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Zhang C, Huang J, Xu W. Longitudinal Relationships Between Depressive Symptoms and Generalized Anxiety Symptoms in Adolescents: A Cross-Lagged Network Analysis. J Youth Adolesc 2024; 53:1918-1927. [PMID: 38451392 DOI: 10.1007/s10964-024-01961-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 02/21/2024] [Indexed: 03/08/2024]
Abstract
The comorbidity of depression and generalized anxiety have raised questions about the existing classification system. Based on the perspective of network analysis, the developmental relationship between psychological symptoms can be explored more clearly. The current study aimed to explore the longitudinal network association of depressive symptoms and generalized anxiety symptoms in non-clinical adolescents. The sample contained 1,947 Chinese adolescents (Mage = 13.93, SD = 1.71; 48.5% girls). Their depression (PHQ-9) and generalized anxiety (GAD-7) symptoms were assessed at baseline (T1) and 6-month follow-up (T2). Data was analyzed using a cross-lagged network analysis. Depressive symptoms and generalized anxiety symptoms were closely related and did not appear to be distinct categories in adolescence. More generalized anxiety symptoms predicted depressive symptoms rather than vice versa. After controlling for gender, and age, "Difficulty relaxing" presented the highest out-expected influence (out-EI) in the network, while "trouble concentrating", and "suicidal ideation" showed the lowest in expected influence (in-EI). Findings suggested that interventions for generalized anxiety symptoms may help reduce depressive symptoms among Chinese adolescents. Specifically, alleviating "difficulty relaxing" may improve overall mental health.
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Affiliation(s)
- Chunyang Zhang
- Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education (Beijing Normal University), Faculty of Psychology, Beijing Normal University, Beijing, PR China
| | - Jingyuan Huang
- Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education (Beijing Normal University), Faculty of Psychology, Beijing Normal University, Beijing, PR China
| | - Wei Xu
- Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education (Beijing Normal University), Faculty of Psychology, Beijing Normal University, Beijing, PR China.
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Basterfield C, Fitzsimmons-Craft EE, Taylor CB, Eisenberg D, Wilfley DE, Newman MG. Internalizing psychopathology and its links to suicidal ideation, dysfunctional attitudes, and help-seeking readiness in a national sample of college students. J Affect Disord 2024; 350:255-263. [PMID: 38224742 PMCID: PMC11057016 DOI: 10.1016/j.jad.2024.01.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 12/16/2023] [Accepted: 01/04/2024] [Indexed: 01/17/2024]
Abstract
BACKGROUND Recent evidence suggests that multiple emotional disorders may be better assessed using dimensional models of psychopathology. The current study utilized a cross-sectional population survey of college students (N = 8613 participants) to examine the extent to which broad psychopathology factors accounted for specific associations between emotional problems and clinical and behavioral validators: suicidality, dysfunctional attitudes, and treatment seeking. METHODS Confirmatory factor models were estimated to identify the best structure of psychopathology. Models were then estimated to examine the broad and specific associations between each psychopathology indicator and the clinical and behavioral validators. RESULTS The hierarchical model of psychopathology with internalizing problems at the top, fear, and distress at the second level, and five specific symptom dimensions at the third level evidenced the best fit. The associations between symptom indicators of psychopathology and clinical and behavioral validators were relatively small and inconsistent. Instead, much of the association between clinical and behavioral validators and emotional problems operated at a higher-order level. LIMITATIONS The cross-sectional nature of the survey precludes the ability to make conclusions regarding causality. CONCLUSIONS Researchers should focus on investigating the shared or common components across emotional disorders, particularly concerning individuals presenting with higher rates of suicidal ideation dysfunctional attitudes, and help-seeking behavior. Using higher-order dimensions of psychopathology could simplify the complex presentation of multiple co-occurring disorders and suggest valid constructs for future investigations.
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Macdonald-Gagnon G, Stefanovics EA, Potenza MN, Pietrzak RH. Generalized anxiety and mild anxiety symptoms in U.S. military veterans: Prevalence, characteristics, and functioning. J Psychiatr Res 2024; 171:263-270. [PMID: 38325107 DOI: 10.1016/j.jpsychires.2024.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 01/30/2024] [Accepted: 02/01/2024] [Indexed: 02/09/2024]
Abstract
Generalized anxiety disorder (GAD) is a mental disorder characterized by excessive anxiety and worries that impair daily functioning. While prior work has documented the prevalence and correlates of GAD and subthreshold GAD (SGAD) in clinical samples, contemporary data on the epidemiology of anxiety symptoms are lacking, particularly in higher-risk populations such as military veterans. To address this gap, we analyzed data from a large, nationally representative sample of U.S. veterans to examine the: prevalence of probable GAD and mild anxiety symptoms measured using a brief screener; sociodemographic and military characteristics associated with anxiety symptoms; and psychiatric and functional correlates of anxiety symptoms. Results revealed that a total of 7.9% (95% confidence interval [CI] = 6.7-9.3%) and 22.1% (95%CI = 20.5-23.9%) of veterans screened positive for probable GAD and mild anxiety symptoms, respectively. Relative to veterans without anxiety symptoms, those with probable GAD and mild anxiety symptoms were younger, more likely to be female and racial/ethnic minorities, and more likely to have served 2+ deployments. Further, a "dose-response" association was observed between anxiety symptom severity and clinical correlates, with robust associations observed between probable GAD and poorer mental health, suicidal thoughts and behaviors, and functional impairment. Mild anxiety symptoms showed intermediate magnitude associations with these outcomes. Results of this study suggest that 3-of-10 U.S. veterans report anxiety symptoms. While the use of a brief screener to assess mild anxiety symptoms and probable GAD is limited, findings underscore the importance of a dimensional approach to assessing anxiety symptoms and associated clinical and functional characteristics in veterans.
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Affiliation(s)
| | - Elina A Stefanovics
- Department of Psychiatry, Yale University, School of Medicine, New Haven, CT, USA; U.S. Department of Veterans Affairs New England Mental Illness Research and Education Clinical Center (MIRECC), West Haven, CT, USA
| | - Marc N Potenza
- Department of Psychiatry, Yale University, School of Medicine, New Haven, CT, USA; Yale Child Study Center, Yale University, New Haven, CT, USA; Connecticut Mental Health Center, New Haven, CT, USA; Connecticut Council on Problem Gambling, Wethersfield, CT, USA; Department of Neuroscience, Yale University, New Haven, CT, USA; Wu Tsai Institute, Yale University, New Haven, CT, USA
| | - Robert H Pietrzak
- Department of Psychiatry, Yale University, School of Medicine, New Haven, CT, USA; U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA; Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
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Anxiety among pediatric asthma patients and their parents and quick-reliever medication use: The role of physical activity parenting behaviours. World Allergy Organ J 2023; 16:100733. [PMID: 36744050 PMCID: PMC9874065 DOI: 10.1016/j.waojou.2022.100733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 11/01/2022] [Accepted: 11/28/2022] [Indexed: 01/23/2023] Open
Abstract
Background Clinical guidelines recommend the identification of asthma comorbidities, especially treatable problems such as parental behaviours and child and parent anxiety. Purpose We aimed to (1) explore associations of asthma severity with child and parent state anxiety, trait anxiety, and asthma-related anxiety as well as with caregiver behaviours around physical activity and (2) explore if caregiver behaviours around physical activity were associated with use of inhaled β-Agonists when symptomatic, and with child and parent anxiety. Patients and methods Patients ages 3-17 years with asthma (n = 72) and their parents were recruited from the Pulmonology-Allergology Pediatric clinic University Hospital Centre Split in Split, Croatia during 2021. During a clinical visit, the pharmacological regimen was assessed and spirometry was performed. Children completed the State-Trait Anxiety Inventory for Children (STAI-C) and the Youth Asthma-Related Anxiety Scale (YASS). Parents completed the State-Trait Anxiety Inventory (STAI), the Parent Asthma-Related Anxiety Scale (PASS), and the Physical Activity Parenting Practices - Short Form (PAPP). Results Most patients had mild asthma (69.4%). Children with moderate to severe asthma had increased asthma-related anxiety (mean = 11.94 ± 6.1) compared with children with mild asthma (mean = 5.97 ± 6.39, p = 0.003). Parents of children with mild asthma reported behaviours allowing unsupervised physical activity outside more often when compared to parents of children with moderate or severe asthma. Physical activity facilitation parenting behaviour reduced the odds of a child's need for quick-reliever medication when symptomatic (OR = 0.376,95% CI = -1.885 to -0.072; p = 0.034); more coercive parenting increased the odds of a child's additional use of such medications (OR = 2.602; 95% CI = 0.005 to 1.908; p = 0.049). Parents of children in the highest quartile of trait anxiety showed less non-directive support (1.97 ± 1.01 vs. 2.89 ± 1.19, p = 0.031) and less autonomy support (3.14 ± 1.32 vs. 4.11 ± 1.23, p = 0.037) of physical activity in their children than those with less trait anxiety. Conclusion Asthma-related anxiety was an important construct in this sample of children, associated with their disease severity as well as their parent's behaviours around the child's physical activities. Current research, conducted during the COVID-19 pandemic, recognised the tangible ways that parents support or avoid the asthmatic children's physical activity participation. Child anxiety and recognised parental physical activity behaviours are potentially important factors to assess and target for intervention.
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Shukla A, Choudhari SG, Gaidhane AM, Quazi Syed Z. Role of Art Therapy in the Promotion of Mental Health: A Critical Review. Cureus 2022; 14:e28026. [PMID: 36134083 PMCID: PMC9472646 DOI: 10.7759/cureus.28026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 08/15/2022] [Indexed: 11/05/2022] Open
Abstract
Art therapy is used most commonly to treat mental illnesses and can aid in controlling manifestations correlated with psychosocially challenging behaviours, slowing cognitive decline, and enhancing the quality of life. Art therapy can help people express themselves more freely, improve their mental health, and improve interpersonal relationships. The basis of art therapy is established on the idea that people can recover and feel better via artistic expression. This review examines the current research on how active participation in the arts might improve mental health. A detailed literature search was carried out utilizing essential databases such as PubMed, the WHO's mental health database, and Google and Google Scholar. This review study looks into research done on art therapy and its potential advantages for adult mental health rehabilitation. It focuses on visual art therapy since it’s a key to reducing variation within the "creative arts" and defines the peculiar elements and effectiveness of art therapy used by mental health services. It was found that the use of art therapy as an adjunct treatment showed improved mental health in patients.
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The Relation Between Worry and Mental Health in Nonclinical Population and Individuals with Anxiety and Depressive Disorders: A Meta-Analysis. COGNITIVE THERAPY AND RESEARCH 2022. [DOI: 10.1007/s10608-021-10288-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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7
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Turi ER, Reigada LC, Liu J, Leonard SI, Bruzzese JM. Associations among anxiety, self-efficacy, and self-care in rural adolescents with poorly controlled asthma. Ann Allergy Asthma Immunol 2021; 127:661-666.e1. [PMID: 34547441 PMCID: PMC8627490 DOI: 10.1016/j.anai.2021.09.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 08/17/2021] [Accepted: 09/11/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Rural adolescents are vulnerable to asthma; good self-care can reduce morbidity. The subtypes of anxiety (eg, asthma-related, generalized) may have differential associations with asthma self-care. Low self-efficacy, a determinant of behavior, is associated with increased anxiety. Little is known regarding these relationships in rural adolescents. OBJECTIVE To evaluate whether anxiety symptoms are associated with asthma symptom prevention and management among rural adolescents and whether self-efficacy mediates these relationships. METHODS We used baseline data from 197 rural adolescents (mean age = 16 years; 69% girls; 62% Black) who were part of a trial that tested the effectiveness of a school-based asthma intervention. Adolescents completed the Youth Asthma-Related Anxiety Scale, Screen for Child Anxiety and Emotional Disorders, Asthma Management Self-efficacy Index, and Asthma Prevention and Management Indices. Linear regression was performed to test whether: (1) asthma-related and generalized anxiety had curvilinear relationships with self-care; (2) social and separation anxiety had linear relationships with self-care; and (3) self-efficacy mediated relationships. RESULTS Asthma-related anxiety had a significant curvilinear relationship with prevention (P = 0.001) and a linear association with management (P = .01). Generalized anxiety had a significant curvilinear association with management (P = .03), whereas social anxiety had a significant linear relationship with prevention (P = .04). Self-efficacy partially or fully mediated these relationships. CONCLUSION Anxiety symptoms were associated with asthma self-care among this sample of rural adolescents, with differing roles for prevention and management. Self-efficacy may be a mechanism to improve asthma self-care among rural adolescents with anxiety. With a lack of self-efficacy, asthma-related, generalized, or social anxiety may motivate adolescents to take steps to care for their asthma.
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Affiliation(s)
- Eleanor R Turi
- Office of Scholarship and Research, Columbia University School of Nursing, New York, New York
| | - Laura C Reigada
- Department of Psychology, Brooklyn College and The Graduate Center, The City University of New York, New York, New York
| | - Jianfang Liu
- Office of Scholarship and Research, Columbia University School of Nursing, New York, New York
| | - Sarah I Leonard
- Office of Scholarship and Research, Columbia University School of Nursing, New York, New York
| | - Jean-Marie Bruzzese
- Office of Scholarship and Research, Columbia University School of Nursing, New York, New York.
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Yoon S, Kim Y, Lee SH. Does the Loudness Dependence of Auditory Evoked Potential Predict Response to Selective Serotonin Reuptake Inhibitors?: A Meta-analysis. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2021; 19:254-261. [PMID: 33888654 PMCID: PMC8077049 DOI: 10.9758/cpn.2021.19.2.254] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/05/2020] [Accepted: 06/16/2020] [Indexed: 12/12/2022]
Abstract
Objective Loudness of dependence of the auditory evoked potential (LDAEP) is an electroencephalogram-based measure that represents amplitude changes of auditory evoked potentials in primary auditory cortex. Several narrative reviews argued that pre-treatment LDAEP values predict responses to selective serotonin reuptake inhibitors (SSRIs). This study aims to quantify the overall relationship between baseline LDAEP values and treatment response to SSRIs in patients with depression and generalized anxiety disorders, evidenced by clinical symptoms reductions, across multiple studies. Methods In our meta-analysis, seven articles with a total sample of 241 patients were included. Results Our results showed that stronger baseline LDAEP values predicted favorable response to SSRIs for depression and anxiety, with a moderate effect size. Conclusion The current results support the idea that LDAEP is a promising biomarker for SSRIs treatment prediction in patients with depression and generalized anxiety disorder.
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Affiliation(s)
- Sunkyung Yoon
- Department of Psychology, University of South Florida, Tampa, FL, USA
| | - Yourim Kim
- Clinical Emotion and Cognition Research Laboratory, Goyang, Korea
| | - Seung-Hwan Lee
- Clinical Emotion and Cognition Research Laboratory, Goyang, Korea.,Department of Psychiatry, Inje University Ilsan Paik Hospital, Goyang, Korea
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Use of a personalised depression intervention in primary care to prevent anxiety: a secondary study of a cluster randomised trial. Br J Gen Pract 2021; 71:e95-e104. [PMID: 33495203 PMCID: PMC7846354 DOI: 10.3399/bjgp20x714041] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 08/12/2020] [Indexed: 01/10/2023] Open
Abstract
Background In the predictD-intervention, GPs used a personalised biopsychosocial programme to prevent depression. This reduced the incidence of major depression by 21.0%, although the results were not statistically significant. Aim To determine whether the predictD-intervention is effective at preventing anxiety in primary care patients without depression or anxiety. Design and setting Secondary study of a cluster randomised trial with practices randomly assigned to either the predictD-intervention or usual care. This study was conducted in seven Spanish cities from October 2010 to July 2012. Method In each city, 10 practices and two GPs per practice, as well as four to six patients every recruiting day, were randomly selected until there were 26–27 eligible patients for each GP. The endpoint was cumulative incidence of anxiety as measured by the PRIME-MD screening tool over 18 months. Results A total of 3326 patients without depression and 140 GPs from 70 practices consented and were eligible to participate; 328 of these patients were removed because they had an anxiety syndrome at baseline. Of the 2998 valid patients, 2597 (86.6%) were evaluated at the end of the study. At 18 months, 10.4% (95% CI = 8.7% to 12.1%) of the patients in the predictD-intervention group developed anxiety compared with 13.1% (95% CI = 11.4% to 14.8%) in the usual-care group (absolute difference = −2.7% [95% CI = −5.1% to −0.3%]; P = 0.029). Conclusion A personalised intervention delivered by GPs for the prevention of depression provided a modest but statistically significant reduction in the incidence of anxiety.
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Dietel FA, Möllmann A, Bürkner PC, Wilhelm S, Buhlmann U. Interpretation Bias Across Body Dysmorphic, Social Anxiety and Generalized Anxiety Disorder—A Multilevel, Diffusion Model Account. COGNITIVE THERAPY AND RESEARCH 2021. [DOI: 10.1007/s10608-020-10180-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Abstract
Background
Interpretation biases are suggested to be transdiagnostic phenomena, but have rarely been compared across different disorders and current concerns.
Methods
We investigated explicit, decision-based, and more implicit, reaction time-based interpretation bias in individuals with body dysmorphic disorder (BDD; N = 29), social anxiety disorder (SAD; N = 36), generalized anxiety disorder (GAD; N = 22), and non-clinical controls (NC; N = 32), using an adapted Word Sentence Association Paradigm (WSAP).
Results
Results indicated that interpretation bias occurred transdiagnostically, while content-specific bias patterns varied meaningfully across groups. BDD and SAD shared explicit and, more inconsistently, implicit interpretation biases for appearance-related and social situations. The GAD group exhibited an explicit and implicit negative interpretation bias for general situations, and an additional implicit lack of positive bias. Mechanistic Wiener diffusion model analyses revealed that interpretation bias patterns were mainly driven by speeded information uptake, potentially mirroring disorder-specific associative memory organization.
Conclusions
These findings have important implications for understanding interpretation biases as both etiological and treatment factors.
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Moving Beyond the Negative: Contributions of Positive and Negative Affect on Quality of Life in Patients With Generalized Anxiety Disorder. J Nerv Ment Dis 2020; 208:843-847. [PMID: 32910074 DOI: 10.1097/nmd.0000000000001228] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Individuals with generalized anxiety disorder (GAD) report poorer quality of life (QOL) than do nonanxious controls. Further, although positive affect (PA) and negative affect (NA) have been shown to predict QOL, no previous literature has tested this relationship in the context of individuals with GAD. In the present study, we evaluated the unique and interactive contributions of PA and NA on QOL within a sample of individuals diagnosed with GAD (N = 50). Specifically, a hierarchical regression was conducted to evaluate the unique contributions of PA, NA, and their interaction on QOL, over and above symptoms of depression. PA and depression symptoms were both significant predictors of QOL, whereas neither the main effect for NA nor the PA × NA interaction was statistically significant. Results suggest that, for those with GAD, PA uniquely contributes to QOL. Strategies to upregulate PA may be a useful treatment target for increasing QOL in individuals with GAD.
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12
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Abbing A, de Sonneville L, Baars E, Bourne D, Swaab H. Anxiety reduction through art therapy in women. Exploring stress regulation and executive functioning as underlying neurocognitive mechanisms. PLoS One 2019; 14:e0225200. [PMID: 31794566 PMCID: PMC6890254 DOI: 10.1371/journal.pone.0225200] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 10/26/2019] [Indexed: 12/21/2022] Open
Abstract
Objectives To explore possible working mechanisms of anxiety reduction in women with anxiety disorders, treated with art therapy (AT). Methods A RCT comparing AT versus waiting list (WL) condition on aspects of self-regulation. Stress regulation (heart rate and heart rate variability) and executive functioning (daily behavioural and cognitive performance aspects of executive functioning (EF)) were evaluated in a pre-post design. Participants were women, aged 18–65 years with moderate to severe anxiety symptoms. Results Effectiveness of AT compared to WL was demonstrated in a higher resting HRV post treatment, improvements in aspects of self-reported daily EF (emotion control, working memory, plan/organize and task monitor), but not in cognitive performance of EF, stress responsiveness and down regulation of stress. The decrease in anxiety level was associated with improvements in self-reported daily EF. Conclusions AT improves resting HRV and aspects of EF, the latter was associated with art therapy-related anxiety reduction.
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Affiliation(s)
- Annemarie Abbing
- Faculty of Health, University of Applied Sciences Leiden, Leiden, The Netherlands
- Clinical Neurodevelopmental Sciences, Faculty of Social Sciences, Leiden University, Leiden, The Netherlands
- * E-mail:
| | - Leo de Sonneville
- Clinical Neurodevelopmental Sciences, Faculty of Social Sciences, Leiden University, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition, Leiden, The Netherlands
| | - Erik Baars
- Faculty of Health, University of Applied Sciences Leiden, Leiden, The Netherlands
| | - Daniëlle Bourne
- Department of Psychiatry, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Hanna Swaab
- Clinical Neurodevelopmental Sciences, Faculty of Social Sciences, Leiden University, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition, Leiden, The Netherlands
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Carnevali L, Mancini M, Koenig J, Makovac E, Watson DR, Meeten F, Critchley HD, Ottaviani C. Cortical morphometric predictors of autonomic dysfunction in generalized anxiety disorder. Auton Neurosci 2019; 217:41-48. [DOI: 10.1016/j.autneu.2019.01.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 12/03/2018] [Accepted: 01/03/2019] [Indexed: 12/16/2022]
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Molent C, Maggioni E, Cecchetto F, Garzitto M, Piccin S, Bonivento C, Maieron M, D'Agostini S, Balestrieri M, Perna G, Altamura AC, Brambilla P. Reduced cortical thickness and increased gyrification in generalized anxiety disorder: a 3 T MRI study. Psychol Med 2018; 48:2001-2010. [PMID: 29239286 DOI: 10.1017/s003329171700352x] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Although the study of the neuroanatomical correlates of generalized anxiety disorder (GAD) is gaining increasing interest, up to now the cortical anatomy of GAD patients has been poorly investigated and still no data on cortical gyrification are available. The aim of the present study is to quantitatively examine the cortical morphology in patients with GAD compared with healthy controls (HC) using magnetic resonance imaging (MRI). To the best of our knowledge, this is the first study analyzing the gyrification patterns in GAD. METHODS A total of 31 GAD patients and 31 HC underwent 3 T structural MRI. For each subject, cortical surface area (CSA), cortical thickness (CT), gray matter volume (GMV), and local gyrification index (LGI) were estimated in 19 regions of interest using the Freesurfer software. These parameters were then compared between the two groups using General Linear Model designs. RESULTS Compared with HC, GAD patients showed: (1) reduced CT in right caudal middle frontal gyrus (p < 0.05, Bonferroni corrected), (2) hyper-gyrification in right fusiform, inferior temporal, superior parietal and supramarginal gyri and in left supramarginal and superior frontal gyri (p < 0.05, Bonferroni corrected). No significant alterations in CSA and GMV were observed. CONCLUSIONS Our findings support the hypothesis of a neuroanatomical basis for GAD, highlighting a possible key role of the right hemisphere. The alterations of CT and gyrification in GAD suggest a neurodevelopmental origin of the disorder. Further studies on GAD are needed to understand the evolution of the cerebral morphology with age and during the clinical course of the illness.
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Affiliation(s)
- Cinzia Molent
- Unit of Psychiatry, Department of Medicine (DAME),University of Udine,Udine,Italy
| | - Eleonora Maggioni
- Department of Neurosciences and Mental Health,IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico,University of Milan,Milan,Italy
| | - Filippo Cecchetto
- Unit of Psychiatry, Department of Medicine (DAME),University of Udine,Udine,Italy
| | - Marco Garzitto
- Scientific Institute IRCCS 'Eugenio Medea',Polo FVG, San Vito al Tagliamento, Pordenone,Italy
| | - Sara Piccin
- Scientific Institute IRCCS 'Eugenio Medea',Polo FVG, San Vito al Tagliamento, Pordenone,Italy
| | - Carolina Bonivento
- Unit of Psychiatry, Department of Medicine (DAME),University of Udine,Udine,Italy
| | - Marta Maieron
- Department of Physics,Azienda Ospedaliero Universitaria 'S.Maria della Misericordia',Udine,Italy
| | - Serena D'Agostini
- Department of Neuroradiology,Azienda Ospedaliero Universitaria 'S.Maria della Misericordia',Udine,Italy
| | - Matteo Balestrieri
- Unit of Psychiatry, Department of Medicine (DAME),University of Udine,Udine,Italy
| | - Giampaolo Perna
- Department of Clinical Neurosciences,Villa San Benedetto Menni, Hermanas Hospitalarias,FoRiPsi, Albese con Cassano, Como,Italy
| | - A Carlo Altamura
- Department of Neurosciences and Mental Health,IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico,University of Milan,Milan,Italy
| | - Paolo Brambilla
- Department of Neurosciences and Mental Health,IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico,University of Milan,Milan,Italy
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Maes M, Bonifacio KL, Morelli NR, Vargas HO, Moreira EG, St Stoyanov D, Barbosa DS, Carvalho AF, Nunes SOV. Generalized Anxiety Disorder (GAD) and Comorbid Major Depression with GAD Are Characterized by Enhanced Nitro-oxidative Stress, Increased Lipid Peroxidation, and Lowered Lipid-Associated Antioxidant Defenses. Neurotox Res 2018; 34:489-510. [PMID: 29736827 DOI: 10.1007/s12640-018-9906-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 03/30/2018] [Accepted: 04/13/2018] [Indexed: 02/06/2023]
Abstract
Accumulating evidence shows that nitro-oxidative pathways play an important role in the pathophysiology of major depressive disorder (MDD) and bipolar disorder (BD) and maybe anxiety disorders. The current study aims to examine superoxide dismutase (SOD1), catalase, lipid hydroperoxides (LOOH), nitric oxide metabolites (NOx), advanced oxidation protein products (AOPP), malondialdehyde (MDA), glutathione (GSH), paraoxonase 1 (PON1), high-density lipoprotein cholesterol (HDL), and uric acid (UA) in participants with and without generalized anxiety disorder (GAD) co-occurring or not with BD, MDD, or tobacco use disorder. Z unit-weighted composite scores were computed as indices of nitro-oxidative stress driving lipid and protein oxidation. SOD1, LOOH, NOx, and uric acid were significantly higher and HDL and PON1 significantly lower in participants with GAD than in those without GAD. GAD was more adequately predicted by increased SOD + LOOH + NOx and lowered HDL + PON1 composite scores. Composite scores of nitro-oxidative stress coupled with aldehyde and AOPP production were significantly increased in participants with comorbid GAD + MDD as compared with all other study groups, namely MDD, GAD + BD, BD, GAD, and healthy controls. In conclusion, GAD is characterized by increased nitro-oxidative stress and lipid peroxidation and lowered lipid-associated antioxidant defenses, while increased uric acid levels in GAD may protect against aldehyde production and protein oxidation. This study suggests that increased nitro-oxidative stress and especially increased SOD1 activity, NO production, and lipid peroxidation as well as lowered HDL-cholesterol and PON1 activity could be novel drug targets for GAD especially when comorbid with MDD.
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Affiliation(s)
- Michael Maes
- Health Sciences Graduation Program, Health Sciences Center, State University of Londrina, Londrina, Parana, Brazil.
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
- Department of Psychiatry, Medical University of Plovdiv and Technological Center for Emergency Medicine, Plovdiv, Bulgaria.
- School of Medicine, IMPACT Strategic Research Centre, Deakin University, PO Box 281, Geelong, VIC, 3220, Australia.
| | - Kamila Landucci Bonifacio
- Health Sciences Graduation Program, Health Sciences Center, State University of Londrina, Londrina, Parana, Brazil
| | - Nayara Rampazzo Morelli
- Health Sciences Graduation Program, Health Sciences Center, State University of Londrina, Londrina, Parana, Brazil
| | - Heber Odebrecht Vargas
- Health Sciences Graduation Program, Health Sciences Center, State University of Londrina, Londrina, Parana, Brazil
| | | | - Drozdstoy St Stoyanov
- Department of Psychiatry, Medical University of Plovdiv and Technological Center for Emergency Medicine, Plovdiv, Bulgaria
| | - Décio Sabbatini Barbosa
- Health Sciences Graduation Program, Health Sciences Center, State University of Londrina, Londrina, Parana, Brazil
| | - André F Carvalho
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Centre for Addiction & Mental Health, Toronto, ON, Canada
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Lorenzo-Luaces L, Amsterdam JD, DeRubeis RJ. Residual anxiety may be associated with depressive relapse during continuation therapy of bipolar II depression. J Affect Disord 2018; 227:379-383. [PMID: 29149756 DOI: 10.1016/j.jad.2017.11.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 10/30/2017] [Accepted: 11/07/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Anxiety symptoms are common in bipolar disorder. We explored the effect of anxiety on the outcome of acute and continuation pharmacotherapy of bipolar II depression. METHODS Data were derived from a randomized double-blind 12-week acute (N = 129) and 6-month continuation (N = 55) comparison of venlafaxine versus lithium monotherapy in bipolar II depression in adults. We distinguished between the items of the Hamilton Rating Scale for Depression (HRSD) that capture depression vs. anxiety (i.e., psychomotor agitation, psychic anxiety, somatic anxiety, hypochondriasis, and obsessive-compulsive concerns) and examined the effect of treatment on depression and anxiety. Additionally, we explored whether baseline anxiety or depression predicted changes over time in depression and anxiety ratings or moderated treatment outcomes. We also explored whether residual depressive and anxious symptoms predicted relapse during continuation therapy. RESULTS Venlafaxine was superior to lithium in reducing both depression and anxiety, though its effects on anxiety were more modest than those on depression. Baseline anxiety predicted change over time in anxiety, but not depression. By contrast, baseline depression did not predict change over time in depression or anxiety. Residual anxiety, specifically uncontrollable worry, was a stronger predictor of relapse than residual depression. CONCLUSION Successful treatment of symptoms of anxiety in bipolar depression may protect against depressive relapse.
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Affiliation(s)
- Lorenzo Lorenzo-Luaces
- Department of Psychological and Brain Sciences, Indiana University - Bloomington, Bloomington, IN, United States.
| | - Jay D Amsterdam
- Depression Research Unit, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania School of Medicine, Philadelphia, PA, United States
| | - Robert J DeRubeis
- Depression Research Unit, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania School of Medicine, Philadelphia, PA, United States; Department of Psychology, University of Pennsylvania, Philadelphia, PA, United States
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17
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Cavicchioli FL, Maes M, Roomruangwong C, Bonifacio KL, Barbosa DS, Anderson G, Vargas HO, Nunes SOV. Associations between severity of anxiety and clinical and biological features of major affective disorders. Psychiatry Res 2018; 260:17-23. [PMID: 29156296 DOI: 10.1016/j.psychres.2017.11.024] [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: 06/28/2017] [Revised: 10/25/2017] [Accepted: 11/06/2017] [Indexed: 12/24/2022]
Abstract
Patients with major affective disorders (MAFD) with comorbid anxiety show a greater functional impairment than those without anxiety. The aim of this study is to delineate the associations between severity of anxiety in MAFD, namely bipolar disorder (BD) and major depression (MDD), and MAFD characteristics and serum high-density lipoprotein (HDL)-cholesterol levels. Recruited were 82 participants with anxiety disoders and 83 without anxiety disoders, including 101 MAFD patients and 51 healthy controls. We used the Hamilton Anxiety Rating Scale (HAM-A) to measure severity of anxiety and made the diagnoses of posttraumatic stress disorder (PTSD), obsessive compulsive disorder (OCD), panic disorder (PD), generalized anxiety disorder (GAD) and phobias. The HAM-A score is significantly predicted by higher number of depressive episodes, GAD and phobias, childhood trauma, tobacco use disorder, metabolic syndrome and lowered HDL-cholesterol. Increased HAM-A scores are, independently from severity of depression, associated with lowered quality of life, increased disabilities and suicidal ideation. Lithium treatment significantly lowers HAM-A scores. It is concluded that severity of anxiety significantly worsens the phenomenology of MAFD. Therefore, treatments of MAFD should target increased severity of anxiety and its risk factors including low HDL-cholesterol, metabolic syndrome, childhood trauma and tobacco use disorder.
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Affiliation(s)
| | - Michael Maes
- Health Sciences Graduation Program, Health Sciences Center, State University of Londrina, Brazil; Department of Psychiatry, Chulalongkorn University, Bangkok, Thailand; Impact Strategic Research Center, Deakin University, Geelong, Australia; Department of Psychiatry, Medical University of Plovdiv, Plovdiv, Bulgaria.
| | | | | | - Decio Sabbatini Barbosa
- Health Sciences Graduation Program, Health Sciences Center, State University of Londrina, Brazil
| | | | - Heber Odebrecht Vargas
- Health Sciences Graduation Program, Health Sciences Center, State University of Londrina, Brazil
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18
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Weinberg A, Sandre A. Distinct Associations Between Low Positive Affect, Panic, and Neural Responses to Reward and Threat During Late Stages of Affective Picture Processing. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2017; 3:59-68. [PMID: 29397080 DOI: 10.1016/j.bpsc.2017.09.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 08/25/2017] [Accepted: 09/12/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND Abnormal patterns of attention to threat and reward have been proposed as potential mechanisms of dysfunction in anxiety and mood disorders. However, research on this topic has been inconsistent, perhaps because of both clinical heterogeneity in the samples assessed and measurement of attentional biases that is temporally imprecise. METHODS The present study measured transdiagnostic symptoms of anxiety and depression in 205 young adults and recorded affect-modulated event-related potentials in response to task-irrelevant pictures in a speeded response task. RESULTS Low positive affect was uniquely associated with reduced modulation of later event-related potentials (i.e., the P300 and the late positive potential) by rewarding images, suggesting deficits in sustained attention to reward. Low positive affect was also associated with a blunted threat-elicited late positive potential. Symptoms of panic were associated with an increased N1 to rewarding images, as well as an increased late positive potential to all picture types. CONCLUSIONS These data suggest that dysfunction in neural markers of sustained attention to threat and reward relate in specific ways to transdiagnostic symptom dimensions of anxiety and depression. Moreover, event-related potentials are likely to be useful in investigations of the time course of attentional abnormalities associated with these symptom dimensions.
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Affiliation(s)
- Anna Weinberg
- Department of Psychology, McGill University, Montreal, Quebec, Canada.
| | - Aislinn Sandre
- Department of Psychology, McGill University, Montreal, Quebec, Canada
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19
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Vanwoerden S, Steinberg L, Coffman AD, Paulus DJ, Morey LC, Sharp C. Evaluation of the PAI-A Anxiety and Depression Scales: Evidence of Construct Validity. J Pers Assess 2017; 100:313-320. [PMID: 28759266 DOI: 10.1080/00223891.2017.1347569] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Against the background of a dearth of studies examining the properties of the scale scores of the Personality Assessment Inventory-Adolescent (PAI-A; Morey, 2007), this study was conducted to evaluate evidence of construct validity for the Anxiety (ANX) and Depression (DEP) scales of the PAI-A. Convergent and discriminant validity of the ANX and DEP scale scores were investigated using a sample of adolescents admitted to the adolescent program of a private tertiary care inpatient treatment facility. Multiple methods assessing anxious and depressive symptomology and diagnoses were included. Construct validity of the ANX and DEP scales was mostly supported. Advantages of using the PAI-A for the assessment of anxiety and depression were discussed.
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Affiliation(s)
| | | | | | | | | | - Carla Sharp
- a Department of Psychology , University of Houston
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20
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Karim HT, Tudorascu DL, Butters MA, Walker S, Aizenstein HJ, Andreescu C. In the grip of worry: cerebral blood flow changes during worry induction and reappraisal in late-life generalized anxiety disorder. Transl Psychiatry 2017; 7:e1204. [PMID: 28809854 PMCID: PMC5611745 DOI: 10.1038/tp.2017.180] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 05/16/2017] [Accepted: 06/07/2017] [Indexed: 12/29/2022] Open
Abstract
Severe worry includes a complex blend of maladaptive affective and cognitive processes. Contrary to other forms of anxiety, there is no consensus in the field regarding the neural basis of worry. To date, no study has looked at neural patterns associated specifically with in-scanner induction and reappraisal of worry. In this study, we attempt to describe distinct components of the 'neural phenomenology' of worry: induction, maintenance, severity and reappraisal, by using a personalized, in-scanner worry script. Twenty older, non-anxious participants and twenty late-life generalized anxiety disorder (GAD) participants were included. Whole-brain axial pseudo-continuous arterial spin-labeling scans were collected. We used a voxel-wise two-way ANOVA to test the group-by-block interaction. Worry induction was associated with greater cerebral blood flow (CBF) in the visual cortex, thalamus, caudate and medial frontal cortex compared with the rest. Reappraisal was associated with greater CBF in similar regions, whereas the orbital frontal gyrus showed lower CBF relative to rest. Relative to non-anxious participants, GAD had greater CBF in multiple regions during worry induction (visual and parietal cortex, middle and superior frontal) and lower CBF during reappraisal in the supplemental motor area, middle cingulate gyrus, insula and putamen. Except for the thalamus, there was no change in CBF throughout the five blocks of worry induction and reappraisal. Severe worry is distinctly associated with increased CBF in several neocortical regulatory regions. We present new data supporting the view of worry as a complex process, engaging multiple regions in the initiation, maintenance and reappraisal of worry.
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Affiliation(s)
- H T Karim
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - D L Tudorascu
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA,Department of Biostatistics, Graduate School of Public Health, Pittsburgh, PA, USA
| | - M A Butters
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - S Walker
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - H J Aizenstein
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA,Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - C Andreescu
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA,Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, 3811 O’Hara Street, Pittsburgh, PA 15213, USA. E-mail:
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21
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Kircanski K, LeMoult J, Ordaz S, Gotlib IH. Investigating the nature of co-occurring depression and anxiety: Comparing diagnostic and dimensional research approaches. J Affect Disord 2017; 216:123-135. [PMID: 27554605 PMCID: PMC5308464 DOI: 10.1016/j.jad.2016.08.006] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 07/11/2016] [Accepted: 08/11/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND Although approximately half of adults diagnosed with a depressive or anxiety disorder exhibit their simultaneous co-occurrence, traditional research has centered on single-target diagnoses, overlooking comorbidities within samples. In this article, we review and extend the literature that directly investigates co-occurring depression and anxiety, with the goal of shifting the focus from co-occurring diagnoses to symptom dimensions. METHODS First, we review studies that have directly compared psychobiological features (neural, neuroendocrine, autonomic) across depression, anxiety, and their co-occurrence, defined either categorically or dimensionally. Second, we analyze adults' diurnal cortisol secretion to examine the independent and interactive relations of continuously-assessed depressive and anxiety symptoms to neuroendocrine function. RESULTS Previous findings on the psychobiology of diagnostic co-occurrence are mixed. While nascent, evidence from dimensionally focused studies suggests that co-occurring levels of depressive and anxiety symptoms can interact with one another, as reflected in a distinct psychobiological profile for individuals with high levels of both symptom dimensions. Results of our analyses support this formulation: we found that depressive and anxiety symptom dimensions interacted consistently in their relation to the measures of diurnal cortisol. LIMITATIONS The illustrative sample was relatively small and included only women; future research should examine generalizability of these findings. CONCLUSIONS A dimensional approach to investigating the psychobiology of co-occurring depression and anxiety affords both conceptual and practical advantages. Simultaneously assessing depressive and anxiety symptom dimensions can efficiently capture their unique, shared, and interactive features, thereby identifying targets for intervention across a wide range of symptom presentations.
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Affiliation(s)
| | - Joelle LeMoult
- Department of Psychology, Stanford University, United States
| | - Sarah Ordaz
- Department of Psychology, Stanford University, United States; Department of Psychiatry, Stanford University, United States
| | - Ian H Gotlib
- Department of Psychology, Stanford University, United States
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22
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Validity of the Associated Symptom Criteria for Generalized Anxiety Disorder: Observations From the Singapore Mental Health Study. J Nerv Ment Dis 2017; 205:390-396. [PMID: 27805985 DOI: 10.1097/nmd.0000000000000608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Previous findings on the diagnostic validity and reliability of generalized anxiety disorder (GAD)-associated symptom criteria suggest need for further evaluation. The current study examined convergent validity and specificity of GAD-associated symptoms in a representative Singapore community sample. The Singapore of Mental Health Study a cross-sectional epidemiological survey conducted among 6166 Singapore residents aged 18 and older. The Composite International Diagnostic Interview version 3.0 was used to diagnose mental disorders. Associated symptoms in the GAD criteria and autonomic hyperactivity symptoms showed convergent validity with a GAD diagnosis. However, associated symptoms of GAD were also linked to major depressive disorder (MDD), bipolar disorder, and obsessive-compulsive disorder, suggesting lack of adequate specificity. The inability of the diagnostic criteria to differentiate GAD from symptoms of other conditions highlights the need to better define its associated symptoms criteria. The relationship of overlapping symptoms between GAD and MDD is also discussed.
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23
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Levine JC, Fleming R, Piedmont JI, Cain SM, Chen WJ. Heart rate variability and generalized anxiety disorder during laboratory-induced worry and aversive imagery. J Affect Disord 2016; 205:207-215. [PMID: 27449553 DOI: 10.1016/j.jad.2016.07.019] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 07/09/2016] [Indexed: 01/21/2023]
Abstract
BACKGROUND To date only a few published studies have examined the effect of disorder-relevant stressors on heart rate variability (HRV) in participants meeting a clinical diagnosis of GAD, with conflicting results. The primary aim of this study was to determine if GAD is associated with lower HRV at rest, and whether vagal regulation during task varies by type (i.e., baseline, anticipation, imagery, or worry). METHODS This study investigated resting cardiac vagal tone and vagal regulation in a sample of 40 participants with or without a validated diagnosis of generalized anxiety disorder (GAD). High-frequency heart rate variability (HF-HRV) was used to index cardiac vagal activity. RESULTS GAD was associated with vagal withdrawal during both imagery and worry inductions, but no group differences in resting vagal tone or worry were observed. LIMITATIONS Methodological limitations include inherent limits to generalizability of laboratory-based findings; specifically worry induction and cardiac reactivity to lab-based stressors. CONCLUSIONS The results support the notion that GAD is associated with vagal withdrawal during active bouts of idiographic worry and imagery, and question the assumption that GAD is associated with low resting vagal tone. In light of polyvagal theory these findings provide additional support for the presence of emotion regulation deficits in GAD, and identify specific ANS processes that underlie GAD.
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Affiliation(s)
| | | | | | | | - Wei-Ju Chen
- University of Wisconsin - Milwaukee, Milwaukee, WI, USA
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24
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Bosley HG, Fisher AJ, Taylor CB. Differential responses of positive affect, negative affect, and worry in CBT for generalized anxiety disorder: A person-specific analysis of symptom course during therapy. Psychother Res 2016; 28:630-642. [PMID: 27799015 DOI: 10.1080/10503307.2016.1233366] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
INTRODUCTION Research indicates that individuals with generalized anxiety disorder (GAD) may experience deficits in positive affect (PA), and tend to dampen or intentionally suppress PA. Despite the presence of PA-related pathology in GAD, little is known about change in PA during GAD treatment. OBJECTIVE This study examines changes in PA, negative affect (NA) and worry in seven participants during cognitive behavioral therapy (CBT) for GAD. METHOD Intensive repeated measures (i.e., time series) data were subjected to person-specific regression analysis to delineate individual change trajectories. RESULTS Significant improvement in worry was observed in all but one participant. Fear and irritability - indices of NA - each improved in 5/7 participants while sadness improved in 4/7 participants (worsening in one). Of all symptom domains, PA had the poorest treatment response: PA improved in only 2/7 participants and actually significantly worsened in 5/7 individuals even as NA and worry improved during therapy. CONCLUSION These findings indicate that treatment gains from traditional CBT for GAD may not generalize to improvements in PA regulation, or even emotional functioning more broadly. This evidence is a call to increase the focus on PA regulation in treatment for GAD; perhaps PA could be a missing piece in our understanding of ways to bolster GAD treatment outcomes.
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Affiliation(s)
- Hannah G Bosley
- a Department of Psychology , University of California, Berkeley , Berkeley , CA , USA
| | - Aaron J Fisher
- a Department of Psychology , University of California, Berkeley , Berkeley , CA , USA
| | - C Barr Taylor
- b Department of Psychiatry and Behavioral Sciences , Stanford University Medical Center , Stanford , CA , USA.,c Center for Mobile Health , Palo Alto University , Palo Alto , CA , USA
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25
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Curtiss J, Klemanski DH. Taxonicity and network structure of generalized anxiety disorder and major depressive disorder: An admixture analysis and complex network analysis. J Affect Disord 2016; 199:99-105. [PMID: 27100054 DOI: 10.1016/j.jad.2016.04.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2016] [Revised: 03/11/2016] [Accepted: 04/11/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Recent years have witnessed sustained efforts to delineate the nosology of generalized anxiety disorder (GAD), especially in light of its substantial comorbidity with major depressive disorder (MDD). Traditional diagnostic conceptualizations regard these disorders as categorically distinct; however, extant literature attests to appreciable similarities. The application of admixture analyses and complex network analyses has become more prevalent in recent years to investigate the presence of meaningful subgroups in mental disorders and to address qualitative similarity in network structure across disorders. To date, no studies have extended these analytic techniques to determine whether GAD and MDD constitute independent syndromes. The current study used a clinical sample comprising individuals diagnosed with primary GAD or primary MDD to examine potential subgroups and network structure using symptoms of each disorder as indicators. METHODS The current sample comprised 111 individuals who received primary diagnoses of either GAD or MDD and completed a battery of assessments related to anxiety and depression. RESULTS Results of the admixture analyses converged on a single class solution, suggesting that individuals with GAD derive from the same population as those with MDD. Furthermore, results of the complex network analyses did not reveal differences in centrality parameters across disorders, suggesting qualitative similarity. LIMITATIONS The cross-sectional nature of this study precludes conclusions about the temporal and causal dynamics of these disorders CONCLUSION GAD and MDD exhibit robust similarities, as evidenced by the converging results of the admixture analyses and complex network analyses. This conclusion complements the findings of transdiagnostic research, which has identified common mechanisms underlying multiple emotional disorders.
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Affiliation(s)
- Joshua Curtiss
- Boston University, United States; Yale University, United States.
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Slavin-Mulford J, Clements A, Hilsenroth M, Charnas J, Zodan J. An examination of generalized anxiety disorder and dysthymia utilizing the Rorschach inkblot method. Psychiatry Res 2016; 240:137-143. [PMID: 27107389 DOI: 10.1016/j.psychres.2016.04.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 12/15/2015] [Accepted: 04/08/2016] [Indexed: 11/16/2022]
Abstract
This study examined transdiagnostic features of generalized anxiety disorder (GAD) and dysthymia in an outpatient clinical sample. Fifteen patients who met DSM-IV criteria for GAD and twenty-one patients who met DSM-IV criteria for dysthymia but who did not have comorbid anxiety disorder were evaluated utilizing the Rorschach. Salient clinical variables were then compared. Results showed that patients with GAD scored significantly higher on variables related to cognitive agitation and a desire/need for external soothing. In addition, there was a trend for patients with GAD to produce higher scores on a measure of ruminative focus on negative aspects of the self. Thus, not surprisingly, GAD patients' experienced more distress than the dysthymic patients. The implications of these findings are discussed with regards to better understanding the shared and distinct features of GAD and dysthymia.
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Affiliation(s)
- Jenelle Slavin-Mulford
- Department of Psychological Sciences, Augusta University, 2500 Walton Way, Augusta, GA 30904, USA.
| | - Alyssa Clements
- Department of Psychological Sciences, Augusta University, 2500 Walton Way, Augusta, GA 30904, USA
| | - Mark Hilsenroth
- Department of Clinical Psychology, Gordon F. Derner Institute of Advanced Psychological Studies, Adelphi University, 158 Cambridge Avenue, Garden City, NY 11530, USA
| | - Jocelyn Charnas
- Department of Clinical Psychology, Gordon F. Derner Institute of Advanced Psychological Studies, Adelphi University, 158 Cambridge Avenue, Garden City, NY 11530, USA
| | - Jennifer Zodan
- Nassau University Medical Center, 2201 Hempstead Turnpike, East Meadow, NY 11554, USA
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27
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Aldao A. Introduction to the Special Issue: Emotion Regulation as a Transdiagnostic Process. COGNITIVE THERAPY AND RESEARCH 2016. [DOI: 10.1007/s10608-016-9764-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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28
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Waszczuk MA, Zavos HMS, Gregory AM, Eley TC. The stability and change of etiological influences on depression, anxiety symptoms and their co-occurrence across adolescence and young adulthood. Psychol Med 2016; 46:161-75. [PMID: 26310536 PMCID: PMC4673666 DOI: 10.1017/s0033291715001634] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 07/29/2015] [Accepted: 08/03/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND Depression and anxiety persist within and across diagnostic boundaries. The manner in which common v. disorder-specific genetic and environmental influences operate across development to maintain internalizing disorders and their co-morbidity is unclear. This paper investigates the stability and change of etiological influences on depression, panic, generalized, separation and social anxiety symptoms, and their co-occurrence, across adolescence and young adulthood. METHOD A total of 2619 twins/siblings prospectively reported symptoms of depression and anxiety at mean ages 15, 17 and 20 years. RESULTS Each symptom scale showed a similar pattern of moderate continuity across development, largely underpinned by genetic stability. New genetic influences contributing to change in the developmental course of the symptoms emerged at each time point. All symptom scales correlated moderately with one another over time. Genetic influences, both stable and time-specific, overlapped considerably between the scales. Non-shared environmental influences were largely time- and symptom-specific, but some contributed moderately to the stability of depression and anxiety symptom scales. These stable, longitudinal environmental influences were highly correlated between the symptoms. CONCLUSIONS The results highlight both stable and dynamic etiology of depression and anxiety symptom scales. They provide preliminary evidence that stable as well as newly emerging genes contribute to the co-morbidity between depression and anxiety across adolescence and young adulthood. Conversely, environmental influences are largely time-specific and contribute to change in symptoms over time. The results inform molecular genetics research and transdiagnostic treatment and prevention approaches.
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Affiliation(s)
- M. A. Waszczuk
- King's College London, MRC
Social, Genetic and Developmental Psychiatry Centre, Institute of
Psychiatry, Psychology and Neuroscience, London,
UK
| | - H. M. S. Zavos
- King's College London, MRC
Social, Genetic and Developmental Psychiatry Centre, Institute of
Psychiatry, Psychology and Neuroscience, London,
UK
| | - A. M. Gregory
- Department of Psychology,
Goldsmiths, University of London,
London, UK
| | - T. C. Eley
- King's College London, MRC
Social, Genetic and Developmental Psychiatry Centre, Institute of
Psychiatry, Psychology and Neuroscience, London,
UK
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Davies SJC, Pearson RM, Stapinski L, Bould H, Christmas DM, Button KS, Skapinakis P, Lewis G, Evans J. Symptoms of generalized anxiety disorder but not panic disorder at age 15 years increase the risk of depression at 18 years in the Avon Longitudinal Study of Parents and Children (ALSPAC) cohort study. Psychol Med 2016; 46:73-85. [PMID: 26315278 PMCID: PMC4886844 DOI: 10.1017/s003329171500149x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Revised: 07/06/2015] [Accepted: 07/08/2015] [Indexed: 12/31/2022]
Abstract
BACKGROUND Generalized anxiety disorder (GAD) and panic disorder (PD) differ in their biology and co-morbidities. We hypothesized that GAD but not PD symptoms at the age of 15 years are associated with depression diagnosis at 18 years. METHOD Using longitudinal data from the Avon Longitudinal Study of Parents and Children (ALSPAC) birth cohort we examined relationships of GAD and PD symptoms (measured by the Development and Well-Being Assessment) at 15 years with depression at 18 years (by the Clinical Interview Schedule - Revised) using logistic regression. We excluded adolescents already depressed at 15 years and adjusted for social class, maternal education, birth order, gender, alcohol intake and smoking. We repeated these analyses following multiple imputation for missing data. RESULTS In the sample with complete data (n = 2835), high and moderate GAD symptoms in adolescents not depressed at 15 years were associated with increased risk of depression at 18 years both in unadjusted analyses and adjusting for PD symptoms at 15 years and the above potential confounders. The adjusted odds ratio (OR) for depression at 18 years in adolescents with high relative to low GAD scores was 5.2 [95% confidence interval (CI) 3.0-9.1, overall p < 0.0001]. There were no associations between PD symptoms and depression at 18 years in any model (high relative to low PD scores, adjusted OR = 1.3, 95% CI 0.3-4.8, overall p = 0.737). Missing data imputation strengthened the relationship of GAD symptoms with depression (high relative to low GAD scores, OR = 6.2, 95% CI 3.9-9.9) but those for PD became weaker. CONCLUSIONS Symptoms of GAD but not PD at 15 years are associated with depression at 18 years. Clinicians should be aware that adolescents with GAD symptoms may develop depression.
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Affiliation(s)
- S. J. C. Davies
- Centre for Academic Mental Health, School of Social and Community Medicine, University of Bristol, Bristol, UK
- Geriatric Psychiatry Division, CAMH, University of Toronto, Toronto, Canada
| | - R. M. Pearson
- Centre for Academic Mental Health, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - L. Stapinski
- NHMRC Centre for Research Excellence in Mental Health and Substance Use, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - H. Bould
- Centre for Academic Mental Health, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - D. M. Christmas
- Centre for Academic Mental Health, School of Social and Community Medicine, University of Bristol, Bristol, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - K. S. Button
- Centre for Academic Mental Health, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - P. Skapinakis
- Centre for Academic Mental Health, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - G. Lewis
- Division of Psychiatry, University College London, London, UK
| | - J. Evans
- Centre for Academic Mental Health, School of Social and Community Medicine, University of Bristol, Bristol, UK
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Seeley SH, Mennin DS, Aldao A, McLaughlin KA, Rottenberg J, Fresco DM. Impact of Comorbid Depressive Disorders on Subjective and Physiological Responses to Emotion in Generalized Anxiety Disorder. COGNITIVE THERAPY AND RESEARCH 2015; 40:290-303. [PMID: 27660375 DOI: 10.1007/s10608-015-9744-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Generalized anxiety disorder (GAD) and unipolar depressive disorders (UDD) have been shown to differ from each other in dimensions of affective functioning despite their high rates of comorbidity. We showed emotional film clips to a community sample (n = 170) with GAD, GAD with secondary UDD, or no diagnosis. Groups had comparable subjective responses to the clips, but the GAD group had significantly lower heart rate variability (HRV) during fear and after sadness, compared to controls. While HRV in the GAD and control groups rose in response to the sadness and happiness clips, it returned to baseline levels afterwards in the GAD group, potentially indicating lesser ability to sustain attention on emotional stimuli. HRV in the GAD + UDD group changed only in response to sadness, but was otherwise unvarying between timepoints. Though preliminary, these findings suggest comorbid UDD as a potential moderator of emotional responding in GAD.
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Affiliation(s)
- Saren H Seeley
- The University of Arizona, 1503 East University Boulevard, Tucson, AZ 85721, USA
| | - Douglas S Mennin
- Department of Psychology, Hunter College, City University of New York, 695 Park Avenue, HN742, New York, NY 10065, USA; The Graduate Center, City University of New York, 365 5th Avenue, New York, NY 10016, USA
| | - Amelia Aldao
- Ohio State University, 1835 Neil Avenue, Columbus, OH 43210, USA
| | - Katie A McLaughlin
- University of Washington, 3939 University Way NE, Seattle, WA 98105, USA
| | | | - David M Fresco
- Kent State University, 226 Kent Hall Annex, Kent, OH 44242, USA
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Shapero BG, Abramson LY, Alloy LB. Emotional Reactivity and Internalizing Symptoms: Moderating Role of Emotion Regulation. COGNITIVE THERAPY AND RESEARCH 2015; 40:328-340. [PMID: 27231404 DOI: 10.1007/s10608-015-9722-4] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Emotion dysregulation has been associated with increases in many forms of psychopathology in adolescents and adults. The development of effective emotion regulation skills is important during adolescence, especially as stressful life events increase during this time. The current study examined two emotion regulation strategies, cognitive reappraisal and affective suppression, in interaction with self-report and biological measures of emotional reactivity as predictors of internalizing symptoms. A community sample of adolescents (n = 127), at an age of risk for depression and anxiety, completed self-report measures of emotional reactivity and internalizing symptoms. In addition, they completed a modified social stress task and were assessed on biological measures of reactivity and regulation. Findings suggested that the trait tendency to reappraise was associated with a reduced impact of emotional reactivity on depressive, but not anxiety symptoms. Implications for shared and specific aspects of emotional reactivity and regulation are discussed.
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Affiliation(s)
- Benjamin G Shapero
- Temple University, Department of Psychology, 1701 N. 13 St., Philadelphia, PA 19122, USA
| | - Lyn Y Abramson
- University of Wisconsin-Madison, Department of Psychology, 1202 W. Johnson St., Madison, WI, 53706, USA
| | - Lauren B Alloy
- Temple University, Department of Psychology, 1701 N. 13 St., Philadelphia, PA 19122, USA
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MacNamara A, Kotov R, Hajcak G. Diagnostic and symptom-based predictors of emotional processing in generalized anxiety disorder and major depressive disorder: An event-related potential study. COGNITIVE THERAPY AND RESEARCH 2015; 40:275-289. [PMID: 27346901 DOI: 10.1007/s10608-015-9717-1] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The delineation of specific versus overlapping mechanisms in GAD and MDD could shed light on the integrity of these diagnostic categories. For example, negative emotion generation is one mechanism that may be especially relevant to both disorders. Emotional processing abnormalities were examined among 97 outpatients with generalized anxiety disorder (GAD) or major depressive disorder (MDD) and 25 healthy adults, using the late positive potential (LPP), an event-related potential that is larger for emotional versus neutral stimuli. GAD and MDD were also assessed dimensionally across all participants. Both MDD diagnosis and dimensional depression scores were associated with reduced ΔLPP. When controlling for MDD diagnosis/dimension, both the diagnosis and dimension of GAD were associated with increased ΔLPP. Both MDD and GAD dimensions, but not diagnoses, were associated with increased ΔRT to targets that followed emotional pictures. Therefore, MDD and GAD have distinguishable and opposing features evident in neural measures of emotion processing.
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Affiliation(s)
| | - Roman Kotov
- Department of Psychiatry, Stony Brook University
| | - Greg Hajcak
- Department of Psychology, Stony Brook University
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Read KL, Settipani CA, Peterman J, Kendall PC, Compton S, Piacentini J, McCracken J, Bergman L, Walkup J, Sakolsky D, Birmaher B, Albano AM, Rynn M, Ginsburg G, Keeton C, Gosch E, Suveg C, Sherrill J, March J. Predicting Anxiety Diagnoses and Severity with the CBCL-A: Improvement Relative to Other CBCL Scales? JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2015; 37:100-111. [PMID: 26257470 PMCID: PMC4527577 DOI: 10.1007/s10862-014-9439-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The Child Behavior Checklist (CBCL) is a widely used parent-report of child and adolescent behavior. We examined the ability of the CBCL-A scale, a previously published subset of CBCL items, to predict the presence of generalized anxiety disorder (GAD), separation anxiety disorder (SAD), and social phobia (SoP), as well as anxiety severity, among 488 youth randomized in the Child Anxiety Multimodal Study (CAMS). We predicted that the CBCL-A's unique inclusion of items related to somatic symptoms would better identify anxiety disorder and severity than other CBCL scales, given that somatic complaints are often key features of anxiety among youth. Results support the use of the anxiety-based CBCL subscales as first-line screeners for generally elevated symptoms of anxiety, rather than tools to identify specific anxiety disorders. Although somatic symptoms are often reported and included in diagnostic criteria for certain anxiety disorders (e.g., SAD, GAD), the unique combination of somatic and non-somatic symptoms for the CBCL-A subscale did not increase its ability to consistently predict the presence of specific anxiety disorders.
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Relationship between trait repetitive negative thinking styles and symptoms of psychopathology. PERSONALITY AND INDIVIDUAL DIFFERENCES 2014. [DOI: 10.1016/j.paid.2014.07.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Moreno-Peral P, Luna JDD, Marston L, King M, Nazareth I, Motrico E, GildeGómez-Barragán MJ, Torres-González F, Montón-Franco C, Sánchez-Celaya M, Díaz-Barreiros MÁ, Vicens C, Muñoz-Bravo C, Bellón JÁ. Predicting the onset of anxiety syndromes at 12 months in primary care attendees. The predictA-Spain study. PLoS One 2014; 9:e106370. [PMID: 25184313 PMCID: PMC4153639 DOI: 10.1371/journal.pone.0106370] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 07/25/2014] [Indexed: 01/07/2023] Open
Abstract
Background There are no risk algorithms for the onset of anxiety syndromes at 12 months in primary care. We aimed to develop and validate internally a risk algorithm to predict the onset of anxiety syndromes at 12 months. Methods A prospective cohort study with evaluations at baseline, 6 and 12 months. We measured 39 known risk factors and used multilevel logistic regression and inverse probability weighting to build the risk algorithm. Our main outcome was generalized anxiety, panic and other non-specific anxiety syndromes as measured by the Primary Care Evaluation of Mental Disorders, Patient Health Questionnaire (PRIME-MD-PHQ). We recruited 3,564 adult primary care attendees without anxiety syndromes from 174 family physicians and 32 health centers in 6 Spanish provinces. Results The cumulative 12-month incidence of anxiety syndromes was 12.2%. The predictA-Spain risk algorithm included the following predictors of anxiety syndromes: province; sex (female); younger age; taking medicines for anxiety, depression or stress; worse physical and mental quality of life (SF-12); dissatisfaction with paid and unpaid work; perception of financial strain; and the interactions sex*age, sex*perception of financial strain, and age*dissatisfaction with paid work. The C-index was 0.80 (95% confidence interval = 0.78–0.83) and the Hedges' g = 1.17 (95% confidence interval = 1.04–1.29). The Copas shrinkage factor was 0.98 and calibration plots showed an accurate goodness of fit. Conclusions The predictA-Spain risk algorithm is valid to predict anxiety syndromes at 12 months. Although external validation is required, the predictA-Spain is available for use as a predictive tool in the prevention of anxiety syndromes in primary care.
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Affiliation(s)
- Patricia Moreno-Peral
- Unidad de Investigación del Distrito Sanitario Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
| | - Juan de Dios Luna
- Departamento de Bioestadística, Universidad de Granada, Granada, Spain
| | - Louise Marston
- Department of Primary care and Population Health, University College London, London, United Kingdom
| | - Michael King
- Mental Health Sciences, Faculty of Brain Sciences, University College London, London, United Kingdom
| | - Irwin Nazareth
- Department of Primary care and Population Health, University College London, London, United Kingdom
| | - Emma Motrico
- Unidad de Investigación del Distrito Sanitario Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
- Universidad Loyola Andalucía, Sevilla, Spain
| | | | | | - Carmen Montón-Franco
- Centro de Salud Casablanca, Instituto Aragonés de Ciencias de la Salud, Zaragoza, Spain. Departamento de Medicina y Psiquiatría, Universidad de Zaragoza, Zaragoza, Spain
| | - Marta Sánchez-Celaya
- Directora Continuidad Asistencial Hospital Universitario Infanta Sofía, Madrid, Spain
| | - Miguel Ángel Díaz-Barreiros
- Centro de Salud Vecindario, Gerencia de Atención Primaria de Gran Canaria, Servicio Canario de Salud, Las Palmas, Spain
| | - Catalina Vicens
- Centro de Salud son Serra-La Vileta, Unidad Docente de Medicina Familiar y Comunitaria de Mallorca, Instituto Balear de la Salud, Palma de Mallorca, Illes Balears, Spain
| | - Carlos Muñoz-Bravo
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Málaga, Málaga, Spain
| | - Juan Ángel Bellón
- Unidad de Investigación del Distrito Sanitario Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Málaga, Málaga, Spain
- Centro de Salud El Palo, Servicio Andaluz de Salud, Málaga, Spain
- * E-mail:
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Yang MJ, Kim BN, Lee EH, Lee D, Yu BH, Jeon HJ, Kim JH. Diagnostic utility of worry and rumination: a comparison between generalized anxiety disorder and major depressive disorder. Psychiatry Clin Neurosci 2014; 68:712-20. [PMID: 24735252 DOI: 10.1111/pcn.12193] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Revised: 01/10/2014] [Accepted: 04/11/2014] [Indexed: 11/24/2022]
Abstract
AIM Although previous reports have addressed worry and rumination as prominent cognitive processes in generalized anxiety disorder (GAD) and major depressive disorder (MDD) and their distinct correlation with anxious and depressive symptoms, the differential association of worry and rumination with the diagnosis of GAD and MDD remains unclear. The purpose of this study was to investigate the distinct features of worry and rumination in factor structure and their predictive validity for the diagnosis of GAD and MDD. METHODS Four hundred and sixty-eight patients with GAD (n = 148) and MDD (n = 320) were enrolled and the diagnoses were confirmed with the Structured Clinical Interview for DSM-IV. Participants completed the Penn State Worry Questionnaire and Ruminative Response Scale and the severity of anxiety and depressive symptoms was assessed via clinician ratings. RESULTS In joint factor analysis using the Penn State Worry Questionnaire and Ruminative Response Scale items, worry and rumination emerged as distinct factors. In logistic regression analyses, worry contributed to a higher probability of the diagnosis of GAD than rumination, as rumination did in MDD than worry. CONCLUSION This is the first comprehensive study investigating the diagnostic utility of worry and rumination in a well-defined clinical sample of both GAD and MDD. Our results suggest that worry and rumination are distinct cognitive processes and play a differential role in the diagnosis of GAD and MDD, distinguishing them at the cognitive level.
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Affiliation(s)
- Min-Jeong Yang
- Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Szabó C, Németh A, Kéri S. Ethical sensitivity in obsessive-compulsive disorder and generalized anxiety disorder: the role of reversal learning. J Behav Ther Exp Psychiatry 2013; 44:404-10. [PMID: 23693154 DOI: 10.1016/j.jbtep.2013.04.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Revised: 04/01/2013] [Accepted: 04/17/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND OBJECTIVES In obsessive-compulsive disorder (OCD), amplified moral sensitivity may be related to the orbitofrontal-striatal circuit, which is also critical in reversal learning. This study examined three questions: (1) What aspects of ethical sensitivity is altered in OCD?; (2) What is the relationship between ethical sensitivity and reversal learning?; (3) Are potential alterations in ethical sensitivity and reversal learning present in generalized anxiety disorder (GAD)? METHODS Participants were 28 outpatients with OCD, 21 individuals with GAD, and 30 matched healthy controls. Participants received the ethical sensitivity scale questionnaire (ESSQ), rating scales for clinical symptoms, a reversal learning task, and the Wisconsin Card Sorting Test (WCST). RESULTS We found higher ethical sensitivity scores in OCD compared with healthy controls in the case of generating interpretations and options and identifying the consequences of actions. Individuals with OCD displayed prolonged reaction times on probabilistic errors without shift and final reversal errors. Participants with GAD did not differ from healthy controls on the ESSQ, but they were slower on reversal learning relative to nonpatients. In OCD, reaction time on final reversal errors mediated the relationship between ethical sensitivity and compulsions. WCST performance was intact in OCD and GAD. LIMITATIONS Small sample size, limited neuropsychological assessment, self-rating scale for ethical sensitivity. CONCLUSION Prolonged reaction time at switching reinforcement contingencies is related to increased ethical sensitivity in OCD. Slow affective switching may link ethical sensitivity and compulsions.
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Affiliation(s)
- Csilla Szabó
- National Psychiatry Center, Lehel Str. 39, H1135 Budapest, Hungary
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Betts KS, Williams GM, Najman JM, Scott J, Alati R. The association between lower birth weight and comorbid generalised anxiety and major depressive disorder. J Affect Disord 2013; 146:231-7. [PMID: 23040738 DOI: 10.1016/j.jad.2012.09.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Revised: 09/12/2012] [Accepted: 09/12/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Studies testing the association between birth weight and depression or anxiety have found inconsistent results and there has been a lack of research on the possible relationship between birth weight and comorbid anxiety and depression. We tested for an association between lower birth weight and major depression, generalised anxiety and comorbid generalised anxiety and major depression. METHOD Data was taken from 2113 mothers and their offspring participating in the Mater University Study of Pregnancy (MUSP) birth cohort. Generalised anxiety, major depression and comorbid generalised anxiety and major depression at 21 years were tested for associations with birth weight using multinomial logistic regression. RESULTS Lower birth weight was found to predict comorbid generalised anxiety and major depression, but did not predict either generalised anxiety or major depression. LIMITATIONS We were unable to specify comorbidity by the primary disorder, or by the severity or recurrence of the depression. CONCLUSION Previous associations found between birth weight and mental health may reflect a specific link between lower birth weight and comorbid generalised anxiety and major depressive disorders. As neither disorder individually was associated with lower birth weight, this may suggest that this developmental origin represents a unique risk pathway to comorbidity not shared with either discrete disorder.
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Affiliation(s)
- Kim Steven Betts
- Care of Rosa Alati, School of Population Health, The University of Queensland, 4th floor, Public Health Building, Herston Rd, Herston QLD 4006, Australia.
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Judah MR, Grant DM, Mills AC, Lechner WV, Slish ML, Davidson CL, Wingate LR. The Prospective Role of Depression, Anxiety, and Worry in Stress Generation. JOURNAL OF SOCIAL AND CLINICAL PSYCHOLOGY 2013. [DOI: 10.1521/jscp.2013.32.4.381] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Tully PJ, Cosh SM. Generalized anxiety disorder prevalence and comorbidity with depression in coronary heart disease: a meta-analysis. J Health Psychol 2013; 18:1601-16. [PMID: 23300050 DOI: 10.1177/1359105312467390] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Generalized anxiety disorder prevalence and comorbidity with depression in coronary heart disease patients remain unquantified. Systematic searching of Medline, Embase, SCOPUS and PsycINFO databases revealed 1025 unique citations. Aggregate generalized anxiety disorder prevalence (12 studies, N = 3485) was 10.94 per cent (95% confidence interval: 7.8-13.99) and 13.52 per cent (95% confidence interval: 8.39-18.66) employing Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria (random effects). Lifetime generalized anxiety disorder prevalence was 25.80 per cent (95% confidence interval: 20.84-30.77). In seven studies, modest correlation was evident between generalized anxiety disorder and depression, Fisher's Z = .30 (95% confidence interval: .19-.42), suggesting that each psychiatric disorder is best conceptualized as contributing unique variance to coronary heart disease prognosis.
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Executive skills in older adults with GAD: relations with clinical variables and CBT outcome. J Anxiety Disord 2013; 27:131-9. [PMID: 23376600 DOI: 10.1016/j.janxdis.2012.12.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Accepted: 12/01/2012] [Indexed: 01/15/2023]
Abstract
Although cognitive behavior therapy (CBT) is an effective intervention for treating generalized anxiety disorder (GAD) in older adults, researchers are now considering augmenting the therapy to enhance outcome. We are also long overdue in identifying moderators of CBT response (e.g., cognitive abilities) in late life anxiety. The goals of the current investigation were to examine performance on verbal versus nonverbal tests of executive skills (ES) and to test the relation between ES and clinical indices in older GAD patients. Hierarchical and logistic regression models identified baseline ES predictors of premature termination, homework compliance and quality, and indices of cognitive restructuring, an essential component of CBT. Although the analyses of response on symptom measures did not reveal any significant baseline predictors, an alternative ES grouping scheme showed that those whose ES improved during CBT also responded best in terms of worry reduction. These findings can be applied to the optimization of treatment for older anxiety patients, who are an underserved demographic group.
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Kim NS, Khalife D, Judge KA, Paulus DJ, Jordan JT, Yopchick JE. Visual causal models enhance clinical explanations of treatments for generalized anxiety disorder. JOURNAL OF HEALTH COMMUNICATION 2013; 18 Suppl 1:103-117. [PMID: 24093349 PMCID: PMC3814909 DOI: 10.1080/10810730.2013.829136] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
A daily challenge in clinical practice is to adequately explain disorders and treatments to patients of varying levels of literacy in a time-limited situation. Drawing jointly upon research on causal reasoning and multimodal theory, the authors asked whether adding visual causal models to clinical explanations promotes patient learning. Participants were 86 people currently or formerly diagnosed with a mood disorder and 104 lay people in Boston, Massachusetts, USA, who were randomly assigned to receive either a visual causal model (dual-mode) presentation or auditory-only presentation of an explanation about generalized anxiety disorder and its treatment. Participants' knowledge was tested before, immediately after, and 4 weeks after the presentation. Patients and lay people learned significantly more from visual causal model presentations than from auditory-only presentations, and visual causal models were perceived to be helpful. Participants retained some information 4 weeks after the presentation, although the advantage of visual causal models did not persist in the long term. In conclusion, dual-mode presentations featuring visual causal models yield significant relative gains in patient comprehension immediately after the clinical session, at a time when the authors suggest that patients may be most willing to begin the recommended treatment plan.
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Affiliation(s)
- Nancy S. Kim
- Department of Psychology, Northeastern University, Boston, Massachusetts, USA
| | - Danielle Khalife
- Department of Psychology, Northeastern University, Boston, Massachusetts, USA
| | - Kelly A. Judge
- Department of Psychology, Northeastern University, Boston, Massachusetts, USA
| | - Daniel J. Paulus
- Department of Psychology, Northeastern University, Boston, Massachusetts, USA
| | - Jake T. Jordan
- Department of Psychology, Northeastern University, Boston, Massachusetts, USA
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Beesdo-Baum K, Jenjahn E, Höfler M, Lueken U, Becker ES, Hoyer J. Avoidance, safety behavior, and reassurance seeking in generalized anxiety disorder. Depress Anxiety 2012; 29:948-57. [PMID: 22581482 DOI: 10.1002/da.21955] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2011] [Revised: 02/28/2012] [Accepted: 03/23/2012] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The behavioral symptoms of Generalized Anxiety Disorder (GAD) are not well characterized. This study examines behavioral symptoms in patients with GAD compared to healthy participants, their change during behavioral therapy, and their role for predicting short- and long-term outcome. METHODS Secondary data analysis of 56 patients with DSM-IV GAD from a randomized controlled trial testing worry exposure (n = 29) and applied relaxation (n = 27), compared to 33 demographically matched healthy participants. Participants reported on attempts to control or prevent worry, specifically cognitive and behavioral avoidance, safety behavior, and reassurance, along with other GAD symptoms. The Hamilton Anxiety Scale served as immediate (post therapy) and the Penn State Worry Questionnaire as immediate and long-term (6-/12-month follow-up) treatment outcome measure. RESULTS GAD patients engage significantly more in attempts to control or prevent worry as reflected in cognitive and behavioral avoidance, safety behavior, and reassurance seeking than healthy comparison participants. Behavior therapy significantly reduces these behavioral strategies without substantial indication of differential effects of treatment type. However, only patients remitting from GAD reach the low symptom level of healthy participants. The initial level of behavioral symptoms is irrelevant for immediate treatment success, but higher degrees of cognitive and behavioral avoidance and safety behavior at the end of treatment predict worse long-term outcome. CONCLUSIONS Behavioral symptoms appear to be relevant features in GAD that improve with successful treatment. Further research is warranted to examine whether inclusion of behavioral symptoms in the definition of GAD would have beneficial effects on diagnostic recognition and treatment.
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Affiliation(s)
- Katja Beesdo-Baum
- Institute of Clinical Psychology and Psychotherapy, Technische Universitaet Dresden, Germany.
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Faravelli C, Castellini G, Benni L, Brugnera A, Landi M, Lo Sauro C, Pietrini F, Rotella F, Ricca V. Generalized anxiety disorder: is there any specific symptom? Compr Psychiatry 2012; 53:1056-62. [PMID: 22578985 DOI: 10.1016/j.comppsych.2012.04.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2011] [Revised: 02/27/2012] [Accepted: 04/04/2012] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVE The main aim of the present research was to evaluate the coherence of generalized anxiety disorder (GAD) psychopathological pattern, the robustness of its diagnostic criteria, and the clinical utility of considering this disorder as a discrete condition rather than assigning it a dimensional value. METHOD The study was designed in a purely naturalistic setting and carried out using a community sample; data from the Sesto Fiorentino Study were reanalyzed. RESULTS Of the 105 subjects who satisfied the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for the diagnosis of GAD, only 18 (17.1%) had no other comorbid DSM-IV disorder. The most frequent comorbid condition was major depressive disorder (70.4 %). Only 2 of the GAD diagnostic symptoms (excessive worry and muscle tension) showed a specific association with the diagnosis itself, whereas the others, such as feeling wound up, tense, or restless, concentration problems, and fatigue, were found to be more prevalent in major depressive disorder than in GAD. CONCLUSION Our study demonstrates that GAD, as defined by DSM-IV criteria, shows a substantial overlap with other DSM-IV diagnoses (especially with mood disorders) in the general population. Furthermore, GAD symptoms are frequent in all other disorders included in the mood/anxiety spectrum. Finally, none of the GAD symptoms, apart from muscle tension, distinguished GAD from patients without GAD.
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Affiliation(s)
- Carlo Faravelli
- Department of Psychology, University of Florence, Florence, Italy.
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Weinberg A, Klein DN, Hajcak G. Increased error-related brain activity distinguishes generalized anxiety disorder with and without comorbid major depressive disorder. JOURNAL OF ABNORMAL PSYCHOLOGY 2012; 121:885-96. [PMID: 22564180 DOI: 10.1037/a0028270] [Citation(s) in RCA: 140] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Generalized anxiety disorder (GAD) and major depressive disorder (MDD) are so frequently comorbid that some have suggested that the 2 should be collapsed into a single overarching "distress" disorder. Yet there is also increasing evidence that the 2 categories are not redundant. Neurobehavioral markers that differentiate GAD and MDD would be helpful in ongoing efforts to refine classification schemes based on neurobiological measures. The error-related negativity (ERN) may be one such marker. The ERN is an event-related potential component presenting as a negative deflection approximately 50 ms following an erroneous response and reflects activity of the anterior cingulate cortex. There is evidence for an enhanced ERN in individuals with GAD, but the literature in MDD is mixed. The present study measured the ERN in 26 GAD, 23 comorbid GAD and MDD, and 36 control participants, all of whom were female and medication-free. Consistent with previous research, the GAD group was characterized by a larger ERN and an increased difference between error and correct trials than controls. No such enhancement was evident in the comorbid group, suggesting comorbid depression may moderate the relationship between the ERN and anxiety. The present study further suggests that the ERN is a potentially useful neurobiological marker for future studies that consider the pathophysiology of multiple disorders in order to construct or refine neurobiologically based diagnostic phenotypes.
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Affiliation(s)
- Anna Weinberg
- Department of Psychology, Stony Brook University, Stony Brook, NY 11794-2500, USA.
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Faravelli C, Castellini G, Landi M, Brugnera A. Are Psychiatric Diagnoses an Obstacle for Research and Practice? Reliability, Validity and the Problem of Psychiatric Diagnoses. The Case of GAD. Clin Pract Epidemiol Ment Health 2012; 8:12-5. [PMID: 22408646 PMCID: PMC3293164 DOI: 10.2174/1745017901208010012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Revised: 11/28/2011] [Accepted: 11/29/2011] [Indexed: 11/22/2022]
Abstract
The present article focused on the problem of validity, reliability and specificity of psychiatric diagnoses.The authors moved by the concept of syndrome, defined by Sydenham in the 18th century as a constellation of several interrelated symptoms, showing a stable, characteristic structure and a peculiar prognosis, in order to analyse the peculiarity of the current psychiatric nosology. In our opinion, the current nosographic system based on DSM-IV criteria, prevents psychiatry from benefiting of the significant technological progress that has led the rest of medical sciences to important clinical achievements in the last 20 years. The case of Generalized Anxiety Disorder was taken as an example of a disease characterized by unstable diagnostic criteria, high rate of comorbidity and uncertain boundaries. An analysis of the data from the Sesto Fiorentino study was performed to investigate the presence of common mood and anxiety symptoms across the most represented DSM IV diagnoses, in order to evaluate the specificity of these symptoms.The results supported the hypothesis of a low specificity of these symptoms, suggesting the need for psychiatry to find new and more specific markers and instruments.
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Kertz SJ, Bigda-Peyton JS, Rosmarin DH, Björgvinsson T. The importance of worry across diagnostic presentations: prevalence, severity and associated symptoms in a partial hospital setting. J Anxiety Disord 2012; 26:126-33. [PMID: 22078242 DOI: 10.1016/j.janxdis.2011.10.005] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2011] [Revised: 10/07/2011] [Accepted: 10/09/2011] [Indexed: 01/19/2023]
Abstract
Although excessive worry has been linked primarily with Generalized Anxiety Disorder (GAD), recent work suggests worry is dimensional, with potential relevance to a range of psychiatric disorders. The current study examined associations between worry and psychological symptoms across several primary diagnoses and tested worry's hypothesized unique relation to GAD in an acute psychiatric setting. Participants were 568 patients with primary diagnoses of Major Depression, Bipolar Disorder-Depressed, Bipolar Disorder-Manic, and Psychosis. Participants completed a structured diagnostic interview and questionnaires at admission. Partial correlations controlling for GAD diagnosis indicated that worry correlated with higher depression and poorer overall well-being in the Depressed, Bipolar-Depressed, and Psychosis groups and decreased functioning in the Depressed, Bipolar-Manic, and Psychosis groups. Depressed and Bipolar-Depressed groups endorsed the highest level of worry. A comorbid anxiety disorder was associated with higher worry across primary diagnoses, even after controlling for GAD. Of the anxiety disorders, GAD and Panic Disorder diagnoses predicted higher worry scores. Results discussed in terms of conceptual implications for worry as a transdiagnostic concept and clinical interventions.
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Affiliation(s)
- Sarah J Kertz
- McLean Hospital/Harvard Medical School, 115 Mill St., Belmont, MA 02478, USA.
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Starr LR, Davila J. Temporal patterns of anxious and depressed mood in generalized anxiety disorder: a daily diary study. Behav Res Ther 2011; 50:131-41. [PMID: 22196213 DOI: 10.1016/j.brat.2011.11.005] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2011] [Revised: 10/28/2011] [Accepted: 11/25/2011] [Indexed: 11/24/2022]
Abstract
Research suggests that anxiety disorders tend to temporally precede depressive disorders, a finding potentially relevant to understanding comorbidity. The current study used diary methods to determine whether daily anxious mood also temporally precedes daily depressed mood. 55 participants with generalized anxiety disorder (GAD) and history of depressive symptoms completed a 21-day daily diary tracking anxious and depressed mood. Daily anxious and depressed moods were concurrently associated. Daily anxious mood predicted later depressed mood at a variety of time lags, with significance peaking at a two-day lag. Depressed mood generally did not predict later anxious mood. Results suggest that the temporal antecedence of anxiety over depression extends to daily symptoms in GAD. Implications for the refinement of comorbidity models, including causal theories, are discussed.
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Affiliation(s)
- Lisa R Starr
- Department of Psychology, University of California, Los Angeles, USA.
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King M, Bottomley C, Bellón-Saameño JA, Torres-Gonzalez F, Švab I, Rifel J, Maaroos HI, Aluoja A, Geerlings MI, Xavier M, Carraça I, Vicente B, Saldivia S, Nazareth I. An international risk prediction algorithm for the onset of generalized anxiety and panic syndromes in general practice attendees: predictA. Psychol Med 2011; 41:1625-1639. [PMID: 21208520 DOI: 10.1017/s0033291710002400] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND There are no risk models for the prediction of anxiety that may help in prevention. We aimed to develop a risk algorithm for the onset of generalized anxiety and panic syndromes. METHOD Family practice attendees were recruited between April 2003 and February 2005 and followed over 24 months in the UK, Spain, Portugal and Slovenia (Europe4 countries) and over 6 months in The Netherlands, Estonia and Chile. Our main outcome was generalized anxiety and panic syndromes as measured by the Patient Health Questionnaire. We entered 38 variables into a risk model using stepwise logistic regression in Europe4 data, corrected for over-fitting and tested it in The Netherlands, Estonia and Chile. RESULTS There were 4905 attendees in Europe4, 1094 in Estonia, 1221 in The Netherlands and 2825 in Chile. In the algorithm four variables were fixed characteristics (sex, age, lifetime depression screen, family history of psychological difficulties); three current status (Short Form 12 physical health subscale and mental health subscale scores, and unsupported difficulties in paid and/or unpaid work); one concerned country; and one time of follow-up. The overall C-index in Europe4 was 0.752 [95% confidence interval (CI) 0.724-0.780]. The effect size for difference in predicted log odds between developing and not developing anxiety was 0.972 (95% CI 0.837-1.107). The validation of predictA resulted in C-indices of 0.731 (95% CI 0.654-0.809) in Estonia, 0.811 (95% CI 0.736-0.886) in The Netherlands and 0.707 (95% CI 0.671-0.742) in Chile. CONCLUSIONS PredictA accurately predicts the risk of anxiety syndromes. The algorithm is strikingly similar to the predictD algorithm for major depression, suggesting considerable overlap in the concepts of anxiety and depression.
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Affiliation(s)
- M King
- Department of Mental Health Sciences, UCL Medical School, UK.
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Gordon D, Heimberg RG. Reliability and validity of DSM-IV generalized anxiety disorder features. J Anxiety Disord 2011; 25:813-21. [PMID: 21596519 DOI: 10.1016/j.janxdis.2011.04.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2010] [Revised: 03/30/2011] [Accepted: 04/10/2011] [Indexed: 11/27/2022]
Abstract
The reliability of generalized anxiety disorder (GAD) features has been shown to be moderate, based on research utilizing the Anxiety Disorders Interview Schedule for DSM-IV (ADIS-IV), a semi-structured diagnostic interview. This may be a function of the criteria for the diagnosis of GAD, which have undergone much revision since its first inclusion in the Diagnostic and Statistical Manual of Mental Disorders. The reliability and validity of disorder feature ratings were examined in a diverse sample of patients who presented for assessment and treatment of excessive worry, generalized anxiety, or tension at an anxiety specialty clinic and who met criteria for a principal diagnosis of GAD (N=129). Internal consistency of the ratings of excessiveness of worry, uncontrollability of worry, and the associated symptom cluster was moderate to low and varied by disorder feature. Inter-rater reliability for all features of GAD and severity of the disorder varied between good and poor. Additional findings showed that the GAD features, as measured using the ADIS-IV module, have modest to strong convergent validity, varying by feature, and poor discriminant validity when tested against measures of social anxiety. Potential reasons for rater disagreement are discussed. Results are also considered in terms of how they may inform the evolving criteria for GAD in DSM-V.
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Affiliation(s)
- Dina Gordon
- Adult Anxiety Clinic, Department of Psychology, Temple University, Philadelphia, PA, USA
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