The impact of anxiety and mood disorders on physical disease: the worried not-so-well

Efficacy of a Relaxation Scenario in Virtual Reality for the Comorbid Symptoms of Anxiety and Asthenia in a General Hospital Setting: A Pilot Comparative Randomized Open-Label Study

BACKGROUND

Patients in general hospitals often display concomitant signs of mental maladjustment: low mood, anxiety, apathy, asthenia, all of which can have a negative impact on the course of the underlying disease and the recovery process. One of the non-pharmacological approaches that has gained wider acceptance in medical practice in recent years is the use of procedures based on virtual reality.

AIM

Assess the efficacy of the new domestic, virtual reality application Flow as relates to symptoms of anxiety and asthenia in patients undergoing inpatient treatment.

METHODS

The study was open-label and had a comparison group; the patients were assigned to the experimental or control group using a randomization table. The patients were assessed using the Spielberger State Anxiety Inventory; the Fatigue Symptom Rating Scale; the Well-being, Activity, Mood questionnaire; the Depression Anxiety Stress Scale; and the Clinical Global Impression Scale. Physical parameters were measured before and after each virtual reality session. The obtained data were statistically processed.

RESULTS

The study involved 60 patients. In 40 patients, the treatment program included a course of five daily relaxation sessions in virtual reality; the control group consisted of 20 patients, who were treated in accordance with the usual practice of the institution. The addition of virtual reality sessions to the standard treatment course yielded significant advantage in terms of affective symptoms reduction in patients both after a single session and as a result of undergoing the full course, and several days after its completion. The patients in the experimental group also showed a significant decrease in blood pressure after the sessions, and this was most pronounced in individuals who initially had elevated and high blood pressure.

CONCLUSION

The use of relaxation program courses in the virtual reality application Flow is an effective and promising means of non-pharmacological care for non-psychiatric inpatients showing symptoms of anxiety, apathy, depressive mood, as well as hypertension.

Posttraumatic stress disorder predicts poor health-related quality of life in cardiac patients in Palestine

Background

The longitudinal association of posttraumatic stress disorder (PTSD) with health-related quality of life (HRQL) in cardiac patients’ remains poorly studied, particularly in conflict-affected settings.

Materials and methods

For this cohort study, we used baseline and one-year follow-up data collected from patients 30 to 80 years old consecutively admitted with a cardiac diagnosis to four major hospitals in Nablus, Palestine. All subjects were screened for PTSD and HRQL using the PTSD Checklist Specific and the HeartQoL questionnaire. We used a generalized structural equation model (GSEM) to examine the independent predictive association of PTSD at baseline with HRQL at follow-up. We also examined the mediating roles of depression, anxiety, and stress at baseline.

Results

The prevalence of moderate-to-high PTSD symptoms among 1022 patients at baseline was 27∙0%. Patients with PTSD symptoms reported an approximate 20∙0% lower HRQL at follow-up. The PTSD and HRQL relationship was largely mediated by depressive and anxiety symptoms. It was not materially altered by adjustment for socio-demographic, clinical, and lifestyle factors.

Discussion

Our findings suggest that individuals with a combination of PTSD and depression, or anxiety are potentially faced with poor HRQL as a longer-term outcome of their cardiac disease. In Palestine, psychological disorders are often stigmatized; however, integration of mental health care with cardiac care may offer an entry door for addressing psychological problems in the population. Further studies need to assess the effective mental health interventions for improving quality of life in cardiac patients.

Increases in Stressors Prior to-Versus During the COVID-19 Pandemic in the United States Are Associated With Depression Among Middle-Aged Mothers

Working parents in are struggling to balance the demands of their occupation with those of childcare and homeschooling during the COVID-19 pandemic. Moreover, studies show that women are shouldering more of the burden and reporting greater levels of psychological distress, anxiety, and depression relative to men. However, research has yet to show that increases in psychological symptoms are linked to changes in stress during the pandemic. Herein, we conduct a small-N study to explore the associations between stress and psychological symptoms during the pandemic among mothers using structural equation modeling, namely latent change score models. Thirty-three mothers completed questionnaires reporting current anxious and depressive symptoms (Beck Anxiety and Depression Index, respectively), as well as stressful life experiences prior to-versus during the pandemic (Social Readjustment Rating Scale). Women endorsed significantly more stressful events during the pandemic, relative to the pre-pandemic period. Additionally, 58% of mothers scored as moderate-to-high risk for developing a stress-related physical illness in the near future because of their pandemic-level stress. Depressive symptoms were associated with the degree of change in life stress, whereas anxiety symptoms were more related to pre-pandemic levels of stress. The present study preliminarily sheds light on the nuanced antecedents to mothers’ experiences of anxious and depressive symptoms during the COVID-19 pandemic. Although further work is needed in larger, more diverse samples of mothers, this study highlights the potential need for appropriate policies, and prevention and intervention programs to ameliorate the effects of pandemics on mothers’ mental health.

Association between prescribed antidepressants and other prescribed drugs differ by gender: a nationwide register-based study in Sweden

BACKGROUND

People with depression are prescribed more drugs than people in general, partly due to comorbidity with other conditions. However, little research has been done on depression-related drug use from a gender perspective.

AIM

Examine the association between antidepressants, other types of prescribed drugs, and polypharmacy, by gender.

METHODS

Data on drugs dispensed October to December 2016 to all Swedish citizens aged 18-84 years were collected from the Swedish prescribed drug register. Logistic regression analyses were performed to examine the associations between antidepressants and other drugs, by gender.

RESULTS

For both men and women, associations were found between antidepressants and drugs for alimentary tract problems, respiratory problems, blood, nervous system, analgesics, and polypharmacy. However, for women, but not men, associations were also found for drugs for diabetes, musculoskeletal problems, dermatological problems, and systemic hormones.

CONCLUSIONS

Associations were found between antidepressants and many other types of drugs for both men and women; indicating comorbidity between depression and other conditions. Further, some of the associations between antidepressants and other drugs were found to be specific among women. Whether this indicates that men and women differ in comorbidity between depression and other conditions cannot be concluded based on this cross-sectional study. However, comorbidity impairs the possibility of recovery; in the somatic condition as well as the depression. Thus, physicians need to be aware that the association between antidepressants and other types of drugs are more common among women than men.

Unhealthy behaviour modification, psychological distress, and 1-year survival in cardiac rehabilitation

OBJECTIVE

Cardiac rehabilitation (CR) is considered the recommended secondary prevention treatment for cardiovascular diseases (CVD), in terms of health behaviours and, secondarily, better cardiac outcomes promotion. However, the role of psychiatric and psychosomatic distress on the efficacy of CR is unclear. This research aimed to evaluate the impact of CR on unhealthy behaviour modification and cardiac course, considering the moderating role of depression, anxiety, and psychosomatic syndromes.

DESIGN

A longitudinal design between and within groups was employed. The assessment was repeated four times: at admission to CR (T1), at discharge (T2), 6 (T3) and 12 months following CR completion (T4).

METHOD

One hundred and eight patients undergoing CR versus 85 patients with CVD not referred to CR, underwent psychiatric, psychosomatic, and health behaviour assessment. The assessment included the Structured Clinical Interview for DSM-IV (depression and anxiety), the interview based on Diagnostic Criteria for Psychosomatic Research, GOSPEL Study questionnaire (health behaviours), Pittsburgh Sleep Quality Index, and 8-item Morisky Medication Adherence Scale.

RESULTS

Cardiac rehabilitation was associated with maintenance of physical activity, improvement of behavioural aspects related to food consumption, stress management, and sleep quality. On the contrary, CR was not associated with weight loss, healthy diet, and medication adherence. Depression and psychosomatic syndromes seem to moderate the modification of specific health-related behaviours (physical activity, behavioural aspects of food consumption, stress management, and pharmacological adherence).

CONCLUSION

In CR settings, an integrated assessment including both psychiatric and psychosomatic syndromes is needed to address psychological factors associated with unhealthy behaviour modification. Statement of contribution What is already known on this subject? Cardiac rehabilitation (CR) is considered a class 1A treatment recommendation and the most cost-effective model of secondary prevention to reduce cardiovascular events. There is evidence about the association between psychological distress and both unhealthy behaviour and cardiac course. Depression and psychosomatic distress, such as type A behaviour and demoralization, are frequently associated with CVD course. However, the role of psychiatric and psychosomatic distress in CR is not well known. What does this study add? CR exerted a protective effect on physical activity and a positive effect on eating behaviour, stress management, and quality of sleep. CR did not show any particular effect on smoking, overweight/obesity, dietary habits, medication adherence, and patients' 1-year survival. Findings from this study suggest the importance to consider specific psychological and psychosomatic aspects in affecting lifestyle.

Health-related social control among older men with depressive symptomatology

OBJECTIVES

Social control attempts, or attempts by social network members to influence a person's behavior, significantly predict men's health behaviors and psychological well-being. Despite the fact that depression is associated with compromised interpersonal functioning and poor health behaviors, the association between social control processes and depression has not been studied. Thus, this pilot study explored differential vulnerability to spouses' social control attempts among older, male primary care patients with varying levels of depression symptom severity and the degree to which these attempts predicted patients' behavioral and affective responses.

METHOD

Participants included 88 older men referred by their primary care providers for a behavioral health assessment at a Veterans Affairs Medical Center. Data on sociodemographics, depressive symptomatology, health behaviors, spouses' positive and negative social control attempts, and patients' behavioral and affective responses to attempts were collected by telephone.

RESULTS

The sample was primarily Caucasian (mean age = 65.3 (SD = 8.1) years). Patients' higher depressive symptoms were significantly associated with positive and negative affective responses to their spouses' social control attempts. The frequency of control attempts and patients' behavioral responses, however, were unrelated to patients' depressive symptoms. Multiple regression models revealed that while spouses' control attempts were unrelated to patients' positive behavioral responses, more frequent negative attempts predicted greater negative behavioral responses (e.g., ignoring spouses' attempts). Moreover, negative control attempts predicted greater negative affective responses (e.g., resentment, sadness).

CONCLUSION

The findings highlight the value of identifying effective social control strategies that maximize positive behavioral change, emotional responses, and health outcomes among older men with depressive symptoms.

Retaining Low-Income Minority Cancer Patients in a Depression Treatment Intervention Trial: Lessons Learned

Previously published work finds significant benefit from medical and behavioral health team care among safety-net patients with major depression. This qualitative study assessed clinical social worker, psychiatrist and patient navigator strategies to increase depression treatment among low-income minority cancer patients participating in the ADAPt-C clinical depression trial. Patient care retention strategies were elicited through in-depth, semi-structured interviews with nine behavioral health providers. Using grounded theory, concepts from the literature and dropout barriers identified by patients, guided interview prompts. Retention strategies clustered around five dropout barriers: (1) informational, (2) instrumental, (3) provider-patient therapeutic alliance, (4) clinic setting, and (5) depression treatment. All strategies emphasized the importance of communication between providers and patients. Findings suggest that strong therapeutic alliance and telephone facilitates collaborative team provider communication and depression treatment retention among patients in safety-net oncology care systems.

Toward scientific equity for the prevention of depression and depressive symptoms in vulnerable youth

Certain subgroups of youth are at high risk for depression and elevated depressive symptoms, and experience limited access to quality mental health care. Examples are socioeconomically disadvantaged, racial/ethnic minority, and sexual minority youth. Research shows that there are efficacious interventions to prevent youth depression and depressive symptoms. These preventive interventions have the potential to play a key role in addressing these mental health disparities by reducing youth risk factors and enhancing protective factors. However, there are comparatively few preventive interventions directed specifically to these vulnerable subgroups, and sample sizes of diverse subgroups in general prevention trials are often too low to assess whether preventive interventions work equally well for vulnerable youth compared to other youth. In this paper, we describe the importance and need for "scientific equity," or equality and fairness in the amount of scientific knowledge produced to understand the potential solutions to such health disparities. We highlight possible strategies for promoting scientific equity, including the following: increasing the number of prevention research participants from vulnerable subgroups, conducting more data synthesis analyses and implementation science research, disseminating preventive interventions that are efficacious for vulnerable youth, and increasing the diversity of the prevention science research workforce. These strategies can increase the availability of research evidence to determine the degree to which preventive interventions can help address mental health disparities. Although this paper utilizes the prevention of youth depression as an illustrative case example, the concepts are applicable to other health outcomes for which there are disparities, such as substance use and obesity.

Low-income cancer patients in depression treatment: dropouts and completers

This study aims to explore reasons for depression treatment dropout among low-income, minority women with depression and cancer. Semi-structured telephone interviews are conducted with 20, predominately Latina, patients who dropped out of depression treatment and 10 who completed. Transcripts analyzed using techniques rooted in grounded theory. Treatment completion barriers cluster according to Meichenbaum and Turk's (Facilitating treatment adherence: A practitioner's guidebook, Plenum Press, New York, 1987) five adherence dimensions: (a) Barriers to Treatment (informational, instrumental, cultural [language, discrimination]); (b) Disease Features (emotional burden of cancer/depression); (c) Cancer/Depression Treatment Regimens; (d) Provider-Patient Relationship (depression treatment dissatisfaction); and (e) Clinical Setting (hospital organizational issues). Although both groups describe multiple overlapping dimensions of barriers, completers seem more motivated and satisfied with treatment, possibly due to completers experiencing the positive treatment effects after the first several sessions. More research should be conducted to determine the most effective clinical treatment methods for this population.

Sleep quality as a potential mediator between psychological distress and diabetes quality of life in veterans with type 2 diabetes

OBJECTIVE

The goal of this study was to explore sleep quality as a potential mediator between depression symptoms and diabetes quality of life (DQOL), and anxiety symptoms and DQOL.

METHOD

Participants were 83 male and 3 female veterans with type 2 diabetes (Mage = 62.4). Self-report measures were completed during the baseline assessment of a larger intervention study conducted at the VA Boston Healthcare System.

RESULTS

Depression symptoms, anxiety symptoms, and sleep quality were all associated with DQOL. Additionally, sleep quality had a partial indirect effect on the relationships between depression symptoms and DQOL, and between anxiety symptoms and DQOL.

CONCLUSIONS

These findings suggest that sleep quality may have an important role in the way that psychological distress affects diabetes quality of life.

Mokken scaling analysis of the Hospital Anxiety and Depression Scale in individuals with cardiovascular disease

OBJECTIVE

The Hospital Anxiety and Depression Scale (HADS) is a prolifically used scale of anxiety and depression. The original bidimensional anxiety-depression latent structure of the HADS has come under significant scrutiny, with previous studies revealing one-, two-, three- and four-dimensional structures. The current study examines the latent structure of the HADS using a non-parametric item response theory method.

METHOD

Using data conglomerated from four independent studies of cardiovascular disease employing the HADS (n=893), Mokken scaling procedure was conducted to assess the latent structure of the HADS.

RESULTS

A single scale consisting of 12 of 14 HADS items was revealed, indicating a unidimensional latent HADS structure.

DISCUSSION

The HADS was initially intended to measure mutually exclusive levels of anxiety and depression; however, the current study indicates that a single dimension of general psychological distress is captured.

The spectrum of worry in the community-dwelling elderly

OBJECTIVES

In this study, we examine the prevalence and distribution of worry, its content, and its associations with quality of life and depression, based on a large sample of community-dwelling elderly. We will attempt to distinguish between pathological and non-pathological worry based on these associations.

DESIGN

Community survey.

SETTING

Inner-city population.

PARTICIPANTS

A total of 2136 people aged between 65 and 96, of whom 66% were women, were recruited through general practitioners and interviewed in their own homes.

MEASUREMENTS

The GMS-AGECAT structured psychiatric interview was used to rate symptoms which were classified into five levels of severity of worry ranging from simple, non-excessive to generalised anxiety disorder (GAD).

RESULTS

In this study, 79% of the participants reported worrying, 37% worrying excessively, while 20% reported excessive, uncontrollable worry and 6.3% met criteria for GAD. Prevalence of all types of worry declined with age and was lower in men. The prevalence of depressed mood was similar in those without worry and those with non-severe worry (Wald post hoc test, p = 0.06) but rose significantly with each level of severe worry (Wald post hoc tests, all p < 0.05). Major depressive disorder was absent in those who did not worry, and had a prevalence of only 0.2% in those with non-severe worry (p = 0.552, Fisher's exact test). It has a significantly elevated prevalence at all levels of excessive worry, and a significantly higher prevalence in those with GAD. All levels of excessive worry were associated with reduced quality of life.

CONCLUSION

Severe worry is highly prevalent in the elderly; most severe worriers do not meet criteria for GAD, but have a reduced quality of life and an increased prevalence of depression.

Cutting the vagus nerve below the diaphragm prevents maternal potentiation of infant rat vocalization

In maternal potentiation, the rate of vocalization by a young organism during isolation is greatly enhanced if that isolation has been immediately preceded by an interaction with the mother (or other adult female in the case of rats). The enhancement in isolation-induced vocalization rate does not occur if the young animal had an interaction with other social companions like littermates or with familiar inanimate stimuli like home cage shavings. The present study demonstrates that pups whose vagus nerve is cut below the diaphragm do not potentiate vocalization after an interaction with their dam. The vocalization rates of denervated pups in a first isolation, in the presence of the dam, and during cold exposure do not differ from control pups. Their non-vocal behaviors also appear unaffected by the surgery. Similar to what has been shown in studies of fever-induced behavioral changes, an intact vagus nerve from the gut is necessary for young rat pups to show normal social mediation of their isolation-induced vocal responses.

Impact of depression and social support on nonadherence to antipsychotic drugs in persons with schizophrenia in Thailand

BACKGROUND

Little is known about the effect of social support on nonadherence in persons with schizophrenia, especially in developing Asian countries where social support is considered to be imperative. Additionally, the role of depression as a mediator in the association between social support deficits and nonadherence has not been evaluated.

METHODS

This was a cross-sectional study conducted in 75 participants at a university hospital in Thailand. Logistic regression was used to determine whether depression and a deficit in social support were associated with nonadherence, and whether depression mediated this association.

RESULTS

There were strong relationships between nonadherence and major depressive episodes (odds ratio [OR] 9.5, confidence interval [CI] 2.3-38.9), living alone (OR 21.8, CI 3.5-143.0), and dissatisfaction with support from family (OR 10.0, CI 1.9-53.1). The OR of the association between social support deficits and nonadherence decreased by nearly one half after adjusting for depression.

DISCUSSION

Depression and social support deficits were significantly associated with nonadherence in persons with schizophrenia. Depression is important in mediating the association between social support deficits and nonadherence. Enhancing social support, as well as early detection and effective intervention for depression should be emphasized in interventions to improve adherence in persons with schizophrenia.

Association of anxiety and depression with microtubule-associated protein 2- and synaptopodin-immunolabeled dendrite and spine densities in hippocampal CA3 of older humans

CONTEXT

Chronic psychological distress has deleterious effects on many of the body's physiological systems. In experimental animal models, chronic stress leads to neuroanatomic changes in the hippocampus, in particular a decrease in the length and branching of dendrites as well as a decrease in the number of dendritic spines.

OBJECTIVES

To examine whether analogous distress-related neuroanatomic changes occur in humans and whether such changes might also be related to cognitive dysfunction observed in older people who report greater psychological distress.

DESIGN

Postmortem study of brain tissues from participants of the Religious Orders Study, an ongoing population-based clinicopathological study of aging and cognition.

SETTING

The Rush University Religious Orders Study and the University of Pennsylvania Cellular and Molecular Neuropathology Program.

PARTICIPANTS

Seventy-two deceased participants of the Religious Orders Study.

MAIN OUTCOME MEASURES

Densities of microtubule-associated protein 2-immunolabeled dendrites and synaptopodin-immunolabeled dendritic spines in the CA3 subfield of the hippocampus, quantified using semiautomated image acquisition and analysis.

RESULTS

Higher levels of trait anxiety and longitudinal depression scores were associated with decreased densities of dendrites and spines in CA3. Dendrite and spine densities did not correlate with an index of global cognition or with densities of common age-related pathological changes.

CONCLUSIONS

Regressive neuronal changes occur in humans who experience greater psychological distress. These changes are analogous to neuronal changes in animal models of chronic stress.

"It doesn't do any harm, but patients feel better": a qualitative exploratory study on gastroenterologists' perspectives on the role of antidepressants in inflammatory bowel disease

Background

Interest in psychological factors in patients with inflammatory bowel disease (IBD) has increased in recent years. It has even been proposed that treating psychological co-morbidities with antidepressants may control disease activity and improve quality of life. Despite this, there is no data on gastroenterologists' attitudes to, and experiences with, antidepressant therapy in patients with IBD.

Methods

We conducted semi-structured interviews with 18 gastroenterologists associated with metropolitan teaching hospitals. Qualitative content analysis was used to examine their responses.

Results

Seventy-eight percent of gastroenterologists had treated IBD patients with antidepressants for pain, depression and/or anxiety, and insomnia. Antidepressants were reported to be useful in improving psychosocial well-being, quality of life, and self-management of the disease by patients. However, in this group of gastroenterologists, there appears to be skepticism towards psychological disorders themselves or antidepressant therapy having a central role in either the causation of IBD or its clinical course. Nevertheless, these gastroenterologists were receptive to the idea of conducting a trial of the role of antidepressants in IBD.

Conclusion

While the majority of specialists have treated IBD patients with antidepressants, there is considerable skepticism with regard to efficacy of antidepressive therapy or the role of psychological factors in the outcome of IBD patients.