Pathways to anxiety-depression comorbidity: A longitudinal examination of childhood anxiety disorders

The role of the lateral septum in neuropsychiatric disease

The lateral septum (LS) is a structure in the midline of the brain that is interconnected with areas associated with stress and feeding. This review highlights the role of the LS in anxiety, depression, and eating disorders and their comorbidity. There is a prevailing view that the LS is anxiolytic. This review finds that the LS is both anxiolytic and anxiogenic. Furthermore, the LS can promote and inhibit feeding. Given these shared roles, the LS represents a common site for the comorbidity of neuropsychiatric disorders, and therefore a potential pharmacological target. This is crucial since currently available treatments are not always effective. Corticotrophin-releasing factor 2 antagonists are potential drugs for the treatment of anxiety and anorexia and require further research. Furthermore, other drugs currently in trials for binge eating, such as alpha-adrenergic agonists, may in fact promote food intake. It is hoped that the advancements in chemo- and optogenetic techniques will allow future studies to profile the specific neural connections of the LS and their function. This information could facilitate our understanding of the underlying mechanisms, and therefore pharmacological targets, of these psychiatric conditions.

Eczema is a shared risk factor for anxiety and depression: A meta-analysis and systematic review

Globally, anxiety and depression are the most common psychiatric disorders that add large burdens to individuals and society; however, the mechanisms underlying these disorders are unclear. Several studies have found that eczema is a shared risk factor for both these conditions. We identified and evaluated eligible observational studies from EMBASE and PubMed. In total, 20 relevant cohort and case-control studies comprising 141,910 patients with eczema and 4,736,222 control participants fulfilled our established criteria. Information extracted included study design, location, sample size, sex distribution of cases and controls or reference cohorts, measurements of outcomes, odds ratio (OR) with 95% confidence interval (CI), and adjusted factors for exposure associated with outcome risk. The meta-analysis was performed by calculating the pooled OR with 95% CI, and heterogeneity was assessed using Cochrane Q and I2 statistics. The pooled effect showed a positive association (n = 4,896,099, OR = 1.63, 95% CI [1.42-1.88], p<0.001) between eczema and depression or anxiety, with positive associations also observed in the depression (n = 4,878,746, OR = 1.64, 95% CI [1.39-1.94], p<0.001) and anxiety (n = 4,607,597, OR = 1.68, 95% CI [1.27-2.21], p<0.001) groups. Subgroup and sensitivity analyses confirmed that these findings were stable and reliable. This study suggests that eczema is associated with an increased risk of developing depression and anxiety, which may assist clinicians in the prevention or treatment of these disorders.

Mediators between Positive and Negative Parenting and Child Depressive and Anxious Symptoms: Findings from a Diverse, At-Risk Sample

Background: Although children’s depressive and anxious symptoms have been broadly construed as internalizing problems, the current study sought to identify factors that may differentially contribute to these two mental health problems in a high-risk sample. Prior research has not adequately tested both depressive versus anxious symptoms simultaneously, nor has it adequately considered the role of negative versus positive parenting simultaneously, thereby neglecting the potential overlap in both sets of constructs. Overlooking such potential statistical overlap obfuscates how factors may differentially contribute to either depressive versus anxious symptoms. Existing research has also focused on lower-risk community samples. Method: The present study investigated whether children’s negative self-concept or maladaptive attributional style mediated the link between both negative and positive parenting in a racially diverse, at-risk sample of 65 primary school-age children recruited from mental health agencies. Results: When tested together, more negative parenting, but not less positive parenting, retained direct effects on both depressive and anxious symptoms. Both negative self-concept and maladaptive attributional style fully mediated the association between less positive parenting and children’s depressive symptoms, whereas positive self-concept, but not attributional style, mediated between less positive parenting and anxious symptoms. Conclusions: The current findings underscore potential differential intervention targets for these two internalizing problems and highlight the need for future research to consider both depressive and anxious symptoms, and related predictors, simultaneously to control for their shared variance.

Anxiety and depression in individuals with and without cancer during the early COVID-19 pandemic period

Introduction/Objective. The COVID-19 disease, which has turned into an important public health problem, has negatively affected individuals not only physically but also psychologically. The aim of this study is to examine the anxiety and depression status of cancer patients, comparing to individuals with non-cancer chronic diseases and healthy individuals during the COVID-19 pandemic period. Methods. This cross-sectional study was conducted during the COVID-19 pandemic period between May 8 and June 25, 2020 with 1107 people in Turkey. The mean age of the participants in the study was 36.41 ? 12.80. The sample comprised three groups: cancer group (n = 262), chronic disease control group (n = 250), and healthy control group (n = 595). The data were collected with the Descriptive Characteristics Form and Hospital Anxiety and Depression Scale. Results. The anxiety and depression scores were found to be higher in patients with cancer comparing to the other two groups. Having cancer was predictive of higher anxiety and depression score explaining13% of the anxiety scores variance and 17% of the depression scores variance. Patients with the non-cancer chronic diseases, and healthy participants had anxiety and depression mean scores in the range of the borderline level. Conclusion. These findings suggest that depression and anxiety rates among patients with cancer are specifically higher comparing to patients with other chronic diseases and healthy individuals. The levels of anxiety and depression in the latter two groups should also be paid attention to during the pandemic. This study may have important practical implications in terms of the need for psychological screening. This study was registered at the Protocol Registration and Results System (https://www.clinicaltrials.gov) with the registration number NCT04698044.

Comparative Proteomics of Rat Olfactory Bulb Reveal Insights into Susceptibility and Resiliency to Chronic-stress-induced Depression or Anxiety

Chronic stress causes the abnormality of olfactory bulb (OB) in both anxiety and depression, however, the unique and common neurobiological underpinnings are still poorly understood. Previously, we built the three groups by chronic mild stress (CMS), depression-susceptible (Dep-Sus): with depression-like behavior, anxiety-susceptible (Anx-Sus): with anxiety-like behavior and insusceptible (Insus): without depression- and anxiety-like behaviors. To continuously explore the protein expression changes in these three groups, comparative quantitative proteomics analysis was conducted on the rat OB as crucial part of the olfactory system. Next, bioinformatics analyses were implemented whereas protein expressions were independently analyzed by parallel reaction monitoring (PRM) or Western blot (WB). The OB-proteome analysis identified totally 133 differentially expressed proteins as a CMS response. These deregulated proteins were involved in multiple functions and significant pathways potentially correlated with phenotypes of maladaptive behavior of depression or anxiety as well as adaptive behavior, and hence might act as potential candidate protein targets. The subsequent PRM-based or WB-based analyses showed that changes in Nefl, Mtmr7 and Tk2; Prkaca, Coa3, Cox6c2, Lamc1 and Tubal3; and Pabpn1, Nme3, Sos1 and Lum were uniquely associated with Dep-Sus, Anx-Sus, and Insus groups, respectively. These phenotype-specific deregulated proteins were primarily involved in multiple metabolic and signaling pathways, suggesting that the identical CMS differently impacted the olfactory protein regulation system and biological processes. To sum up, our present data as a useful proteomics underpinning provided the common and distinct molecular insights into the biochemical understanding of OB dysfunction underlying susceptibility and resiliency to chronic-stress-induced anxiety or depression.

Antidepressant Use in a 3- to 12-Year Follow-up of Anxious Youth: Results from the CAMELS Trial

The current study explored whether patient characteristics predicted patterns of antidepressant use (i.e., never used, single episode of use, or two or more episodes) in a naturalistic follow-up. Participants in the child/adolescent multimodal (CAMS) extended long-term study. (n = 318) indicated medication use over the course of eight follow-up visits, 3-12 years after receiving treatment in CAMS. 40.6% of participants reported never using an antidepressant during follow-up, 41.4% reported a single episode of antidepressant use, and 18.0% reported multiple episodes of antidepressant use. Greater baseline anxiety severity marginally predicted a single episode of antidepressant use; baseline depression severity predicted multiple episodes of use. Reasons for discontinuing antidepressants included perceived ineffectiveness (31.8%), side effects (25.5%), and improvement in symptoms (18.5%). Exploratory analyses examined predictors of medication use. Findings suggest that antidepressant use is common among anxious youth, as is discontinuation of antidepressant use. Clinical implications and future directions are discussed.

Changes in network centrality of psychopathology symptoms between the COVID-19 outbreak and after peak

The current study investigated the mechanism and changes in psychopathology symptoms throughout the COVID-19 outbreak and after peak. Two studies were conducted separately in China during outbreak and the after peak stages, with 2540 participants were recruited from February 6 to 16, 2020, and 2543 participants were recruited from April 25 to May 5, 2020. The network models were created to explore the relationship between psychopathology symptoms both within and across anxiety and depression, with anxiety measured by the Generalized Anxiety Disorder-7 and depression measured by the Patient Health Questionnaire-9. Symptom network analysis was conducted to evaluate network and bridge centrality, and the network properties were compared between the outbreak and after peak. Noticeably, psychomotor symptoms such as impaired motor skills, restlessness, and inability to relax exhibited high centrality during the outbreak, which still relatively high but showed substantial remission during after peak stage (in terms of strength, betweenness, or bridge centrality). Meanwhile, symptoms of irritability (strength, betweenness, or bridge centrality) and loss of energy (bridge centrality) played an important role in the network after the peak of the pandemic. This study provides novel insights into the changes in central features during the different COVID-19 stages and highlights motor-related symptoms as bridge symptoms, which could activate the connection between anxiety and depression. The results revealed that restrictions on movement were associated with worsen in psychomotor symptoms, indicating that future psychological interventions should target motor-related symptoms as priority.

Association of ADHD symptoms, depression and suicidal behaviors with anxiety in Chinese medical college students

BACKGROUND

Anxiety is one of the most common psychiatric disorder and imposes a great burden on both the individual and the society. Previous studies indicate a high comorbidity of anxiety disorders and Attention Deficit Hyperactivity Disorder (ADHD). However, few studies have examined the comorbidity of anxiety and ADHD among medical college students in mainland China. This study aimed to examine the prevalence of anxiety and the associated risk factor of anxiety disorder as well as to explore the association between ADHD symptoms, depression, suicidal behaviors and anxiety.

METHODS

A cross-sectional design was employed among 4882 medical college students who were recruited and enrolled with convenience sampling. Self-reported demographic information and clinical characteristics were collected online on a computer or through a social media app named Wechat.

RESULTS

The prevalence of anxiety in this study was 19.9%. Students with anxiety were more likely to have a poor relationship with parents, be of Han nationality, have smoking or drinking habits, have an extensive physical disorder history and have engaged in suicidal behaviors. The independent risk factors for anxiety were: smoking, physical disorder history, suicidal ideations, suicide attempts, inattention and hyperactivity. Significant associations were observed between anxiety and depression, inattention, hyperactivity, suicide plans and suicide attempts.

CONCLUSIONS

Nearly one in five medical students suffered from anxiety. The findings of this study indicate the importance of addressing both anxiety and ADHD symptoms in order to better promote mental health and the well-being of medical students as well as reduce suicidal behaviors.

Anxiety-Depression of Dialysis Patients and Their Caregivers

Background and Objectives: Anxiety–depression of patients undergoing hemodialysis has a strong relation with the levels of anxiety–depression of their caregivers. The aim of this study was to evaluate anxiety–depression of dialysis patients and their caregivers. Materials and Methods: In this cross-sectional study, 414 pairs of patients and caregivers from 24 hemodialysis centers of Greece completed the Hospital Anxiety and Depression Scale (HADS). The statistical analysis of the data was performed through the Statistical Program SPSS version 20.0. The statistical significance level was set up at 5%. Results: The mean age of patients was 64 (54.06–72.41) years old and the mean duration of hemodialysis was 36 (16–72) months. The mean age of caregivers was 54 (44–66) years old. Of the total sample, 17.1% (n = 71) of patients had high levels of anxiety and 12.3% (n = 51) had high levels of depression. Additionally, 27.8% (n = 115) of caregivers had high levels of anxiety and 11.4% (n = 47) had high levels of depression. Caregivers had higher levels of anxiety when their patients had high levels of anxiety as well (42.3%). Additionally, they had higher levels of depression when their patients had high levels of depression as well (17.6%). Conclusions: The results of this study showed a significant association between the levels of anxiety and depression among patients and caregivers. There is a necessity for individualized assessment of dialysis patients and their caregivers and the implementation of specific interventions for reducing the levels of anxiety and depression among them.

A Longitudinal Follow-up Study Examining Adolescent Depressive Symptoms as a Function of Prior Anxiety Treatment

OBJECTIVE

Children who are fearful and anxious are at heightened risk for developing depression in adolescence. Treating anxiety disorders in pre-/early adolescence may be one mechanism through which depressive symptoms later in adolescence can be prevented. We hypothesized that anxious youth who responded positively to cognitive-behavioral therapy (CBT) for anxiety would show reduced onset of depressive symptoms 2 years later compared to treatment nonresponders, and that this effect would be specific to youth treated with CBT compared to an active supportive comparison treatment.

METHOD

Participants were 80 adolescents ages 11 to 17 years who had previously completed a randomized trial comparing predictors of treatment response to CBT and child-centered therapy (CCT). Youth met DSM-IV criteria for generalized, separation, and/or social anxiety disorder at the time of treatment. The present study was a prospective naturalistic 2-year follow-up examining trajectories toward depression, in which participants were reassessed for depressive symptoms 2 years after anxiety treatment. Treatment response was defined as a 35% reduction in independent evaluator-rated anxiety severity on the Pediatric Anxiety Rating Scale after treatment.

RESULTS

As hypothesized, lower levels of depressive symptoms were observed in anxious youth who responded to CBT for anxiety (β = -0.807, p = .004) but not CCT (β = 0.254, p = .505). Sensitivity analyses showed that the effects were driven by girls.

CONCLUSION

Findings suggest that CBT for anxiety is a promising approach to preventing adolescent depressive symptomatology, especially among girls. The results highlight the need for better early screening for anxiety and better dissemination of CBT programs targeting anxiety in youth.

Child sex moderates the relationship between cortisol stress reactivity and symptoms over time

BACKGROUND

Past work suggests that individual differences in stress reactivity have implications for the development of psychopathology; in particular, females' stress reactivity appears more closely tied to internalizing symptoms than males' reactivity. Conversely, males who are under-reactive to threat may be at risk for externalizing problems. However, little is known about when such differences may emerge, although this knowledge could have implications for early prevention.

METHODS

Cortisol reactivity to a laboratory stressor was assessed in 409 three-year-old children (201 boys), along with parent-reported children's internalizing (anxiety and depression) and externalizing (oppositional-defiant and attention problems and hyperactivity) symptoms. Parent-reported symptoms were re-collected at child ages 5 (N = 379) and 8 (N = 364). Multilevel modelling was used to investigate whether the relationship between cortisol reactivity and symptoms differed between boys and girls over time.

RESULTS

Girls with lower cortisol reactivity showed a negative association between depressive symptoms and time, while girls with higher reactivity showed no such association. No interaction between sex and cortisol reactivity was found for anxious symptoms. Boys with higher cortisol reactivity showed a negative association between symptoms and time, while boys with lower cortisol reactivity showed no such association. Time and ADHD symptoms were unrelated for boys, regardless of their cortisol reactivity.

CONCLUSIONS

Findings suggest that the implications of stress reactivity indexed via cortisol vary for boys and girls, as well as for different symptom manifestations.

Prevalence of DSM-5 depressive disorders and comorbidity in Spanish early adolescents: Has there been an increase in the last 20 years?

The aim of the study was to investigate the current prevalence of DSM-5 Depressive Disorders (DD) among Spanish school children and compare it with data obtained 20 years ago from the same place. We assessed comorbidity, severity and sociodemographic related factors. With a double-phase design, a sample of 1514 students participated in the 1st phase and 562 students (175 at risk of depression) were assessed in the 2nd phase with the Mini-International Neuropsychiatric Interview for Kids. The estimated current prevalence of Major Depressive Disorder (MDD) was 1.6%, similar to the 1.5% found 20 years ago. A total of 3.4% were diagnosed with some form of DD (MDD or Persistent Depressive Disorder (PDD)). No significant differences between genders were found in either of the two periods studied. The rate of depressive symptoms (11.6%) was not significantly different from that of previous data (9.4%). 80% and 71.9% of the children diagnosed with MDD and PDD respectively also had an anxiety disorder. In conclusion, we have not found an increase in depression among Spanish early adolescents. However, the data on the prevalence of DD, the comorbidity, and the impairment all highlight the need to design and implement appropriate preventive interventions in schools.

Anxiety-related disorders: An overview

Anxiety-related disorders are common in the child and adolescent population. They cause significant distress, which can affect social, emotional, family and academic functioning. They frequently present in general paediatric and primary care settings. Comprehensive assessment should include the child as well as parent and family functioning because anxiety-related disorders in other family members are common and, if untreated, can affect outcomes for the child. There are good evidence-based psychological interventions available, which should be the first line of treatment offered; accessing appropriate therapies for an adequate duration of treatment can, however, be challenging. Medication, particularly selective serotonin reuptake inhibitors, may have a role to play but should be used in the context of psychologically based therapies. Prevention of anxiety-related disorders in childhood is a major public health issue. Prevention programmes are available and should commence in the antenatal period through infancy, early childhood and adolescence, promoting positive attachments and resilience.

Predictors of long-term outcome of CBT for youth with anxiety disorders treated in community clinics

Cognitive behavioral therapy (CBT) has proven long-term effects in youth with anxiety disorders. However, only a few studies have examined predictors of long-term outcomes of CBT treatment. The present study investigated possible predictors of long-term treatment outcomes in youth with mixed anxiety disorders treated in community mental health clinics. A total of 139 youth (mean age at assessment 15.5 years, range 11-21 years) with a principal diagnosis of separation anxiety disorder, social anxiety disorder, and/or generalized anxiety disorder were evaluated a mean of 3.9 years post-treatment (range 2.2-5.9 years). Outcomes were loss of all inclusion anxiety diagnoses, loss of the principal inclusion anxiety diagnosis, and changes in youth- and parent-rated youth anxiety symptoms. Predictors encompassed youth, parent and demographic factors, and post-treatment recovery. The most consistent finding was that low family social class predicted poorer outcomes. Higher treatment motivation was associated with better outcome whereas a diagnosis of social anxiety was associated with poorer outcome. Identified predictors extend on previous findings from efficacy trials, and the results indicate a need for more specific treatment protocols.

Results from the Child/Adolescent Anxiety Multimodal Longitudinal Study (CAMELS): Functional outcomes

OBJECTIVE

To report functional outcomes from the multisite Child/Adolescent Anxiety Multimodal Extended Long-term Study (CAMELS), which examined the impact of youth anxiety treatment (cognitive-behavioral therapy [CBT], coping cat; Sertraline, SRT; COMB [CBT + SRT]; pill placebo) on (a) global and (b) domain-specific functioning assessed an average of 3.1 times, 3- to 12-years postrandomization (first assessment = mean 6.5 years postrandomization).

METHOD

Three-hundred and 19 of 488 families from the Child/Adolescent Anxiety Multimodal Study (CAMS; Walkup et al., 2008) participated. Growth curve modeling examined the impact of treatment condition and acute treatment outcomes (i.e., response, remission) on global functioning, global and domain-specific impairment, and life satisfaction across follow-up visits. Logistic regressions explored the impact of treatment remission and condition on low frequency events (arrests/convictions) and education.

RESULTS

Treatment responders and remitters demonstrated better global functioning, decreased overall impairment, and increased life satisfaction at follow-up. Treatment remission, but not response, predicted decreased domain-specific impairment (social relationships, self-care/independence, academic functioning), and maintenance of increased life satisfaction across follow-ups. Participants in the CBT condition, compared with pill placebo, demonstrated improved trajectories pertaining to life satisfaction, overall impairment, and impairment in academic functioning. Randomization to CBT or COMB treatment was associated with increasing employment rates. Trajectories for participants randomized to SRT was not significantly different from placebo. Treatment outcome and condition did not predict legal outcomes, school/work variables, or family life.

CONCLUSION

Positive early intervention outcomes are associated with improved overall functioning, life satisfaction, and functioning within specific domains 6.5 years posttreatment. Treatment type differentially predicted trajectories of functioning. Findings support the positive impact of pediatric anxiety treatment into adolescence and early adulthood. (PsycINFO Database Record

Relationships between affective states and childhood internalizing disorders

Internalizing disorders are mainly defined as psychosomatic, anxiety and depression problems. The aim of this study was to analyze the relationships between dairy affective states and internalizing disorders in early adolescence (10-12 years old), considering the influence of sex. The participants of the study were 367 children aged between 10 and 12 (190 girls and 177 boys). The results showed that fear was the best predictor for all internalizing disorders, and the only common predictor for all of them. The prediction of boys' internalizing disorders was based only in fear, whereas the prediction for girls involved more variables besides fear. An early detection/regulation of these affective states (particularly fear) may be useful for the prevention and treatment of child internalizing disorders.

A holistic approach to factors affecting depression in haemodialysis patients

Depression in dialysis populations is affected by co-morbid diseases, such as cardiovascular disease, diabetes, and immune dysfunction, and it also includes high suicide risk and frequent hospitalizations. Depressive disorders have a close association with malnutrition and chronic inflammation, as well as with cognitive impairment. Impaired cognitive function may be manifested as low adherence to dialysis treatment, leading to malnutrition. Additionally, chronic pain and low quality of sleep lead to high rates of depressive symptoms in haemodialysis patients, while an untreated depression can cause sleep disturbances and increased mortality risk. Depression can also lead to sexual dysfunction and non-adherence, while unemployment can cause depressive disorders, due to patients' feelings of being a financial burden on their family. The present review provides a holistic approach to the factors affecting depression in haemodialysis, offering significant knowledge to renal professionals.

Long-Term Outcomes of Youth Treated for an Anxiety Disorder: A Critical Review

Pediatric anxiety disorders are common, disabling, and chronic conditions. Efforts over the past two decades have focused on developing and testing effective treatments. Short-term efficacy of both Cognitive Behavioral Therapy (CBT) and selective serotonin reuptake inhibitors has been established. Data are emerging on the long-term (i.e., 2 years or longer) effectiveness of these treatments, but this literature has yet to be adequately synthesized. This study presents a systematic and critical qualitative review of published long-term follow-up (LTFU) studies of youth treated for an anxiety disorder. A comprehensive search of several databases identified 21 published reports (representing 15 LTFU cohorts of treated youth) meeting specified inclusion criteria. LTFU assessments occurred a mean of 5.85 years after initial treatment (range 2-19 years). Diagnostic rates at LTFU and predictors (e.g., demographic, baseline child clinical variables, treatment type) of outcomes at LTFU were also examined. A discussion of the limitations of this literature is provided to qualify interpretations of findings and to inform future studies. Findings can aid clinicians and families in making treatment decisions and setting reasonable expectations for the long-term prognosis after treatment for anxiety.

The effect of positive and negative memory bias on anxiety and depression symptoms among adolescents

OBJECTIVE

To examine the interaction effect of anxiety and depression on the intentional forgetting of positive and negative valence words.

METHODS

One hundred fifty-five grade 7 to grade 10 students participated in the study. The item-method directed forgetting paradigm was used to examine the intentional forgetting of positive-valence, negative-valence, and neutral-valence words.

RESULTS

Negative-valence words were recognized better than either positive-valence or neutral-valence words. The results revealed an anxiety main effect (p = .01, LLCI = -.09, and ULCI = -.01) and a depression main effect (p = .04, LLCI = .00, and ULCI = .24). The anxiety score was negative, whereas the depression score was positively related to the directed forgetting of negative-valence words. Regression-based moderation analysis revealed a significant anxiety × depression interaction effect on the directed forgetting of positive-valence words (p = .02, LLCI = .00, and ULCI = .01). Greater anxiety was associated with more directed forgetting of positive-valance words only among participants with high depression scores. With negative-valence words, the anxiety × depression interaction effect was not significant (p = .15, LLCI = - .00, and ULCI = .01).

CONCLUSION

Therapeutic strategies to increase positive memory bias may reduce anxiety symptoms only among those with high depression scores. Interventions to reduce negative memory bias may reduce anxiety symptoms irrespective of levels of depression.