economic, social, and health burden and must be addressed in a comprehensive manner.
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Affiliation(s)
- Emily C Davis
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute, University of California at Los Angeles, 760 Westwood Plaza, Los Angeles, CA, 90024, USA
| | - Mary Jane Rotheram-Borus
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute, University of California at Los Angeles, 760 Westwood Plaza, Los Angeles, CA, 90024, USA.
| | - Thomas W Weichle
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute, University of California at Los Angeles, 760 Westwood Plaza, Los Angeles, CA, 90024, USA
| | - Roxana Rezai
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute, University of California at Los Angeles, 760 Westwood Plaza, Los Angeles, CA, 90024, USA
| | - Mark Tomlinson
- Department of Psychology, Stellenbosch University, Private Bag X1 Matieland, Stellenbosch, 7602, South Africa
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Lieberman L, Gorka SM, DiGangi JA, Frederick A, Phan KL. Impact of posttraumatic stress symptom dimensions on amygdala reactivity to emotional faces. Prog Neuropsychopharmacol Biol Psychiatry 2017; 79:401-407. [PMID: 28756011 PMCID: PMC5610932 DOI: 10.1016/j.pnpbp.2017.07.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 07/21/2017] [Accepted: 07/25/2017] [Indexed: 11/26/2022]
Abstract
Posttraumatic stress disorder (PTSD) is highly prevalent and associated with impairment, even at the subthreshold level. It is therefore important to identify biological processes that contribute to the pathophysiology of posttraumatic stress symptoms (PTSS). Although neuroimaging research has highlighted the importance of heightened amygdala reactivity to aversive stimuli in PTSS, not all studies have yielded evidence of this relationship. Given that PTSS is comprised of four, factor analytically distinct dimensions of symptoms - re-experiencing, avoidance, hyperarousal, and negative cognitions and mood - it is possible that heightened amygdala reactivity to aversive stimuli is specific to certain PTSS clusters. In a sample of 45 trauma-exposed individuals, the present study therefore examined how specific PTSS clusters relate to amygdala responding during functional magnetic resonance imaging (fMRI) to both negative and positive emotional faces during a well-validated social-emotional task, the Emotional Face Assessment Task (EFAT). Results indicated that hyperarousal symptoms were positively associated with left amygdala reactivity across all emotional face conditions. There was no interaction of hyperarousal by condition (i.e., fearful, sad, angry, or happy faces), and other PTSS clusters were not associated with amygdala reactivity. These results indicate that the hyperarousal cluster of PTSS may have a unique relationship with amygdala reactivity to socioemotional information. The results also corroborate a growing literature suggesting that trauma-exposed individuals characterized by high PTSS hyperarousal symptoms may display exaggerated psychophysiological reactivity to appetitive and aversive stimuli.
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Affiliation(s)
- Lynne Lieberman
- University of Illinois-Chicago, Department of Psychology, 1007 West Harrison St. (M/C 285), Chicago, IL 60607
| | - Stephanie M. Gorka
- University of Illinois-Chicago, Department of Psychiatry, 1747 West Roosevelt Road, Chicago, IL 60608
| | - Julia A. DiGangi
- University of Illinois-Chicago, Department of Psychiatry, 1747 West Roosevelt Road, Chicago, IL 60608
| | - Alyssa Frederick
- University of Illinois-Chicago, Department of Psychiatry, 1747 West Roosevelt Road, Chicago, IL 60608
| | - K. Luan Phan
- University of Illinois-Chicago, Department of Psychology, 1007 West Harrison St. (M/C 285), Chicago, IL 60607,University of Illinois-Chicago, Department of Psychiatry, 1747 West Roosevelt Road, Chicago, IL 60608,University of Illinois-Chicago, Department of Anatomy and Cell Biology and the Graduate Program in Neuroscience, 808 S. Wood Street, Chicago, IL 60612,Jesse Brown VA Medical Center, Mental Health Service Line, 820 S. Damen Avenue, Chicago, IL 60612
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78
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Lieberman L, Gorka SM, Funkhouser CJ, Shankman SA, Phan KL. Impact of posttraumatic stress symptom dimensions on psychophysiological reactivity to threat and reward. J Psychiatr Res 2017; 92:55-63. [PMID: 28410485 PMCID: PMC10593111 DOI: 10.1016/j.jpsychires.2017.04.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 02/19/2017] [Accepted: 04/06/2017] [Indexed: 12/28/2022]
Abstract
Posttraumatic stress symptoms (PTSS) are associated with significant distress and impairment. Research has therefore focused on identifying neurobehavioral deficits that contribute to the pathophysiology of PTSS. One issue that has contributed to difficulty in identifying these deficits is the highly heterogeneous nature of PTSS. PTSS is comprised of four, factor analytically distinct dimensions of symptoms - re-experiencing, avoidance, hyperarousal, and negative cognitions and mood. It is therefore unlikely that there is one single mechanism that accounts for all of PTSS and elucidating neurobehavioral deficits associated with specific PTSS symptom dimensions may better inform clinical prevention and intervention efforts. Within the broader internalizing disorder literature, two key constructs that contribute to psychopathology are aberrant neural reactivity to threat and reward. However, the literature linking PTSS to these deficits is mixed, suggesting that aberrant neural reactivity to threat or reward may be specific to certain PTSS dimensions. In a sample of 51 trauma-exposed adults with a range PTSS, the present study therefore examined how the four dimensions of PTSS uniquely relate to two well-validated event-related potential (ERP) neural indices of threat and reward reactivity - the error-related negativity (ERN) and reward-related positivity (RewP), respectively. Results indicated that hyperarousal symptoms were associated with enhanced ERN, and enhanced RewP. In contrast, negative cognitions and mood symptoms were uniquely associated with a more blunted RewP. These results indicate that certain PTSS symptom dimensions have unique relations with neural indicators of threat and reward reactivity and may therefore have distinct pathophysiologies.
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Affiliation(s)
- Lynne Lieberman
- University of Illinois-Chicago, Department of Psychology, 1007 West Harrison St. (M/C 285), Chicago, IL 60607, USA
| | - Stephanie M Gorka
- University of Illinois-Chicago, Department of Psychiatry, 1747 West Roosevelt Road, Chicago, IL 60608, USA
| | - Carter J Funkhouser
- University of Illinois-Chicago, Department of Psychology, 1007 West Harrison St. (M/C 285), Chicago, IL 60607, USA
| | - Stewart A Shankman
- University of Illinois-Chicago, Department of Psychology, 1007 West Harrison St. (M/C 285), Chicago, IL 60607, USA; University of Illinois-Chicago, Department of Psychiatry, 1747 West Roosevelt Road, Chicago, IL 60608, USA
| | - K Luan Phan
- University of Illinois-Chicago, Department of Psychology, 1007 West Harrison St. (M/C 285), Chicago, IL 60607, USA; University of Illinois-Chicago, Department of Psychiatry, 1747 West Roosevelt Road, Chicago, IL 60608, USA; University of Illinois-Chicago, Department of Anatomy and Cell Biology and the Graduate Program in Neuroscience, 808 S. Wood Street, Chicago, IL 60612, USA; Jesse Brown VA Medical Center, Mental Health Service Line, 820 S. Damen Avenue, Chicago, IL 60612, USA.
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79
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Feingold D, Brill S, Goor-Aryeh I, Delayahu Y, Lev-Ran S. Depression and anxiety among chronic pain patients receiving prescription opioids and medical marijuana. J Affect Disord 2017; 218:1-7. [PMID: 28453948 DOI: 10.1016/j.jad.2017.04.026] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 04/17/2017] [Indexed: 01/11/2023]
Abstract
BACKGROUND High rates of depression and anxiety have been consistently reported among patients suffering from chronic pain. Prescription opioids are one of the most common modalities for pharmacological treatment of pain, however in recent years medical marijuana(MM) has been increasingly used for pain control in the US and in several countries worldwide. The aim of this study was to compare levels of depression and anxiety among pain patients receiving prescription opioids and MM. METHODS Participants were patients suffering from chronic pain treated with prescription opioids (OP,N=474), MM (N=329) or both (OPMM,N=77). Depression and anxiety were assessed using the depression module of the Patient Health Questionnaire (PHQ-9) and the Generalized Anxiety Disorder scale (GAD-7). RESULTS Prevalence of depression among patients in the OP, MM and OPMM groups was 57.1%, 22.3% and 51.4%, respectively and rates of anxiety were 48.4%, 21.5% and 38.7%, respectively. After controlling for confounders, patients in the OP group were significantly more likely to screen positive for depression (Adjusted Odds Ratio(AOR)=6.18;95%CI=4.12-9.338) and anxiety(AOR=4.12;CI=3.84-5.71)) compared to those in the MM group. Individuals in the OPMM group were more prone for depression (AOR for depression=3.34;CI=1.52-7.34)) compared to those in the MM group. LIMITATIONS Cross-sectional study, restricting inference of causality. CONCLUSIONS Levels of depression and anxiety are higher among chronic pain patients receiving prescription opioids compared to those receiving MM. Findings should be taken into consideration when deciding on the most appropriate treatment modality for chronic pain, particularly among those at risk for depression and anxiety.
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Affiliation(s)
- Daniel Feingold
- Ariel University, Ariel, Israel; Dual Diagnosis Clinic, Lev-Hasharon Medical Center, Pardesiya, Israel.
| | - Silviu Brill
- Pain Center, Sourasky Medical Center, Tel Aviv, Israel
| | | | - Yael Delayahu
- Department of Dual Diagnosis, Abarbanel Mental Health Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shaul Lev-Ran
- Dual Diagnosis Clinic, Lev-Hasharon Medical Center, Pardesiya, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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80
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Johnson SU, Hoffart A, Nordahl HM, Wampold BE. Metacognitive therapy versus disorder-specific CBT for comorbid anxiety disorders: A randomized controlled trial. J Anxiety Disord 2017. [PMID: 28651207 DOI: 10.1016/j.janxdis.2017.06.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Few studies have compared the effects of Metacognitive therapy (MCT) and Cognitive behavioral therapy (CBT) for comorbid anxiety disorders. In the current study we compared CBT and MCT for heterogeneous anxiety disorders in a residential setting. Ninety patients with a primary diagnosis of Post Traumatic Stress Disorder, Social Phobia or Panic disorder, with and without Agoraphobia, were randomized to either CBT or MCT. Patients were assessed at pre-treatment, post-treatment and one-year follow-up. Primary outcome measures were Beck Anxiety Inventory and ADIS IV and secondary outcome measures were SCID II, Beck Depression Inventory, Penn State Worry Questionnaire, The Symptom Checklist-90 and the Inventory of Interpersonal Problems-64. Treatment fidelity was satisfactory and therapist credibility was equal in both treatments. There was a significant difference in the level of anxiety favouring MCT at post-treatment (d=0.7), but there were no differences at one-year follow-up, mainly due to a further improvement in the CBT group during the follow-up period. Both treatments were efficacious. No differences in effect on comorbid diagnoses and symptoms were found, but MCT produced larger change in personality problems. MCT seems to have a more rapid effect on anxiety symptoms, but there were no significant differences in the long term for patients with comorbid anxiety disorders.
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Affiliation(s)
- Sverre Urnes Johnson
- Modum Bad Psychiatric Center, Vikersund, Norway; University of Oslo, Department of Psychology, Norway.
| | - Asle Hoffart
- Modum Bad Psychiatric Center, Vikersund, Norway; University of Oslo, Department of Psychology, Norway.
| | - Hans M Nordahl
- Norwegian University of Science and Technology, Institute of Mental Health, Norway; St. Olavs Hospital, Div of Psychiatry, Nidaros DPS, 7006 Trondheim.
| | - Bruce E Wampold
- Modum Bad Psychiatric Center, Vikersund, Norway; University of Wisconsin-Madison, USA.
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81
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Raknes S, Pallesen S, Himle JA, Bjaastad JF, Wergeland GJ, Hoffart A, Dyregrov K, Håland ÅT, Haugland BSM. Quality of life in anxious adolescents. Child Adolesc Psychiatry Ment Health 2017; 11:33. [PMID: 28814971 PMCID: PMC5517841 DOI: 10.1186/s13034-017-0173-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 06/19/2017] [Indexed: 01/12/2023] Open
Abstract
PURPOSE To examine associations between health-related quality of life (HRQoL) and anxiety symptoms across anxiety domains (obsessions/compulsions, social anxiety, panic disorder, agoraphobia, separation anxiety, physical injury fears, generalised anxiety, and posttraumatic stress) in a general adolescent population. Expanded knowledge about these associations can provide valuable information for improving interventions and prevention strategies for adolescent anxiety. METHODS Cross-sectional data about anxiety were collected via a school survey from a community sample of Norwegian adolescents aged 12-17 (N = 1719). Based on scores from the Spence Children's Anxiety Scale (SCAS), each adolescent was categorized as reporting a low, medium, or high level of anxiety. Each adolescent's HRQoL was then measured using the Questionnaire for Measuring Health-Related Quality of Life in Children and Adolescents Revised Version (KINDL-R). Hierarchical regression analyses were performed to determine any relationship between anxiety symptoms and HRQoL. RESULTS Across domains of anxiety, anxiety symptoms were inversely associated with overall HRQoL. All HRQoL-dimensions were inversely associated with overall level of anxiety symptoms. In adolescents with medium and high anxiety symptoms, poor HRQoL was documented in all HRQoL dimensions with the exception of the family dimension. CONCLUSIONS The strong association between elevated levels of anxiety symptoms and poor HRQoL demonstrate the importance of improved mental health interventions and prevention initiatives targeting anxious adolescents.
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Affiliation(s)
- Solfrid Raknes
- Regional Centre for Child and Youth Mental Health and Child Welfare, Uni Research Health/University of Bergen, Bergen, Norway
| | - Ståle Pallesen
- 0000 0004 1936 7443grid.7914.bDepartment of Psychosocial Science, University of Bergen, Bergen, Norway
| | - Joseph A. Himle
- 0000000086837370grid.214458.eSchool of Social Work, University of Michigan, Ann Arbor, USA
| | - Jon Fauskanger Bjaastad
- Regional Centre for Child and Youth Mental Health and Child Welfare, Uni Research Health/University of Bergen, Bergen, Norway ,0000 0004 0627 2891grid.412835.9Division of Psychiatry, Stavanger University Hospital, 4068 Stavanger, Norway
| | - Gro Janne Wergeland
- Regional Centre for Child and Youth Mental Health and Child Welfare, Uni Research Health/University of Bergen, Bergen, Norway ,0000 0000 9753 1393grid.412008.fDepartment of Child and Adolescent Psychiatry, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Asle Hoffart
- 0000 0004 1936 8921grid.5510.1Research Institute, Modum Bad Psychiatric Center and Department of Psychology, University of Oslo, Oslo, Norway
| | - Kari Dyregrov
- grid.477239.cFaculty of Health and Social Sciences and Center for Crisis Psychology, Bergen University College, Bergen, Norway
| | - Åshild Tellefsen Håland
- 0000 0004 0627 3712grid.417290.9Clinic of Mental Health, Psychiatry and Addiction Treatment, Sørlandet Hospital HF, Kristiansand, Norway
| | - Bente Storm Mowatt Haugland
- Regional Centre for Child and Youth Mental Health and Child Welfare, Uni Research Health/University of Bergen, Bergen, Norway
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Misuse of prescription opioids among chronic pain patients suffering from anxiety: A cross-sectional analysis. Gen Hosp Psychiatry 2017; 47:36-42. [PMID: 28807136 DOI: 10.1016/j.genhosppsych.2017.04.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 04/17/2017] [Accepted: 04/21/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVE In the past two decades, chronic pain has been increasingly treated with prescription opioids, particularly in developed countries. This has drawn public concern of possible risks associated with the potential misuse of prescriptions opioids. Previous research has indicated that this may be particularly true among individuals suffering from co-occurring psychiatric disorders. The present study sought to explore rates of misuse among chronic pain patients prescribed opioids, comparing individuals with and without anxiety. METHODS Chronic pain patients receiving prescription opioids (N=554) were screened for anxiety using the Generalized Anxiety Disorder (GAD-7) scale and for opioid misuse using the Current Opioid Misuse Measure (COMM). RESULTS Among patients who screened positive for anxiety (GAD-7≥10), 50% also screened positive for opioid misuse, compared to 10% among those without anxiety. After controlling for possible confounding sociodemographic and clinical variables, patients with anxiety were significantly more prone to screen positive for opioid misuse (Adjusted Odds Ratio (AOR)=2.18; 95% Confidence Interval (CI)=1.37-4.17) compared to those without anxiety. This was maintained when conducting separate comparisons for severe, but not mild or moderate, level of anxiety. CONCLUSIONS These findings highlight the importance of detecting and addressing co-occurring anxiety when treating patients with chronic pain who receive prescription opioids.
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83
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Getachew B, Hauser SR, Csoka AB, Taylor RE, Tizabi Y. Role of cortical alpha-2 adrenoceptors in alcohol withdrawal-induced depression and tricyclic antidepressants. Drug Alcohol Depend 2017; 175:133-139. [PMID: 28414989 PMCID: PMC5483174 DOI: 10.1016/j.drugalcdep.2017.03.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 02/09/2017] [Accepted: 03/02/2017] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Although a role for alpha-2 adrenoceptors (alpha-2 ARs) in alcohol use disorder (AUD) and depression is suggested, very little information on a direct interaction between alcohol and these receptors is available. METHODS In this study adult female Wistar and Wistar-Kyoto (WKY) rats, a putative animal model of depression, were exposed to alcohol vapor 3h daily for 10days (blood alcohol concentration ∼150mg%) followed by daily injection of 10mg/kg of imipramine (IMP, a selective norepinephrine NE/serotonin reuptake inhibitor) or nomifensine (NOMI, a selective NE/dopamine reuptake inhibitor). On day 11 animals were tested for open field locomotor activity (OFLA) and forced swim test (FST) and were sacrificed 2h later for measurement of alpha-2 ARs densities in the frontal cortex and hippocampus using [3H]RX 821002 as the specific ligand. RESULTS Chronic alcohol treatment increased the immobility in the FST, without affecting OFLA in both Wistar and WKY rats, suggesting induction of depressive-like behavior in Wistar rats and an exacerbation of this behavior in WKY rats. Alcohol treatment also resulted in an increase in cortical but not hippocampal alpha-2 ARs densities in both Wistar and WKY rats. The behavioral effects of alcohol were completely blocked by IMP and NOMI and the neurochemical effects (increases in alpha-2 ARs) were significantly attenuated by both drugs in both strains. CONCLUSIONS The results suggest a role for cortical alpha-2 ARs in alcohol withdrawal-induced depression and that selective subtype antagonists of these receptors may be of adjunct therapeutic potential in AUD-depression co-morbidity.
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Affiliation(s)
- Bruk Getachew
- Department of Pharmacology, Howard University College of Medicine, Washington, DC, USA
| | - Sheketha R. Hauser
- Department of Pharmacology, Howard University College of Medicine, Washington, DC, USA
| | - Antonei B. Csoka
- Department of Anatomy, Howard University College of Medicine, Washington, DC, USA
| | - Robert E. Taylor
- Department of Pharmacology, Howard University College of Medicine, Washington, DC, USA
| | - Yousef Tizabi
- Department of Pharmacology, Howard University College of Medicine, Washington, DC, USA.
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84
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Foa EB, Asnaani A, Rosenfield D, Zandberg LJ, Gariti P, Imms P. Concurrent varenicline and prolonged exposure for patients with nicotine dependence and PTSD: A randomized controlled trial. J Consult Clin Psychol 2017; 85:862-872. [PMID: 28569519 DOI: 10.1037/ccp0000213] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Prevalence of smoking among individuals with posttraumatic stress disorder (PTSD) is disproportionately high, and PTSD is associated with especially poor response to smoking cessation treatment. OBJECTIVE The current study examined whether integrating treatments for smoking cessation (varenicline plus smoking cessation counseling; VARCC) and PTSD (prolonged exposure therapy; PE) enhances smoking outcomes among smokers diagnosed with PTSD. METHOD 142 adults with nicotine dependence (ND) and PTSD were randomized to a treatment program consisting of varenicline, smoking cessation counseling, and PE (VARCC + PE) or to VARCC only. Seven-day point prevalence abstinence (PPA) at posttreatment (3-months postquit day) and follow-up (6-months postquit day), verified by serum cotinine levels and exhaled carbon monoxide, was the primary smoking outcome. Psychological outcomes were PTSD and depression severity. Mixed effects models included baseline PTSD severity as a moderator of treatment condition effects. RESULTS Overall, VARCC + PE participants did not show greater PPA than VARCC participants. However, treatment effects were moderated by baseline PTSD severity. For participants with moderate and high PTSD severity, VARCC + PE led to significantly higher PPA than VARCC alone (ps<.05). No differences between treatment conditions emerged for participants with low baseline PTSD severity. Participants who received PE showed significantly greater reduction of PTSD and depression symptoms than those who did not receive PE. CONCLUSIONS Integrating psychological treatment for PTSD and smoking cessation treatment enhances smoking cessation for participants with moderate or severe PTSD symptom severity, but does not enhance smoking cessation for participants with low baseline PTSD severity. (PsycINFO Database Record
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Affiliation(s)
- Edna B Foa
- Department of Psychiatry Center for the Treatment and Study of Anxiety
| | - Anu Asnaani
- Department of Psychiatry Center for the Treatment and Study of Anxiety
| | | | - Laurie J Zandberg
- Department of Psychiatry Center for the Treatment and Study of Anxiety
| | - Peter Gariti
- Department of Psychiatry Center for the Treatment and Study of Anxiety
| | - Patricia Imms
- Department of Psychiatry Center for the Treatment and Study of Anxiety
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85
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Brandt CP, Paulus DJ, Jardin C, Heggeness L, Lemaire C, Zvolensky MJ. Examining anxiety sensitivity as an explanatory construct underlying HIV-related stigma: Relations to anxious arousal, social anxiety, and HIV symptoms among persons living with HIV. J Anxiety Disord 2017; 48:95-101. [PMID: 27527687 PMCID: PMC5293677 DOI: 10.1016/j.janxdis.2016.08.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 08/04/2016] [Accepted: 08/05/2016] [Indexed: 12/01/2022]
Abstract
Persons living with HIV (PLHIV) are a health disparity subgroup of the overall population for mental and physical health problems. HIV-related stigma has been shown to increase anxiety symptoms and HIV symptoms among PLHIV. However, little is known about factors that may impact the relations between HIV-related stigma and anxiety symptoms and HIV symptoms among PLHIV. To address this gap in the literature, the current study examined anxiety sensitivity (i.e., the extent to which individuals believe anxiety and anxiety-related sensations) in the relation between HIV-related stigma, social anxiety, anxious arousal, and HIV symptoms among a sample of 87 PLHIV (60.9% cis gender male, 52.9% Black, non-Hispanic). Results indicated that anxiety sensitivity mediated the relations between HIV-related stigma and the dependent variables, with effect sizes indicating moderate to large effects of anxiety sensitivity on these relations. Findings suggest that anxiety sensitivity be a mechanistic factor in the relations between HIV-related stigma and social anxiety, anxious arousal, and HIV symptoms, and therefore, be important element in efforts to reduce mental/physical health disparity among this population.
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Affiliation(s)
- Charles P. Brandt
- University of Houston, Department of Psychology. 3695 Cullen Blvd. Room 126, Houston, Texas 77204,Baylor College of Medicine. 1 Baylor Plaza, Houston, Texas 77030,Corresponding author may be reached at
| | - Daniel J. Paulus
- University of Houston, Department of Psychology. 3695 Cullen Blvd. Room 126, Houston, Texas 77204
| | - Charles Jardin
- University of Houston, Department of Psychology. 3695 Cullen Blvd. Room 126, Houston, Texas 77204
| | - Luke Heggeness
- Kent State University, Department of Psychology. 144 Kent Hall, Kent, Ohio 44242
| | - Chad Lemaire
- Legacy Community Health. 1415 California St, Houston, Texas 77006
| | - Michael J. Zvolensky
- University of Houston, Department of Psychology. 3695 Cullen Blvd. Room 126, Houston, Texas 77204,The University of Texas MD Anderson Cancer Center, Department of Behavioral Science. 1515 Holcombe Blvd, Houston, Texas 77030
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Meuret AE, Kroll J, Ritz T. Panic Disorder Comorbidity with Medical Conditions and Treatment Implications. Annu Rev Clin Psychol 2017; 13:209-240. [PMID: 28375724 DOI: 10.1146/annurev-clinpsy-021815-093044] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Panic disorder (PD) is unique among the anxiety disorders in that panic symptoms are primarily of a physical nature. Consequently, comorbidity with medical illness is significant. This review examines the association between PD and medical illness. We identify shared pathophysiological and psychological correlates and illustrate how physiological activation in panic sufferers underlies their symptom experience in the context of the fight-or-flight response and beyond a situation-specific response pattern. We then review evidence for bodily symptom perception accuracy in PD. Prevalence of comorbidity for PD and medical illness is presented, with a focus on respiratory and cardiovascular illness, irritable bowel syndrome, and diabetes, followed by an outline for potential pathways of a bidirectional association. We conclude by illustrating commonalities in mediating mechanistic pathways and moderating risk factors across medical illnesses, and we discuss implications for diagnosis and treatment of both types of conditions.
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Affiliation(s)
- Alicia E Meuret
- Department of Psychology, Southern Methodist University, Dallas, Texas 75275;
| | - Juliet Kroll
- Department of Psychology, Southern Methodist University, Dallas, Texas 75275;
| | - Thomas Ritz
- Department of Psychology, Southern Methodist University, Dallas, Texas 75275;
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Raknes S, Pallesen S, Bjaastad JF, Wergeland GJ, Hoffart A, Dyregrov K, Håland ÅT, Haugland BSM. Negative Life Events, Social Support, and Self-Efficacy in Anxious Adolescents. Psychol Rep 2017; 120:609-626. [PMID: 28558534 DOI: 10.1177/0033294117699820] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE To examine the prevalence and correlates of anxiety in a community sample of adolescents. Knowing the prevalence and characteristics of anxious adolescents is valuable to improve anxiety prevention strategies and interventions. DESIGN Cross-sectional data about anxiety were collected via a school survey from a community sample of Norwegian adolescents aged 12-17 (N = 1719). METHODS Based on scores from the Spence Children's Anxiety Scale, the adolescents were categorized as not anxious or anxious. Logistic regression analysis was performed to access the impact of each factor on the likelihood that participants would report an elevated level of anxiety. RESULTS A total of 22% of the adolescents were categorized as anxious. Female gender, experienced negative life events, low social support, and low self-efficacy were associated with elevated level of anxiety. CONCLUSIONS The high prevalence of anxiety in adolescents demonstrates the importance of improved prevention interventions targeting anxious adolescents. We argue that addressing is the responsibility of not only the individual adolescents and their families but also schools, school health services, and policy makers. School-based interventions that increase social support and self-efficacy would probably be particularly beneficial for anxious adolescents.
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Affiliation(s)
- Solfrid Raknes
- Regional Centre for Child and Youth Mental Health and Child Welfare, Uni Research Health/University of Bergen, Bergen, Norway
| | - Ståle Pallesen
- Department of Psychosocial Science, University of Bergen, Bergen, Norway
| | - Jon Fauskanger Bjaastad
- Regional Centre for Child and Youth Mental Health and Child Welfare, Uni Research Health/University of Bergen, Bergen, Norway; Division of Psychiatry, Stavanger University Hospital, Stavanger, Norway
| | - Gro Janne Wergeland
- Regional Centre for Child and Youth Mental Health and Child Welfare, Uni Research Health/University of Bergen, Bergen, Norway; Department of Child and Adolescent Psychiatry, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Asle Hoffart
- Research Institute, Modum Bad Psychiatric Center and Department of Psychology, University of Oslo, Oslo, Norway
| | - Kari Dyregrov
- Bergen University College, Faculty of Health and Social Sciences and Center for Crisis Psychology, Bergen, Norway
| | - Åshild Tellefsen Håland
- Clinic of Mental Health, Psychiatry and Addiction Treatment, Sørlandet Hospital HF, Kristiansand, Norway
| | - Bente Storm Mowatt Haugland
- Regional Centre for Child and Youth Mental Health and Child Welfare, Uni Research Health/University of Bergen, Bergen, Norway
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Abstract
Similar to the burden of other diseases, the burden of sexual dysfunction has not been systematically studied. However, there is growing evidence of various burdens (e.g., economic, symptomatic, humanistic) among patients suffering from sexual dysfunctions. The burden of sexual dysfunction has been studied a bit more often in men, namely the burden of erectile dysfunction (ED), premature ejaculation (PE) and testosterone deficiency syndrome (TDS). Erectile dysfunction is frequently associated with chronic conditions such as cardiovascular disease, diabetes, and depression. These conditions could go undiagnosed, and ED could be a marker of those diseases. The only available report from the United Kingdom estimated the total economic burden of ED at £53 million annually in terms of direct costs and lost productivity. The burden of PE includes significant psychological distress: anxiety, depression, lack of sexual confidence, poor self-esteem, impaired quality of life, and interpersonal difficulties. Some suggest that increase in female sexual dysfunction is associated with partner's PE, in addition to significant interpersonal difficulties. The burden of TDS includes depression, sexual dysfunction, mild cognitive impairment, and osteoporosis. One UK estimate of the economic burden of female sexual dysfunctions demonstrated that the average cost per patient was higher than the per annum cost of ED. There are no data on burden of paraphilic disorders. The burden of sexual dysfunctions is underappreciated and not well studied, yet it is significant for both the patients and the society.
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Affiliation(s)
- Richard Balon
- a Departments of Psychiatry and Behavioral Neurosciences and Anesthesiology , Wayne State University School of Medicine , Detroit , Michigan , USA
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Blanco C, Compton WM, Saha TD, Goldstein BI, Ruan WJ, Huang B, Grant BF. Epidemiology of DSM-5 bipolar I disorder: Results from the National Epidemiologic Survey on Alcohol and Related Conditions - III. J Psychiatr Res 2017; 84:310-317. [PMID: 27814503 PMCID: PMC7416534 DOI: 10.1016/j.jpsychires.2016.10.003] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 09/07/2016] [Accepted: 10/06/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND The objective of this study was to present 12-month and lifetime prevalence, correlates, comorbidity, treatment and disability of DSM-5 bipolar I disorder. METHODS Nationally representative U.S. adult sample (N = 36,309), the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions - III. RESULTS Prevalences of 12-month and lifetime DSM-5 bipolar I disorder were 1.5% and 2.1% and did not differ between men (1.6% and 2.2%) and women (1.5% and 2.0%). Prevalences of bipolar I disorder were greater among Native Americans, and lower among Blacks, Hispanics and Asians/Pacific Islanders than whites. Rates were also lower among younger than older individuals, those previously married than currently married and with lower education and income relative to higher education and income. Bipolar I disorder was more strongly related to borderline and schizotypal personality disorders (adjusted odds ratios (AORS) = 2.2-4.7)), than to anxiety disorders (AORs = 1.3-2.9), and substance use disorders (AORs = 1.3-2.1) overall and among men and women. Quality of life was lower among individuals with bipolar I disorder relative to those without the disorder. Treatment rates among individuals with bipolar I disorder were low in the total sample (46%, SE = 2.63), among men (36.7%, SE = 3.82) and among women (55.8%, SE = 3.32). CONCLUSIONS Bipolar I disorder continues to be common disabling and highly comorbid disorder among men and women, contributing substantially to low quality of life and burden of disease in our society.
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Affiliation(s)
- Carlos Blanco
- Division of Epidemiology, Service and Prevention Research, National Institute on Drug Abuse, 6001 Executive Blvd., Rockville, MD, 20852, USA.
| | - Wilson M. Compton
- Division of Epidemiology, Service and Prevention Research, National Institute on Drug Abuse, 6001 Executive Blvd. Rockville, MD 20852
| | - Tulshi D. Saha
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Lane, Rockville, MD 20852
| | - Benjamin I. Goldstein
- Sunnybrook Health Sciences Centre, 2075 Bayview Ave., Room FG 53, Toronto, Canada, M4N 3M5
| | - W. June Ruan
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Lane, Rockville, MD 20852
| | - Boji Huang
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Lane, Rockville, MD, 20852, USA.
| | - Bridget F. Grant
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Lane, Rockville, MD 20852
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90
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Sickel AE, Seacat JD, Nabors NA. Mental health stigma: Impact on mental health treatment attitudes and physical health. J Health Psychol 2016; 24:586-599. [PMID: 27909162 DOI: 10.1177/1359105316681430] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The purpose of this study was to test two models of the impact of mental health stigma on both attitudes toward seeking psychological help and physical health. General self-efficacy, self-esteem, and anxiety were tested as potential mediators of these two relationships. A sample of adults ( N = 423) aged 18-72 years was surveyed using the participant pool of a large, distance learning university. Structural equation modeling results indicated that mental health stigma directly and indirectly influenced treatment attitudes and physical health. Internal self-variables mediated the relationship between mental health stigma and both study outcomes.
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91
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Happell B, Ewart SB, Platania-Phung C, Bocking J, Scholz B, Stanton R. What Physical Health Means to Me: Perspectives of People with Mental Illness. Issues Ment Health Nurs 2016; 37:934-941. [PMID: 27786585 DOI: 10.1080/01612840.2016.1226999] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
There are significant inequalities in physical health and life expectancy between people with and without a mental illness. Understanding perspectives of people with mental illness on personal meanings of physical health is essential to ensuring health services are aligned with consumer understandings, needs, and values. A qualitative exploratory study was undertaken involving focus groups with 31 consumers in The Australian Capital Territory, Australia. Participants were asked: "What does physical health mean to you?" Thematic analysis was applied to interview transcripts. Five themes are discussed, representing different emphases in the meaning of physical health: (1) physical and mental are interconnected, (2) absence of disease, (3) moving the body, (4) struggling for healthy diet, and (5) functioning and participation. Physical pain was a difficulty that arose across these themes. Mental health consumers see physical health as always connected with well-being. Nurses would benefit from been informed by consumer understandings of physical health. In addition, there should be more attention to quality of life measures of people with mental illness as these are more congruent with consumer perspectives on physical health than biomedical measures.
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Affiliation(s)
- Brenda Happell
- a SYNERGY: Nursing and Midwifery Research Centre, University of Canberra, Faculty of Health, and ACT Health, Canberra Hospital , Woden , Australia
| | - Stephanie B Ewart
- b SYNERGY: Nursing and Midwifery Research Centre, University of Canberra and ACT Health , Woden , Australia
| | - Chris Platania-Phung
- a SYNERGY: Nursing and Midwifery Research Centre, University of Canberra, Faculty of Health, and ACT Health, Canberra Hospital , Woden , Australia
| | - Julia Bocking
- a SYNERGY: Nursing and Midwifery Research Centre, University of Canberra, Faculty of Health, and ACT Health, Canberra Hospital , Woden , Australia
| | - Brett Scholz
- a SYNERGY: Nursing and Midwifery Research Centre, University of Canberra, Faculty of Health, and ACT Health, Canberra Hospital , Woden , Australia
| | - Robert Stanton
- c Central Queensland University, School of Medical and Applied Sciences, Queensland, Australia, SYNERGY: Nursing and Midwifery Research Centre, University of Canberra, Faculty of Health, and ACT Health, Canberra Hospital , Woden , Australia
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92
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Vollmer LL, Ghosal S, McGuire JL, Ahlbrand RL, Li KY, Santin JM, Ratliff-Rang CA, Patrone LGA, Rush J, Lewkowich IP, Herman JP, Putnam RW, Sah R. Microglial Acid Sensing Regulates Carbon Dioxide-Evoked Fear. Biol Psychiatry 2016; 80:541-51. [PMID: 27422366 PMCID: PMC5014599 DOI: 10.1016/j.biopsych.2016.04.022] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 04/08/2016] [Accepted: 04/13/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Carbon dioxide (CO2) inhalation, a biological challenge and pathologic marker in panic disorder, evokes intense fear and panic attacks in susceptible individuals. The molecular identity and anatomic location of CO2-sensing systems that translate CO2-evoked fear remain unclear. We investigated contributions of microglial acid sensor T cell death-associated gene-8 (TDAG8) and microglial proinflammatory responses in CO2-evoked behavioral and physiological responses. METHODS CO2-evoked freezing, autonomic, and respiratory responses were assessed in TDAG8-deficient ((-/-)) and wild-type ((+/+)) mice. Involvement of TDAG8-dependent microglial activation and proinflammatory cytokine interleukin (IL)-1β with CO2-evoked responses was investigated using microglial blocker, minocycline, and IL-1β antagonist IL-1RA. CO2-chemosensitive firing responses using single-cell patch clamping were measured in TDAG8(-/-) and TDAG8(+/+) mice to gain functional insights. RESULTS TDAG8 expression was localized in microglia enriched within the sensory circumventricular organs. TDAG8(-/-) mice displayed attenuated CO2-evoked freezing and sympathetic responses. TDAG8 deficiency was associated with reduced microglial activation and proinflammatory cytokine IL-1β within the subfornical organ. Central infusion of microglial activation blocker minocycline and IL-1β antagonist IL-1RA attenuated CO2-evoked freezing. Finally, CO2-evoked neuronal firing in patch-clamped subfornical organ neurons was dependent on acid sensor TDAG8 and IL-1β. CONCLUSIONS Our data identify TDAG8-dependent microglial acid sensing as a unique chemosensor for detecting and translating hypercapnia to fear-associated behavioral and physiological responses, providing a novel mechanism for homeostatic threat detection of relevance to psychiatric conditions such as panic disorder.
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Affiliation(s)
- Lauren Larke Vollmer
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati; Neuroscience Graduate Program, University of Cincinnati, Cincinnati
| | - Sriparna Ghosal
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati; Neuroscience Graduate Program, University of Cincinnati, Cincinnati
| | - Jennifer L McGuire
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati
| | - Rebecca L Ahlbrand
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati
| | - Ke-Yong Li
- Department of Neuroscience, Cell Biology and Physiology, Wright State University, Dayton
| | - Joseph M Santin
- Department of Biological Sciences, Wright State University, Dayton
| | | | - Luis G A Patrone
- Department of Animal Morphology and Physiology, São Paulo State University, FCAV, Jaboticabal, São Paulo, Brazil
| | - Jennifer Rush
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati
| | - Ian P Lewkowich
- Division of Immunobiology, Children's Hospital Medical Center, Cincinnati
| | - James P Herman
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati; Neuroscience Graduate Program, University of Cincinnati, Cincinnati
| | - Robert W Putnam
- Department of Neuroscience, Cell Biology and Physiology, Wright State University, Dayton
| | - Renu Sah
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati; Neuroscience Graduate Program, University of Cincinnati, Cincinnati; Veterans Affairs (VA) Medical Center, Cincinnati, Ohio.
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93
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Johnson SU, Hoffart A. Metacognitive Therapy for Comorbid Anxiety Disorders: A Case Study. Front Psychol 2016; 7:1515. [PMID: 27746757 PMCID: PMC5043054 DOI: 10.3389/fpsyg.2016.01515] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 09/20/2016] [Indexed: 11/13/2022] Open
Abstract
We aimed to systematically evaluate a generic model of metacognitive therapy (MCT) with a highly comorbid anxiety disorder patient, that had been treated with diagnosis-specific cognitive-behavioral therapy (CBT) without significant effect. Traditionally, CBT has progressed within a disorder-specific approach, however, it has been suggested that this could be less optimal with highly comorbid patients. To address comorbidity, transdiagnostic treatment models have been emerging. This case study used an AB-design with repeated assessments during each therapy session and a 1-year follow-up assessment to evaluate the effectiveness of MCT. Following 8 sessions of MCT, significant decrease in anxiety and depression symptoms, as well as loss of diagnostic status was observed. Outcomes were preserved at 12 months follow up. The generic model of MCT seems promising as an approach to highly comorbid mixed anxiety depression patients. Further testing using more powered methodologies are needed.
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Affiliation(s)
- Sverre U Johnson
- Clinical Psychology, University of OsloOslo, Norway; Modum Bad Psychiatric CenterVikersund, Norway
| | - Asle Hoffart
- Clinical Psychology, University of OsloOslo, Norway; Modum Bad Psychiatric CenterVikersund, Norway
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94
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Goldstein RB, Smith SM, Chou SP, Saha TD, Jung J, Zhang H, Pickering RP, Ruan WJ, Huang B, Grant BF. The epidemiology of DSM-5 posttraumatic stress disorder in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions-III. Soc Psychiatry Psychiatr Epidemiol 2016; 51:1137-48. [PMID: 27106853 PMCID: PMC4980174 DOI: 10.1007/s00127-016-1208-5] [Citation(s) in RCA: 352] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 03/16/2016] [Indexed: 01/10/2023]
Abstract
OBJECTIVES To present current, nationally representative US findings on the past-year and lifetime prevalences, sociodemographic correlates, psychiatric comorbidity, associated disability, and treatment of DSM-5 posttraumatic stress disorder (PTSD). METHODS Face-to-face interviews with 36,309 adults in the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions-III. PTSD, alcohol and drug use disorders, and selected mood, anxiety, and personality disorders were assessed using the Alcohol Use Disorder and Associated Disabilities Interview Schedule-5. RESULTS Past-year and lifetime prevalences were 4.7 and 6.1 %, higher for female, white, Native American, younger, and previously married respondents, those with <high school education and lower incomes, and rural residents. PTSD was significantly associated with a broad range of substance use, mood, anxiety, and personality disorders, and past-month disability. Among respondents with lifetime PTSD, 59.4 % sought treatment; an average of 4.5 years elapsed from disorder onset to first treatment. CONCLUSIONS DSM-5 PTSD is prevalent, highly comorbid, disabling, and associated with delayed help seeking. Additional research is needed to elucidate relationships identified herein, estimate PTSD-related costs, investigate hypotheses regarding etiology, course, and treatment, and support decisions about resource allocation to service delivery and research. Initiatives are needed to destigmatize PTSD, educate the public about its treatment, and encourage affected individuals to seek help.
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Affiliation(s)
- Risë B. Goldstein
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Ln., M.S. 9304, Bethesda, MD, 20892,Health Behavior Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, 6100 Executive Blvd., Room 7B13C, Bethesda, MD 20892
| | - Sharon M. Smith
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Ln., M.S. 9304, Bethesda, MD, 20892,Translational Blood Science and Resources Branch, Division of Blood Diseases and Resources, National Heart, Lung, and Blood Institute, National Institutes of Health, 6701 Rockledge Dr., Bethesda, MD 20892
| | - S. Patricia Chou
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Ln., M.S. 9304, Bethesda, MD, 20892
| | - Tulshi D. Saha
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Ln., M.S. 9304, Bethesda, MD, 20892
| | - Jeesun Jung
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Ln., M.S. 9304, Bethesda, MD, 20892
| | - Haitao Zhang
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Ln., M.S. 9304, Bethesda, MD, 20892
| | - Roger P. Pickering
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Ln., M.S. 9304, Bethesda, MD, 20892
| | - W. June Ruan
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Ln., M.S. 9304, Bethesda, MD, 20892
| | - Boji Huang
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Ln., M.S. 9304, Bethesda, MD, 20892
| | - Bridget F. Grant
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Ln., M.S. 9304, Bethesda, MD, 20892
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95
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Wurm M, Edlund S, Tillfors M, Boersma K. Characteristics and consequences of the co-occurrence between social anxiety and pain-related fear in chronic pain patients receiving multimodal pain rehabilitation treatment. Scand J Pain 2016; 12:45-52. [DOI: 10.1016/j.sjpain.2016.03.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Revised: 03/05/2016] [Accepted: 03/21/2016] [Indexed: 12/25/2022]
Abstract
Abstract
Background and aims
Chronic pain problems are related to specific pain related fears and maladaptive pain-coping but also commonly co-occur with other anxiety problems. Shared emotional vulnerability factors may explain this comorbidity and may influence treatment outcome. Indeed, pain patients going through multimodal pain treatment are a heterogeneous group and treatment results vary. One understudied anxiety disorder co-occurring with pain is social anxiety. This may be relevant as many pain-related challenges are situated in social contexts. The aim of this study is to investigate the occurrence of subgroups with differential patterns of social anxiety and pain related fear in a sample of chronic pain patients who receive multimodal pain treatment. The aim is also to study the characteristics of these potential subgroups and the consequences of different patterns of social anxiety and pain related fear.
Methods
180 patients with chronic musculoskeletal pain answered questionnaires before and after a multimodal pain treatment in a hospital rehabilitation setting in middle Sweden. A cluster analysis using pre-treatment scores on the Social Phobia Screening Questionnaire and the Tampa Scale of Kinesiophobia was performed. Subgroups were thereafter validated and compared on impairment due to social anxiety, pain catastrophizing, anxiety, and depression. Moreover, subgroups were described and compared on vulnerability factors (anxiety sensitivity, negative affect) and outcome factors (pain intensity, pain interference, and return to work self-efficacy).
Results
Four distinct clusters emerged: (1) low scores, (2) pain-related fear only, (3) social concern only, and (4) high social anxiety and pain-related fear. Patients high on social anxiety and pain-related fear had significantly higher levels of anxiety sensitivity, negative affect, and higher general emotional symptomatology. They also had remaining problems posttreatment.
Conclusions
A subgroup of patients with clinical levels of social anxiety has suboptimal rehabilitation results, with residual emotional problems and high levels of emotional vulnerability.
Implications
These patients may be in need of additional treatment efforts that are not being met today. To prevent insufficient treatment results and prolonged work disability, these patients need to be detected during screening and may benefit from pain treatment that takes their emotional problems into account.
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Affiliation(s)
- Matilda Wurm
- Center for Health and Medical Psychology (CHAMP), School of Law , Psychology and Social Work (JPS), Örebro University , Örebro , Sweden
| | - Sara Edlund
- Center for Health and Medical Psychology (CHAMP), School of Law , Psychology and Social Work (JPS), Örebro University , Örebro , Sweden
| | - Maria Tillfors
- Center for Health and Medical Psychology (CHAMP), School of Law , Psychology and Social Work (JPS), Örebro University , Örebro , Sweden
| | - Katja Boersma
- Center for Health and Medical Psychology (CHAMP), School of Law , Psychology and Social Work (JPS), Örebro University , Örebro , Sweden
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96
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Wampold BE. Beauty is in the eye of the beholder: Personalized goals may be more (or less) than meets the eye. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2016. [DOI: 10.1111/cpsp.12150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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97
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Baughman KR, Bonfine N, Dugan SE, Adams R, Gallagher M, Olds RS, Piatt E, Ritter C. Disease Burden Among Individuals with Severe Mental Illness in a Community Setting. Community Ment Health J 2016; 52:424-32. [PMID: 26611625 DOI: 10.1007/s10597-015-9973-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Accepted: 11/13/2015] [Indexed: 11/25/2022]
Abstract
This study examines the prevalence of comorbid physical health conditions within a community sample of individuals with severe mental illness (SMI), compares them to a matched national sample without SMI, and identifies which comorbidities create the greatest disease burden for those with SMI. Self-reported health status, co-morbid medical conditions and perceived disease burden were collected from 203 adults with SMI. Prevalence of chronic health conditions was compared to a propensity-matched sample without SMI from the National Comorbidity Survey-Replication (NCS-R). Compared to NCS-R sample without SMI, our sample with SMI had a higher prevalence of seven out of nine categories of chronic health conditions. Chronic pain and headaches, as well as the number of chronic conditions, were associated with increased disease burden for individuals with SMI. Further investigation of possible interventions, including effective pain management, is needed to improve the health status of this population.
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Affiliation(s)
- Kristin R Baughman
- Department of Family and Community Medicine, Northeast Ohio Medical University, 1409 State Route 44, PO Box 95, Rootstown, OH, 44272, USA.
| | - Natalie Bonfine
- Department of Psychiatry, Northeast Ohio Medical University, 1409 State Route 44, PO Box 95, Rootstown, OH, 44272, USA
| | - Sara E Dugan
- Pharmacy Practice Department, Northeast Ohio Medical University, 1409 State Route 44, PO Box 95, Rootstown, OH, 44272, USA
| | - Richard Adams
- Department of Sociology, Kent State University, 215 Merrill Hall, PO Box 5190, Kent, OH, 44242, USA
| | - Mary Gallagher
- Department of Sociology, Kent State University at Stark, 6000 Frank Ave NW, North Canton, OH, 44720, USA
| | - R Scott Olds
- Department of Family and Community Medicine, University of New Mexico, 1 University of New Mexico Bldg 177, Albuquerque, NM, 87131, USA
| | - Elizabeth Piatt
- Department of Sociology, Hiram College, 6832 Hinsdale St, Hiram, OH, 44234, USA
| | - Christian Ritter
- Department of Psychiatry, Northeast Ohio Medical University, 1409 State Route 44, PO Box 95, Rootstown, OH, 44272, USA
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Cittaro D, Lampis V, Luchetti A, Coccurello R, Guffanti A, Felsani A, Moles A, Stupka E, D' Amato FR, Battaglia M. Histone Modifications in a Mouse Model of Early Adversities and Panic Disorder: Role for Asic1 and Neurodevelopmental Genes. Sci Rep 2016; 6:25131. [PMID: 27121911 PMCID: PMC4848503 DOI: 10.1038/srep25131] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 04/12/2016] [Indexed: 11/20/2022] Open
Abstract
Hyperventilation following transient, CO2-induced acidosis is ubiquitous in mammals and heritable. In humans, respiratory and emotional hypersensitivity to CO2 marks separation anxiety and panic disorders, and is enhanced by early-life adversities. Mice exposed to the repeated cross-fostering paradigm (RCF) of interference with maternal environment show heightened separation anxiety and hyperventilation to 6% CO2-enriched air. Gene-environment interactions affect CO2 hypersensitivity in both humans and mice. We therefore hypothesised that epigenetic modifications and increased expression of genes involved in pH-detection could explain these relationships. Medullae oblongata of RCF- and normally-reared female outbred mice were assessed by ChIP-seq for H3Ac, H3K4me3, H3K27me3 histone modifications, and by SAGE for differential gene expression. Integration of multiple experiments by network analysis revealed an active component of 148 genes pointing to the mTOR signalling pathway and nociception. Among these genes, Asic1 showed heightened mRNA expression, coherent with RCF-mice’s respiratory hypersensitivity to CO2 and altered nociception. Functional enrichment and mRNA transcript analyses yielded a consistent picture of enhancement for several genes affecting chemoception, neurodevelopment, and emotionality. Particularly, results with Asic1 support recent human findings with panic and CO2 responses, and provide new perspectives on how early adversities and genes interplay to affect key components of panic and related disorders.
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Affiliation(s)
- Davide Cittaro
- Centre for Translational Genomics and Bioinformatics, San Raffaele Scientific Institute, Milan, Italy
| | - Valentina Lampis
- Developmental Psychopathology Unit, Vita-Salute San Raffaele University, Milan, Italy
| | - Alessandra Luchetti
- Institute of Cell Biology and Neurobiology, National Research Council/Fondazione Santa Lucia, Rome, Italy
| | - Roberto Coccurello
- Institute of Cell Biology and Neurobiology, National Research Council/Fondazione Santa Lucia, Rome, Italy
| | - Alessandro Guffanti
- Laboratory of Molecular Neuroscience, Department of Biological Chemistry, The Edmond and Lily Safra Center of Brain Science, The Hebrew University of Jerusalem, Jerusalem, Israel.,Genomnia srl, Lainate, Italy
| | - Armando Felsani
- Institute of Cell Biology and Neurobiology, National Research Council/Fondazione Santa Lucia, Rome, Italy.,Genomnia srl, Lainate, Italy
| | - Anna Moles
- Institute of Cell Biology and Neurobiology, National Research Council/Fondazione Santa Lucia, Rome, Italy.,Genomnia srl, Lainate, Italy
| | - Elia Stupka
- Centre for Translational Genomics and Bioinformatics, San Raffaele Scientific Institute, Milan, Italy
| | - Francesca R D' Amato
- Institute of Cell Biology and Neurobiology, National Research Council/Fondazione Santa Lucia, Rome, Italy
| | - Marco Battaglia
- Department of Psychiatry, University Of Toronto, Toronto, Canada.,Division of Child and Youth Mental Health, Centre for Addiction and Mental Health, Toronto, Canada
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99
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Gurak KK, Freund B, Ironson G. The Use of Both Prolonged Exposure and Cognitive Processing Therapy in the Treatment of a Person With PTSD, Multiple Traumas, Depression, and Suicidality. Clin Case Stud 2016. [DOI: 10.1177/1534650116641214] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Despite a high prevalence of comorbid disorders such as major depressive disorder (MDD), the empirical guidelines for how to manage co-occurring conditions in the treatment of posttraumatic stress disorder (PTSD) are lacking. In the context of a complicated presentation of PTSD, this case illustration demonstrates the application of an integrated treatment approach with “Amanda,” a 28-year-old female with a history of multiple traumas, undiagnosed PTSD for 10 years, and comorbid MDD. In addition, Amanda began having suicidal thoughts mid-treatment. This case study demonstrates how the integration of coping skills training and cognitive processing therapy, in conjunction with prolonged exposure, helped Amanda successfully complete treatment and be able to discuss her traumatic events with minimal distress. At discharge, Amanda no longer met criteria for PTSD, had experienced significant improvements in depression and anxiety symptoms, and was no longer experiencing suicidal thoughts. These improvements were maintained at both 3 and 6 months post treatment.
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100
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Prevalence and correlates of DSM-IV-TR major depressive disorder, self-reported diagnosed depression and current depressive symptoms among adults in Germany. J Affect Disord 2016; 190:167-177. [PMID: 26519637 DOI: 10.1016/j.jad.2015.10.006] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 09/30/2015] [Accepted: 10/02/2015] [Indexed: 01/22/2023]
Abstract
BACKGROUND While standardized diagnostic interviews using established criteria are the gold standard for assessing depression, less time consuming measures of depression and depressive symptoms are commonly used in large population health surveys. We examine the prevalence and health-related correlates of three depression measures among adults aged 18-79 years in Germany. METHODS Using cross-sectional data from the national German Health Interview and Examination Survey for Adults (DEGS1) (n=7987) and its mental health module (DEGS1-MH) (n=4483), we analysed prevalence and socio-demographic and health-related correlates of (a) major depressive disorder (MDD) established by Composite International Diagnostic Interview (CIDI) using DSM-IV-TR criteria (CIDI-MDD) in the last 12 months, (b) self-reported physician or psychotherapist diagnosed depression in the last 12 months, and (c) current depressive symptoms in the last two weeks (PHQ-9, score ≥10). RESULTS Prevalence of 12-month CIDI-MDD was 4.2% in men and 9.9% in women. Prevalence of 12-month self-reported health professional-diagnosed depression was 3.8% and 8.1% and of current depressive symptoms 6.1% and 10.2% in men and women, respectively. Case-overlap between measures was only moderate (32-45%). In adjusted multivariable analyses, depression according to all three measures was associated with lower self-rated health, lower physical and social functioning, higher somatic comorbidity (except for women with 12-month CIDI-MDD), more sick leave and higher health service utilization. LIMITATIONS Persons with severe depression may be underrepresented. Associations between CIDI-MDD and correlates and overlap with other measures may be underestimated due to time lag between DEGS1 and DEGS1-MH. CONCLUSIONS Prevalence and identified cases varied between these three depression measures, but all measures were consistently associated with a wide range of adverse health outcomes.
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