Investigating the nature of co-occurring depression and anxiety: Comparing diagnostic and dimensional research approaches

Stereoselective Activity of 1-Propargyl-4-styrylpiperidine-like Analogues That Can Discriminate between Monoamine Oxidase Isoforms A and B

The resurgence of interest in monoamine oxidases (MAOs) has been fueled by recent correlations of this enzymatic activity with cardiovascular, neurological, and oncological disorders. This has promoted increased research into selective MAO-A and MAO-B inhibitors. Here, we shed light on how selective inhibition of MAO-A and MAO-B can be achieved by geometric isomers of cis- and trans-1-propargyl-4-styrylpiperidines. While the cis isomers are potent human MAO-A inhibitors, the trans analogues selectively target only the MAO-B isoform. The inhibition was studied by kinetic analysis, UV-vis spectrum measurements, and X-ray crystallography. The selective inhibition of the MAO-A and MAO-B isoforms was confirmed ex vivo in mouse brain homogenates, and additional in vivo studies in mice show the therapeutic potential of 1-propargyl-4-styrylpiperidines for central nervous system disorders. This study represents a unique case of stereoselective activity of cis/trans isomers that can discriminate between structurally related enzyme isoforms.

Effect of comorbid anxiety and depression in complicated grief on perceived cognitive failures

BACKGROUND

Bereavement is associated with cognitive difficulties, but it is unclear whether these difficulties are associated with normative and/or complicated grief (CG) and how comorbid depression and anxiety contribute to them. Self-reported "minor errors in thinking" (i.e., cognitive failures) may manifest following bereavement and be differentially affected by CG, anxiety, and depression.

METHODS

Associations between perceived cognitive failures and CG, anxiety, and depression were investigated in 581 bereaved participants. To examine both single and comorbid conditions across the spectrum of bereaved participants, these relationships were examined using both linear regressions and group comparisons.

RESULTS

Continuous measures of depression, anxiety, and grief each independently predicted perceived cognitive failures. Group comparisons indicated that the group with three comorbid conditions had the highest frequency of perceived cognitive failures and the group with no conditions had the lowest. In addition, groups with threshold depression levels (both alone and comorbid with another condition) had higher frequencies of perceived cognitive failures than other groups, suggesting that depression was more strongly associated with perceived cognitive failures than CG or anxiety.

CONCLUSIONS

Future research about cognition following bereavement should address how multiple mental health symptoms or conditions combine to affect perceived and actual cognitive capacity.

Youth's school experience: Testing the role of symptoms of anxiety and co-occurring symptoms of depression

Although symptoms of anxiety often coexist with symptoms of depression, little is known on how such coexistence affects youth's school experiences.

OBJECTIVES

We tested how the two types of behaviors, when coexisting, were associated with youth's negative attitude toward teachers, school, and poor peer relations.

METHOD

Data were collected from 203 ethnically and socioeconomically diverse youth (male: 24.6%; mean = 15.8 years, standard deviation = 2.4) with the 3rd edition of the Behavioral Assessment for Children: Self-Report of Personality.

RESULTS

Scores for symptoms of depression alone explained negative attitude toward teachers (β = .28; R²  = 17.88%), negative attitude toward school (β = .27; R²  = 14.74%), and poor peer relations (β = .42; R²  = 44.60%) as effectively as scores for both types of behaviors did.

CONCLUSION

The coexistence of symptoms of anxiety and depression did not appear to impair youth's attitude toward teachers, school and peer relations more than symptoms of depression did alone.

A longitudinal study of the associations of BDNF genotype and methylation with poststroke anxiety

BACKGROUND

Although the precise etiology of poststroke anxiety (PSA) has yet to be fully elucidated, it is known that brain-derived neurotrophic factor (BDNF) is important for neural plasticity and long-term potentiation, associated with the pathophysiology of anxiety. The expression of BDNF is regulated by epigenetic and genetic profiles. Thus, we investigated the association between BDNF methylation status and PSA at 2 weeks and 1 year after stroke while accounting for interactions with the BDNF Val66Met polymorphism.

METHODS

The baseline sample comprised 286 patients who were assessed at 2 weeks after stroke; of these patients, 222 (78%) were followed up with at 1 year after stroke. The presence of PSA was determined using the anxiety subscale of the Hospital Anxiety and Depression Scale (HADS), and the effects of BDNF methylation status and polymorphisms on PSA status were assessed with multivariate logistic regression models.

RESULTS

The prevalence of PSA was slightly lower (27 [9.4%]) at baseline, and 35 (15.8%) patients were identified as having PSA at the 1-year follow-up. Stroke patients with a higher average methylation status were more likely to have PSA at 1 year. The BDNF Val66Met polymorphism was not independently associated with PSA during either the acute or chronic phase after stroke, but there was a significant interactive effect between BDNF methylation and genotype on PSA at 2 weeks.

CONCLUSIONS

In this study, BDNF methylation in combination with the met/met BDNF polymorphism (Val66Met polymorphism) was associated with PSA. These findings may help identify patients at higher risk for PSA.

Prevalence of Chronic Health Conditions in Australian Adults with Depression and/or Anxiety

The association between psychotic illness and poor physical health is now clearly articulated in the literature. By contrast the impact of depression and/or anxiety on physical health is considerably less understood, despite depression being the leading cause of disability worldwide and is associated with significantly higher prevalence of physical comorbidities than found in the general population. An Australia national cross-sectional population-based survey was conducted to ascertain the prevalence of chronic physical health conditions in persons with, and without depression and/or anxiety, allowing for demographic characteristics and lifestyle factors. The telephone-based survey was conducted using trained interviewers. Survey questions included those eliciting information about demographics, health status, and health behaviours. Independent t-tests and chi square tests showed demographic, health behaviours, and physical illness differed between those with and without depression and/or anxiety. Heart disease, high blood pressure, stroke, cancer, arthritis, chronic neck and/or back pain, and asthma were significantly higher in participants diagnosed with depression and/or anxiety. Binary logistic regression showed the strongest predictor of chronic illness was having a diagnosis of depression and/or anxiety. Depression and anxiety present major health problems impacting a considerable proportion of the population. A greater understanding of the associated physical health issues should provide impetus to broaden the physical health and mental illness research agenda to include these diagnoses.

Resistance training in addition to aerobic activity is associated with lower likelihood of depression and comorbid depression and anxiety symptoms: A cross sectional analysis of Australian women

The mental health benefits of resistance training (RT) alone or beyond those provided by aerobic physical activity (PA) are unclear. This study aimed to determine the association between meeting recommendations for aerobic PA and/or RT, and symptoms of depression and/or anxiety. Participants were Australian female members of the 10,000 Steps project (n = 5180, 50.0 ± 11.5 years). Symptoms of depression and anxiety were determined using the Depression Anxiety Stress Score. Participants were grouped as 'depression only', 'anxiety only', 'co-occurring depression and anxiety' or 'neither depression nor anxiety' based on relevant subscale score (cut-points: depression≥14 points, anxiety≥10 points). The International Physical Activity Questionnaire-Long Form questionnaire was used to determine PA with an additional item to specify RT frequency. Participants were classified as adhering to 'aerobic PA only' (≥150 min PA/week), 'RT only' (RT ≥ 2 days/week), 'aerobic PA + RT' (≥150 min PA/week+RT ≥ 2 days/week), or 'neither aerobic PA nor RT' (<150 min PA/week+RT < 2 days/week). Adjusted relative risk ratios (RRR [95%CI]) were estimated using multinomial logistic regression models. Relative to the 'neither PA nor RT' (n = 2215), the probabilities of 'depression only' (n = 317) and 'co-occurring depression and anxiety' (n = 417) were lower for the 'aerobic PA only' (n = 1590) (RRR = 0.74 [0.56-0.97] and RRR = 0.76 [0.59-0.97] respectively), and 'both PA + RT' (n = 974) groups (RRR = 0.61 [0.43-0.86] and RRR = 0.47 [0.33-0.67] respectively). There were no associations between adhering to one or both recommendations and 'anxiety only' (n = 317), or between 'RT only' (n = 401) and depression and/or anxiety. Prevention and treatment strategies including both aerobic PA and RT may provide additional benefits for depression with or without comorbid anxiety.

At the forefront of psychoneuroimmunology in pregnancy: Implications for racial disparities in birth outcomes PART 1: Behavioral risks factors

Birth prior to full term is a substantial public health issue. In the US, ˜400,000 babies per year are born preterm (<37 weeks), while>1 million are early term (37-38^6/7 weeks). Birth prior to full term confers risk both immediate and long term, including neonatal intensive care, decrements in school performance, and increased mortality risk from infancy through young adulthood. Risk for low birth weight and preterm birth are 1.5-2 times greater among African Americans versus Whites. Psychosocial stress related to being a member of a discriminated racial minority group contributes substantially to these racial disparities. Providing promising targets for intervention, depressed mood, anxiety, and poor sleep are each linked with exposure to chronic stress, including racial discrimination. A rigorous transdisciplinary approach addressing these gaps holds great promise for clinical impact in addressing racial disparities as well as ameliorating effects of stress on perinatal health more broadly. As will be reviewed in a companion paper, the mechanistic roles of physiological sequelae to stress - including neuroendocrine, inflammatory regulation, biological aging, and the microbiome - also require delineation.

Predicting anxiety from wholebrain activity patterns to emotional faces in young adults: a machine learning approach

BACKGROUND

It is becoming increasingly clear that pathophysiological processes underlying psychiatric disorders categories are heterogeneous on many levels, including symptoms, disease course, comorbidity and biological underpinnings. This heterogeneity poses challenges for identifying biological markers associated with dimensions of symptoms and behaviour that could provide targets to guide treatment choice and novel treatment. In response, the research domain criteria (RDoC) (Insel et al., 2010) was developed to advocate a dimensional approach which omits any disease definitions, disorder thresholds, or cut-points for various levels of psychopathology to understanding the pathophysiological processes underlying psychiatry disorders. In the present study we aimed to apply pattern regression analysis to identify brain signatures during dynamic emotional face processing that are predictive of anxiety and depression symptoms in a continuum that ranges from normal to pathological levels, cutting across categorically-defined diagnoses.

METHODS

The sample was composed of one-hundred and fifty-four young adults (mean age=21.6 and s.d.=2.0, 103 females) consisting of eighty-two young adults seeking treatment for psychological distress that cut across categorically-defined diagnoses and 72 matched healthy young adults. Participants performed a dynamic face task involving fearful, angry and happy faces (and geometric shapes) while undergoing functional Magnetic Resonance Imaging (fMRI). Pattern regression analyses consisted of Gaussian Process Regression (GPR) implemented in the Pattern Recognition for Neuroimaging toolbox (PRoNTo). Predicted and actual clinical scores were compared using Pearson's correlation coefficient (r) and normalized mean squared error (MSE) to evaluate the models' performance. Permutation test was applied to estimate significance levels.

RESULTS

GPR identified patterns of neural activity to dynamic emotional face processing predictive of self-report anxiety in the whole sample, which covered a continuum that ranged from healthy to different levels of distress, including subthreshold to fully-syndromal psychiatric diagnoses. Results were significant using two different cross validation strategies (two-fold: r=0.28 (p-value=0.001), MSE=4.47 (p-value=0.001) and five fold r=0.28 (p-value=0.002), MSE=4.62 (p-value=0.003). The contributions of individual regions to the predictive model were very small, demonstrating that predictions were based on the overall pattern rather than on a small combination of regions.

CONCLUSIONS

These findings represent early evidence that neuroimaging techniques may inform clinical assessment of young adults irrespective of diagnoses by allowing accurate and objective quantitative estimation of psychopathology.

The relationship of anxious and depressive symptoms in Parkinson's disease with voxel-based neuroanatomical and functional connectivity measures

BACKGROUND

Anxiety and depression are two frequent comorbidities of Parkinson's disease (PD). However, the underlying neural mechanism is still unclear and the studies on their neural correlates were insufficient.

METHODS

Using voxel-based neuroanatomical and functional connectivity (FC) measures, i.e. grey matter volume, fractional anisotropy, and weighted degree centrality (WD), we examined their correlations with the severity levels of anxious and depressive symptoms in 36 PD patients.

RESULTS

Positive correlations were shown between anxiety and the WDs in the left amygdala, and between depression and short-ranged WDs in the left parahippocampal gyrus. Using these two regions as the seeds, we found that the severity levels of anxiety and depression were positively correlated with the FCs between the two seeds and the areas in the default mode network (DMN), while negatively correlated with the FCs between the two seeds and the prefrontal and superior temporal cortices. Anxiety was also positively correlated with the FC between the amygdala and the superior parietal lobule.

LIMITATIONS

The severity levels of anxious and depressive symptoms of our participants is relatively mild than some previous studies. The cross-sectional design of this study cannot clarify the etiological relationship between PD and two comorbidities.

CONCLUSIONS

Our results were in line with the key roles of the amygdala and parahippocampal gyrus in anxiety and depression, and reflected the distinct effects of the DMN, prefrontal and superior temporal cortices, and sensory-motor regions on emotional regulation. The identification of these neural substrates might assist clinical monitoring mood disturbances in PD.

Effects of attitudes towards ambiguity on subclinical depression and anxiety in healthy individuals

This study aims to examine the effects of multidimensional attitudes towards ambiguity on subclinical depression and anxiety in healthy individuals. Attitudes Towards Ambiguity Scale, consisting of four clusters (enjoyment, anxiety, exclusion, and noninterference), Self-Rating Depression Scale, and State-Trait Anxiety Inventory-trait version were administered to 1019 Japanese volunteers. The result of a regression analysis suggested that the score of Attitudes Towards Ambiguity Scale-enjoyment factor significantly contributed to the Self-Rating Depression Scale score while that of Attitudes Towards Ambiguity Scale-anxiety factor significantly contributed to the State-Trait Anxiety Inventory-trait score. Among attitudes toward ambiguity, enjoyment may have protective effects against subclinical depression whereas anxiety can enhance anxiety-trait in nonclinical individuals.

Hair cortisol and childhood trauma predict psychological therapy response in depression and anxiety disorders

OBJECTIVE

Around 30-50% of patients with depression and anxiety disorders fail to respond to standard psychological therapy. Given that cortisol affects cognition, patients with altered hypothalamic-pituitary-adrenal (HPA) axis functioning may benefit less from such treatments. To investigate this, reliable pretreatment cortisol measures are needed.

METHOD

N = 89 outpatients with depression and anxiety disorders were recruited before undergoing therapy within an Improving Access to Psychological Therapies (IAPT) service. Three-month hair cortisol was determined, and the Childhood Trauma Questionnaire was administered. Patients were classified as responders if they showed significant decreases in depression (>= 6 points on the Patient Health Questionnaire) or anxiety (>= 5 points on the Generalised Anxiety Disorder Scale).

RESULTS

Non-responders in terms of depression (57%) had lower pretreatment hair cortisol concentrations (P = 0.041) and reported more physical abuse (P = 0.024), sexual abuse (P = 0.010) and total trauma (P = 0.039) when compared to responders. Non-responders in terms of anxiety (48%) had lower pretreatment hair cortisol (P = 0.027), as well as higher levels of emotional abuse (P = 0.034), physical abuse (P = 0.042) and total trauma (P = 0.048).

CONCLUSION

If future research confirms hair cortisol to be a predictor of psychological therapy response, this may prove a useful clinical biomarker which identifies a subgroup requiring more intensive treatment.

Comorbid depressive and anxiety symptoms and the risk of type 2 diabetes: Findings from the Lifelines Cohort Study

BACKGROUND

Prior studies indicate that depression is a risk factor for type 2 diabetes (T2D), though there is considerable heterogeneity in reported estimates. Identifying homogeneous subgroups of depression strongly associated with T2D may be beneficial. This study examined associations between depression and anxiety comorbidity with the risk of T2D.

METHODS

78,025 participants from the Lifelines Cohort Study (age range = 30-75 years) without diabetes at baseline were included in this study. The Mini-International Neuropsychiatric Interview assessed depressive and anxiety symptoms at baseline. Incident T2D was assessed by self-report or hemoglobin A1c levels during an approximately 3.8-year follow-up period. Risk of T2D was compared across four groups (no depressive or anxiety symptoms, depressive symptoms alone, anxiety symptoms alone, comorbid depressive/anxiety symptoms) using mixed effects logistic regression analyses adjusted for sociodemographic, lifestyle, and cardiometabolic characteristics.

RESULTS

1,096 participants developed diabetes. Compared to those without depressive or anxiety symptoms (n = 74,467), those with comorbid depressive and anxiety symptoms (n = 743) were more likely to develop T2D (n = 28, OR = 2.12, 95% CI = 1.22-3.68). Depressive symptoms alone (n = 650) and anxiety symptoms alone (n = 2,165) were not significantly associated with T2D (n = 23 and n = 24, respectively, developed diabetes). Those with comorbid symptoms were also more likely to develop T2D compared to those with depressive symptoms alone (OR = 2.86, 95% CI = 1.25-6.54).

LIMITATIONS

Depressive and anxiety symptom assessments were based on a screening tool. Hemoglobin A1c data were only available for a subset of participants.

CONCLUSIONS

Depression with comorbid anxiety may be a subgroup of depression that is strongly associated with the risk of T2D.

Depressive- and anxiety-like phenotypes in young adult APPSwe/PS1dE9 transgenic mice with insensitivity to chronic mild stress

Early Alzheimer's disease (AD) and depression share many symptoms, but the underlying mechanisms are not clear. Therefore, characterizing the shared and different biological changes between the two disorders will be helpful in making an early diagnosis and planning treatment. In the present study, 8-week-old APP_Swe/PS1_dE9 transgenic mice received chronic mild stress (CMS) for 8 weeks followed by a series of behavioral, biochemical and pathological analyses. APP_Swe/PS1_dE9 mice showed depressive- and anxiety-like behaviors, and reduced sociability, accompanied by high levels of soluble beta-amyloid, glial activation, neuroinflammation and brain derived neurotrophic factor signaling disturbance in the hippocampus. Notably, APP_Swe/PS1_dE9 mice exposure to CMS partially aggravated anxiety-like states rather than depressive-like responses and sociability deficits, with further elevated hippocampal interleukin-6 and tumor necrosis factor-α levels. These results demonstrated that young adult APP_Swe/PS1_dE9 have depressive- and anxiety-like phenotypes that were resistant to CMS compared to wild-type mice. This finding may help to understand the pathogenic mechanism of psychiatric symptoms associated with early AD.

Social dominance predicts hippocampal glucocorticoid receptor recruitment and resilience to prenatal adversity

The developing fetus is highly sensitive to prenatal stress, which may alter Hypothalamic-Pituitary-Adrenal (HPA) axis programming and increase the risk of behavioral disorders. There is high variability among the human population, wherein many offspring of stressed pregnancies display resilience to adversity, while the remainder displays vulnerability. In order to identify biological substrates mediating between resilience or vulnerability to prenatal adversity, we exposed stress-resistant Dominant (Dom) and stress-sensitive Submissive (Sub) mice to mild prenatal restraint stress (PRS, 45 min on gestational days (GD) 15, 16 and 17). We hypothesized that PRS would differentially alter prenatal programming of limbic regions regulating the HPA axis and affect among Dom and Sub offspring. Indeed, PRS increased Sub offspring’s serum corticosterone, and exaggerated their anxiety- and depressive-like behavior, while Dom offspring remained resilient to the hormonal and behavioral consequences of PRS. Moreover, PRS exposure markedly facilitated glucocorticoid receptor (GR) recruitment to the hippocampus among Dom mice in response to restraint stress, which may be responsible for their resilience to stressful challenge. These findings suggest proclivity to adaptive or maladaptive prenatal programming of hippocampal GR recruitment to be inheritable and predictable by social dominance or submissiveness.

[Trauma First - an Outpatient, Cognitive-Behavioural Intervention for Children and Adolescents With Trauma-Related Disorders: a Pilot Study]

Trauma First - an Outpatient, Cognitive-Behavioural Intervention for Children and Adolescents With Trauma-Related Disorders: a Pilot Study Abstract. Objective. Although traumatic experiences are one of the most important causes for psychiatric disorders in childhood and adulthood, trauma-specific intervention approaches are rarely applied in German outpatient clinics. The aim of the present pilot study was to evaluate a manualized, outpatient, cognitive-behavioural intervention programme ("Trauma First") for children and youths with trauma and stress-related disorders. We hypothesized that there would be specific improvements in PTSD symptoms as well as in depression, anxiety, and behavioural problems following the structured intervention programme. Method: The pilot study consisted of a pre-post-test design without a control group. Symptom severity of 33 children and youths (age: 10-15 years; 54.5 % female) with traumatic experiences was assessed by self-ratings and parent-ratings before and after the treatment. Results: After the treatment, improvements were found in children's PTSD symptoms, depression, anxiety, and behavioural problems (Cohen's d: 0.51-1.49). A trend was found showing improvement of children's life satisfaction. Effect sizes were comparable with results from meta-analyses. Conclusions: The pilot study provided first evidence for the effectiveness of "Trauma First" under ecologically valid conditions. This study is a first step in the evaluation process of psychotherapeutic effectiveness, which should be continued by conducting a randomized-controlled study design.

Generalized Anxiety disorder but not depression is associated with insomnia: a population based study

Background:

Insomnia is a common problem, however, its prevalence has never been examined in Indian population. Moreover, a number of psychiatric disorders have been found to be associated with insomnia in clinical population, but this association has scarcely been examined in general population.

Methods:

This epidemiological study was done in an urban and a rural population. Subjects were selected using Kish method. After obtaining informed consent, psychiatric disorders were diagnosed using Hindi version of Mini International Neuropsychiatric Interview. Hindi version of Insomnia Severity Index was used to diagnose insomnia.

Results:

1700 subjects were included in this study. In this study, prevalence of insomnia was 10.3%. Its prevalence increased with increasing years of education (p=0.009). Insomnia was more frequent in subjects living in joint families (p<0.001), having higher education (p=0.009), those who were separated (p<0.001), among subjects belonging to middle socio-economic status (p<0.001) and in urban population compared to semi-urban and rural population (p<0.001). Insomnia was also more frequent among subjects with major depressive disorder, generalized anxiety disorder, alcohol dependence, cannabis dependence and tobacco use. However, binary logistic regression analysis showed that only higher education, unemployment, generalized anxiety disorder and tobacco use were associated with insomnia.

Conclusion:

Insomnia in general population is associated with higher education, unemployment, generalized anxiety disorders and tobacco use.

Amygdala-centred functional connectivity affects daily cortisol concentrations: a putative link with anxiety

The amygdala plays a critical role in emotion. Its functional coupling with the hippocampus and ventromedial prefrontal cortex extending to a portion of the anterior cingulate cortex (ACC) is implicated in anxiogenesis and hypothalamic-pituitary-adrenal (HPA) system regulation. However, it remains unclear how amygdala-centred functional connectivity (FC) affects anxiety and cortisol concentrations in everyday life. Here, we investigate the relationship between daily cortisol concentrations (dCOR) and amygdala-centred FC during emotional processing in forty-one healthy humans. FC analyses revealed that higher dCOR predicted strengthened amygdala-centred FC with the hippocampus and cerebellum, but inhibited FC with the supramarginal gyrus and a perigenual part of the ACC (pgACC) when processing fearful faces (vs. neutral faces). Notably, the strength of amygdala-hippocampus FC mediated the positive relationship between cortisol and anxiety, specifically when the effect of amygdala-pgACC FC, a presumptive neural indicator of emotional control, was taken into account. Individuals with diminished connectivity between the amygdala and pgACC during fear-related processing might be more vulnerable to anxiogenesis as it pertains to greater circulating cortisol levels in everyday life. Individual functional patterns of amygdala-hippocampal-pgACC connectivity might provide a key to understand the complicate link between cortisol and anxiety-related behaviors.

Cross-sectional association of exercise, strengthening activities, and cardiorespiratory fitness on generalized anxiety, panic and depressive symptoms

OBJECTIVE

Limited research has evaluated the individual and combined associations of physical activity (PA), cardiorespiratory fitness (CRF) and muscle strengthening activities (MSA) on generalized anxiety, panic and depressive symptoms. We evaluated this topic in a representative sample of young (20-39 years) adults, with considerations by sex.

METHODS

Data from the 1999-2004 National Health and Nutrition Examination Survey (N = 2088) were used. Generalized anxiety, panic and depressive symptoms were assessed via self-report as well as using the Generalized Anxiety Disorder, Panic Disorder, and Depressive Disorders modules of the automated version of the World Health Organization Composite International Diagnostic Interview (CIDI-Auto 2.1). PA and MSA were assessed via validated self-report questionnaires and CRF was determined via a submaximal treadmill-based test. An index variable was created summing the number (range = 0-3) of these parameters for each participant. For example, those meeting PA guidelines, MSA guidelines and having moderate-to-high CRF were classified as having an index score of 3.

RESULTS

MSA was not independently associated with generalized anxiety, panic and depressive symptoms, but those with higher levels of PA and CRF had a reduced odds of these symptoms (ranging from 40 to 46% reduced odds). Compared to those with an index score of 0, those with an index score of 1, 2, and 3, respectively, had a 39%, 54% and 71% reduced odds of having generalized anxiety, panic and depressive symptoms. Results were consistent across both sexes.

CONCLUSION

PA and CRF, but not MSA, were independently associated with generalized anxiety, panic and depressive symptoms. There was evidence of an additive association between PA, CRF, and MSA on these symptoms.