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Zhong Q, Niu L, Chen K, Lee TMC, Zhang R. Prevalence and risk of subthreshold anxiety developing into threshold anxiety disorder in the general population. J Affect Disord 2024; 367:815-822. [PMID: 39265868 DOI: 10.1016/j.jad.2024.09.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Revised: 09/02/2024] [Accepted: 09/08/2024] [Indexed: 09/14/2024]
Abstract
BACKGROUND Subthreshold anxiety may act as a critical precursor and risk factor for the onset of threshold anxiety. However, accurate prevalence rates of subthreshold anxiety and its role in leading to threshold anxiety require further elucidation. METHODS We conducted a search on PubMed and Web of Science using predefined criteria and identified 45 articles with a total of 278,971 individuals to estimate the prevalence rates using a random effects model. The incidence risk ratio (IRR) was estimated by comparing the proportion of individuals with subthreshold anxiety who developed threshold anxiety to those without subthreshold anxiety in seven articles involving 18,693 individuals. RESULTS Our analysis revealed an overall prevalence of subthreshold anxiety of 6.19%. Specifically, among individuals with subthreshold generalized anxiety disorders, adolescents show the highest prevalence (9.47%), outpacing adults (4.69%) and the elderly (3.49%). Further analysis of seven studies showed an increased risk of developing threshold anxiety in individuals with subthreshold anxiety (IRR = 2.63), with a higher transition rate (9.59%) compared to those without subthreshold anxiety (3.65%). CONCLUSIONS Anxiety disorders may be conceptualized as a spectrum, with subthreshold anxiety serving as a significant prodromal state and risk factor for the development of threshold anxiety. Proactive management of subthreshold anxiety represents an effective approach for the prevention of its progression to threshold anxiety. Future research should investigate the risk of progression from subthreshold to threshold anxiety across various types, and explore how factors, such as social support and personality traits facilitate this progression.
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Affiliation(s)
- Qianting Zhong
- Cognitive Control and Brain Healthy Laboratory, Department of Psychology, School of Public Health, Southern Medical University, Guangzhou, China
| | - Lijing Niu
- Cognitive Control and Brain Healthy Laboratory, Department of Psychology, School of Public Health, Southern Medical University, Guangzhou, China
| | - Keyin Chen
- Cognitive Control and Brain Healthy Laboratory, Department of Psychology, School of Public Health, Southern Medical University, Guangzhou, China
| | - Tatia M C Lee
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong Special Administrative Region of China; Laboratory of Neuropsychology and Human Neuroscience, The University of Hong Kong, Hong Kong Special Administrative Region of China; Center for Brain Science and Brain-Inspired Intelligence, Guangdong-Hong Kong-Macao Greater Bay Area, Guangzhou, China
| | - Ruibin Zhang
- Cognitive Control and Brain Healthy Laboratory, Department of Psychology, School of Public Health, Southern Medical University, Guangzhou, China; Department of Psychiatry, Zhujiang Hospital, Southern Medical University, Guangzhou, China; Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, Guangdong-Hong Kong Joint Laboratory for Psychiatric Disorders, Southern Medical University.
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Myruski S, de Rutte J, Findley A, Roy AK, Dennis-Tiwary TA. Preference for digital media use, biobehavioral attention bias, and anxiety symptoms in adolescents. COMPUTERS IN HUMAN BEHAVIOR REPORTS 2024; 15:100439. [PMID: 39268514 PMCID: PMC11391916 DOI: 10.1016/j.chbr.2024.100439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2024] Open
Abstract
Adolescence is a critical developmental period of biological and social change during which 1 in 3 youth experience significant anxiety symptoms. The social-emotional lives of the majority of adolescents are largely conducted via digital media use (DMU; e.g., social media, text messaging). Yet the past decade of research on DMU and anxiety has yielded mixed results (e.g., Keles et al., 2020 review), leaving the complex role that DMU might play in the emergence and maintenance of anxiety poorly understood. A key step forward is to leverage psychophysiology to identify individual differences in cognitive and emotional processes that confer vulnerability to potential negative effects of DMU. Further, given the ubiquity of DMU, a greater focus is needed on measurements that move beyond sheer frequency to capture DMU in comparison to face-to-face (FTF) social interactions. This study examined attention bias (AB), characterized by selective and exaggerated attention toward or away from threat, as a moderator of the link between DMU and anxiety in adolescents (N = 75; 42 female) aged 12-14 years (M = 13.28, SD = 0.87). AB was indexed during a dot probe task using reaction time metrics (i.e., trial-level bias) and via ERPs capturing attentional selection and discrimination (N170) and cognitive control (N2) to threat compared to neutral faces. AB moderated associations between DMU and anxiety. A greater preference to use DMU vs FTF predicted greater anxiety among those with a greater behavioral bias away from threat, blunted N170, and blunted N2 in the presence of threat. Future research should examine potential causal and bidirectional links between DMU and anxiety and explore whether preferences for technology-mediated interactions and individual differences in threat processing increase risk.
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Affiliation(s)
| | - Jennifer de Rutte
- Hunter College, CUNY, United States
- The Graduate Center, CUNY, United States
| | - Abigail Findley
- Hunter College, CUNY, United States
- The Graduate Center, CUNY, United States
| | - Amy K Roy
- Fordham University, United States
- NYU Langone School of Medicine, United States
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Yin X, Yang J, Xiang Q, Peng L, Song J, Liang S, Wu J. Brain network hierarchy reorganization in subthreshold depression. Neuroimage Clin 2024; 42:103594. [PMID: 38518552 PMCID: PMC10973537 DOI: 10.1016/j.nicl.2024.103594] [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: 02/14/2024] [Revised: 03/12/2024] [Accepted: 03/17/2024] [Indexed: 03/24/2024]
Abstract
BACKGROUND Hierarchy is the organizing principle of human brain network. How network hierarchy changes in subthreshold depression (StD) is unclear. The aim of this study was to investigate the altered brain network hierarchy and its clinical significance in patients with StD. METHODS A total of 43 patients with StD and 43 healthy controls matched for age, gender and years of education participated in this study. Alterations in the hierarchy of StD brain networks were depicted by connectome gradient analysis. We assessed changes in network hierarchy by comparing gradient scores in each network in patients with StD and healthy controls. The study compared different brain subdivisions if there was a different network. Finally, we analysed the relationship between the altered gradient scores and clinical characteristics. RESULTS Patients with StD had contracted network hierarchy and suppressed cortical range gradients. In the principal gradient, the gradient scores of default mode network were significantly reduced in patients with StD compared to controls. In the default network, the subdivisions of reduced gradient scores were mainly located in the precuneus, superior temporal gyrus, and anterior and posterior cingulate gyrus. Reduced gradient scores in the default mode network, the anterior and posterior cingulate gyrus were correlated with severity of depression. CONCLUSIONS The network hierarchy of the StD changed and was significantly correlated with depressive symptoms and severity. These results provided new insights into further understanding of the neural mechanisms of StD.
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Affiliation(s)
- Xiaolong Yin
- National-Local Joint Engineering Research Center of Rehabilitation Medicine Technology, Fujian University of Traditional Chinese Medicine, Fuzhou 350122, China; Rehabilitation Industry Institute, Fujian University of Traditional Chinese Medicine, Fuzhou 350122, China
| | - Junchao Yang
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou 350122, China
| | - Qing Xiang
- National-Local Joint Engineering Research Center of Rehabilitation Medicine Technology, Fujian University of Traditional Chinese Medicine, Fuzhou 350122, China; Rehabilitation Industry Institute, Fujian University of Traditional Chinese Medicine, Fuzhou 350122, China
| | - Lixin Peng
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou 350122, China
| | - Jian Song
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou 350122, China
| | - Shengxiang Liang
- National-Local Joint Engineering Research Center of Rehabilitation Medicine Technology, Fujian University of Traditional Chinese Medicine, Fuzhou 350122, China; Rehabilitation Industry Institute, Fujian University of Traditional Chinese Medicine, Fuzhou 350122, China; Traditional Chinese Medicine Rehabilitation Research Center of State Administration of Traditional Chinese Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou 350122, China.
| | - Jingsong Wu
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou 350122, China.
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Bogoian HR, Barber SJ, Carter SE, Mingo C, Rosano C, Dotson VM. Association of white matter hyperintensities and clinical vascular burden with depressive symptoms in Black older adults. Int J Geriatr Psychiatry 2024; 39:e6052. [PMID: 38165121 PMCID: PMC10947565 DOI: 10.1002/gps.6052] [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: 05/17/2023] [Accepted: 12/18/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVES Black older adults have a higher vascular burden compared to non-Hispanic White (NHW) older adults, which may put them at risk for a form of depression known as vascular depression (VaDep). The literature examining VaDep in Black older adults is sparse. The current study addressed this important gap by examining whether vascular burden was associated with depressive symptoms in Black older adults. METHODS Participants included 113 Black older adults from the Healthy Brain Project, a substudy of the Health, Aging, and Body Composition Study. In multiple regression analyses, clinical vascular burden (sum of vascular conditions) and white matter hyperintensity (WMH) volume predicted depressive symptoms as measured by the Center for Epidemiologic Studies Depression Scale, controlling for demographic variables. Follow-up analyses compared the associations in the Black subsample and in 179 NHW older adults. RESULTS Higher total WMH volume, but not clinically-defined vascular burden, predicted higher concurrent depressive symptoms and higher average depressive symptoms over 4 years. Similar associations were found between uncinate fasciculus (UF) WMHs and concurrent depressive symptoms and between superior longitudinal fasciculus WMHs and average depressive symptoms. The association between depressive symptoms and UF WMH was stronger in Black compared to NHW individuals. CONCLUSION This research is consistent with the VaDep hypothesis and extends it to Black older adults, a group that has historically been underrepresented in the literature. Results highlight WMH in the UF as particularly relevant to depressive symptoms in Black older adults and suggest this group may be particularly vulnerable to the negative effects of WMH.
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Affiliation(s)
- Hannah R. Bogoian
- Department of Psychology, Georgia State University, Atlanta, Georgia, USA
| | - Sarah J. Barber
- Department of Psychology, Georgia State University, Atlanta, Georgia, USA
- Gerontology Institute, Georgia State University, Atlanta, Georgia, USA
| | - Sierra E. Carter
- Department of Psychology, Georgia State University, Atlanta, Georgia, USA
| | - Chivon Mingo
- Gerontology Institute, Georgia State University, Atlanta, Georgia, USA
| | - Caterina Rosano
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Vonetta M. Dotson
- Department of Psychology, Georgia State University, Atlanta, Georgia, USA
- Gerontology Institute, Georgia State University, Atlanta, Georgia, USA
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Kim BH, Park SY, Park CI, Bang M, Kim HJ, Lee SH. Altered cortical thickness of the superior frontal gyrus and fusiform gyrus in individuals with subthreshold social anxiety. Sci Rep 2023; 13:21822. [PMID: 38071248 PMCID: PMC10710474 DOI: 10.1038/s41598-023-49288-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 12/06/2023] [Indexed: 12/18/2023] Open
Abstract
Subthreshold social anxiety (SSA) is a condition in which individuals experience social anxiety that does not reach the threshold required for a clinical diagnosis of a social anxiety disorder (SAD). Although SSA may not impair lives as severely as SAD, it can affect social functioning. However, only a few studies focused on structural neural correlates of SSA. We recruited 65 individuals with SSA and used the Leibowitz Social Anxiety Scale to assess their social and performance anxiety levels and other relevant measures of social anxiety. Voxel-wise whole-brain correlational analyses showed a positive association between the cortical thickness (CT) of the superior frontal gyrus (SFG) and social anxiety levels and a negative correlation between the CT of the fusiform gyrus (FG) and performance anxiety levels in individuals with SSA. Exploratory Pearson's correlation analyses showed significant positive correlations between the CT of the SFG and Generalized Anxiety Disorder-7 total scores and negative associations between the CT of the FG and Beck Anxiety Inventory total scores. Our study provides insight into the neural basis of SSA, particularly performance anxiety, by highlighting the association between CT in specific brain regions and SSA characteristics.
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Affiliation(s)
- Byoung-Ho Kim
- Department of Psychiatry, CHA Bundang Medical Center, CHA University School of Medicine, 59 Yatap-Ro, Bundang-Gu, Seongnam-Si, Gyeonggi-Do, 463-712, Republic of Korea
| | - So-Young Park
- CHA University School of Medicine, Seongnam, Republic of Korea
| | - Chun Il Park
- Department of Psychiatry, CHA Bundang Medical Center, CHA University School of Medicine, 59 Yatap-Ro, Bundang-Gu, Seongnam-Si, Gyeonggi-Do, 463-712, Republic of Korea
| | - Minji Bang
- Department of Psychiatry, CHA Bundang Medical Center, CHA University School of Medicine, 59 Yatap-Ro, Bundang-Gu, Seongnam-Si, Gyeonggi-Do, 463-712, Republic of Korea
| | - Hyun-Ju Kim
- Department of Psychiatry, CHA Bundang Medical Center, CHA University School of Medicine, 59 Yatap-Ro, Bundang-Gu, Seongnam-Si, Gyeonggi-Do, 463-712, Republic of Korea.
| | - Sang-Hyuk Lee
- Department of Psychiatry, CHA Bundang Medical Center, CHA University School of Medicine, 59 Yatap-Ro, Bundang-Gu, Seongnam-Si, Gyeonggi-Do, 463-712, Republic of Korea.
- CHA University School of Medicine, Seongnam, Republic of Korea.
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Dell L, Casetta C, Benassi H, Cowlishaw S, Agathos J, O'Donnell M, Crane M, Lewis V, Pacella B, Terhaag S, Morton D, McFarlane A, Bryant R, Forbes D. Mental health across the early years in the military. Psychol Med 2023; 53:3683-3691. [PMID: 35197132 PMCID: PMC10277765 DOI: 10.1017/s0033291722000332] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 12/20/2021] [Accepted: 01/27/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND The mental health impact of the initial years of military service is an under-researched area. This study is the first to explore mental health trajectories and associated predictors in military members across the first 3-4 years of their career to provide evidence to inform early interventions. METHODS This prospective cohort study surveyed Australian Defence personnel (n = 5329) at four time-points across their early military career. Core outcomes were psychological distress (K10+) and posttraumatic stress symptoms [four-item PTSD Checklist (PCL-4)] with intra-individual, organizational and event-related trajectory predictors. Latent class growth analyses (LCGAs) identified subgroups within the sample that followed similar longitudinal trajectories for these outcomes, while conditional LCGAs examined the variables that influenced patterns of mental health. RESULTS Three clear trajectories emerged for psychological distress: resilient (84.0%), worsening (9.6%) and recovery (6.5%). Four trajectories emerged for post-traumatic stress, including resilient (82.5%), recovery (9.6%), worsening (5.8%) and chronic subthreshold (2.3%) trajectories. Across both outcomes, prior trauma exposure alongside modifiable factors, such as maladaptive coping styles, and increased anger and sleep difficulties were associated with the worsening and chronic subthreshold trajectories, whilst members in the resilient trajectories were more likely to be male, report increased social support from family/friends and Australian Defence Force (ADF) sources, and use adaptive coping styles. CONCLUSIONS The emergence of symptoms of mental health problems occurs early in the military lifecycle for a significant proportion of individuals. Modifiable factors associated with wellbeing identified in this study are ideal targets for intervention, and should be embedded and consolidated throughout the military career.
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Affiliation(s)
- Lisa Dell
- Phoenix Australia Centre for Posttraumatic Mental Health, 161 Barry Street, Carlton VIC, Melbourne 3053, Australia
- Department of Psychiatry, Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Parkville VIC, Melbourne 3053, Australia
| | - Carolina Casetta
- Department of Defence, Joint Health Command, Canberra, Australia
| | - Helen Benassi
- Department of Defence, Joint Health Command, Canberra, Australia
- Research School of Population Health, Australian National University, Canberra, Australia
| | - Sean Cowlishaw
- Phoenix Australia Centre for Posttraumatic Mental Health, 161 Barry Street, Carlton VIC, Melbourne 3053, Australia
- Department of Psychiatry, Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Parkville VIC, Melbourne 3053, Australia
| | - James Agathos
- Phoenix Australia Centre for Posttraumatic Mental Health, 161 Barry Street, Carlton VIC, Melbourne 3053, Australia
- Department of Psychiatry, Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Parkville VIC, Melbourne 3053, Australia
| | - Meaghan O'Donnell
- Phoenix Australia Centre for Posttraumatic Mental Health, 161 Barry Street, Carlton VIC, Melbourne 3053, Australia
- Department of Psychiatry, Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Parkville VIC, Melbourne 3053, Australia
| | - Monique Crane
- Department of Psychology, Faculty of Medicine, Health and Human Sciences, Macquarie University, Macquarie Park NSW, Sydney 2109, Australia
| | - Virginia Lewis
- Australian Institute for Primary Care and Ageing, La Trobe University, Bundoora VIC, Melbourne 3086, Australia
| | - Belinda Pacella
- Phoenix Australia Centre for Posttraumatic Mental Health, 161 Barry Street, Carlton VIC, Melbourne 3053, Australia
- Department of Psychiatry, Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Parkville VIC, Melbourne 3053, Australia
| | - Sonia Terhaag
- Phoenix Australia Centre for Posttraumatic Mental Health, 161 Barry Street, Carlton VIC, Melbourne 3053, Australia
- Department of Psychiatry, Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Parkville VIC, Melbourne 3053, Australia
| | - David Morton
- Department of Defence, Joint Health Command, Canberra, Australia
| | - Alexander McFarlane
- Faculty of Health and Medical Sciences, Adelaide Medical School, University of Adelaide, Adelaide SA 5005, Australia
| | - Richard Bryant
- Faculty of Science, School of Psychology, University of New South Wales, Sydney NSW 2052, Australia
| | - David Forbes
- Phoenix Australia Centre for Posttraumatic Mental Health, 161 Barry Street, Carlton VIC, Melbourne 3053, Australia
- Department of Psychiatry, Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Parkville VIC, Melbourne 3053, Australia
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Robson BL, Preece DA, Dickson JM. Goal motives in depression and anxiety: the mediating role of emotion regulation difficulties. AUSTRALIAN PSYCHOLOGIST 2023. [DOI: 10.1080/00050067.2022.2162809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Affiliation(s)
- Bridget L. Robson
- School of Arts and Humanities (Psychology), Edith Cowan University, Joondalup, Australia
| | | | - Joanne M. Dickson
- School of Arts and Humanities (Psychology), Edith Cowan University, Joondalup, Australia
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Volz HP, Saliger J, Kasper S, Möller HJ, Seifritz E. Subsyndromal generalised anxiety disorder: operationalisation and epidemiology - a systematic literature survey. Int J Psychiatry Clin Pract 2022; 26:277-286. [PMID: 34314295 DOI: 10.1080/13651501.2021.1941120] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The diagnosis of anxiety disorders, like other psychiatric disorders also, is operationalised since the introduction of diagnostic manuals. The diagnostic criteria of Generalised Anxiety Disorder (GAD) have been tightened in the last decades. This leads to the exclusion of patients with a high level of anxiety, but not fulfilling certain of the GAD-criteria, from effective treatment. Such so-called subsyndromal, subthreshold or subclinical GAD-states, however, often exhibit a comparable burden of disease like the full syndromal disorder and often tend to develop into the full syndromal disorder. The purpose of this review is - beside systematically reporting the papers found in respective data bases from 2013 onwards - to summarise the relevant data regarding definitions, epidemiology and consequences of subsyndromal anxiety states in order to give a comprehensive review.
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Affiliation(s)
- Hans-Peter Volz
- Hospital for Psychiatry, Psychotherapy and Psychosomatic Medicine Schloss Werneck, Werneck, Germany
| | - Julia Saliger
- Hospital for Psychiatry, Psychotherapy and Psychosomatic Medicine Schloss Werneck, Werneck, Germany
| | | | - Hans-Jürgen Möller
- Clinic and Policlinic for Psychiatry and Psychotherapy, Ludwig-Maximilian-University Munich, Munich, Germany
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric Hospital, University of Zürich, Zürich, Switzerland
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Impact of the CBT-Meno protocol on menopause-specific beliefs, dysfunctional attitudes, and coping behaviors. Menopause 2022; 29:963-972. [PMID: 35881942 DOI: 10.1097/gme.0000000000002003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE A recent clinical trial demonstrated that a group cognitive-behavioral therapy protocol for menopause (CBT-Meno; Green et al. Menopause 2019;26(9):972-980) was effective in reducing menopausal symptoms, including vasomotor and depressive symptoms. The current analyses evaluated the effectiveness of CBT-Meno in improving menopause-specific beliefs, dysfunctional attitudes associated with depression, and menopause-specific behaviors. METHODS In a subset of participants from the larger trial, women assigned to CBT-Meno or waitlist and who had completed symptom, cognitive, and behavioral measures at least at baseline were included. Assessments were conducted at baseline, 12 weeks after baseline, and 3 months after treatment. Measures included the Hot Flash Related Daily Interference Scale, the vasomotor subscale of the Greene Climacteric Scale, the Beck Depression Inventory II, the Hot Flush Beliefs Scale, the Dysfunctional Attitudes Scale, and the Hot Flush Behavior Scale (HFBehS). RESULTS As reported in the main study outcomes (Green et al. Menopause 2019;26(9):972-980), CBT-Meno participants reported greater improvements than waitlist in terms of vasomotor symptom interference and depressive symptoms (Hot Flash Related Daily Interference Scale, Beck Depression Inventory II; partial eta-squared [ η2p ] = 0.15-0.18), although not in vasomotor severity (Greene Climacteric Scale [vasomotor subscale]; η2p = 0.05). CBT-Meno participants reported greater improvements than waitlist in menopause-specific beliefs (Hot Flush Beliefs Scale; η2p = 0.08-0.12), dysfunctional attitudes (Dysfunctional Attitudes Scale; η2p = 0.09), and menopause-specific behaviors (HFBehS; η2p = 0.08-0.12). Within-group analyses showed improvements in CBT-Meno on all variables ( d = 0.38-1.26) except in cooling strategies ( d = 0.18). Gains in CBT-Meno were maintained from posttreatment to 3-month follow-up, although a decrease in positive coping behaviors was observed (HFBehS-positive behavior subscale; d = 0.99). CONCLUSIONS The CBT-Meno protocol is effective in improving menopause-related symptoms and a broader range of outcomes, including problematic beliefs about menopause, dysfunctional attitudes related to depression, and menopause-specific behaviors.
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Are Care-Recipient Outcomes Attributable to Improved Caregiver Well-Being? A Cluster-Randomized Controlled Trial of Benefit-Finding Intervention. Am J Geriatr Psychiatry 2022; 30:903-913. [PMID: 34563429 DOI: 10.1016/j.jagp.2021.08.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 08/21/2021] [Accepted: 08/21/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVES The benefit-finding therapeutic (BFT) intervention, training cognitive reappraisal, and alternative thinking to construct positive aspects of caregiving have been found to reduce caregiver depression. This study examines BFT effects on care-recipient outcomes via reduced caregiver depression. DESIGN Cluster-randomized double-blind controlled trial. SETTING Social centers and clinics. PARTICIPANTS A total of 129 caregivers. Inclusion criteria were 1) primary caregiver aged 18+, 2) without cognitive impairment, 3) providing ≥14 care hours weekly to a relative with mild-to-moderate Alzheimer's disease, and 4) scoring ≥3 on the Hamilton Depression Rating Scale. Exclusion criterion was care-recipient having Parkinsonism or other forms of dementia. INTERVENTIONS BFT was evaluated against two forms of psychoeducation-standard and simplified (lectures only) psychoeducation. MEASUREMENTS Care-recipient outcomes included neuropsychiatric symptoms (NPS), functional impairment, and global dementia severity (Clinical Dementia Rating sum-of-box), measured at baseline, postintervention, and 4- and 10-month follow up. RESULTS Mixed-effects regressions showed a significant effect on NPS when compared with simplified psychoeducation only, with BFT participants reporting fewer NPS (especially mood symptoms) at 4-month follow-up (d = -0.52). Furthermore, longitudinal path analysis (using changes in caregiver depression scores at postintervention to predict changes in care-recipient NPS at follow-up) found that this effect was mediated by improved caregiver depression. No other intervention or mediation effects were found or were consistent across analyses. CONCLUSIONS Less depressed caregivers may be able to provide better care and more positive interactions, leading to reduced NPS in care-recipients. However, this benefit of BFT was limited to the comparison with simplified psychoeducation only.
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Waszczuk MA, Hopwood CJ, Luft BJ, Morey LC, Perlman G, Ruggero CJ, Skodol AE, Kotov R. The prognostic utility of personality traits versus past psychiatric diagnoses: Predicting future mental health and functioning. Clin Psychol Sci 2022; 10:734-751. [PMID: 35967764 PMCID: PMC9366938 DOI: 10.1177/21677026211056596] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
Past psychiatric diagnoses are central to patient case formulation and prognosis. Recently, alternative classification models such as the Hierarchical Taxonomy of Psychopathology (HiTOP) proposed to assess traits to predict clinically-relevant outcomes. The current study directly compared personality traits and past diagnoses as predictors of future mental health and functioning in three independent, prospective samples. Regression analyses found that personality traits significantly predicted future first onsets of psychiatric disorders (ΔR2=06-.15), symptom chronicity (ΔR2=.03-.06), and functioning (ΔR2=.02-.07), beyond past and current psychiatric diagnoses. Conversely, past psychiatric diagnoses did not provide an incremental prediction of outcomes when personality traits and other concurrent predictors were already included in the model. Overall, personality traits predicted a variety of outcomes in diverse settings, beyond diagnoses. Past diagnoses were generally not informative about future outcomes when personality was considered. Together, these findings support the added value of personality traits assessment in case formulation, consistent with HiTOP model.
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Affiliation(s)
- Monika A Waszczuk
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, IL
- Department of Psychiatry, Stony Brook University, Stony Brook, NY
| | | | - Benjamin J Luft
- Department of Medicine, Stony Brook University, Stony Brook, NY
| | - Leslie C Morey
- Department of Psychology, Texas A&M University, College Station, TX
| | - Greg Perlman
- Department of Psychiatry, Stony Brook University, Stony Brook, NY
| | | | | | - Roman Kotov
- Department of Psychiatry, Stony Brook University, Stony Brook, NY
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12
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Volz HP, Stirnweiß J, Kasper S, Möller HJ, Seifritz E. Subthreshold depression - concept, operationalisation and epidemiological data. A scoping review. Int J Psychiatry Clin Pract 2022; 27:92-106. [PMID: 35736807 DOI: 10.1080/13651501.2022.2087530] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Purpose: In diagnostic systems (e.g., DSM-5, ICD-10), depression is defined categorically. However, the concept of subthreshold depression (SD) has gained increasing interest in recent years. The purpose of the present paper was to review, based on a scoping review, the relevant papers in this field published between October 2011 and September 2020.Materials and methods: Of the 1,160 papers identified, 64 records could be included in further analysis. The scoping review was conducted using both electronic and manual methods.Results: The main result of the analysis is that the operationalisation criteria used are highly heterogeneous, which also leads to very heterogenous epidemiological data.Conclusions: Clear conclusions are not possible scrutinising the reported results. Most definitions seem to be arbitrary, with considerable overlap (e.g., between SD and minor depression). The review also revealed that the impact of SD on quality of life and related parameters appear to be in the range of the respective impact of major depression (MD) and therapeutic approaches might be helpful for SD and also for the prevention of conversion from SD to MD. Keeping the presented difficulties in mind, a proposal for the definition of SD is made in the present paper in order to facilitate the discussion leading to more homogeneous criteria.
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Affiliation(s)
- Hans-Peter Volz
- Hospital for Psychiatry, Psychotherapy und Psychosomatic Medicine Schloss Werneck, Werneck, Germany
| | - Johanna Stirnweiß
- Hospital for Psychiatry, Psychotherapy und Psychosomatic Medicine Schloss Werneck, Werneck, Germany
| | - Siegfried Kasper
- Center of Brain Research, Medical University of Vienna, Vienna, Austria
| | - Hans-Jürgen Möller
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University Munich, Munich, Germany
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy, and Psychosomatics. Psychiatric Hospital, University of Zürich, Zürich, Switzerland
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13
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Chow TK, Bowie CR, Morton M, Lalovic A, McInerney SJ, Rizvi SJ. Contributors of Functional Impairment in Major Depressive Disorder: a Biopsychosocial Approach. Curr Behav Neurosci Rep 2022. [DOI: 10.1007/s40473-022-00247-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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14
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Grella ON, Dunlap A, Nicholson AM, Stevens K, Pittman B, Corbera S, Diefenbach G, Pearlson G, Assaf M. Personality as a mediator of autistic traits and internalizing symptoms in two community samples. BMC Psychol 2022; 10:81. [PMID: 35346350 PMCID: PMC8962582 DOI: 10.1186/s40359-022-00774-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 03/04/2022] [Indexed: 11/10/2022] Open
Abstract
Background Autism spectrum disorder (ASD) is characterized by deficits in social functioning and is comorbid with internalizing disorders and symptoms. While personality is associated with these symptoms and social functioning in non-ASD samples, its role mediating the relationship between ASD traits and internalizing symptoms is not clear. Methods We studied the mediating effect of personality on the correlations between ASD traits and internalizing symptoms (i.e., depression, anxiety, stress) in two samples. Additionally, we explored the moderating effect of gender. Analyses were applied to a small (Study 1; N = 101) undergraduate sample. A broader sample recruited via an online crowdsourcing platform (Study 2; N = 371) was used to validate the results. Results Study 1’s mediation analyses revealed that neuroticism was the only significant mediator. Study 2 replicated these results by finding extraversion to be an additional mediator for anxiety and extraversion, openness, and agreeableness as additional mediators for stress. Moderation analyses revealed that gender was never a significant moderator. Conclusions These results support the effects of personality on the relationship between autism traits and internalizing symptoms. Future research should explore these effects in clinical samples to better understand the role of personality in symptomatology and the need to address it as part of intervention. Supplementary Information The online version contains supplementary material available at 10.1186/s40359-022-00774-z.
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Affiliation(s)
- Olivia N Grella
- Olin Neuropsychiatry Research Center, Institute of Living, Hartford Hospital, 200 Retreat Avenue, Hartford, CT, 061016, USA.
| | - Amanda Dunlap
- Olin Neuropsychiatry Research Center, Institute of Living, Hartford Hospital, 200 Retreat Avenue, Hartford, CT, 061016, USA
| | - Alycia M Nicholson
- Olin Neuropsychiatry Research Center, Institute of Living, Hartford Hospital, 200 Retreat Avenue, Hartford, CT, 061016, USA
| | - Kimberly Stevens
- Anxiety Disorders Center, Institute of Living, Hartford Hospital, Hartford, CT, USA
| | - Brian Pittman
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Silvia Corbera
- Olin Neuropsychiatry Research Center, Institute of Living, Hartford Hospital, 200 Retreat Avenue, Hartford, CT, 061016, USA.,Department of Psychological Science, Central Connecticut State University, New Britain, CT, USA
| | - Gretchen Diefenbach
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.,Anxiety Disorders Center, Institute of Living, Hartford Hospital, Hartford, CT, USA
| | - Godfrey Pearlson
- Olin Neuropsychiatry Research Center, Institute of Living, Hartford Hospital, 200 Retreat Avenue, Hartford, CT, 061016, USA.,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Michal Assaf
- Olin Neuropsychiatry Research Center, Institute of Living, Hartford Hospital, 200 Retreat Avenue, Hartford, CT, 061016, USA.,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
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15
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Perez GR, Stasik-O’Brien SM, Laifer LM, Brock RL. Psychological and Physical Intimate Partner Aggression Are Associated with Broad and Specific Internalizing Symptoms during Pregnancy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031662. [PMID: 35162685 PMCID: PMC8834854 DOI: 10.3390/ijerph19031662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/21/2022] [Accepted: 01/28/2022] [Indexed: 12/10/2022]
Abstract
Background: Intimate partner violence (IPV) has serious consequences, particularly during high-risk periods such as pregnancy, which poses a significant risk to maternal mental health. However, it is unclear whether IPV presents a broad risk for psychopathology or is specific to distinct diagnoses or symptom dimensions (e.g., panic, social anxiety). Further, the relative impact of physical versus psychological aggression remains unclear. Methods: One hundred and fifty-nine pregnant couples completed surveys assessing psychological and physical intimate partner aggression unfolding in the couple relationship, as well as a range of internalizing symptoms. Results: Psychological and physical aggression were each associated with broad negative affectivity, which underlies mood and anxiety disorders; however, only psychological aggression demonstrated a unique association. Further, for pregnant women, aggression was uniquely associated with several symptom dimensions characteristic of PTSD. In contrast, men demonstrated a relatively heterogeneous symptom presentation in relation to aggression. Conclusion: The present study identifies unique symptom manifestations associated with IPV for couples navigating pregnancy and suggests psychological aggression can be more detrimental to mental health than physical aggression. To promote maternal perinatal mental health, clinicians should screen for covert forms of psychological aggression during pregnancy (e.g., raised voices, insults), trauma-related distress, and symptom elevations in women and their partners.
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Affiliation(s)
- Gabriela R. Perez
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, NE 68588, USA; (G.R.P.); (L.M.L.)
- Department of Psychology, Idaho State University, Pocatello, ID 83209, USA
| | | | - Lauren M. Laifer
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, NE 68588, USA; (G.R.P.); (L.M.L.)
| | - Rebecca L. Brock
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, NE 68588, USA; (G.R.P.); (L.M.L.)
- Correspondence:
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16
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Cochrane SK, Calfee RP, Stonner MM, Dale AM. The relationship between depression, anxiety, and pain interference with therapy referral and utilization among patients with hand conditions. J Hand Ther 2022; 35:24-31. [PMID: 33250395 PMCID: PMC8985319 DOI: 10.1016/j.jht.2020.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 09/17/2020] [Accepted: 10/09/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Patients with upper extremity conditions may also experience symptoms of depression, anxiety, and pain that limit functional recovery. PURPOSE OF THE STUDY This study examined the impact of mental health and pain symptoms on referral rates to therapy and utilization of therapy services to achieve functional recovery among patients with common hand conditions. STUDY DESIGN This is a retrospective cohort study of patients from one orthopedic center. METHODS Data extraction provided demographics, the International Classification of Diseases, 10th revision diagnoses, therapy referral, therapy visit counts, treatment goal attainment, and Patient-Reported Outcomes Measurement Information System (PROMIS) Depression, Anxiety, and Pain Interference scores. The chi-square test, t-test, and logistic regression analyses assessed associations between baseline PROMIS depression, anxiety, and pain interference to therapy referral, the number of therapy visits, and goal attainment. RESULTS Forty-nine percent (172/351) of patients were referred to hand therapy. There was no relationship between three baseline PROMIS scores based on physician referral (t-test P values .32-.67) and no association between PROMIS scores and therapy utilization or goal attainment (Pearson correlation (r): 0.002 to 0.020, P > .05). Referral to therapy was most strongly associated with having a traumatic condition (P < .01). Patients with high depression, anxiety, and pain interference scores on average required one more therapy visit to achieve treatment goals (average visits: 3.7 vs 3.1; 4.1 vs 2.7; 3.4 vs 2.3, respectively). Fewer patients with high depression scores (50%) achieved their long-term goals than patients with low depression scores (69%, P = .20). CONCLUSIONS Patients' baseline level of depressive symptoms and anxiety do not predict referrals to hand therapy by orthopedic hand surgeons. There is some indication that patients with increased depressive symptoms, anxiety, and pain interference require more therapy with fewer achieving all goals, suggesting that mental health status may affect response to therapy. Therapists may address mental health needs in treatment plans. Future studies should examine if nonreferred patients with depressive symptoms achieve maximal functional recovery.
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Affiliation(s)
- Shannon K. Cochrane
- Washington University School of Medicine in St. Louis, Program in Occupational Therapy, St. Louis, MO, USA
| | - Ryan P. Calfee
- Washington University School of Medicine in Saint Louis, Orthopedic Surgery, Saint Louis, MO, USA
| | - Macyn M. Stonner
- Washington University School of Medicine in St. Louis, Milliken Hand Rehabilitation Center, Center for Advanced Medicine, St. Louis, MO, USA
| | - Ann Marie Dale
- Division of General Medical Sciences, Department of Medicine, Washington University School of Medicine in St. Louis, Saint Louis, MO, USA,Corresponding author. Department of Medicine, Washington University School of Medicine in St. Louis, 4523 Clayton Ave., CB 8005, Saint Louis, MO 63110, USA. Tel.: 314-454-8470; fax: 314-454-5113. (A.M. Dale)
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17
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Kim HJ, Kim JE, Lee SH. Functional Impairment in Patients with Panic Disorder. Psychiatry Investig 2021; 18:434-442. [PMID: 33979948 PMCID: PMC8169331 DOI: 10.30773/pi.2020.0425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 02/20/2021] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE Anxiety and depression and sociodemographic factors such as age, gender, education level, income, and marital status among people with panic disorder (PD) are associated with functional impairment in the areas of work, social, and family. Although both PD-specific scales such as the Panic Disorder Severity Scale (PDSS) and Anxiety Sensitivity Inventory-Revised (ASI-R) and early trauma have been investigated, their relationship with functional impairment in PD patients has not been clarified. METHODS This study included 267 PD patients. The PDSS, Beck Depression Inventory (BDI), ASI-R, and Early Trauma Inventory were used. Pearson's correlation and multiple linear regression analyses were performed. The Sheehan Disability Scale (SDS) was administered to assess the functional impairment level in PD patients. RESULTS Our findings showed that high levels of PDSS, BDI, and ASI-R were significantly correlated with the functional impairment among PD patients. Multiple regression analyses showed that PDSS, BDI, and ASI-R can predict the functional impairment levels, and PDSS and ASI-R were significantly associated with lost and underproductive days in PD patients. CONCLUSION Panic-specific symptoms, depression, and AS are associated with functional impairment level in PD patients. Elevated symptom severity can play a role by affecting productivity and daily responsibilities in PD patients.
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Affiliation(s)
- Hyun-Ju Kim
- Department of Psychiatry, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
| | - Ji Eun Kim
- Graduate School of Social Welfare, Yonsei University, Seoul, Republic of Korea
| | - Sang-Hyuk Lee
- Department of Psychiatry, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea.,Department of Clinical Pharmacology and Therapeutics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
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18
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Möller HJ, Volz HP, Seifritz E, Müller H, Kenntner-Mabiala R, Kaussner Y, Schoch S, Kasper S. Silexan does not affect driving performance after single and multiple dose applications: Results from a double-blind, placebo and reference-controlled study in healthy volunteers. J Psychiatr Res 2021; 136:543-551. [PMID: 33221027 DOI: 10.1016/j.jpsychires.2020.10.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 10/12/2020] [Accepted: 10/23/2020] [Indexed: 01/04/2023]
Abstract
Anxiolytic drugs often have sedative effects that impair the ability to drive. Our double-blind, randomized crossover trial investigated the effect of Silexan, a non-sedating, anxiolytic herbal medicinal product, on driving performance in healthy volunteers. Part 1 aimed at demonstrating equivalence between 80 mg/d Silexan and placebo. Part 2 was performed to demonstrate superiority of 160 and 320 mg Silexan over 1 mg lorazepam and included a placebo arm for assay sensitivity. Driving performance was assessed in a validated, alcohol-calibrated simulator test. The primary outcome was the standard deviation of the lane position (SDLP). Secondary outcomes included driving errors and sleepiness. Fifty and 25 subjects were randomized in Parts 1 and 2, respectively. In Part 1, Silexan 80 mg was confirmed to be equivalent to placebo after single administration (equivalence range: δ = ±2 cm). The 95% confidence interval (CI) for the SDLP marginal mean value difference Silexan-placebo for single administration was -1.43; +1.38 and thus similar to the 95% CI of -1.45; +0.79 cm for 7 days' multiple dosing. In Part 2, 95% CIs for SDLP marginal mean value differences to lorazepam were -8.58; -5.42 cm for Silexan 160 mg and -8.65; -5.45 cm for 320 mg (p < 0.001). Confirmatory results were supported by secondary outcomes, where results for Silexan were comparable to placebo and more favorable than for lorazepam. The study demonstrates that single doses of up to 320 mg Silexan and multiple doses of 80 mg/d have no adverse effect on driving performance.
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Affiliation(s)
- Hans-Jürgen Möller
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University, Nußbaumstraße 7, 80336 Munich, Germany.
| | - Hans-Peter Volz
- Hospital for Psychiatry, Psychotherapy and Psychosomatic Medicine Schloss Werneck, Balthasar-Neumann-Platz 1, 97440 Werneck, Germany
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Lenggstrasse 31, 8032 Zürich, Switzerland
| | - Heiko Müller
- Dr. Willmar Schwabe GmbH & Co. KG, Willmar-Schwabe-Straße 4, 76227 Karlsruhe, Germany
| | - Ramona Kenntner-Mabiala
- Würzburg Institute for Traffic Sciences (WIVW), Robert-Bosch-Straße 4, 97209 Veitshöchheim, Germany
| | - Yvonne Kaussner
- Würzburg Institute for Traffic Sciences (WIVW), Robert-Bosch-Straße 4, 97209 Veitshöchheim, Germany; Department for General Practice, Julius-Maximilians-Universität Wurzburg, Josef-Schneider-Straße 2 / Haus D7, 97080 Wurzburg, Germany
| | - Stefanie Schoch
- Würzburg Institute for Traffic Sciences (WIVW), Robert-Bosch-Straße 4, 97209 Veitshöchheim, Germany
| | - Siegfried Kasper
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
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19
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Hruska B, Barduhn MS. Dynamic psychosocial risk and protective factors associated with mental health in Emergency Medical Service (EMS) personnel. J Affect Disord 2021; 282:9-17. [PMID: 33387746 DOI: 10.1016/j.jad.2020.12.130] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 10/31/2020] [Accepted: 12/23/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND EMS personnel have a heightened risk of developing posttraumatic stress disorder (PTSD) and major depression relative to other occupational populations necessitating a greater understanding of the risk and protective factors that operate each day in relation to this risk. This study examined dynamic psychosocial factors and their relationship with daily mental health symptoms among EMS workers. The psychosocial factors examined consisted of occupational stressors, sleep disturbance, social conflict, meaning made from the day's challenges, recovery activities, social support, and perceived prosocial impact. METHOD Seventy-nine EMS workers recruited from an emergency medical service provider in Central New York completed a daily assessment for 8 days asking questions about occupational stressors encountered, sleep efficiency, social conflicts, meaning made from the day's challenges, recovery activities engaged in, social support received, and perceived prosocial impact. RESULTS Daily occupational stressors were associated with elevated daily PTSD symptom severity (b = 0.13, SE = 0.06, p = .023). Social conflicts were associated with greater depression symptom severity (b = 0.75, SE = 0.14, p < .001); the meaning made from day's stressors (b = -0.17, SE = 0.05, p = .002) and the recovery activities engaged in (b = -0.30, SE = 0.07, p < .001) were associated with lower daily depression symptom severity. LIMITATIONS A relatively modest sample size and small sampling window may constrain the generalizations made from this study. CONCLUSIONS Occupational stressors and social conflicts are key risk factors related to the daily expression of PTSD and depression symptom severity in EMS workers. The meaning made from the day's challenges and the recovery activities engaged in may protect against depression. These results reveal several dynamic psychosocial factors that aid in understanding features of the work day that contribute to the mental health burden observed among EMS personnel.
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Affiliation(s)
- Bryce Hruska
- Department of Public Health, Syracuse University, Syracuse, NY, USA.
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20
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Xie X, Song J, Zhu J, Han M, He Y, Huang J, Tao J, Wu J. The effectiveness of Tai Chi on the depressive symptom of young adults with subthreshold depression: a study protocol for a randomized controlled trial. Trials 2021; 22:106. [PMID: 33516240 PMCID: PMC7847042 DOI: 10.1186/s13063-021-05054-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 01/20/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Depression is seriously affecting the physical and mental health of young people worldwide. Subthreshold depression, as an early stage of depression, is essential for early prevention and treatment of depression. Tai Chi, as a traditional Chinese mind-body therapy, may become an alternative intervention. However, the neurophysiological mechanism of Tai Chi for young people with subthreshold depression remains unclear, restricting its further promotion and application. Therefore, rigorous randomized clinical trials are needed to further observe the intervention effect of Tai Chi on young adults with subthreshold depression and explore the neurophysiological mechanism. METHOD/DESIGN This report describes a two-arm, randomized, parallel controlled trial with allocation concealment and assessor blinding. A total of 64 eligible participants are randomly allocated to the Tai Chi group and the waiting list group in a 1:1 ratio. Participants in the Tai Chi group receive 12 weeks of Tai Chi training, with a total of 36 times and each for 60 min. Specifically, the participants in the waiting list group are requested to maintain their routine lifestyle. In this study, the primary outcome measure is the mean change in scores on the PHQ-9 and HAMD-17 between baseline and 12 weeks; the secondary outcomes are the mean change in the scores on CES-D, CPSS, GAD-7, and PSQI. Besides, the saliva cortisol levels and fMRI are monitored to explore the mechanism of action of Tai Chi on subthreshold depression. DISCUSSION The protocol uses a randomized controlled trial to examine the effectiveness of Tai Chi for young adults with subthreshold depression and explore neurophysiological mechanisms. If the test results are positive, it can be verified that Tai Chi can promote the physical and mental health of young adults with subthreshold depression. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR1900028289 . Registered on 17 December 2019.
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Affiliation(s)
- Xiaoting Xie
- Fujian University of Traditional Chinese Medicine, Fuzhou, 350122, China.,Key Laboratory of Orthopedics & Traumatology of Traditional Chinese Medicine and Rehabilitation (Fu Jian university of TCM), Ministry of Education, Fuzhou, 350122, China
| | - Jian Song
- Fujian University of Traditional Chinese Medicine, Fuzhou, 350122, China.,Key Laboratory of Orthopedics & Traumatology of Traditional Chinese Medicine and Rehabilitation (Fu Jian university of TCM), Ministry of Education, Fuzhou, 350122, China.,Fujian Collaborative Innovation Center for Rehabilitation Technology, Fuzhou, 350122, China
| | - Jingfang Zhu
- Fujian University of Traditional Chinese Medicine, Fuzhou, 350122, China.,Key Laboratory of Orthopedics & Traumatology of Traditional Chinese Medicine and Rehabilitation (Fu Jian university of TCM), Ministry of Education, Fuzhou, 350122, China.,Fujian Collaborative Innovation Center for Rehabilitation Technology, Fuzhou, 350122, China
| | - Mengyu Han
- Fujian University of Traditional Chinese Medicine, Fuzhou, 350122, China.,Key Laboratory of Orthopedics & Traumatology of Traditional Chinese Medicine and Rehabilitation (Fu Jian university of TCM), Ministry of Education, Fuzhou, 350122, China
| | - Youze He
- Fujian University of Traditional Chinese Medicine, Fuzhou, 350122, China.,Key Laboratory of Orthopedics & Traumatology of Traditional Chinese Medicine and Rehabilitation (Fu Jian university of TCM), Ministry of Education, Fuzhou, 350122, China
| | - Jia Huang
- Fujian University of Traditional Chinese Medicine, Fuzhou, 350122, China.,Key Laboratory of Orthopedics & Traumatology of Traditional Chinese Medicine and Rehabilitation (Fu Jian university of TCM), Ministry of Education, Fuzhou, 350122, China.,Fujian Collaborative Innovation Center for Rehabilitation Technology, Fuzhou, 350122, China.,TCM Rehabilitation Research Center Of SATCM, Fuzhou, 350122, China
| | - Jing Tao
- Fujian University of Traditional Chinese Medicine, Fuzhou, 350122, China.,Key Laboratory of Orthopedics & Traumatology of Traditional Chinese Medicine and Rehabilitation (Fu Jian university of TCM), Ministry of Education, Fuzhou, 350122, China.,Fujian Collaborative Innovation Center for Rehabilitation Technology, Fuzhou, 350122, China.,TCM Rehabilitation Research Center Of SATCM, Fuzhou, 350122, China
| | - Jingsong Wu
- Fujian University of Traditional Chinese Medicine, Fuzhou, 350122, China. .,Key Laboratory of Orthopedics & Traumatology of Traditional Chinese Medicine and Rehabilitation (Fu Jian university of TCM), Ministry of Education, Fuzhou, 350122, China. .,Fujian Collaborative Innovation Center for Rehabilitation Technology, Fuzhou, 350122, China. .,TCM Rehabilitation Research Center Of SATCM, Fuzhou, 350122, China.
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21
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Seifritz E, Möller HJ, Volz HP, Müller WE, Hopyan T, Wacker A, Schläfke S, Kasper S. No Abuse Potential of Silexan in Healthy Recreational Drug Users: A Randomized Controlled Trial. Int J Neuropsychopharmacol 2020; 24:171-180. [PMID: 33300578 PMCID: PMC7968617 DOI: 10.1093/ijnp/pyaa064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 09/14/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Silexan is a lavender essential oil with established anxiolytic and calming efficacy. Here we asked whether there is a potential for abuse in human patients. METHODS We carried out a phase I abuse liability single-center, double-blind, 5-way crossover study in healthy users of recreational central nervous system depressants. They received single oral doses of 80 mg (therapeutic dose) and 640 mg Silexan, 2 mg and 4 mg lorazepam (active control) and placebo in randomized order, with 4- to 14-day washout periods between treatments. Pharmacodynamic measures included validated visual analogue scales assessing positive, negative, and sedative drug effects and balance of effects; a short form of the Addiction Research Center Inventory; and a drug similarity assessment. The primary outcome measure was the individual maximum value on the drug liking visual analogue scale during 24 hours post-dose. RESULTS Forty participants were randomized and 34 were evaluable for pharmacodynamic outcomes. In intraindividual head-to-head comparisons of the drug liking visual analogue scale maximum value, both doses of Silexan were rated similar to placebo whereas differences were observed between Silexan and lorazepam and between placebo and lorazepam (P < .001). These data were supported by all secondary measures of positive drug effects and of balance of effects. Differences between placebo and both doses of Silexan were always negligible in magnitude. Moreover, Silexan showed no sedative effects and was not perceived to be similar to commonly used drugs that participants had used in the past. CONCLUSIONS Silexan did not exhibit any abuse potential in a standard abuse potential detection screen study and is unlikely to be recreationally abused.
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Affiliation(s)
- Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zürich, Switzerland
- Correspondence: Prof. Dr. Erich Seifritz, MD, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zürich, Lenggstrasse 31 / PO-Box 1931, 8032 Zürich, Switzerland, ()
| | - Hans-Jürgen Möller
- Clinic and Policlinic for Psychiatry and Psychotherapy, Ludwig Maximilian University, Munich, Germany
| | - Hans-Peter Volz
- Hospital for Psychiatry, Psychotherapy and Psychosomatic Medicine Schloss Werneck, Werneck, Germany
| | - Walter E Müller
- Department of Pharmacology, Biocenter Goethe-University, Frankfurt, Germany
| | - Talar Hopyan
- Scientific Affairs-Neuropsychology | Early Phase; Syneos Health, Toronto, Canada
| | - Anna Wacker
- Dr. Willmar Schwabe GmbH & Co. KG, Karlsruhe, Germany
| | | | - Siegfried Kasper
- Center for Brain Research, Medical University of Vienna, Vienna, Austria
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22
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Efficacy of light therapy for a college student sample with non-seasonal subthreshold depression: An RCT study. J Affect Disord 2020; 277:443-449. [PMID: 32871530 DOI: 10.1016/j.jad.2020.08.055] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/17/2020] [Accepted: 08/21/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND Light therapy has been successfully used to treat seasonal and non-seasonal depression, but there is limited evidence for its efficacy in subthreshold depression. This study examines the efficacy of light therapy for symptoms of depression and anxiety in non-seasonal subthreshold depression. METHODS College students with non-seasonal subthreshold depression were recruited. The participants were randomly allocated to one of the three conditions: high- (LT-5000 lux) and low-intensity (LT-500 lux) light therapy conditions and a waiting-list control condition (WLC). The primary outcome was Hamilton Depression Rating Scale (HAMD), and secondary outcomes were Beck Depression Inventory-II (BDI-II) and state anxiety inventory (SAI), which were assessed at baseline (Week 0), during the trial (Week 4), and after completion of the light therapy (Week 8). RESULTS A total of 142 participants completed the trial. The LT-5000 (effect size [d] = 1.56, 95% CI: 1.15 to 1.98) and LT-500 conditions (d = 0.84, 95% CI: 0.43 to 1.26) were significantly superior to the WLC condition. For the LT-5000, LT-500, and WLC conditions by the end of the 8-week trial, a response on the HAMD was achieved by 70.0%, 42.0% and 19.0% of the participants, and remission was achieved by 76.0%, 54.0%, and 19.0%, respectively. LIMITATIONS The subjects were not followed up regularly after completion of the trial. CONCLUSION Light therapy, both at high- and low-intensity, was efficacious in the treatment of college students with non-seasonal subthreshold depression. High-intensity light therapy was superior to low-intensity light therapy by the end of an 8-week trial.
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Riegler C, Wiedmann S, Rücker V, Teismann H, Berger K, Störk S, Vieta E, Faller H, Baune BT, Heuschmann PU. A Self-administered Version of the Functioning Assessment Short Test for Use in Population-based Studies: A Pilot Study. Clin Pract Epidemiol Ment Health 2020; 16:192-203. [PMID: 33088336 PMCID: PMC7539537 DOI: 10.2174/1745017902016010192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 07/19/2020] [Accepted: 07/24/2020] [Indexed: 11/22/2022]
Abstract
Background: The Functioning Assessment Short Test (FAST) is an interviewer-administered scale assessing functional impairment originally developed for psychiatric patients. Objectives: To adapt the FAST for the general population, we developed a self-administered version of the scale and assessed its properties in a pilot study. Methods: The original FAST scale was translated into German via forward and backward translation. Afterwards, we adjusted the scale for self-administered application and inquired participants from two ongoing studies in Germany, ‘STAAB’ (Würzburg) and ‘BiDirect’ (Münster), both recruiting subjects from the general population across a wide age range (STAAB: 30-79 years, BiDirect: 35-65 years). To assess reliability, agreement of self-assessment with proxy-assessment by partners was measured via intraclass correlation coefficient (ICC) over the FAST score. Construct validity was estimated by conducting correlations with validated scales of depression (PHQ-9), anxiety (GAD-7), and health-related quality of life (SF-12) and regression analyses using these scales besides potentially disabling comorbidities (e.g. Chronic Back Pain (CBP)). Results: Participants (n=54) had a median age of 57.0 years (quartiles: 49.8, 65.3), 46.3% were female. Reliability was moderate: ICC 0.50 (95% CI 0.46-0.54). The FAST score significantly correlated with PHQ-9, GAD-7, and the mental sub-scale of SF-12. In univariable linear regression, all three scales and chronic back pain explained variance of the FAST score. In multivariable analysis, only CBP and the SF-12 remained significant predictors. Conclusion: The German self-administered version of the FAST yielded moderate psychometric properties in this pilot study, indicating its applicability to assess functional impairment in the general population.
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Affiliation(s)
- Christoph Riegler
- Institute for Clinical Epidemiology und Biometry, University of Würzburg, Würzburg, Germany.,Department of Neurology, Charité - Universitätsmedizin Berlin (corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin), Berlin, Germany
| | - Silke Wiedmann
- Institute for Clinical Epidemiology und Biometry, University of Würzburg, Würzburg, Germany.,Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Berlin, Germany
| | - Viktoria Rücker
- Institute for Clinical Epidemiology und Biometry, University of Würzburg, Würzburg, Germany
| | - Henning Teismann
- Institute for Epidemiology and Social Medicine, University of Münster, Münster, Germany
| | - Klaus Berger
- Institute for Epidemiology and Social Medicine, University of Münster, Münster, Germany
| | - Stefan Störk
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Würzburg, Germany.,Department of Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Eduard Vieta
- Bipolar and Depressive Disorders Program, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - Hermann Faller
- Department of Medical Psychology and Psychotherapy, Medical Sociology and Rehabilitation Sciences, University of Würzburg, Würzburg, Germany
| | - Bernhard T Baune
- Department of Psychiatry, Melbourne Medical School, The University of Melbourne, Melbourne, Australia.,Department of Psychiatry and Psychotherapy, University of Münster, Münster, Germany
| | - Peter U Heuschmann
- Institute for Clinical Epidemiology und Biometry, University of Würzburg, Würzburg, Germany.,Comprehensive Heart Failure Center, University and University Hospital Würzburg, Würzburg, Germany.,Clinical Trial Center Würzburg, University of Würzburg, Würzburg, Germany
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Boredom proneness and rumination mediate relationships between depression and anxiety with problematic smartphone use severity. CURRENT PSYCHOLOGY 2020. [DOI: 10.1007/s12144-020-01052-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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25
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Rudenstine S, Espinosa A, Kumar A. Depression and Anxiety Subgroups Across Alcohol Use Disorder and Substance Use in a National Epidemiologic Study. J Dual Diagn 2020; 16:299-311. [PMID: 32657223 DOI: 10.1080/15504263.2020.1784498] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Objective: The high prevalence of alcohol/substance use among individuals with psychiatric disorders elucidates the import of investigations into associations between types and severity of psychiatric symptoms and alcohol/substance use. This study examined the likelihood of alcohol use disorder and substance use among individuals with varying depression and anxiety symptoms and severity thereof. Differences across sex were also examined.Methods: Using data from the National Epidemiological Survey on Alcohol and Related Conditions, a nationally representative sample from the United States (N = 43,093), separate logistic regressions estimated the odds of lifetime alcohol use disorder, depressant, stimulant, hallucinogen, and comorbid substance use across psychiatric symptom clusters controlling for age, sex, and ethnicity.Results: Symptom severity was a more important correlate of alcohol use disorder and substance use than symptom type. In particular, the odds ratio of lifetime use of depressants, stimulants, hallucinogens, or any combination of these types of substances were higher for individuals with either severe depression or severe depression and anxiety relative to a healthy control. Moreover, the odds of having a diagnosis of lifetime alcohol use disorder were higher for individuals with severe symptoms of depression, anxiety, and both depression and anxiety, relative to healthy individuals. Those with mild depression were more likely to engage in substance use than individuals with anxiety alone. Patterns of association among males and females were highly consistent.Conclusions: The findings highlight an enhanced risk of alcohol and substance use among individuals with severe depression and/or anxiety symptoms above what is seen among individuals with less severe symptomatology. In addition, this study shows a unique risk posed by the presence of depression on substance use. This study offers a framework for future studies to examine the causal mechanisms explaining the connection between psychiatric symptoms and alcohol/substance use.
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Affiliation(s)
- Sasha Rudenstine
- Department of Psychology, The City College of New York, New York, NY, USA.,Department of Psychology, Graduate Center, City University of New York, New York, NY, USA
| | - Adriana Espinosa
- Department of Psychology, The City College of New York, New York, NY, USA
| | - Anusha Kumar
- Department of Psychology, The City College of New York, New York, NY, USA
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Bogoian HR, King TZ, Turner JA, Semmel ES, Dotson VM. Linking depressive symptom dimensions to cerebellar subregion volumes in later life. Transl Psychiatry 2020; 10:201. [PMID: 32561707 PMCID: PMC7305200 DOI: 10.1038/s41398-020-00883-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 05/19/2020] [Accepted: 06/09/2020] [Indexed: 11/10/2022] Open
Abstract
The present study examined the relationship between subthreshold depressive symptoms and gray matter volume in subregions of the posterior cerebellum. Structural magnetic resonance imaging data from 38 adults aged 51 to 80 years were analyzed along with participants' responses to the Center for Epidemiologic Studies Depression Scale. Subscale scores for depressed mood, somatic symptoms, and lack of positive affect were calculated, and multiple regression analyses were used to examine the relationship between symptom dimensions and cerebellar volumes. Greater total depressive symptoms and greater somatic symptoms of depression were significantly related to larger volumes of vermis VI, a region within the salience network, which is altered in depression. Exploratory analyses revealed that higher scores on the lack of positive affect subscale were related to larger vermis VIII volumes. These results support that depressive symptom profiles have unique relationships within the cerebellum that may be important as the field move towards targeted treatment approaches for depression.
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Affiliation(s)
- Hannah R. Bogoian
- grid.256304.60000 0004 1936 7400Department of Psychology, Georgia State University, Atlanta, GA USA
| | - Tricia Z. King
- grid.256304.60000 0004 1936 7400Department of Psychology, Georgia State University, Atlanta, GA USA ,grid.256304.60000 0004 1936 7400Neuroscience Institute, Georgia State University, Atlanta, GA USA
| | - Jessica A. Turner
- grid.256304.60000 0004 1936 7400Department of Psychology, Georgia State University, Atlanta, GA USA ,grid.256304.60000 0004 1936 7400Neuroscience Institute, Georgia State University, Atlanta, GA USA
| | - Eric S. Semmel
- grid.256304.60000 0004 1936 7400Department of Psychology, Georgia State University, Atlanta, GA USA ,grid.256304.60000 0004 1936 7400Neuroscience Institute, Georgia State University, Atlanta, GA USA
| | - Vonetta M. Dotson
- grid.256304.60000 0004 1936 7400Department of Psychology, Georgia State University, Atlanta, GA USA ,grid.256304.60000 0004 1936 7400Neuroscience Institute, Georgia State University, Atlanta, GA USA ,grid.256304.60000 0004 1936 7400Gerontology Institute, Georgia State University, Atlanta, GA USA
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Association between Anxiety and Vascular Dementia Risk: New Evidence and an Updated Meta-Analysis. J Clin Med 2020; 9:jcm9051368. [PMID: 32384818 PMCID: PMC7291213 DOI: 10.3390/jcm9051368] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 04/30/2020] [Accepted: 05/01/2020] [Indexed: 12/12/2022] Open
Abstract
The association between anxiety and vascular dementia (VaD) is unclear. We aimed to reliably estimate the association between anxiety and VaD risk using meta-analysis to pool new results from a large community-based cohort (Zaragoza Dementia and Depression (ZARADEMP) study) and results from previous studies. ZARADEMP participants (n = 4057) free of dementia were followed up on for up to 12 years. Cases and subcases of anxiety were determined at baseline. A panel of four psychiatrists diagnosed incident cases of VaD by consensus. We searched for similar studies published up to October 2019 using PubMed and Web of Science. Observational studies reporting associations between anxiety and VaD risk, and adjusting at least for age, were selected. Odds ratios (ORs) from each study were combined using fixed-effects models. In the ZARADEMP study, the risk of VaD was 1.41 times higher among individuals with anxiety (95% CI: 0.75–2.68) compared with non-cases (p = 0.288). Pooling this result with results from two previous studies yielded an OR of 1.65 (95% CI: 1.07–2.53; p = 0.022). These findings indicate that anxiety is associated with an increased risk of VaD. Taking into account that anxiety is commonly observed in the elderly, treating and preventing it might reduce the prevalence and incidence of VaD. However, whether anxiety is a cause of a prodrome of VaD is still unknown, and future research is needed to clarify this.
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Santabárbara J, Villagrasa B, Lopez-Anton R, la Cámara CD, Gracia-García P, Lobo A. Anxiety and Risk of Vascular Dementia in an Elderly Community Sample: The Role of Sex. Brain Sci 2020; 10:E265. [PMID: 32366003 PMCID: PMC7287941 DOI: 10.3390/brainsci10050265] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 04/13/2020] [Accepted: 04/16/2020] [Indexed: 01/04/2023] Open
Abstract
Background: To assess the association between anxiety and risk of vascular dementia (VaD), as well as potential sex differences, in a community-based cohort. Methods: A random sample of 4057 dementia-free community participants aged 55 or older, from the longitudinal, community-based Zaragoza Dementia and Depression Project (ZARADEMP) study were followed for 4.5 years. Geriatric Mental State B (GMS)-Automated Geriatric Examination for Computer Assisted Taxonomy (AGECAT) was used for the assessment and diagnosis of anxiety, and a panel of research psychiatrists diagnosed the incident cases of VaD according to DSM-IV (Diagnostic and Statistical Manual of mental disordes). Multivariate survival analysis with competing risk regression model was performed. Results: In men, the incidence rate of VaD was significantly higher among anxiety subjects compared with non-anxiety subjects (incidence rate ratio (IRR) (95% confidence interval (CI)): 3.24 (1.13-9.35); p = 0.029), and no difference was observed in women (IRR (95%CI): 0.68 (0.19-2.23); p = 0.168). In the multivariate model, for men, cases of anxiety had 2.6-fold higher risk of VaD (subdistribution hazard ratio (SHR): 2.61; 95%CI: 0.88-7.74) when all potential confounding factors were controlled, with no statistical significance (p = 0.084), but a clinically relevant effect (Cohen's d: 0.74). No association was found in women. Conclusions: In men, but not in women, risk of VaD was higher among individuals with anxiety, with a clinically relevant effect. Potential anxiety-related preventive interventions for VaD might be tailored to men and women separately.
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Affiliation(s)
- Javier Santabárbara
- Department of Preventive Medicine and Public Health, Universidad de Zaragoza, 50009 Zaragoza, Spain;
- Instituto de Investigación Sanitaria de Aragón (IIS Aragón), 50009 Zaragoza, Spain; (R.L.-A.); (C.D.l.C.); (A.L.)
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Ministry of Science and Innovation, 28029 Madrid, Spain;
| | - Beatriz Villagrasa
- Psychogeriatry Area, CASM Benito Menni, Sant Boi del Llobregat, 08830 Barcelona, Spain
| | - Raúl Lopez-Anton
- Instituto de Investigación Sanitaria de Aragón (IIS Aragón), 50009 Zaragoza, Spain; (R.L.-A.); (C.D.l.C.); (A.L.)
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Ministry of Science and Innovation, 28029 Madrid, Spain;
- Department of Psychology and Sociology, Universidad de Zaragoza, 50009 Zaragoza, Spain
| | - Concepción De la Cámara
- Instituto de Investigación Sanitaria de Aragón (IIS Aragón), 50009 Zaragoza, Spain; (R.L.-A.); (C.D.l.C.); (A.L.)
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Ministry of Science and Innovation, 28029 Madrid, Spain;
- Psychiatry Service, Hospital Clínico Universitario Lozano Blesa, 50009 Zaragoza, Spain
- Department of Medicine and Psychiatry, Universidad de Zaragoza, 50009 Zaragoza, Spain
| | - Patricia Gracia-García
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Ministry of Science and Innovation, 28029 Madrid, Spain;
- Psychiatry Service, Hospital Universitario Miguel Servet, 50009 Zaragoza, Spain
| | - Antonio Lobo
- Instituto de Investigación Sanitaria de Aragón (IIS Aragón), 50009 Zaragoza, Spain; (R.L.-A.); (C.D.l.C.); (A.L.)
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Ministry of Science and Innovation, 28029 Madrid, Spain;
- Department of Medicine and Psychiatry, Universidad de Zaragoza, 50009 Zaragoza, Spain
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Grunze H, Born C. The Impact of Subsyndromal Bipolar Symptoms on Patient's Functionality and Quality of Life. Front Psychiatry 2020; 11:510. [PMID: 32595531 PMCID: PMC7304232 DOI: 10.3389/fpsyt.2020.00510] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 05/18/2020] [Indexed: 02/05/2023] Open
Abstract
Subsyndromal symptoms have rarely been in the focus of bipolar research. This may be, in part, due to the fact that there is neither a uniform definition nor do they constitute an indication of regulatory and commercial interest. Nevertheless, they do have a decisive impact on the long-term course of bipolar disorder (BD), and the degree of functionality and quality of life (QoL) is more likely determined by their presence or absence than by acute episodes. Summarizing the literature an estimated 20-50% of patients suffer inter-episodically or chronically from subsyndromal BD. The most prominent symptoms that interfere with functionality are subsyndromal depression, disturbances of sleep, and perceived cognitive impairment, whereas anxiety negatively impacts on QoL. In the absence of evidence-based pharmacological treatments for subsyndromal BD, clinical practice adopts guidelines designed for treatment-resistant full-blown episodes of BD, supplemented by cognitive-behavioral, family focused or social-rhythm-based psychotherapies.
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30
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Haller J, Krecsak L, Zámbori J. Double-blind placebo controlled trial of the anxiolytic effects of a standardized Echinacea extract. Phytother Res 2019; 34:660-668. [PMID: 31876052 DOI: 10.1002/ptr.6558] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 09/30/2019] [Accepted: 11/08/2019] [Indexed: 01/12/2023]
Abstract
Earlier studies suggested that specific Echinacea preparations might decrease anxiety. To further study the issue, we performed a double blind, placebo controlled trial with a standardized Echinacea angustifolia root extract. Participants were volunteers scoring above 45 points on the state or on the trait subscale of the State Trait Anxiety Inventory (STAI). They were treated with 40 mg Echinacea or with placebo tablets twice daily for 7 days followed by a 3 week-long washout period. Participants were also administered the Beck Depression Inventory (BDI) and the Perceived Stress Scale (PSS). In the Echinacea group, state anxiety scores decreased by approximately 11 points by the end of the treatment period, whereas the decrease was around 3-points in the placebo group (p< 0.01). The effect maintained over the washout period. The difference from placebo was significant from the 7th day of treatment throughout. Changes were less robust with trait anxiety scores, but the preparation performed better than placebo in patients with high baseline anxiety. Neither BDI nor PSS scores were affected by the treatments. Adverse effects were rare and mild, and all were observed in the placebo group. These findings suggest that particular Echinacea preparations have significant beneficial effects on anxiety in humans.
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Affiliation(s)
- József Haller
- Institute of Experimental Medicine, Budapest, Hungary.,University of Public Service, Budapest, Hungary
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31
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Waszczuk MA, Li K, Ruggero CJ, Clouston SAP, Luft BJ, Kotov R. Maladaptive Personality Traits and 10-Year Course of Psychiatric and Medical Symptoms and Functional Impairment Following Trauma. Ann Behav Med 2019; 52:697-712. [PMID: 30010707 DOI: 10.1093/abm/kax030] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Personality is a major predictor of many mental and physical disorders, but its contributions to illness course are understudied. Purpose The current study aimed to explore whether personality is associated with a course of psychiatric and medical illness over 10 years following trauma. Methods World Trade Center (WTC) responders (N = 532) completed the personality inventory for DSM-5, which measures both broad domains and narrow facets. Responders' mental and physical health was assessed in the decade following the WTC disaster during annual monitoring visits at a WTC Health Program clinic. Multilevel modeling was used in an exploratory manner to chart the course of health and functioning, and examine associations of maladaptive personality domains and facets with intercepts (initial illness) and slopes (course) of illness trajectories. Results Three maladaptive personality domains-negative affectivity, detachment and psychoticism-were uniquely associated with initial posttraumatic stress disorder (PTSD); detachment and psychoticism were also associated with initial functional impairment. Five facets-emotional lability, anhedonia, callousness, distractibility and perceptual dysregulation-were uniquely associated with initial mental and physical health and functional impairment. Anxiousness and depressivity facets were associated with worse initial levels of psychiatric outcomes only. With regard to illness trajectory, callousness and perceptual dysregulation were associated with the increase in PTSD symptoms. Anxiousness was associated with greater persistence of respiratory symptoms. Conclusions Several personality domains and facets were associated with initial levels and long-term course of illness and functional impairment in a traumatized population. Results inform the role of maladaptive personality in the development and maintenance of chronic mental-physical comorbidity. Personality might constitute a transdiagnostic prognostic and treatment target.
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Affiliation(s)
- Monika A Waszczuk
- Department of Psychiatry, Stony Brook University, Health Sciences Center, Stony Brook, New York, USA
| | - Kaiqiao Li
- Department of Psychiatry, Stony Brook University, Health Sciences Center, Stony Brook, New York, USA
| | - Camilo J Ruggero
- Department of Psychology, University of North Texas, Denton, TX, USA
| | - Sean A P Clouston
- Program in Public Health and Department of Preventive Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Benjamin J Luft
- Department of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Roman Kotov
- Department of Psychiatry, Stony Brook University, Health Sciences Center, Stony Brook, New York, USA
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Yoldi-Negrete M, Morera D, Palacios-Cruz L, Camarena B, Ortega H, Castañeda-Franco M, Becerra-Palars C, Martino D, Strejilevich S, Fresan A. Subsyndromal anxiety: Does it affect the quality of life? A study on euthymic patients with bipolar disorder. EUROPEAN JOURNAL OF PSYCHIATRY 2019. [DOI: 10.1016/j.ejpsy.2019.06.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Hayes L, Pössel P, Roane SJ. Perceived Everyday Discrimination and Depressive Symptoms: Does Cognitive Style Mediate? JOURNAL OF COUNSELING AND DEVELOPMENT 2019. [DOI: 10.1002/jcad.12291] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Lauren Hayes
- Department of Counseling and Human Development, University of Louisville
- Now at Department of Counseling, Educational Psychology, and Research, University of Memphis
| | - Patrick Pössel
- Department of Counseling and Human Development, University of Louisville
| | - Sarah J. Roane
- Department of Counseling and Human Development, University of Louisville
- Now at Dartmouth–Hitchcock Medical Center, Dartmouth Geisel School of Medicine, Dartmouth College
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Möller HJ, Volz HP, Dienel A, Schläfke S, Kasper S. Efficacy of Silexan in subthreshold anxiety: meta-analysis of randomised, placebo-controlled trials. Eur Arch Psychiatry Clin Neurosci 2019; 269:183-193. [PMID: 29150713 PMCID: PMC6726711 DOI: 10.1007/s00406-017-0852-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 11/02/2017] [Indexed: 12/19/2022]
Abstract
Subthreshold psychiatric disorders do not fully meet the diagnostic criteria of syndromal disorders but may be associated with comparable disability. To investigate the anxiolytic effect of Silexan, an active substance from lavender oil for oral administration, in patients with subthreshold anxiety, a meta-analysis that included all published trials with Silexan in this indication was performed. Three randomised, placebo-controlled trials in subthreshold anxiety disorders (anxiety disorder not otherwise specified, restlessness and agitation, mixed anxiety and depressive disorder) were included. Eligible participants with a baseline Hamilton Anxiety Rating Scale (HAMA) total score ≥ 18 points received 1 × 80 mg/day Silexan or placebo for 10 weeks. Outcomes included the HAMA, the Pittsburgh Sleep Quality Index, the Zung Self-rating Anxiety Scale, the Clinical Global Impressions questionnaire and the SF-36 health status inventory. Data were analysed using meta-analysis based on pooled raw data of individual patients (random effects models). A total of 697 patients were assessed for efficacy. Silexan was superior to placebo in reducing the HAMA total score during 10 weeks' treatment [mean value difference, 95% confidence interval: 3.83 (1.28; 6.37) points]. Superiority was comparably pronounced for psychic and somatic anxiety as well as for observer- and self-rated anxiety. Silexan had a beneficial effect on sleep (secondary to the anxiolytic effect) without causing sedation and improved the patients' health-related quality of life. Adverse event incidence in both treatment groups was comparable [risk ratio: 1.06 (0.85; 1.33)]. Silexan has a significant and clinically meaningful anxiolytic effect in subthreshold anxiety. The results cannot be generalised to other lavender oil products.
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Affiliation(s)
- Hans-Jürgen Möller
- 0000 0004 1936 973Xgrid.5252.0Clinic and Polyclinic for Psychiatry and Psychotherapy, Ludwig Maximilian University, Munich, Germany
| | - Hans-Peter Volz
- Hospital for Psychiatry, Psychotherapy and Psychosomatic Medicine Schloss Werneck, Werneck, Germany
| | - Angelika Dienel
- 0000 0004 0390 2958grid.476242.1Department of Clinical Research 1, Dr. Willmar Schwabe GmbH & Co. KG, Karlsruhe, Germany
| | - Sandra Schläfke
- 0000 0004 0390 2958grid.476242.1Department of Biostatistics, Dr. Willmar Schwabe GmbH & Co. KG, Karlsruhe, Germany
| | - Siegfried Kasper
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
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Todorović N, Ćosović V, Marić-Bojović N. Exposure to childhood trauma as a risk factor for affective and psychotic disorders. MEDICINSKI PODMLADAK 2018. [DOI: 10.5937/mp69-13900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Lawrence P, Fulbrook P, Somerset S, Schulz P. Motivational interviewing to enhance treatment attendance in mental health settings: A systematic review and meta-analysis. J Psychiatr Ment Health Nurs 2017; 24:699-718. [PMID: 28816412 DOI: 10.1111/jpm.12420] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/15/2017] [Indexed: 11/30/2022]
Abstract
UNLABELLED WHAT IS KNOWN ON THE SUBJECT?: Despite differences between samples, some literature reviews have suggested that MI is effective in enhancing treatment attendance for individuals with mental health issues. Little is known regarding the effects of MI as a pre-treatment on individuals who are not seeking treatment for mental health issues. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This systematic review of the literature and meta-analysis demonstrates that MI is most beneficial for individuals who are not seeking mental health treatment. MI represents an opportunity for health promotion when patients are unmotivated but may otherwise be amenable to an intervention. MI is effective as a pre-treatment intervention to motivate individuals to attend further post-MI treatment and counselling. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: MI is a process and a useful tool for clinicians in all therapeutic interactions, to motivate their patients to seek further assistance for mental heath issues. Health promotion and encouragement to attend further treatment sessions can be facilitated through telephone contact. ABSTRACT Introduction The stages of change model suggests that individuals seeking treatment are in the "preparation" or the "action" stage of change, which is the desired outcome of successful Motivational Interviewing (MI) interventions. MI is known to enhance treatment attendance among individuals with mental health problems. Aim This study examined the published research on MI as a pre-treatment to enhance attendance among individuals treatment-seeking and non-treatment-seeking for mental health issues. Methods Fourteen randomized controlled trials were identified, and MI efficacy was examined dichotomously: attendance or non-attendance for post-MI therapy. Subgroup analysis investigated treatment-seeking and non-treatment-seeking groups. Results Despite wide variations in sample sizes, blinding and monitoring, intervention fidelity was absent in the majority of published studies. Meta-analysis revealed that MI pre-treatment improved attendance relative to comparison groups. Conclusions Individuals not seeking treatment for mental health issues benefited the most from MI. Despite differences in MI treatment intensity, short interventions were as effective as longer interventions, whereas two MI sessions for as little as 15 min were effective in enhancing treatment attendance. Implications for Practice Motivational interviewing is a useful tool for clinicians in all therapeutic interactions to help motivate patients to seek assistance for mental health issues.
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Affiliation(s)
- P Lawrence
- Nursing Research and Practice Development Centre, The Prince Charles Hospital, Brisbane, Australia.,School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Brisbane, Australia
| | - P Fulbrook
- Nursing Research and Practice Development Centre, The Prince Charles Hospital, Brisbane, Australia.,School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Brisbane, Australia
| | - S Somerset
- School of Allied and Public Health, Australian Catholic University, Brisbane, Australia
| | - P Schulz
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Brisbane, Australia
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Bergman HE, Przeworski A, Feeny NC. Rates of Subthreshold PTSD Among U.S. Military Veterans and Service Members: A Literature Review. MILITARY PSYCHOLOGY 2017; 29:117-127. [PMID: 28630531 PMCID: PMC5473625 DOI: 10.1037/mil0000154] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Hannah E Bergman
- Case Western Reserve University, Department of Psychological Sciences, 10900 Euclid Avenue, Cleveland, OH 44106, USA
| | - Amy Przeworski
- Case Western Reserve University, Department of Psychological Sciences, 10900 Euclid Avenue, Cleveland, OH 44106, USA
| | - Norah C Feeny
- Case Western Reserve University, Department of Psychological Sciences, 10900 Euclid Avenue, Cleveland, OH 44106, USA
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Naragon-Gainey K, Simms LJ. Clarifying the Links of Conscientiousness With Internalizing and Externalizing Psychopathology. J Pers 2017; 85:880-892. [PMID: 27884039 DOI: 10.1111/jopy.12295] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Although Conscientiousness/disinhibition plays a substantial role in internalizing and externalizing psychopathology, the underlying mechanisms are not well understood. We aim to clarify facet-level associations and to examine whether (a) impairment mediates the link of Conscientiousness with internalizing and externalizing symptoms, and (b) demoralization (assessed via Neuroticism) accounts for their associations. METHOD A total of 450 participants (Mage = 42; primarily female and Caucasian) who reported current/recent psychiatric treatment completed two measures of domain- and facet-level traits (i.e., NEO-PI-3, PID-5), as well as interview measures of impairment and disorders. Correlation, regression, and mediation analyses were conducted. RESULTS Internalizing disorders (and particularly, the distress disorders) were uniquely associated with facets related to low self-efficacy, whereas externalizing disorders were uniquely associated with risk-taking and disregarding rules. For the internalizing disorders only, these associations were reduced after accounting for Neuroticism, though associations with distress disorders remained significant. Impairment mediated the link between Conscientiousness and symptoms for internalizing disorders, but not consistently for externalizing disorders. CONCLUSIONS The internalizing and externalizing disorders are associated with Conscientiousness due to different facet-level content. Demoralization and impairment both contribute to the link between internalizing disorders and Conscientiousness, whereas neither process accounts substantially for the relation of externalizing disorders with Conscientiousness.
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Buddeke J, Kooistra M, Zuithoff NPA, Gerritsen L, Biessels GJ, van der Graaf Y, Geerlings MI. Hippocampal volume and the course of depressive symptoms over eight years of follow-up. Acta Psychiatr Scand 2017; 135:78-86. [PMID: 27800603 DOI: 10.1111/acps.12662] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/10/2016] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To estimate the association between hippocampal and total brain volume and the course of depressive symptoms over eight years of follow-up in patients with a history of vascular disease. METHOD Within the SMART-Medea study, 636 participants (62 ± 10 years) had a 1.5-tesla brain MRI obtaining hippocampal and total brain volumes. Depressive symptoms were assessed with the Patient Health Questionnaire-9 biannually during eight-year follow-up. Generalized estimating equation models with robust standard errors were used to assess the associations of hippocampal and total brain volumes with depressive symptoms during follow-up adjusting for age, sex, education, and intracranial volume. An interaction term between volume and time (6-month intervals) was included to examine whether the course of depressive symptoms differed according to hippocampal and total brain volume. RESULTS The mean PHQ-9 score was 2.8 ± 3.5. Smaller hippocampal volumes were associated with an increasing course of depressive symptom levels, while larger volumes were associated with decreasing levels (P-value interaction = 0.07). Smaller total brain volume was associated with consistently higher levels of depressive symptoms, but not with change in course of depressive symptoms (P-value interaction = 0.45). CONCLUSION Smaller hippocampal volume but not total brain volume is associated with poorer course of depressive symptoms over eight years of follow-up.
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Affiliation(s)
- J Buddeke
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M Kooistra
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - N P A Zuithoff
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - L Gerritsen
- Department of Psychiatry, VU Medical Center Amsterdam, Amsterdam, The Netherlands.,Department of Medical Epidemiology and Biostatistics, Karolinska Institute Stockholm, Stockholm, Sweden
| | - G J Biessels
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Y van der Graaf
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M I Geerlings
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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Karpov B, Joffe G, Aaltonen K, Suvisaari J, Baryshnikov I, Näätänen P, Koivisto M, Melartin T, Oksanen J, Suominen K, Heikkinen M, Paunio T, Isometsä E. Anxiety symptoms in a major mood and schizophrenia spectrum disorders. Eur Psychiatry 2016; 37:1-7. [PMID: 27447101 DOI: 10.1016/j.eurpsy.2016.04.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 04/07/2016] [Accepted: 04/12/2016] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Comorbid anxiety symptoms and disorders are present in many psychiatric disorders, but methodological variations render comparisons of their frequency and intensity difficult. Furthermore, whether risk factors for comorbid anxiety symptoms are similar in patients with mood disorders and schizophrenia spectrum disorders remains unclear. METHODS The Overall Anxiety Severity and Impairment Scale (OASIS) was used to measure anxiety symptoms in psychiatric care patients with schizophrenia or schizoaffective disorder (SSA, n=113), bipolar disorder (BD, n=99), or depressive disorder (DD, n=188) in the Helsinki University Psychiatric Consortium Study. Bivariate correlations and multivariate linear regression models were used to examine associations of depressive symptoms, neuroticism, early psychological trauma and distress, self-efficacy, symptoms of borderline personality disorder, and attachment style with anxiety symptoms in the three diagnostic groups. RESULTS Frequent or constant anxiety was reported by 40.2% of SSA, 51.5% of BD, and 55.6% of DD patients; it was described as severe or extreme by 43.8%, 41.4%, and 41.2% of these patients, respectively. SSA patients were significantly less anxious (P=0.010) and less often avoided anxiety-provoking situations (P=0.009) than the other patients. In regression analyses, OASIS was associated with high neuroticism, symptoms of depression and borderline personality disorder and low self-efficacy in all patients, and with early trauma in patients with mood disorders. CONCLUSIONS Comorbid anxiety symptoms are ubiquitous among psychiatric patients with mood or schizophrenia spectrum disorders, and in almost half of them, reportedly severe. Anxiety symptoms appear to be strongly related to both concurrent depressive symptoms and personality characteristics, regardless of principal diagnosis.
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Affiliation(s)
- B Karpov
- Department of Psychiatry, University of Helsinki, Helsinki University Hospital, PO Box 22 (Välskärinkatu 12 A), 00014 Helsinki, Finland
| | - G Joffe
- Department of Psychiatry, University of Helsinki, Helsinki University Hospital, PO Box 22 (Välskärinkatu 12 A), 00014 Helsinki, Finland
| | - K Aaltonen
- Department of Psychiatry, University of Helsinki, Helsinki University Hospital, PO Box 22 (Välskärinkatu 12 A), 00014 Helsinki, Finland
| | - J Suvisaari
- Institute for Health and Welfare, Department of Mental Health and Substance Abuse Services, Mannerheimintie 166, 00271 Helsinki, Finland
| | - I Baryshnikov
- Department of Psychiatry, University of Helsinki, Helsinki University Hospital, PO Box 22 (Välskärinkatu 12 A), 00014 Helsinki, Finland
| | - P Näätänen
- Department of Psychiatry, University of Helsinki, Helsinki University Hospital, PO Box 22 (Välskärinkatu 12 A), 00014 Helsinki, Finland
| | - M Koivisto
- Department of Psychiatry, University of Helsinki, Helsinki University Hospital, PO Box 22 (Välskärinkatu 12 A), 00014 Helsinki, Finland
| | - T Melartin
- Department of Psychiatry, Helsinki University Central Hospital, PO Box 590, 00029 Helsinki, Finland
| | - J Oksanen
- Institute for Health and Welfare, Department of Mental Health and Substance Abuse Services, Mannerheimintie 166, 00271 Helsinki, Finland
| | - K Suominen
- Institute for Health and Welfare, Department of Mental Health and Substance Abuse Services, Mannerheimintie 166, 00271 Helsinki, Finland; Department of Social Services and Health Care, Helsinki, Finland
| | - M Heikkinen
- Department of Psychiatry, University of Helsinki, Helsinki University Hospital, PO Box 22 (Välskärinkatu 12 A), 00014 Helsinki, Finland
| | - T Paunio
- Department of Psychiatry, University of Helsinki, Helsinki University Hospital, PO Box 22 (Välskärinkatu 12 A), 00014 Helsinki, Finland; Institute for Health and Welfare, Department of Mental Health and Substance Abuse Services, Mannerheimintie 166, 00271 Helsinki, Finland
| | - E Isometsä
- Department of Psychiatry, University of Helsinki, Helsinki University Hospital, PO Box 22 (Välskärinkatu 12 A), 00014 Helsinki, Finland; Institute for Health and Welfare, Department of Mental Health and Substance Abuse Services, Mannerheimintie 166, 00271 Helsinki, Finland.
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Hendriks SM, Spijker J, Licht CMM, Hardeveld F, de Graaf R, Batelaan NM, Penninx BWJH, Beekman ATF. Long-term disability in anxiety disorders. BMC Psychiatry 2016; 16:248. [PMID: 27431392 PMCID: PMC4950589 DOI: 10.1186/s12888-016-0946-y] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 06/24/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND This longitudinal study aims to investigate differences in long-term disability between social anxiety disorder (SAD), panic disorder with agoraphobia (PDA), panic disorder without agoraphobia (PD), generalized anxiety disorder (GAD) and multiple anxiety disorders (multiple AD), focusing on the effects of different course trajectories (remission, recurrence and chronic course) and specific symptom dimensions (anxiety arousal and avoidance behaviour). METHODS Data were used from participants with no psychiatric diagnosis (healthy controls, n = 647) or with a current anxiety disorder (SAD, n = 191; PDA, n = 90; PD, n = 84; GAD, n = 110; multiple AD, n = 480). Severity of anxiety arousal and avoidance behaviour symptoms was measured using the Beck Anxiety Inventory and the Fear Questionnaire. The World Health Organization Disability Assessment Schedule II was used to measure disability. RESULTS Long-term disability was most prevalent in participants with SAD and multiple AD, and lowest in PDA and PD. GAD had an intermediate position. Anxiety arousal and avoidance behaviour were associated with more long-term disability in anxiety disorders than course trajectories. CONCLUSIONS Various anxiety disorders have different disability levels over 4 years of time, therefore diagnostic distinction is important for treatment focus. Anxiety arousal and avoidance behaviour are major predictors for long-term disability in anxiety disorders.
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Affiliation(s)
- Sanne M. Hendriks
- Department of Psychiatry, Pro Persona Mental Health Care, Zandstraat 54, Veenendaal, 3905 ED The Netherlands
| | - Jan Spijker
- Pro Persona Mental Health Care, Radboud University Nijmegen, Reinier Postlaan 6, Nijmegen, 6525 GC The Netherlands
| | - Carmilla M. M. Licht
- Department of Psychiatry/EMGO Institute, VU University Medical Center, AJ Ernststraat 887, Amsterdam, 1081 HL The Netherlands
| | - Florian Hardeveld
- Pro Persona Mental Health Care, Willy Brandtlaan 20, Ede, 6717 RR The Netherlands
| | - Ron de Graaf
- Netherlands Institute of Mental Health and Addiction, Da Costakade 45, Utrecht, 3521 VS The Netherlands
| | - Neeltje M. Batelaan
- Department of Psychiatry/EMGO Institute, VU University Medical Center, AJ Ernststraat 887, Amsterdam, 1081 HL The Netherlands
| | - Brenda W. J. H. Penninx
- Department of Psychiatry/EMGO Institute, VU University Medical Center, AJ Ernststraat 887, Amsterdam, 1081 HL The Netherlands
| | - Aartjan T. F. Beekman
- Department of Psychiatry/EMGO Institute, VU University Medical Center, AJ Ernststraat 887, Amsterdam, 1081 HL The Netherlands
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Carnide N, Franche RL, Hogg-Johnson S, Côté P, Breslin FC, Severin CN, Bültmann U, Krause N. Course of Depressive Symptoms Following a Workplace Injury: A 12-Month Follow-Up Update. JOURNAL OF OCCUPATIONAL REHABILITATION 2016; 26:204-215. [PMID: 26324252 DOI: 10.1007/s10926-015-9604-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Introduction To estimate the prevalence, incidence and course of depressive symptoms, their relationship with return-to-work, and prevalence of depression diagnosis/treatment 12 months following a lost-time workplace musculoskeletal injury. Methods In a prospective cohort study, 332 workers' compensation claimants with a back or upper extremity musculoskeletal disorder completed interviews at 1, 6 and 12 months post-injury. Participants self-reported they had not received a depression diagnosis 1 year pre-injury. Cutoff of 16 on the CES-D defined a high level of depressive symptoms. Self-reported data on depression diagnosis and treatment and work status since injury were collected. Results Cumulative incidence of high depressive symptom levels over 12 months was 50.3 % (95 % CI 44.9-55.7 %). At 12 months, 24.7 % (95 % CI 20.1-29.3 %) of workers exhibited high levels. Over 12 months, 49.7 % (95 % CI 44.3-55.1 %) had low levels at all 3 interviews, 14.5 % (95 % CI 10.7-18.2 %) had persistently high levels, and 25.6 % (95 % CI 20.9-30.3 %) demonstrated improvements. Among workers with low baseline levels, incidence of high levels at 12 months was 6.0 % (95 % CI 2.7-9.3 %). For workers with high baseline levels, 36.1 % (95 % CI 27.9-44.3 %) exhibited persistent high symptoms at 6 and 12 months, while 38.4 % (95 % CI 30.1-46.6 %) experienced low levels at 6 and 12 months. Problematic RTW outcomes were common among workers with a poor depressive symptom course. Among workers with persistent high symptoms, 18.8 % (95 % CI 7.7-29.8 %) self-reported receiving a depression diagnosis by 12 months and 29.2 % (95 % CI 16.3-42.0 %) were receiving treatment at 12 months. Conclusions Depressive symptoms are common in the first year following a lost-time musculoskeletal injury and a poor depressive symptom course is associated with problematic RTW outcomes 12 months post-injury. While symptoms appear to improve over time, the first 6 months appear to be important in establishing future symptom levels and may represent a window of opportunity for early screening.
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Affiliation(s)
- Nancy Carnide
- Institute for Work & Health, 481 University Avenue, Suite 800, Toronto, ON, M5G 2E9, Canada.
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
| | - Renée-Louise Franche
- Institute for Work & Health, 481 University Avenue, Suite 800, Toronto, ON, M5G 2E9, Canada
- WorkSafe BC, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Sheilah Hogg-Johnson
- Institute for Work & Health, 481 University Avenue, Suite 800, Toronto, ON, M5G 2E9, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Pierre Côté
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, ON, Canada
| | - F Curtis Breslin
- Institute for Work & Health, 481 University Avenue, Suite 800, Toronto, ON, M5G 2E9, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- General Education Department, Seneca College of Applied Arts and Technology, Toronto, ON, Canada
| | - Colette N Severin
- Institute for Work & Health, 481 University Avenue, Suite 800, Toronto, ON, M5G 2E9, Canada
| | - Ute Bültmann
- Institute for Work & Health, 481 University Avenue, Suite 800, Toronto, ON, M5G 2E9, Canada
- Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Niklas Krause
- Department of Environmental Health Sciences and Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
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Schmaal L, Marquand AF, Rhebergen D, van Tol MJ, Ruhé HG, van der Wee NJA, Veltman DJ, Penninx BWJH. Predicting the Naturalistic Course of Major Depressive Disorder Using Clinical and Multimodal Neuroimaging Information: A Multivariate Pattern Recognition Study. Biol Psychiatry 2015; 78:278-86. [PMID: 25702259 PMCID: PMC4449319 DOI: 10.1016/j.biopsych.2014.11.018] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 11/07/2014] [Accepted: 11/08/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND A chronic course of major depressive disorder (MDD) is associated with profound alterations in brain volumes and emotional and cognitive processing. However, no neurobiological markers have been identified that prospectively predict MDD course trajectories. This study evaluated the prognostic value of different neuroimaging modalities, clinical characteristics, and their combination to classify MDD course trajectories. METHODS One hundred eighteen MDD patients underwent structural and functional magnetic resonance imaging (MRI) (emotional facial expressions and executive functioning) and were clinically followed-up at 2 years. Three MDD trajectories (chronic n = 23, gradual improving n = 36, and fast remission n = 59) were identified based on Life Chart Interview measuring the presence of symptoms each month. Gaussian process classifiers were employed to evaluate prognostic value of neuroimaging data and clinical characteristics (including baseline severity, duration, and comorbidity). RESULTS Chronic patients could be discriminated from patients with more favorable trajectories from neural responses to various emotional faces (up to 73% accuracy) but not from structural MRI and functional MRI related to executive functioning. Chronic patients could also be discriminated from remitted patients based on clinical characteristics (accuracy 69%) but not when age differences between the groups were taken into account. Combining different task contrasts or data sources increased prediction accuracies in some but not all cases. CONCLUSIONS Our findings provide evidence that the prediction of naturalistic course of depression over 2 years is improved by considering neuroimaging data especially derived from neural responses to emotional facial expressions. Neural responses to emotional salient faces more accurately predicted outcome than clinical data.
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Affiliation(s)
- Lianne Schmaal
- Department of Psychiatry and Neuroscience Campus Amsterdam, VU University Medical Center Amsterdam, Amsterdam, The Netherlands.
| | - Andre F Marquand
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands; Department of Neuroimaging, Institute of Psychiatry, King's College London, United Kingdom
| | - Didi Rhebergen
- Department of Psychiatry and the EMGO(+) Institute for Health and Care Research, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Marie-José van Tol
- Neuroimaging Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Henricus G Ruhé
- Neuroimaging Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Department of Psychiatry, Mood and Anxiety Disorders, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Nic J A van der Wee
- Department of Psychiatry (NJvdW), Leiden University Medical Center, Leiden University, Leiden, The Netherlands
| | - Dick J Veltman
- Department of Psychiatry and Neuroscience Campus Amsterdam, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Brenda W J H Penninx
- Department of Psychiatry and Neuroscience Campus Amsterdam, VU University Medical Center Amsterdam, Amsterdam, The Netherlands; Department of Psychiatry and the EMGO(+) Institute for Health and Care Research, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
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Solberg Ø, Blix I, Heir T. The aftermath of terrorism: posttraumatic stress and functional impairment after the 2011 Oslo bombing. Front Psychol 2015; 6:1156. [PMID: 26300833 PMCID: PMC4528096 DOI: 10.3389/fpsyg.2015.01156] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 07/24/2015] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE In the present study we wanted to investigate the link between exposure, posttraumatic stress symptomatology, and functional impairment in the aftermath of terrorism. METHOD Posttraumatic stress symptomatology and functional impairment related to the Oslo bombing 22nd of July, 2011, in directly and indirectly exposed individuals (N = 1927) were assessed together with demographics, exposure, peri-traumatic reactions, and event centrality approximately 1 year after the attack. RESULTS Directly and indirectly exposed individuals qualifying for posttraumatic stress disorder (PTSD) reported similar peri-traumatic reactions, event centrality, and functional impairment. However, clusters within the PTSD symptomatology were differentially associated with impairment as a function of their exposure. In the directly exposed group, all clusters within the PTSD symptomatology were associated with impairment in function, while only emotional numbing was associated with impairment within the indirectly exposed group. CONCLUSION Considering that terror attacks frequently involve directly exposed individuals and a larger population of indirectly exposed individuals, this finding is of importance, especially in the design of intervention programs and the development of treatment policies.
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Affiliation(s)
- Øivind Solberg
- Norwegian Centre for Violence and Traumatic Stress Studies Oslo, Norway
| | - Ines Blix
- Norwegian Centre for Violence and Traumatic Stress Studies Oslo, Norway
| | - Trond Heir
- Norwegian Centre for Violence and Traumatic Stress Studies Oslo, Norway ; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo Norway
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The prevalence and burden of subthreshold generalized anxiety disorder: a systematic review. BMC Psychiatry 2014; 14:128. [PMID: 24886240 PMCID: PMC4048364 DOI: 10.1186/1471-244x-14-128] [Citation(s) in RCA: 150] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Accepted: 04/23/2014] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND To review the prevalence and impact of generalized anxiety disorder (GAD) below the diagnostic threshold and explore its treatment needs in times of scarce healthcare resources. METHODS A systematic literature search was conducted until January 2013 using PUBMED/MEDLINE, PSYCINFO, EMBASE and reference lists to identify epidemiological studies of subthreshold GAD, i.e. GAD symptoms that do not reach the current thresholds of DSM-III-R, DSM-IV or ICD-10. Quality of all included studies was assessed and median prevalences of subthreshold GAD were calculated for different subpopulations. RESULTS Inclusion criteria led to 15 high-quality and 3 low-quality epidemiological studies with a total of 48,214 participants being reviewed. Whilst GAD proved to be a common mental health disorder, the prevalence for subthreshold GAD was twice that for the full syndrome. Subthreshold GAD is typically persistent, causing considerably more suffering and impairment in psychosocial and work functioning, benzodiazepine and primary health care use, than in non-anxious individuals. Subthreshold GAD can also increase the risk of onset and worsen the course of a range of comorbid mental health, pain and somatic disorders; further increasing costs. Results are robust against bias due to low study quality. CONCLUSIONS Subthreshold GAD is a common, recurrent and impairing disease with verifiable morbidity that claims significant healthcare resources. As such, it should receive additional research and clinical attention.
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Anxiety sensitivity and impairment: evidence for a direct association and partial mediation by subclinical anxiety symptoms. J Affect Disord 2013; 151:875-81. [PMID: 24091303 DOI: 10.1016/j.jad.2013.07.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2013] [Revised: 06/27/2013] [Accepted: 07/31/2013] [Indexed: 11/20/2022]
Abstract
BACKGROUND Mounting evidence suggests that specific psychological risk factors increase the likelihood for the development of anxiety psychopathology. Anxiety sensitivity (AS), the fear of the consequences of anxiety, is one such risk factor. However, very little is known about the consequences of having elevated AS prior to the development of diagnosable psychopathology. We hypothesized that elevated AS may create impairment among premorbid individuals. The aims of the present study were twofold. The first aim was to examine whether having elevated AS would be predictive of impairment in a nonclinical sample. The second aim was to examine whether subclinical anxiety symptoms would partially mediate the association between AS and impairment in daily life. METHOD These aims were examined in two studies utilizing samples of individuals with elevated levels of AS. Study 1 (N=387) and Study 2 (N=79) were comprised of participants with elevated AS. Participants completed a battery of questionnaires and a diagnostic interview to assess for risk status. Only participants without an anxiety disorder were eligible to participate in the study to ensure that they were in the premorbid stage. RESULTS In Study 1, there was a direct effect of AS on impairment. Additionally, there was evidence for anxiety symptoms acting as a partial mediator in the relation between AS and impairment. Study 2 revealed the same pattern of results, with AS having a significant direct effect on impairment that was partially mediated by anxiety symptoms. LIMITATIONS The samples utilized in the present sample were primarily Caucasian females, thereby potentially limiting the generalizability of these findings. CONCLUSIONS This study provides evidence that a premorbid risk factor is associated with impairment before the actual development of an anxiety disorder. Implications of the present investigation and future directions are discussed.
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