Generalised anxiety disorder in Singapore: prevalence, co-morbidity and risk factors in a multi-ethnic population

Evaluating a mobile-based intervention to promote the mental health of informal dementia caregivers in Singapore: Study protocol for a pilot two-armed randomised controlled trial

BACKGROUND

Informal caregivers of persons with dementia (PWD) often suffer adverse impacts on their mental health and require interventions for effective support. As they are often occupied with providing care, web-based interventions could be more convenient and efficient for them. However, there is currently a dearth of evidence-based mobile interventions to enhance the mental well-being of dementia caregivers locally, especially ones that are user-centered and culturally relevant. Hence, having designed an app based on feedback from local dementia caregivers, this study will evaluate the effectiveness of this mobile app in promoting the mental health of informal caregivers of PWD in Singapore.

METHODS

A pilot two-armed randomised controlled trial will be conducted on 60 informal caregivers of PWD recruited via convenience and snowball sampling. Thirty participants will be assigned to the intervention group, while another 30 will be in a waiting-list control group. Questionnaires will be administered at baseline and one month after, with the primary outcome being the difference in the change of depressive symptoms among the two groups.

STATISTICAL ANALYSIS

Primary analyses will follow the intention-to-treat principle and compare changes from baseline to the one-month follow-up time point relative to the control group. A repeated measures ANOVA will be conducted to examine differences between the groups over time.

SIGNIFICANCE

To our knowledge, this is the first study in Singapore that seeks to promote the mental health of informal dementia caregivers through a mobile-based intervention. The findings can inform the development and evaluation of future evidence-based digital interventions for local informal caregivers of PWD to address the gap in availability of such resources for them.

TRIAL REGISTRATION

ClinicalTrials.gov (NCT05551533). Registration date: September 22, 2022.

Correlations between Mental Health, Physical Activity, and Body Composition in American College Students after the COVID-19 Pandemic Lockdown

Restrictions associated with the COVID-19 pandemic had forced American college students to significantly reduce their daily energy expenditure and increase their sedentary behaviors, thus presumably increasing mental health symptoms, decreasing physical activity levels, and enhancing the promotion of unhealthy eating habits. This study aimed to explore the correlations between mental health symptoms, physical activity levels, and body composition in college students in the years following the pandemic, focusing on the lingering effects of lockdown measures. American college students completed pre-existing, well-validated surveys for both mental health (Hospital Anxiety and Depression Scale) and physical activity (International Physical Activity Questionnaire-Long Form). Body composition was assessed in person with the use of an Inbody 570 device. Of the 90 American college students (M age = 22.52 ± 4.54, 50 females) who participated in this study, depressive and anxious symptom scores consistent with heightened symptomatology were reported by 58% of the participants (N = 52), moderate borderline symptomatology by 17% (N = 15), and asymptomatology by 25% (N = 23). In regard to physical activity, 79% (N = 71) of the students were highly physically active, 18% (N = 16) were moderately active, and 3% (N = 3) reported low levels of physical activity. Additionally, 46% (N = 41) of the students maintained an unhealthy body fat percentage based on the World Health Organization recommendations. Strong, significant relationships were found between anxiety and depression symptomatology and body fat percentage (positive correlation, p = 0.003) and between anxiety and depression symptomatology and skeletal muscle mass (negative correlation, p = 0.015), with said symptomatology increasing with added body fat and decreasing with added skeletal muscle mass. The COVID-19 pandemic lockdown restrictions affected American college students through an increase in mental health symptomatology and a deterioration in overall body composition.

Less stress, better success: a scoping review on the effects of anxiety on anesthetic and analgesic consumption

Preoperative anxiety has an incidence of 11-80% in patients undergoing surgical or interventional procedures. Understanding the role of preoperative anxiety on intraoperative anesthetic requirements and postoperative analgesic consumption would allow personalized anesthesia care. Over- or under-anesthetizing patients can lead to complications such as postoperative cognitive dysfunction in elderly patients, or procedural discomfort, respectively. Our scoping review focuses on the current evidence regarding the association between preoperative anxiety and intraoperative anesthetic and/or postoperative analgesic consumption in patients undergoing elective surgical or interventional procedures. Based on 44 studies that met the inclusion criteria, we found that preoperative anxiety has a significant positive correlation effect on intraoperative propofol and postoperative opioid consumption. The analysis of the literature is limited by the heterogeneity of preoperative anxiety tools used, study designs, data analyses, and outcomes. The use of shorter, validated preoperative anxiety assessment tools may help optimize the intraoperative anesthetic and postoperative analgesic regimen. Further research to determine the most feasible and clinically relevant preoperative anxiety tool and subsequent implementation has the potential to optimize perioperative care and improve patient outcomes.

Work-related factors on mental health among migrant factory workers in china: Application of the Demand-Control and Effort-Reward Imbalance Model

Mental health problems are prevalent among migrant workers in China. The present study examined the prevalence of mental health problems (depression, anxiety and suicidal ideation) among migrant workers in China, and identified the work-related factors associated with their mental health problems based on the Demand-Control and Effort-Reward Imbalance Model. A total of 807 migrant workers were recruited from three factories in Shenzhen using stratified randomized sampling. The prevalence of moderate-to-severe anxiety, mild-to-severe depression and suicidal ideation in the past year was 17.8%, 60.3% and 4.8% respectively. Results from stepwise regression analyses reported that role conflict and effort were risk factors, whereas utilization of job skills and reward were protective factors for anxiety and depression. Social support was also associated with lower level of depression. Effort was the only factor associated with suicidal ideation in the stepwise analysis. Interventions to improve their mental health are warranted and they should work to reduce their role conflict, improve effort-reward balance, promote utilization of skills and increase social support.

Impact of COVID-19 on the mental health of Singaporean GPs: a cross-sectional study

Background

COVID-19 has stressed healthcare systems and workers worldwide. GPs, as first points of contact between suspected cases and the healthcare system, have assumed frontline roles in this crisis. While the prevalence of mental health problems and illnesses arising in healthcare workers (HCWs) from tertiary care settings during the COVID-19 pandemic is well-examined,¹ the impact on GPs remains understudied.

Aim

To describe the prevalence and predictors of anxiety, burnout, depression, and post-traumatic stress disorder (PTSD) among GPs during the COVID-19 pandemic.

Design & setting

Survey of GPs operating in Singapore primary care clinics.

Method

GPs completed a survey that comprised of four validated psychometric instruments. Open-ended questions asked about responders’ challenges and their envisaged support. Data were analysed with multiple logistic regression with demographic data as covariates; concepts of grounded theory were used to analyse the qualitative responses.

Results

A total of 257 GPs participated. Fifty-five (21.4%) met the scales’ criteria for anxiety, 211 (82.1%) for burnout, 68 (26.6%) for depression, and 23 (8.9%) for PTSD. Multivariate regression analysis showed working in a public primary care setting was associated with anxiety and depression. Qualitative analyses uncovered possible stressors: changes to clinical and operational practices; increased workloads; and financial difficulties.

Conclusion

Mental health issues were found to be present in Singaporean GPs during the pandemic. Prevalence of anxiety, burnout, and depression were found to be higher than those reported pre-COVID-19. The findings also provide determinants of the issues that serve as possible foci for targeted interventions.

Impacts of Remaining Single above the Mean Marriage Age on Mental Disorders and Suicidality: a Nationwide Study in Korea

BACKGROUND

This study investigated the impact of getting older than the mean marriage age on mental disorders and suicidality among never-married people.

METHODS

We performed an epidemiological survey, a nationwide study of mental disorders, in 2016. In this study, a multi-stage cluster sampling was adopted. The Korean version of the Composite International Diagnostic Interview was conducted with 5,102 respondents aged 18 years or above. The associations between never-married status, mental disorders, and suicidality were explored according to whether the mean age of first marriage (men = 32.8 years; women = 30.1 years) had passed.

RESULTS

Never-married status over the mean marriage age was associated with agoraphobia, obsessive-compulsive disorder, mood disorders, and major depressive disorder after adjusting for sociodemographic factors. Respondents with never-married status above the mean marriage age were associated with suicide attempts (adjusted odds ratio [aOR], 3.21; 95% confidence interval [CI], 1.36-7.60) after controlling for sociodemographic factors and lifetime prevalence of mental disorders, while respondents with never-married status under the mean marriage age were not. Moreover, in respondents with never-married status, getting older than the mean marriage age was associated with suicidal ideations (aOR, 1.49; 95% CI, 1.04-2.15) and suicide attempts (aOR, 3.38; 95% CI, 1.46-7.84) after controlling for sociodemographic factors and lifetime prevalence of mental disorders.

CONCLUSION

Never-married status above the mean first marriage age was associated with mental disorders and suicidality. These findings suggest the need for a national strategy to develop an environment where people with never-married status do not suffer even if their marriage is delayed.

Objective measures of physical performance associated with depression and/or anxiety in midlife Singaporean women

OBJECTIVES

The aim of this study was to identify correlates of depression and anxiety in midlife Asian women, with a special focus on the potential role of objectively measured physical performance.

METHODS

Sociodemographic characteristics, reproductive health, menopause status, medical history, lifestyle choices, physical activity, and physical performance of healthy women aged 45 to 69 attending routine gynecologic care were collected. Depressive symptoms were assessed utilizing the Center for Epidemiologic Studies for Depression Scale (CES-D) and anxiety symptoms by the General Anxiety Disorder Scale (GAD-7). Upper body physical performance was assessed by handgrip strength, and lower body physical performance was assessed by the Short Physical Performance Battery. Chi-square tests and multivariable models were used to assess the crude and adjusted associations, respectively, between the studied risk factors and depression and/or anxiety. The main outcome measures were elevated depressive symptoms ≥16 on the CES-D, and/or elevated anxiety symptoms >10 on the GAD-7 score.

RESULTS

Of 1,159 women (mean age 56.3 ± 6.2), 181 (15.9%) were identified as having depressive and/or anxiety symptoms. Weak upper body (handgrip strength) and poor lower body strength (longer duration to complete the repeated chair stand test) were associated with elevated depressive and/or anxiety symptoms (adjusted odds ratio [aOR], 1.68; 95% CI, 1.18-2.40) and (aOR, 1.33; 95% CI, 1.09-1.63), respectively.

CONCLUSIONS

Weak upper and lower body physical performances were associated with depressive and anxiety symptoms in midlife Singaporean women. Future trials are required to determine whether strengthening exercises that improve physical performance could help reduce depressive and anxiety symptoms in midlife women. : Video Summary: Supplemental Digital Content 1, http://links.lww.com/MENO/A419.

Health Effects of Underground Workspaces cohort: study design and baseline characteristics

The development of underground workspaces is a strategic effort towards healthy urban growth in cities with ever-increasing land scarcity. Despite the growth in underground workspaces, there is limited information regarding the impact of this environment on workers' health. The Health Effects of Underground Workspaces (HEUW) study is a cohort study that was set up to examine the health effects of working in underground workspaces. In this paper, we describe the rationale for the study, study design, data collection, and baseline characteristics of participants. The HEUW study recruited 464 participants at baseline, of whom 424 (91.4%) were followed-up at 3 months and 334 (72.0%) at 12 months from baseline. We used standardized and validated questionnaires to collect information on socio-demographic and lifestyle characteristics, medical history, family history of chronic diseases, sleep quality, health-related quality of life, chronotype, psychological distress, occupational factors, and comfort levels with indoor environmental quality parameters. Clinical and anthropometric parameters including blood pressure, spirometry, height, weight, and waist and hip circumference were also measured. Biochemical tests of participants' blood and urine samples were conducted to measure levels of glucose, lipids, and melatonin. We also conducted objective measurements of individuals' workplace environment, assessing air quality, light intensity, temperature, thermal comfort, and bacterial and fungal counts. The findings this study will help to identify modifiable lifestyle and environmental parameters that are negatively affecting workers' health. The findings may be used to guide the development of more health-promoting workspaces that attempt to negate any potential deleterious health effects from working in underground workspaces.

Cognitive Behavioral Therapy for a Young Woman of Asian Heritage

Generalized anxiety disorder (GAD) is one of the most common anxiety disorders and is associated with significant impairments in academic, occupational, and social functioning. Cognitive behavioral therapy (CBT) has shown to be an effective treatment for GAD; however, little research has examined its effectiveness with individuals of Asian heritage. In fact, as a result of limited use of mental health services within the Asian population, there is little psychotherapy research for this population. The present case examined whether a well-established CBT protocol, Mastering Your Anxiety and Worry (MAW), can be tailored in a culturally responsive manner to consider factors and values that influence well-being and functioning. Treatment consisted of 27 sessions over a 6-month period, with outcome data demonstrating a significant decrease in anxiety symptoms at the end of treatment. Results revealed statistically reliable clinical change on the Depression, Anxiety, and Stress Scale–21 (DASS-21) using Western norms and norms for a Chinese sample. This case demonstrates the potential cross-cultural utility of CBT for GAD for individuals of Asian heritage.

Associations between Urban Green Spaces and Health are Dependent on the Analytical Scale and How Urban Green Spaces are Measured

Although the benefits from exposure to urban green spaces (UGS) are increasingly reported, there are important knowledge gaps in the nature of UGS-health relationships. One such unknown area is the dependence of UGS-health associations on the types of UGS studied, the way they are quantified, and the spatial scale used in the analysis. These knowledge gaps have important ramifications on our ability to develop generalizations to promote implementation and facilitate comparative studies across different socio-cultural and socio-economic contexts. We conducted a study in Singapore to examine the dependence of UGS-health associations on the metrics for quantifying UGS (vegetation cover, canopy cover and park area) in different types of buffer area (circular, nested and network) at different spatial scales. A population-based household survey (n = 1000) was used to collect information on self-reported health and perception and usage pattern of UGS. The results showed that although all three UGS metrics were positively related to mental health at certain scales, overall, canopy cover showed the strongest associations with mental health at most scales. There also appears to be minimum and maximum threshold levels of spatial scale at which UGS and health have significant associations, with the strongest associations consistently shown between 400 m to 1600 m in different buffer types. We discuss the significance of these results for UGS-health studies and applications in UGS planning for improved health of urban dwellers.

Antenatal Anxiety: Prevalence and Patterns in a Routine Obstetric Population

Introduction: Expectant mothers may appear anxious even during healthy pregnancies. Unfortunately, little is known about antenatal anxiety, and affected women may remain undetected and untreated. This study aimed to examine the prevalence, incidence, course and associations of high state anxiety in routine obstetric care. Materials and Methods: This was an observational prospective cohort study at a large maternity unit. Obstetric outpatients with low-risk singleton pregnancies were recruited during first trimester consultations. Participants provided sociodemographic data and completed the State-Trait Anxiety Inventory (STAI) and Edinburgh Postnatal Depression Scale. The STAI was re-administered at each subsequent trimester. Results: Prevalence and incidence of  high state anxiety among 634 completers were 29.5% (95% CI 25.6%-33.6%) and 13.9% (95% CI 9.9%-18.0%), respectively. Anxiety was persistent in 17.0% (95% CI 14.3%-20.2%) and transient in 26.3% (95% CI 23.1%-29.9%). Only persistently anxious participants had high mean second trimester state anxiety scores. Odds for anxiety of greater persistence increased by 29% (95% CI 24%-35%) per 1-point increase in first trimester depression scores, and decreased by 36% (95% CI 7%-56%) with tertiary education. Conclusion: Antenatal anxiety symptoms are common even in normal pregnancies, especially among women with depression and lower education. Our study indicates value in exploring diagnostic criteria and quantitative measures for antenatal anxiety. Key words: Depression, Pregnancy, State-Trait Anxiety Inventory

Generalized anxiety disorder in urban China: Prevalence, awareness, and disease burden

INTRODUCTION

Limited published research has quantified the Generalized Anxiety Disorder (GAD) prevalence and its burden in China. This study aimed to fill in the knowledge gap and to evaluate the burden of GAD among adults in urban China.

METHODS

This study utilized existing data from the China National Health and Wellness Survey (NHWS) 2012-2013. Prevalence of self-reported diagnosed and undiagnosed GAD was estimated. Diagnosed and undiagnosed GAD respondents were compared with non-anxious respondents in terms of health-related quality of life (HRQoL), resource utilization, and work productivity and activity impairment using multivariate generalized linear models. A multivariate logistic model assessed the risk factors for GAD.

RESULTS

The prevalence of undiagnosed/diagnosed GAD was 5.3% in urban China with only 0.5% of GAD respondents reporting a diagnosis. Compared with non-anxious respondents, both diagnosed and undiagnosed GAD respondents had significantly lower HRQoL, more work productivity and activity impairment, and greater healthcare resource utilization in the past six months. Age, gender, marital status, income level, insurance status, smoking, drinking and exercise behaviors, and comorbidity burdens were significantly associated with GAD.

LIMITATIONS

This was a patient-reported study; data are therefore subject to recall bias. The survey was limited to respondents in urban China; therefore, these results focused on urban China and may be under- or over-estimating GAD prevalence in China. Causal inferences cannot be made given the cross-sectional nature of the study.

CONCLUSIONS

GAD may be substantially under-diagnosed in urban China. More healthcare resources should be invested to alleviate the burden of GAD.

Effect of generalized anxiety disorders on the success of pessary treatment for pelvic organ prolapse

INTRODUCTION AND HYPOTHESIS

Our aim was to evaluate the impact of generalized anxiety disorders (GAD) on the effectiveness of pessary treatment for pelvic organ prolapse (POP) in postmenopausal women.

METHODS

One-hundred and ten women with symptomatic POP who underwent pessary treatment were enrolled in this prospective study. Subjective evaluations of pelvic floor symptoms were assessed using the Pelvic Floor Distress Inventory (PFDI-20) and the Pelvic Floor Impact Questionnaire-7 (PFIQ-7), both at baseline and at the 3-month follow-up visit after pessary use. GAD was measured by the Generalized Anxiety Disorder-7 (GAD-7). Independent samples t tests, Mann-Whitney U test, chi-square test, Fisher's exact test, and Wilcoxon signed rank test were used to analyze data.

RESULTS

Twenty-one patients (20.6%) had GAD at baseline. After 3 months of pessary use, PFIQ-7, PFDI-20, and GAD scores were significantly improved in all participants (P < 0.001). In the GAD-negative group, total PFIQ-7 and PFDI-20 scores, including all subscales scores, were significantly decreased from baseline to posttreatment (P < 0.05). However, in the GAD-positive group, both PFIQ-7 and PFDI-20 scores, including subscales, were also significantly decreased from baseline to posttreatment (P < 0.05), except for subscale Colorectal-Anal Impact Questionnaire (CRAIQ-7) of PFIQ-7 (P = 0.225), which represented the impact on quality of life (QoL) from bowel dysfunction.

CONCLUSIONS

Both groups of women with or without GAD showed significant improvement in QoL scores after 3 months of pessary treatment. GAD had no influence on the success of pessary treatment for POP.

Screening for general anxiety disorders in postmenopausal women with symptomatic pelvic organ prolapse

OBJECTIVE

This study aimed to investigate the prevalence of general anxiety disorder (GAD) among postmenopausal women with symptomatic pelvic organ prolapse (POP) and to identify its associated factors.

METHODS

A cross-sectional study was conducted among postmenopausal women with symptomatic POP. Sociodemographic data and medical histories were obtained. Participants completed the POP Quantification (POP-Q), the Pelvic Floor Impact Questionnaire-7 (PFIQ-7), and the Pelvic Floor Distress Inventory (PFDI-20) measures. Measures of GAD were obtained using the Generalized Anxiety Disorder-7 (GAD-7). The data were analyzed using independent sample t-tests, the Mann-Whitney U-test, χ² tests, Fisher's exact tests and logistic regression.

RESULTS

Of the 177 participants interviewed, 19.2% had symptoms of GAD. There were no statistically significant differences in the sociodemographic characteristics or the POP-Q stage between women with and without GAD (p > 0.05). GAD was significantly associated with higher PFDI-20 and PFIQ-7 subscale scores (p < 0.05). After multiple logistic regression analyses, only the PFIQ-7 subscale UIQ-7 (odds ratio = 1.025, 95% confidence interval 1.007-1.043, p = 0.005) and the PFDI-20 subscale CRADI-8 (odds ratio = 1.025, 95% confidence interval 1.004-1.047, p = 0.021), which represented the impact on quality of life from lower urinary tract symptoms and the distress caused by bowel dysfunction, were risk factors that were independently associated with GAD.

CONCLUSIONS

GAD is prevalent in almost one-fifth of postmenopausal women with symptomatic POP. GAD is not associated with the severity of the POP-Q stage but is associated with higher scores for lower urinary tract and bowel dysfunction caused by POP.

Preseason Anxiety and Depressive Symptoms and Prospective Injury Risk in Collegiate Athletes

BACKGROUND

Psychological risk factors are increasingly recognized as important in sport-related injury prevention. Understanding how these psychological factors may affect the risk of injuries could help design effective prevention programs.

PURPOSE

To determine the effect of reported preseason anxiety and depressive symptoms on the risk of injuries during a prospective season in a cohort of collegiate athletes.

STUDY DESIGN

Cohort study; Level of evidence, 2.

METHODS

Collegiate athletes participating in 4 men's sports and 5 women's sports from 2 National Collegiate Athletic Association (NCAA) Division I universities were enrolled and prospectively followed during the 2007-2011 seasons. Preseason anxiety and depressive symptoms were measured at enrollment. Injuries occurring during the season were reported by certified athletic trainers. The injury incidence rate was calculated as the total number of injuries divided by the total number of athlete-exposures (ie, games and practices).

RESULTS

Of 958 enrolled athletes (response rate of 90.3%), 389 (40.6%) athletes sustained a total of 597 injuries. At preseason, 276 (28.8%) athletes reported anxiety symptoms, and 208 (21.7%) reported depressive symptoms. Among athletes reporting any of these symptoms, 48.5% (n = 158) reported having both anxiety and depressive symptoms. Athletes with preseason anxiety symptoms had a significantly higher injury incidence rate compared with athletes without anxiety symptoms (rate ratio [RR], 2.3; 95% CI, 2.0-2.6), adjusting for age, race, body mass index, history of injuries 12 months before baseline, and university attended, and this was observed for both male and female athletes. Only male athletes who reported co-occurring preseason depressive and anxiety symptoms had a significantly increased injury risk (RR, 2.1; 95% CI, 1.6-2.6) compared with male athletes who reported no co-occurring symptoms. However, no such increase in the injury risk was observed among female athletes or male athletes who reported preseason depressive symptoms but no anxiety symptoms.

CONCLUSION

Athletes with anxiety symptoms at preseason were at an increased risk of injuries during the prospective season. Targeted programs could focus on psychological health and injury prevention for athletes, especially for those exhibiting symptoms at preseason.

Psychological status and quality of life among primary caregivers of individuals with mental illness: a hospital based study

Background

This study aimed to explore the psychological status and quality of life among primary caregivers of individuals suffering from various mental illnesses including early psychosis, chronic schizophrenia, depressive disorders, anxiety disorders and dementia.

Methods

A total of 350 primary caregivers with relatives seeking treatment at a tertiary psychiatric hospital were recruited for this study. Socio-demographic data was obtained and the brief version of the World Health Organisation Quality of Life instrument was used to assess caregiver’s quality of life (QOL). Psychological status among primary caregivers was assessed using the General Anxiety Disorder - 7 item (GAD-7) and Patient Health Questionnaire - 9 item (PHQ-9) scales. Family Interview Schedule (FIS) was used to assess the impact of caregiving relating to social problems, interpersonal strain among family members, work related problems and financial difficulties as a result of their relative’s illness. The socio-demographic and clinical correlates of QOL, PHQ-9 and GAD-7 were examined using multiple linear and logistic regression analyses. Associations between QOL domains and psychological status was examined using multiple linear regression analyses.

Results

The mean age of the primary caregivers was 49.7 years (SD = 13.2), ranging from 21 to 82 years, with a preponderance of females (67.6%), aged 50–64 years old (45.7%). Majority were of Chinese ethnicity (57.5%), had secondary level education (43.1%), were married (65.2%), and employed (64.9%). 18.3% of primary caregivers had symptoms of depression (based on PHQ-9 cut-off point of 10 or greater) while 12.7% had symptoms of anxiety (based on GAD-7 cut-off point of 10 or greater). Multiple linear and logistic regression analyses revealed that primary caregivers aged between 35-49 years and 50–64 years, unemployed, living with others, providing care to those diagnosed with dementia and who had higher FIS scores were significantly more likely to report symptoms of depression whilst those who cared for their son/daughter were less likely to be associated with symptoms of depression. Primary caregivers who had lower education, were living with others, were single or divorced/separated, were unemployed and with higher FIS scores were associated with lower QOL domain scores. Those with symptoms of depression were significantly associated with low QOL across all four domains, whilst those with symptoms of anxiety were significantly associated with low QOL in the social relationships domain.

Conclusion

Psychological status of caregivers in the current study was associated with the various domains of QOL. In particular, caregivers’ symptoms of depression were significantly associated with lower QOL across all four domains of QOL whereas symptoms of anxiety were associated with lower scores in the social relationships domain. The study suggests a need to provide caregivers with social support and psycho-education to improve the QOL as well as aid in developing healthy coping strategies.

Prevalence, correlates, comorbidity and severity of generalized anxiety disorder in Singapore

Despite its pervasiveness and associated impairment, generalized anxiety disorder (GAD) remains a poorly recognized disorder. Furthermore, given that GAD has been relatively understudied in Asia, the current study examined the prevalence, correlates and co-morbid conditions of this disorder in a multi-ethnic population of Singapore. Data was utilized from the Singapore Mental Health Study (SMHS), a cross-sectional epidemiological survey conducted among the adult population (n=6616) aged 18 years and above. The Composite International Diagnostic Interview version 3.0 (CIDI v3.0) was used to assess co-morbidity as well as the life-time and 12-month prevalence of disorders. Functional impairment and treatment-seeking behavior were also assessed. The life-time (0.9%) and 12-month (0.4%) prevalence estimates in the current study were found to be lower than those reported in Western populations but comparable to the prevalence estimates found in Asian countries. The relatively lower prevalence rate of GAD in this study suggests the possible role of culture in reporting and manifestation of anxiety symptomatology. The failure of a substantial proportion of individuals to seek treatment despite self-reported impairment was also identified as an area of concern.

Depression and anxiety are co-morbid but dissociable in mild Parkinson's disease: A prospective longitudinal study of patterns and predictors

BACKGROUND

Depression and anxiety are common in Parkinson's disease (PD) and contribute significantly to a reduced quality of life in PD patients. Though they often co-exist, it is unclear whether depression and anxiety result from a shared pathological process. We studied the longitudinal course and determinants of depression and anxiety in PD in order to understand which factors contribute to the development of these symptoms.

METHODS

We conducted a prospective longitudinal study of 89 mild PD patients over 18 months, measuring depressive and anxiety symptoms at 6 monthly intervals using the Geriatric Depression Scale and Hospital Anxiety and Depression Scale--'Anxiety' subscale. Univariate and multivariate Generalised Estimating Equations were used to investigate the course of depression and anxiety and their association with demographic factors, motor measures, non-motor symptoms, and pharmacological factors.

RESULTS

Depression and anxiety were co-morbid in 13.5% of the sample. Depressive symptoms remained relatively stable while anxiety symptoms improved over the course of 18 months. Severity of depressive symptoms was associated with female gender, motor fluctuations, apathy, and anxiety, while severity of anxiety was associated with older age, higher educational attainment, shorter disease duration, younger age of disease onset, and excessive daytime sleepiness.

CONCLUSIONS

Although depression and anxiety are frequently co-morbid in PD, they were dissociable from each other. They had distinct trajectories and different longitudinal relationships with demographic, motor, and non-motor factors that were unique to each disorder.

Maternal anxiety from pregnancy to 2 years postpartum: transactional patterns of maternal early adversity and child temperament

The aims of this study were to examine the anxiety trajectories of women from pregnancy to 2 years postpartum and to assess the influence of their early life experiences and the temperament of the child on these trajectories. We evaluated state anxiety (State-Trait Anxiety Inventory) at pregnancy and 3, 6, 12, 18, and 24 months postpartum and determined its course as a function of self-reported early adverse experiences (Childhood Trauma Questionnaire) and the temperament of the child at 18 months (Early Child Behavior Questionnaire). Based on growth curve modeling, we found that anxiety followed a general U-shape pattern from gestation to 2 years postpartum, which was modified by early life experience of women. Greater early adversity was associated with higher gestational anxiety, followed by a marked decrease once the baby was born, and subsequent increase during the later postpartum period. The temperament of the child also modulated anxiety trajectories. Thus, mothers of children high in negative affectivity and who also experienced greater early adversity had elevated and flat anxiety trajectories, while child extraversion was associated with increasing anxiety courses approaching 2 years postpartum. These results show that maternal anxiety dynamically changes through the postpartum period with a course that is affected by previous and current experiences.

How healthy is the Singaporean worker? Results from the Singapore national health survey 2010

OBJECTIVE

To compare the prevalence of common medical conditions (including mental health and self-rated health) and lifestyle risk factors for disease of the Singapore workforce with the nonworking population, and evaluate the association of these factors with occupation class.

METHODS

Data were obtained from a population-representative cross-sectional survey in 2010. Adjusted prevalence ratios (PRs) were obtained by modified Breslow-Cox proportional hazards regression model.

RESULTS

Within the workforce, after adjustment for age, sex, and ethnicity, daily smoking (PR = 1.87; 95% confidence interval [CI], 1.40 to 2.51; P < 0.001), no regular exercise (PR = 1.13; 95% CI, 1.07 to 1.20; P < 0.001), and poor self-rated health (PR = 1.46, 95% CI, 1.22 to 1.76; P < 0.001) were more prevalent in the lower-skilled occupation classes.

CONCLUSIONS

Lower-skilled occupation classes in Singapore are associated with lifestyle risk factors, and tailored workplace health promotion programs addressing their specific health needs are needed.

Reduced PON1 enzymatic activity and increased lipid hydroperoxide levels that point out oxidative stress in generalized anxiety disorder

In recent years, there has been an increasing focus on generalized anxiety disorder (GAD) which is one of the most prevalent mental disorders in general population. Psychological, genetic, neurobiological, and neurochemical factors are believed to play role in the etiopathogenesis of GAD. The role of oxidative stress, as a neurochemical cause, in various anxiety disorders has been studied in recent years; however, it has not been thoroughly studied in GAD, yet. In this paper, we aimed to evaluate the serum levels of lipid hydroperoxide (LOOH), paraoxonase, and arylesterase in GAD patients without any co-morbid psychiatric disorders and investigate their diagnostic performance. Blood samples were collected from 40 GAD patients and 40 healthy control subjects to measure their serum LOOH levels, arylesterase and paraoxonase activities. Obtained results have been compared between groups and receiver operating characteristic (ROC) curve has been drawn for diagnostic performance of measured biochemical markers. Positive and negative predictive values have been estimated where appropriate. Mean LOOH level of the GAD patients was significantly higher than that of control subjects (t=-5.49, p<0.001), whereas, mean paraoxonase activity was lower in these patients (t=3.056, p=0.03). GAD could be predicted for LOOH level over 7.740 μmol/l with 92.5% positive predictive value and 92% negative predictive value. Increased LOOH level and decreased paraoxonase activity of GAD patients may suggest increased lipid peroxidation and oxidative stress in these patients. LOOH levels may be a state marker for diagnosing GAD.

Anxiety and depression following preeclampsia or hemolysis, elevated liver enzymes, and low platelets syndrome. A systematic review

Women who suffered from pregnancy complications are at increased risk for anxiety and depression. The aim of this study was to evaluate whether having suffered from preeclampsia (PE) or HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome is associated with anxiety and depression, and whether PE/HELLP is an independent risk factor for developing anxiety and depression. Systematic search on PubMed and PsycInfo with no time limit. Studies presenting original data, including women with a history of PE/HELLP and at least one comparison group of women without PE/HELLP, reporting the results for each group separately or in a multivariate regression analysis with PE/HELLP as an independent variable. Study characteristics and outcomes were extracted using a prespecified form. If necessary, additional calculations were performed. The search yielded 267 articles, with only six being suitable for inclusion in this review. Studies on depression (six studies) showed generally positive associations between PE/HELLP and the prevalence of depression or severity of depressive symptoms. However, the results of three studies were not statistically significant. Studies addressing anxiety (two studies) did not show significant associations between PE/HELLP and anxiety scores. Associations between post-traumatic stress and PE/HELLP, investigated in four studies, were often nonsignificant. Due to heterogeneity of study methods, a meta-analysis of the results was not possible. In most studies, confounder control was poor. Evidence is mixed but generally points to positive associations between various forms of psychopathology and previous PE/HELLP. Causality of the associations can, however, not be judged adequately.

Asthma, life events and psychiatric disorders: a population-based study

PURPOSE

Although asthma and other chronic physical conditions have been shown to be associated with psychiatric symptoms, the relative contributions of negative life events to this association and impaired quality of life (QOL) are not clear.

METHODS

This is a cross-sectional study of a nationally representative sample of Singaporean adults aged 20-59 (n = 2,847). Individuals were grouped by asthma, other chronic physical conditions, and no chronic physical conditions. Participants were assessed life events (list of threatening experiences questionnaire), psychiatric disorders [schedule for clinical assessment in neuropsychiatry diagnoses of psychiatric disorder including any psychiatric disorder, major depressive disorder (MDD) and generalized anxiety disorder (GAD)], and QOL (medical outcomes study 12-item short form).

RESULTS

In multivariate analyses controlling for confounding variables, asthma and other chronic physical conditions, compared to no chronic physical conditions, both showed similarly (two- to four-fold) elevated odds ratio (OR) of association with MDD and GAD. However, the asthma group reported more life events as compared to other chronic physical conditions (OR = 4.33, 95 % CI: 2.09-8.95) or no chronic physical conditions (OR = 7.64, 95 % CI: 3.87-15.06). Life events accounted significantly for excess coexistence of psychiatric disorders with asthma over participants without chronic physical conditions. It also contributed significantly to relatively worse QOL observed among individuals with asthma.

CONCLUSIONS

In this cross-sectional study, life events among adults in Singapore appeared to mediate the co-occurrence of psychiatric disorders and functional impairment with asthma, more than with other chronic physical conditions. This should be further investigated in longitudinal studies.

Anxiety and depression, chronic physical conditions, and quality of life in an urban population sample study

OBJECTIVE

No previous studies have empirically demonstrated a multiplicative interactive effect of anxiety disorders and/or depression (ADD) and chronic medical conditions on quality of life (QOL). We hypothesized that QOL impairment was worsened by the presence of ADD and medical co-morbidity, more than when it was with either medical co-morbidity alone or ADD alone.

METHODS

Complete data of 2,801 participants from the National Mental Health Survey of Adults in Singapore were analyzed, using SCAN diagnoses of anxiety disorders and depression, self-reports of chronic medical conditions, and SF-12 measures of QOL (Mental Component Summary, MCS, and Physical Component Summary, PCS).

RESULTS

Persons diagnosed with ADD (compared to those without) had considerably more medical co-morbidities (59 vs. 33%, p < 0.001). In multiple regression analyses, ADD (vs. no ADD) was associated with lower PCS (b = -1.013, p = 0.045) and MCS scores (b = -9.912, p < 0.001), as was number of medical co-morbidities (0, 1-2, 3 +), PCS scores (b = -2.058, p < 0.001) and MCS scores (b = -1.138, p < 0.001). There were significant interactive effects of medical co-morbidities and ADD on PCS (p < 0.001), and MCS (p = 0.086), suggesting that the negative effects of medical conditions on quality of life was aggravated non-additively by the co-morbid presence of ADD, and vice versa.

CONCLUSION

The individual effects of medical and psychiatric morbidity on functional status and quality of life were considerably worse when both were present in the same individual. Future studies should examine the impact of identifying and treating anxiety and depressive disorders in patients with medical problems for better outcomes.

Prevalence and Impact of Mental and Physical Comorbidity in the Adult Singapore Population

Introduction: This study aims to assess the prevalence rates of mental disorders and chronic medical conditions in the Singapore resident population, and examine their association and respective impact on the quality of life. Materials and Methods: A household survey was carried out on a nationally representative sample of the adult (18 years and above) resident population. The main instrument used to establish the diagnosis of mental disorders is the World Mental Health Composite International Diagnostic Interview (WMH-CIDI). The mental disorders included in study were major depressive disorder, bipolar disorder, generalised anxiety disorder, obsessive compulsive disorder, alcohol abuse and alcohol dependence. Respondents were asked if they had any of the chronic medical conditions from a list of 15 conditions. Health-related quality of life was assessed with the EQ-5D. Results: Of the 6616 respondents, the lifetime prevalence of mental disorders was 12.0%, and that of chronic medical disorders were 42.6% and those with comorbid mental and medical disorders was 6.1%. The prevalence of any physical disorder in this population was high (42.6%). Among those with chronic physical disorders, 14.3% also had a mental disorder, and among those with mental disorders, more than half (50.6%) had a medical disorder. Most of the mental disorders were not treated. Males, Indians, older people, and those who were separated or divorced were more likely to have comorbidity. The health-related quality of life was significant worse in those with both mental and medical disorders compared to those with either mental or medical disorder. Conclusion: Our study re-emphasised the common occurrence of mental and medical disorders and the importance for an integrated care system with the capability to screen and treat both types of disorders. It also identified certain subpopulations which are more likely to have comorbidity for which a more targeted intervention could be planned. Key words: Chronic conditions, Ethnicity, Health-related quality of life, Marital status

White-matter abnormalities in the right posterior hemisphere in generalized anxiety disorder: a diffusion imaging study

BACKGROUND

Prior imaging studies have shown structural, functional and biochemical impairments in patients with generalized anxiety disorder (GAD), particularly in the right hemisphere. In this study we investigated, for the first time to the best of our knowledge, the white-matter microstructure organization in GAD.

METHOD

A total of 12 patients with DSM-IV GAD and 15 matched healthy controls underwent a magnetic resonance imaging session of diffusion weighted imaging, exploring white-matter water molecules by the means of apparent diffusion coefficients (ADCs). Regions of interests were placed in the frontal, parietal, temporal and occipital lobes and in the splenium and genu of the corpus callosum, bilaterally.

RESULTS

ADC measures were significantly greater in patients with GAD in the right splenium and right parietal cortex compared with healthy controls (p⩽0.002). No significant correlations between ADCs and age or clinical variables were found.

CONCLUSIONS

We provide evidence that GAD is associated with disrupted white-matter coherence of posterior right hemisphere regions, which may partly sustain the impaired cognitive regulation of anxiety. Future diffusion imaging investigations are expected to better elucidate the communication between the parietal cortex and other right hemisphere regions in sustaining the cognitive processing of social and emotional stimuli in patients with GAD.

Effect of the acute and chronic estrogen on anxiety in the elevated T-maze

Despite the extensive studies on the influences of estrogen (E(2)) on anxiety-like behaviors, there is still conflicting evidence regarding the specific effects of E(2) on anxiety. These discrepancies may be a result of different replacement regimens. The goals of this study were to evaluate anxiety-like behavior in ovariectomized rats (Ovx) using the elevated T-maze (ETM) test for the following variables: (1) the effects of acute versus chronic E(2) dosing, (2) the effects of chronic E(2) at different doses and, (3) the effects of Tamoxifen (Tam) co-administered with E(2). Rats in the acute E(2) dosing group (aE(2)) showed reduced inhibitory avoidance responses with prolong escape latencies compared to Ovx; while rats in the chronic E(2) dosing group (cE(2)) showed reduced inhibitory avoidance responses only. These results suggest that E(2) contains anxiolytic effects when given once or repeatedly. Moreover, when various doses of E(2) (1-100 μg/kg) were chronically given to the Ovx rats, all doses produced impaired inhibitory avoidance responses compared to Ovx, suggesting that chronic replacement of E(2) had no dose-dependent effect on anxiety-like behavior. Interestingly, in the 3-week delay replacement regimen, the low dose E(2) (1 μg/kg, s.c.) group displayed no anxiolytic effects as their inhibitory avoidance responses in the ETM were not different from their Ovx counterparts. On the contrary, the Ovx group that received Tam+E(2) (Tam 1 mg/kg, PO and E(2) 1 μg/kg, s.c.) had reduced inhibitory avoidance responses compared to other groups. These findings indicate that when Tam is co-administered with chronic low dose estrogen, it can act as an estrogen receptor agonist and result in anti-anxiety effects. Therefore, it is likely that the anxiolytic-like behavior relative to generalized anxiety disorder can be conserved when estrogen is given acutely or chronically; while the anxiolytic-like behavior relative to panic disorder can be conserved only when estrogen is given acutely.

Generalized anxiety disorder: course and risk factors in pregnancy

BACKGROUND

There are limited studies of generalized anxiety disorder (GAD) across pregnancy.

METHODS

Women (n = 2793) were enrolled in the Yale Pink and Blue study, a cohort enriched with subjects who suffered from major depressive disorder (MDD) within the past five years or used antidepressants in the past year. Subjects were evaluated with the Composite International Diagnostic Interview at three time points: twice in pregnancy and once after delivery. We defined a generalized anxiety disorder (GAD) episode as per DSM IV but with required duration reduced to one month or longer. Course and correlates of GAD were examined in women who had: 1) no GAD during the 6 months prior or in pregnancy (Group A), 2) GAD in the 6 months prior to but not in pregnancy (Group B), 3) GAD in pregnancy only (Group C) and 4) GAD both in the 6 months prior to and during pregnancy (Group D).

RESULTS

9.5% of the cohort suffered from GAD at some point in pregnancy. Anxiety symptoms were highest in the first trimester and decreased across pregnancy. Regression analysis revealed that previous GAD episodes, education, social support and a history of child abuse distinguished between membership in the four groups.

LIMITATIONS

The sample may not be representational, as it was enhanced with those at risk, and had relatively low representation of socio-economically disadvantaged women.

CONCLUSIONS

Identification of anxious patients during pregnancy may provide an opportunity to engage those in need of psychiatric treatment.

Sex difference in the rates and co-occurring conditions of psychiatric symptoms in incoming college students in Taiwan

OBJECTIVE

The authors investigated the sex difference in the rates and co-occurring patterns in Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-referenced psychiatric symptoms among incoming first-year college students in Taiwan.

METHODS

This was a college-based questionnaire survey. The participants included 2731 incoming first-year college students (male, 52.4%; mean age, 19.3 ± 2.6 years). The participants completed the Chinese version of the Adult Self Report Inventory-4 for the assessment of a wide range of psychiatric symptoms according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition symptom criteria. The participant rate was 74.1%.

RESULTS

There were 55% of the participants having at least one psychiatric symptom. Symptoms of agoraphobia, body dysmorphic, and gender identity disorder were more prevalent in women; those of obsession-compulsion, tics, conduct problems, schizoid personality, and kleptomania were more prevalent in men. The magnitude of symptom correlations between compulsion and gender identity disorder, dysthymia, and antisocial personality, and between gender identity disorder and schizophrenia was significantly greater in male participants, whereas that between conduct problems and obsession and motor tics was significantly greater in female participants.

CONCLUSIONS

The Chinese version of the Adult Self Report Inventory-4 identified similar sex difference in psychiatric symptoms as Western studies. The sex difference in co-occurring psychiatric conditions warrants further investigation.

Biological variations in depression and anxiety between East and West

Ethnicity and culture represent important factors in shaping psychopathology as well as pharmacotherapeutic responses in psychiatric patients. A large body of literature, accumulated over the past several decades, demonstrates that these factors not only determine the metabolism and disposition of medications (pharmacokinetics), but also their interactions with therapeutic targets (pharmacodynamics). This article focuses on the impact of such variations on the diagnosis and treatment of depression and anxiety disorders between East and West. Genes controlling the expression of drug metabolizing enzymes as well as the function of the brain are highly polymorphic, and the patterns and distribution of these polymorphisms are typically divergent across ethnic groups. To the extent that these genetic patterns determine drug response, ethnic variations in these genetic dispositions will lead to differential responses in clinical settings. In addition, the expression of these genes is significantly influenced by environmental factors including diet as well as exposure to other natural products. Superimposed on these biological influences, culturally determined beliefs and behavioral patterns also profoundly influence patients' expectations of treatment response, adherence, and interactions with clinicians. In addition to pharmacotherapeutic responses, emerging data also indicate that significant ethnic variations exist in genetic polymorphisms and neurobiologic correlates (biomarkers) that may be associated with the vulnerability to psychiatric disorders. These considerations argue for the importance of examining biological variations across ethnic groups, especially in the clinical context, in terms of the assessment and treatment of psychiatric patients, and in our understanding of psychiatric phenomenology and nosology.

Culture and the anxiety disorders: recommendations for DSM-V

BACKGROUND

The anxiety disorders specified in the fourth edition, text revision, of The Diagnostic and Statistical Manual (DSM-IV-TR) are identified universally in human societies, and also show substantial cultural particularities in prevalence and symptomatology. Possible explanations for the observed epidemiological variability include lack of measurement equivalence, true differences in prevalence, and limited validity or precision of diagnostic criteria. One central question is whether, through inadvertent "over-specification" of disorders, the post-DSM-III nosology has missed related but somewhat different presentations of the same disorder because they do not exactly fit specified criteria sets. This review canvases the mental health literature for evidence of cross-cultural limitations in DSM-IV-TR anxiety disorder criteria.

METHODS

Searches were conducted of the mental health literature, particularly since 1994, regarding cultural or race/ethnicity-related factors that might limit the universal applicability of the diagnostic criteria for six anxiety disorders.

RESULTS

Possible mismatches between the DSM criteria and the local phenomenology of the disorder in specific cultural contexts were found for three anxiety disorders in particular. These involve the unexpectedness and 10-minute crescendo criteria in Panic Disorder; the definition of social anxiety and social reference group in Social Anxiety Disorder; and the priority given to psychological symptoms of worry in Generalized Anxiety Disorder. Limited evidence was found throughout, particularly in terms of neurobiological markers, genetic risk factors, treatment response, and other DSM-V validators that could help clarify the cross-cultural applicability of criteria.

CONCLUSIONS

On the basis of the available data, options and preliminary recommendations for DSM-V are put forth that should be further evaluated and tested.

Irritable bowel syndrome is strongly associated with generalized anxiety disorder: a community study

BACKGROUND

No previous study has examined the comorbidity of Irritable Bowel Syndrome (IBS) and Generalized Anxiety Disorder (GAD) in a general population using standardized diagnostic methods.

AIM

To examine the prevalence, comorbidity and risk correlates of IBS and GAD in a general population.

METHODS

A random community-based telephone survey was conducted. The questionnaire covered symptoms of IBS, GAD, core depressive symptoms, help-seeking behaviour and functional impairment on the Sheehan Disability Scale.

RESULTS

A total of 2005 participants completed the interview. The current prevalence of IBS was 5.4% and the 12-month prevalence of GAD was 4%. GAD was five times more common among IBS respondents than non-IBS respondents (OR: 5.84, P < 0.001), whereas IBS was 4.7 times more common among GAD respondents than among non-GAD respondents (OR: 6.32, P < 0.001). Core depressive symptoms (OR: 6.25, P < 0.01) and education level (OR: 5.918, P = 0.021) were risk correlates of GAD among IBS respondents. Comorbid respondents were more impaired than respondents having either disorder alone, but were not more likely to seek professional help than IBS-only respondents.

CONCLUSION

Irritable Bowel Syndrome and GAD comorbidity was common and added to impairment in the community. The strong association between psychiatric morbidity and IBS observed in referral centres was not a consequence of increased help-seeking behaviour.

Generalized anxiety disorder in China: prevalence, sociodemographic correlates, comorbidity, and suicide attempts

PURPOSE

This study aims to determine the 12-month and lifetime prevalence of generalized anxiety disorder (GAD) and its sociodemographic correlates.

DESIGN AND METHODS

A total of 5,926 subjects were randomly selected and interviewed.

FINDINGS

The overall 12-month and lifetime prevalence of GAD was 0.8%, and 1.2%, respectively. Being older than 25 years and female, lower education level, unemployed status, and lower (<RMB500/month) or higher (>RMB2000/month) monthly income were associated with increased risk of GAD.

PRACTICE IMPLICATIONS

The low percentage of subjects treated for GAD indicates a major public health problem that should be addressed.

Correlates of generalized anxiety disorder: independent of co-morbidity with depression: findings from the first Israeli National Health Interview Survey (2003-2004)

BACKGROUND

Generalized anxiety disorder (GAD) is a prevalent psychiatric disorder with chronic symptoms and is commonly comorbid with depression.

OBJECTIVES

To identify correlates of GAD among adults and to describe treatment patterns and functional limitations among individuals with this disorder.

METHODS

Data for 2,082 subjects aged >or=21 years from the first Israeli national health interview survey (INHIS-1) (2003-2004) were analyzed. Information on GAD was collected using the short form of the Composite International Diagnostic Interview. Data were also obtained on socio-demographic, physical health characteristics, history of life threatening events, treatment seeking behaviors, use of medication and functional impairment.

RESULTS

The prevalence of GAD was highest among people aged 40-59 years, in those with asthma, hypertension and in those with osteoporosis. Regular exercise was associated with reduced prevalence for GAD (adjusted OR 0.46, 95% CI 0.22-0.95). The exclusion of individuals with major depression from analysis strengthened the association with age (adjusted OR 5.7, 95% CI 1.7, 19.7), weakened the association between GAD and osteoporosis (adjusted OR 3.4, 95% CI 1.2, 9.8), asthma (adjusted OR 3.4, 95% CI 1.2, 9.5) and regular exercise (adjusted OR 0.47 95% CI 0.2, 1.14). In this sub-sample, hypertension was no longer associated with GAD, and a significant association was found between GAD and past experience of life threatening events (adjusted OR 2.3, 95% CI 1.1-4.9). Psychiatric and psychological consultations were low among people with GAD (11.5% and 26.4% for those without and with comorbid depression, respectively), concurrent with a high degree of functional limitation.

CONCLUSIONS

Middle age, history of traumatic life events, and certain chronic medical diseases (e.g., asthma and osteoporosis) are important risk factors for GAD. They could be used to help identify and treat people with GAD.

Screening for depressive symptoms: validation of the center for epidemiologic studies depression scale (CES-D) in a multiethnic group of patients with diabetes in Singapore

OBJECTIVE

We determined the reliability and validity of the Center for Epidemiologic Studies Depression Scale (CES-D) against the DSM-IV-based diagnostic inventory, Schedule for Clinical Assessment in Neuropsychiatry (SCAN), in a multiethnic sample of adult subjects with diabetes attending a diabetes center in Singapore.

RESEARCH DESIGN AND METHODS

A total of 522 subjects (74.7% Chinese, 11.1% Malay, and 14.2% Indian) completed culturally adapted versions of the CES-D; 291 subjects were administered the SCAN inventory.

RESULTS

The CES-D (cutoff score 16) showed high negative predictive values of more than 90% in all three ethnic groups. The prevalence of depressive symptoms (CES-D) and depression (SCAN) was significantly different between the Chinese and Indian subjects (CES-D 27.4 vs. 43.2%, P = 0.006); (SCAN 15.0 vs. 31.1%, P = 0.01).

CONCLUSIONS

The CES-D proved to be a reliable instrument for identifying patients with depressive symptoms in the multiethnic setting of this study.

Case–control study of anxiety symptoms in hemifacial spasm

In a case-control study, we evaluated symptoms in nine different psychological domains in hemifacial spasm (HFS; using the Symptom Checklist-90R [SCL-90R]) and found the anxiety score to be significantly greater in HFS compared to healthy controls in both the univariate (P = 0.004) and multivariate analysis (adjusted for sex, age, marital status, and educational level; P = 0.002). Similar findings were obtained when comparison was made with an independent group of outpatient controls. Compared to outpatient controls, the HFS patients had a higher mean Hamilton Anxiety Rating Score (HAM-A; 10.0 +/- 8.0 [range, 0 to 28] vs. 5.0 +/- 5.0 [range, 0 to 25]; P = 0.004), and 19.5% had HAM-A score of 18 or above compared to 3.8% in controls (P = 0.02). Among the HFS patients, the mean anxiety score in SCL-90R was significantly higher in those defined with mild to severe anxiety under HAM-A compared to those without anxiety (74.0 +/- 6.0 vs. 48.0 +/- 13.0) (P < 0.0005). There was good correlation of the anxiety score with the HAM-A in HFS patients (r = 0.915; P < 0.0001). HFS patients with anxiety reported significant improvement of their symptoms (mean HAM-A score 19.0 +/- 5.0 vs. 11.0 +/- 6.0; P = 0.001) following appropriate management. As stress and anxiety can aggravate HFS, diagnosis and early management of anxiety symptoms can improve quality of life in these patients.