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Chiang HL, Chuang YF, Chen YA, Hsu CT, Ho CC, Hsu HT, Sheu YH, Gau SSF, Liang LL. Physical Fitness and Risk of Mental Disorders in Children and Adolescents. JAMA Pediatr 2024; 178:595-607. [PMID: 38683586 PMCID: PMC11059046 DOI: 10.1001/jamapediatrics.2024.0806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 02/28/2024] [Indexed: 05/01/2024]
Abstract
Importance With the rising prevalence of mental disorders among children and adolescents, identifying modifiable associations is critical. Objective To examine the association between physical fitness and mental disorder risks. Design, Setting, and Participants This nationwide cohort study used data from the Taiwan National Student Fitness Tests and National Health Insurance Research Databases from January 1, 2009 to December 31, 2019. Participants were divided into 2 cohorts targeting anxiety and depression (1 996 633 participants) and attention-deficit/hyperactivity disorder (ADHD; 1 920 596 participants). Participants were aged 10 to 11 years at study entry and followed up for at least 3 years, had a nearly equal gender distribution, and an average follow-up of 6 years. Data were analyzed from October 2022 to February 2024. Exposures Assessments of physical fitness included cardiorespiratory fitness (CF), muscular endurance (ME), muscular power (MP), and flexibility, measured through an 800-m run time, bent-leg curl-ups, standing broad jump, and sit-and-reach test, respectively. Main Outcomes and Measures Kaplan-Meier method calculated the cumulative incidence of anxiety, depression, and ADHD across fitness quartiles. Additionally, multivariable Cox proportional hazards models were used that included all 4 fitness components and explored sex and income as modifiers. Results The anxiety and depression cohort had 1 996 633 participants (1 035 411 participants were male [51.9%], and the median [IQR] age was 10.6 [10.3-11.0] years), while the ADHD cohort had 1 920 596 (975 568 participants were male [51.9%], and the median [IQR] age was 10.6 [10.3-11.0] years). Cumulative incidence of mental disorders was lower among participants in better-performing fitness quartiles, suggesting a dose-dependent association. Gender-specific analyses, controlling for confounders, revealed that improved CF, indicated by a 30-second decrease in run times, was associated with reduced risks of anxiety, depression, and ADHD in female participants, and lower risks of anxiety and ADHD in male participants (adjusted hazard ratio [aHR] for ADHD risk for female participants, 0.92; 95% CI, 0.90-0.94; P < .001; for male participants, 0.93; 95% CI, 0.92-0.94; P < .001). Enhanced ME, marked by an increase of 5 curl-ups per minute, was associated with decreased risks of depression and ADHD in female participants, and lower anxiety and ADHD risks in male participants (aHR for ADHD risk for female participants, 0.94; 95% CI, 0.92-0.97; P < .001; for male participants, 0.96; 95% CI, 0.95-0.97; P < .001). Improved MP, reflected by a 20-cm increase in jump distance, was associated with reduced risks of anxiety and ADHD in female participants and reduced anxiety, depression, and ADHD in male participants (aHR for ADHD risk for female participants, 0.95; 95% CI, 0.91-1.00; P = .04; for male participants, 0.96; 95% CI, 0.94-0.99; P = .001). Conclusions and Relevance This study highlights the potential protective role of cardiorespiratory fitness, muscular endurance, and muscular power in preventing the onset of mental disorders. It warrants further investigation of the effectiveness of physical fitness programs as a preventive measure for mental disorders among children and adolescents.
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Affiliation(s)
- Huey-Ling Chiang
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
- Department of Psychiatry, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Yi-Fang Chuang
- Department of Psychiatry, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- International Health Program, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Public Health, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yi-An Chen
- Institute of Public Health, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chen-Te Hsu
- Department of Sport Management, National Taiwan University of Sport, Taichung, Taiwan
- The Research Center of Sport and Health Industry, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Chien-Chang Ho
- Department of Physical Education, Fu Jen Catholic University, New Taipei City, Taiwan
- Sports Medicine Center, Fu Jen Catholic Hospital, New Taipei City, Taiwan
| | - Hsiu-Tao Hsu
- The Research Center of Sport and Health Industry, National Sun Yat-sen University, Kaohsiung, Taiwan
- Center for Physical and Health Education, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Yi-Han Sheu
- Center for Precision Psychiatry, Massachusetts General Hospital, Boston
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Susan Shur-Fen Gau
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
- Graduate Institute of Clinical Medicine and Graduate Institute of Brain and Mind Sciences, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Li-Lin Liang
- Institute of Public Health, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Health Innovation Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Research Center for Epidemic Prevention and One Health, National Yang Ming Chiao Tung University, Taipei, Taiwan
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Krasniqi E, Vazsonyi AT, Cakirpaloglu P. Internalizing Symptoms among Kosovar Adolescents: Pubertal Correlates in Boys and Girls. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2024; 17:1-16. [PMID: 38938975 PMCID: PMC11199422 DOI: 10.1007/s40653-024-00610-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/12/2024] [Indexed: 06/29/2024]
Abstract
Pubertal status/stage of maturation and pubertal timing have been linked with emotional symptoms of problems among youth, particularly in vulnerable developmental contexts at risk for stress exposure. The present study tested the extent to which pubertal status/stage of maturation and pubertal timing were associated with anxious/depressed, withdrawn/depressed, and somatic complaint symptoms in Kosovar adolescents. It also tested whether sex moderated these relationships. Data were collected from N = 1,342 Kosovar adolescents (665 girls; M age = 13.26 years, SD = 1.27; 677 boys M age = 13.19 years, SD = 1.31). Regression analyses provided evidence that pubertal status/stage was positively associated with rates of anxious/depressed, withdrawn/depressed, and somatic complaint symptoms in girls, but only with withdrawn/depressed symptoms in boys. Additionally, pubertal timing was positively associated with anxious/depressed, and somatic complaint symptoms in girls; no significant links were found for boys. The present study provided evidence that advanced pubertal status/stage as well as timing is positively associated with internalizing symptoms in girls; however, only pubertal status/stage was positively associated with withdrawn/depressed symptoms in boys. The study highlights the importance of pubertal development for internalizing symptoms in a developmental context known for high stress exposure, particularly for girls.
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Affiliation(s)
- Elona Krasniqi
- Department of Psychology Vodární 6, Palacký University Olomouc, 779 00 Olomouc, Czech Republic
| | - Alexander T. Vazsonyi
- Department of Family Sciences, 316 Funkhouser Building, University of Kentucky, Lexington, Kentucky 40506 USA
| | - Panajotis Cakirpaloglu
- Department of Psychology Vodární 6, Palacký University Olomouc, 779 00 Olomouc, Czech Republic
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Gupta T, Eckstrand KL, Forbes EE. Annual Research Review: Puberty and the development of anhedonia - considering childhood adversity and inflammation. J Child Psychol Psychiatry 2024; 65:459-480. [PMID: 38391011 PMCID: PMC10939801 DOI: 10.1111/jcpp.13955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/12/2024] [Indexed: 02/24/2024]
Abstract
Anhedonia, or diminished pleasure and motivation, is a symptom of severe mental illness (e.g., depressive disorder, bipolar disorder, schizophrenia) that emerges during adolescence. Anhedonia is a pernicious symptom that is related to social impairments, treatment resistance, and suicide. As the mechanisms of anhedonia are postulated to include the frontostriatal circuitry and the dopamine neuromodulatory system, the development and plasticity of these systems during the vulnerable period of adolescence, as well as their sensitivity to pubertal hormones, suggest that pubertal maturation could play a role in the development of anhedonia. This review takes a developmental perspective, considering the possibility that anhedonia emerges in the context of pubertal maturation and adolescent development, with childhood adversity and chronic inflammation influencing neural reward systems to accelerate anhedonia's progression. Here, we review the relevant extant literature on the components of this model and suggest directions for future research.
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Affiliation(s)
- Tina Gupta
- University of Pittsburgh, Department of Psychiatry, Pittsburgh, PA USA
| | | | - Erika E. Forbes
- University of Pittsburgh, Department of Psychiatry, Pittsburgh, PA USA
- University of Pittsburgh, Department of Psychology, Pittsburgh, PA USA
- University of Pittsburgh, Department of Pediatrics, Pittsburgh PA USA
- University of Pittsburgh, Department of Clinical and Translational Science, Pittsburgh PA USA
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Hirtz R, Grasemann C, Hölling H, von Holt BH, Albers N, Hinney A, Hebebrand J, Peters T. No relationship between male pubertal timing and depression - new insights from epidemiology and Mendelian randomization. Psychol Med 2024:1-10. [PMID: 38515277 DOI: 10.1017/s0033291724000060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
BACKGROUND In males, the relationship between pubertal timing and depression is understudied and less consistent than in females, likely for reasons of unmeasured confounding. To clarify this relationship, a combined epidemiological and genetic approach was chosen to exploit the methodological advantages of both approaches. METHODS Data from 2026 males from a nationwide, representative study were used to investigate the non-/linear relationship between pubertal timing defined by the age at voice break and depression, considering a multitude of potential confounders and their interactions with pubertal timing. This analysis was complemented by Mendelian randomization (MR), which is robust to inferential problems inherent to epidemiological studies. We used 71 single nucleotide polymorphisms related to pubertal timing in males as instrumental variable to clarify its causal relationship with depression based on data from 807 553 individuals (246 363 cases and 561 190 controls) by univariable and multivariable MR, including BMI as pleiotropic phenotype. RESULTS Univariable MR indicated a causal effect of pubertal timing on depression risk (inverse-variance weighted: OR 0.93, 95%-CI [0.87-0.99)], p = 0.03). However, this was not confirmed by multivariable MR (inverse-variance weighted: OR 0.95, 95%-CI [0.88-1.02)], p = 0.13), consistent with the epidemiological approach (OR 1.01, 95%-CI [0.81-1.26], p = 0.93). Instead, the multivariable MR study indicated a causal relationship of BMI with depression by two of three methods. CONCLUSIONS Pubertal timing is not related to MDD risk in males.
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Affiliation(s)
- Raphael Hirtz
- Department of Pediatrics, Division of Rare Diseases, and CeSER, Ruhr-University Bochum, Alexandrinenstr. 5, 44791 Bochum, Germany
- Division of Pediatric Endocrinology and Diabetology, Department of Pediatrics II, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 40211 Essen, Germany
- Helios University Medical Centre Wuppertal - Children's Hospital, Witten/Herdecke University, Wuppertal, Germany
| | - Corinna Grasemann
- Division of Pediatric Endocrinology and Diabetology, Department of Pediatrics II, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 40211 Essen, Germany
| | - Heike Hölling
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Björn-Hergen von Holt
- Institut für Medizinische Biometrie und Statistik, Universität zu Lübeck, Universitätsklinikum Schleswig-Holstein, 23562 Lübeck, Germany
| | - Nicola Albers
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Essen, University of Duisburg-Essen, Virchowstr. 174, 45147 Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Anke Hinney
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Essen, University of Duisburg-Essen, Virchowstr. 174, 45147 Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Johannes Hebebrand
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Essen, University of Duisburg-Essen, Virchowstr. 174, 45147 Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Triinu Peters
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Essen, University of Duisburg-Essen, Virchowstr. 174, 45147 Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
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Wunram HL, Kasparbauer AM, Oberste M, Bender S. [Movement as a Neuromodulator: How Physical Activity Influences the Physiology of Adolescent Depression]. ZEITSCHRIFT FUR KINDER- UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2023; 52:77-93. [PMID: 37851436 DOI: 10.1024/1422-4917/a000954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
Movement as a Neuromodulator: How Physical Activity Influences the Physiology of Adolescent Depression Abstract: In the context of adolescent depression, physical activity is becoming increasingly recognized for its positive effects on neuropathology. Current scientific findings indicate that physical training affects the biological effects of depression during adolescence. Yet the pathophysiology of adolescent depression is not yet fully understood. Besides psychosocial and genetic influences, various neurobiological factors are being discussed. One explanation model describes a dysfunction of the hypothalamus-pituitary-adrenal axis (HPA axis) with a sustained elevation in cortisol concentration. Recent studies highlight neuroimmunological processes and a reduced concentration of growth factors as causative factors. These changes appear to lead to a dysregulation of the excitation and inhibition balance of the cerebral cortex as well as to cerebral morphological alterations. Regular physical training can potentially counteract the dysregulation of the HPA axis and normalize cortisol levels. The release of proinflammatory cytokines is inhibited, and the expression of growth factors involved in adult neurogenesis is stimulated. One should ensure the synergistic interaction of biological and psychosocial factors when designing the exercise schedule (endurance or strength training, group or individual sports, frequency, duration, and intensity). Addressing these open questions is essential when integrating physical activity into the guidelines for treating depressive disorders in children and adolescents.
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Affiliation(s)
- Heidrun Lioba Wunram
- Klinik und Poliklinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters, Uniklinik Köln, Medizinische Fakultät der Universität zu Köln, Deutschland
- Kinderklinik Uniklinik Köln, Medizinische Fakultät der Universität zu Köln, Deutschland
- Geteilte Erstautorenschaft
| | - Anna-Maria Kasparbauer
- Klinik und Poliklinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters, Uniklinik Köln, Medizinische Fakultät der Universität zu Köln, Deutschland
- Geteilte Erstautorenschaft
| | - Max Oberste
- Institut für Medizinische Statistik und Bioinformatik, Universität zu Köln, Deutschland
| | - Stephan Bender
- Klinik und Poliklinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters, Uniklinik Köln, Medizinische Fakultät der Universität zu Köln, Deutschland
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Son S, Lee H, Jang Y. Continuity and Stability of Child and Adolescent Depressive Symptoms in South Korea: A Meta-analysis of Longitudinal Studies. J Youth Adolesc 2023; 52:598-618. [PMID: 36469180 DOI: 10.1007/s10964-022-01709-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 11/07/2022] [Indexed: 12/12/2022]
Abstract
Many adolescents in South Korea experience risk-level depressive symptoms due to stress caused by personal and environmental changes. Prior studies investigated various characteristics of depressive symptoms. However, it is unclear when the mean level of depression changes with the development of children and adolescents and whether it is stable relative to one another over time. Thus, it is necessary to closely understand the continuity and stability of depressive symptoms across developmental stages in children and adolescents. In this study, continuity refers to the consistency in a group's mean level of depressive symptoms over time; however, stability refers to the consistency in the relative placement of the levels of depressive symptoms of individuals within a group over time. To comprehensively understand previous studies, this meta-analysis compiled data from 95 South Korean longitudinal studies (N = 200,338; 49.7% females) published between 2000 and 2021. Data were analyzed using a three-level random effects model with a 1-year interval for each age group to integrate effect sizes, followed by a generalized additive mixed model integrating age as a continuous variable. The results indicate that the mean-level continuity of depressive symptoms was relatively high and the rank-order stability was low for the children in elementary school (including both upper and lower grades). Additionally, as the adolescents aged, the mean-level continuity of depressive symptoms slightly decreased while stability increased. When entering early adulthood, the continuity and stability of depressive symptoms converged without significant change. As a result of moderating effect, the female-only group indicated a high level of continuity and stability than the male-only or mixed group. The findings highlight that South Korean childhood is a period of relatively high continuity and low stability. Moreover, female students' depressive symptoms fluctuate more than those of males, suggesting the need for providing effective and appropriate help.
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Affiliation(s)
- Sookyoung Son
- Innovation Project Group, Woosuk University, 443, Samnye-ro, Samnye-eup, Wanju-gun, Jeollabuk-do, 55338, Republic of Korea.
| | - Hyunjung Lee
- Department of Education, Korea University, 145 Anam-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - Yoona Jang
- Department of Education, Korea University, 145 Anam-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
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Thapar A, Eyre O, Patel V, Brent D. Depression in young people. Lancet 2022; 400:617-631. [PMID: 35940184 DOI: 10.1016/s0140-6736(22)01012-1] [Citation(s) in RCA: 145] [Impact Index Per Article: 72.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 05/16/2022] [Accepted: 05/19/2022] [Indexed: 02/06/2023]
Abstract
Depression rates in young people have risen sharply in the past decade, especially in females, which is of concern because adolescence is a period of rapid social, emotional, and cognitive development and key life transitions. Adverse outcomes associated with depression in young people include depression recurrence; the onset of other psychiatric disorders; and wider, protracted impairments in interpersonal, social, educational, and occupational functioning. Thus, prevention and early intervention for depression in young people are priorities. Preventive and early intervention strategies typically target predisposing factors, antecedents, and symptoms of depression. Young people who have a family history of depression, exposure to social stressors (eg, bullying, discordant relationships, or stressful life events), and belong to certain subgroups (eg, having a chronic physical health problem or being a sexual minority) are at especially high risk of depression. Clinical antecedents include depressive symptoms, anxiety, and irritability. Evidence favours indicated prevention and targeted prevention to universal prevention. Emerging school-based and community-based social interventions show some promise. Depression is highly heterogeneous; therefore, a stepwise treatment approach is recommended, starting with brief psychosocial interventions, then a specific psychological therapy, and then an antidepressant medication.
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Affiliation(s)
- Anita Thapar
- Wolfson Centre for Young People's Mental Health and Child and Adolescent Psychiatry Section, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK.
| | - Olga Eyre
- Wolfson Centre for Young People's Mental Health and Child and Adolescent Psychiatry Section, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - David Brent
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
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Persistence of Anxiety/Depression Symptoms in Early Adolescence: A Prospective Study of Daily Life Stress, Rumination, and Daytime Sleepiness in a Genetically Informative Cohort. Twin Res Hum Genet 2022; 25:115-128. [PMID: 35856184 DOI: 10.1017/thg.2022.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In this prospective study of mental health, we examine the influence of three interrelated traits - perceived stress, rumination, and daytime sleepiness - and their association with symptoms of anxiety and depression in early adolescence. Given the known associations between these traits, an important objective is to determine the extent to which they may independently predict anxiety/depression symptoms. Twin pairs from the Queensland Twin Adolescent Brain (QTAB) project were assessed on two occasions (N = 211 pairs aged 9-14 years at baseline and 152 pairs aged 10-16 years at follow-up). Linear regression models and quantitative genetic modeling were used to analyze the data. Prospectively, perceived stress, rumination, and daytime sleepiness accounted for 8-11% of the variation in later anxiety/depression; familial influences contributed strongly to these associations. However, only perceived stress significantly predicted change in anxiety/depression, accounting for 3% of variance at follow-up after adjusting for anxiety/depression at baseline, although it did not do so independently of rumination and daytime sleepiness. Bidirectional effects were found between all traits over time. These findings suggest an underlying architecture that is shared, to some degree, by all traits, while the literature points to hypothalamic-pituitary-adrenal (HPA) axis and/or circadian systems as potential sources of overlapping influence and possible avenues for intervention.
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