Temporal patterns of anxious and depressed mood in generalized anxiety disorder: a daily diary study

Parent Anxiety, Depression, Protective Responses, and Parenting Stress in the Context of Parent and Child Chronic Pain: A Daily Diary Study of Parent Variability

Parents with (vs without) chronic pain report poorer psychosocial functioning (eg, worse mental health, parenting difficulties), which has been linked to poorer child outcomes (eg, child pain). However, emerging research suggests that individuals vary in their functioning from day-to-day, particularly those with chronic pain. This study used daily diaries to compare parents with (versus without) chronic pain on variability in their anxiety, mood, protective responses, and parenting stress. We also examined parent chronic pain status as a moderator of the associations between parent variability and youth daily pain and interference. Participants were 76 youth with chronic pain (Mage = 14.26; 71.1% female) and one of their parents (89.5% mothers; n = 38 or 50.0% endorsing chronic pain). Parents and youth completed self-report questionnaires and 7 days of diaries. Parent variability was calculated to reflect the frequency and size of day-to-day changes. Multilevel models revealed that parents with (vs without) chronic pain were significantly more variable in their parenting stress, but not in their anxiety, mood, or protective responses. Contrary to hypotheses, parent variability was not significantly related to youth daily pain intensity or interference and parent chronic pain did not moderate any associations. Instead, mean levels of parent anxiety, protective responses, and parenting stress across the week significantly predicted youth daily pain interference. Findings suggest that while variability was observed among parents (with and without chronic pain) of youth with chronic pain, it did not significantly predict youth's daily pain-related functioning. Further research is needed to confirm these initial findings. PERSPECTIVE: Parents with chronic pain have expressed concerns that the variable nature of their pain negatively impacts their children. Our results found that parents (with and without chronic pain) were variable in their anxiety, mood, protective responses, and parenting stress, but this variability did not significantly predict youth's chronic pain-related functioning.

Relationship between Workload, Psychological State and Recovery in Female Soccer Athletes

This study assessed the multifaceted relations between measures of workload, psychological state, and recovery throughout an entire soccer season in female collegiate soccer athletes (19.8±1.2 yrs, 132±12.3 lbs, 63±3.2 in). A prospective longitudinal study was utilized to measure workload (GPS training load, Rate of Perceived Exertion (RPE), psychological state (mental stress, mental fatigue, and mood), and recovery (sleep duration, sleep quality, and soreness), during 90 observations (59 training sessions and 21 games). Separate linear-mixed effect models were used to assess outcomes of RPE, soreness, and sleep duration. A linear mixed-effects model explained 59% of the variance in RPE following each session. Specifically, each standard deviation increase in GPS load and mental stress in the morning prior to training increased RPE by 1.46 (SE=0.08) and 0.29 (SE=0.07), respectively, following that day's training. Furthermore, a significant interaction was found between several predictor variables and chronological day in the season while predicting RPE. Specifically, for each standard deviation increase in GPS load, RPE went up by 0.0055 per day during the season suggesting that load had a higher impact on RPE as the season progressed. In contrast, the interaction of day by mental stress, sleep duration, and soreness continued to be stronger as the season progressed. Each linear mixed-effect model predicted a larger amount of variance when accounting for individual variations in the random effects.

Social participation, psychological resilience and depression among widowed older adults in China

BACKGROUND

Depression has become a challenging public health problem, and the loss of a spouse is one of the main causes of depression in older adults. Social participation and psychological resilience are protective factors that reduce depressive symptoms in adults. The purpose of this study was to explore the influences of social participation and psychological resilience on the depression of Chinese widowed older adults.

METHODS

We carried out a cross-sectional study on 790 community-dwelling widowed older adults in Shaanxi, China, in 2019. A structured face-to-face interview was used to collect data. We used the ordinary least squares model (OLS), the generalized propensity score matching (GPSM) and the mediation model to test the relationship between social participation, psychological resilience and depression.

RESULTS

We find a U-shaped relationship between social participation and depression, with the increase in social participation scores, the average depression level decreased and then increased. The psychological resilience of the widowed older adults was negatively associated with depression. The higher their psychological resilience, the lower their depression level. Among the four factors of psychological resilience, factor 2 (optimism and positive acceptance of change) and factor 3 (secure relationships and tolerance of negative affect) of psychological resilience were protective factors for depression after adjusting for demographic variables and physical health conditions. Psychological resilience plays a mediating role, as evident in factor 2 and factor 3 mediating the relationship between social participation and depression.

CONCLUSION

An appropriate level of social participation will relieve the depression of widowed older adults. Social participation can reduce the depression level of widowed older adults by improving their psychological resilience. Community and family could reduce depression by intervening in the social participation of widowed older adults. Active social participation is crucial because it has a protective and resilient impact, which can help people recover from the stress of losing a spouse.

Anxiety, depression, and well-being in autistic adults and adults with other developmental disabilities: A longitudinal cross-lagged analysis

Autistic people and people with other developmental disabilities (DD) are at high likelihood for anxiety and depression, which can negatively affect adult life. Therefore, this study sought to understand temporal links between anxiety and depression over time in autistic adults and adults with DDs, and how these conditions impact specific aspects of positive well-being. A sample of 130 adults with autism or other DDs and their caregivers were drawn from a longitudinal study. Participants complete measures of anxiety (Adult Manifest Anxiety Scale), depression (Beck Depression Inventory, 2nd Edition), and well-being (Scales of Psychological Well-Being). Cross-lagged panel analyses revealed significant autoregressive effects for anxiety and depressive symptoms over time, based on both caregiver and self-report (all p < 0.01). Additionally, although findings differed across reporter, cross-lagged links between anxiety and depression emerged over time. Based on caregiver-report, anxiety symptoms predicted later depressive symptoms (p = 0.002) but depressive symptoms did not predict later anxiety (p = 0.10); the opposite pattern was identified for self-report. Aspects of positive well-being (purpose in life, self-acceptance, personal growth) demonstrated differential links with anxiety and depression (p = 0.001-0.53). These findings highlight the utility of a transdiagnostic approach to mental health services for autistic adults and adults with DDs, and the need to monitor for anxious or depressive symptoms in autistic adults and adults with DDs presenting with depression or anxiety, respectively.

Cognitive Symptoms Link Anxiety and Depression Within a Validation of the German State-Trait Inventory for Cognitive and Somatic Anxiety (STICSA)

Background

In the present study we aimed to develop a German version of the State-Trait Inventory for Cognitive and Somatic Anxiety (STICSA) and evaluate the psychometric properties. Associations of cognitive and somatic anxiety with other measures of anxiety, depression, and stress, elucidating possible underlying functional connections, were also examined, as symptoms of anxiety, depression and stress often overlap.

Method

Two samples (n1 = 301; n2 = 303) were collected online and in the lab, respectively. Dynamic connections between somatic and cognitive anxiety, other measures of anxiety, depression, and stress, were analyzed using a network approach. Psychometric analyses were conducted using exploratory and confirmatory factor analyses.

Results

We replicated and validated the two-factorial structure of the STICSA with the German translation. Network analyses revealed cognitive trait anxiety as the most central node, bridging anxiety and depression. Somatic trait anxiety exhibited the highest discriminant validity for distinguishing anxiety from depression.

Conclusion

The central role of cognitive symptoms in these dynamic interactions suggests an overlap of these symptoms between anxiety and depression and that differential diagnostics should focus more on anxious somatic symptoms than on cognitive symptoms. The STICSA could therefore be useful in delineating differences between anxiety and depression and for differential assessment of mood and anxiety symptoms. Additional understanding of both cognitive and somatic aspects of anxiety might prove useful for therapeutic interventions.

Network intervention analysis of anxiety-related outcomes and processes of acceptance and commitment therapy (ACT) for anxious cancer survivors

OBJECTIVE

Psychotherapies like Acceptance and Commitment Therapy (ACT) are thought to target multiple clinical outcomes by intervening on multiple mechanistic process variables. However, the standard mediation approach does not readily model the potentially complex associations among multiple processes and outcomes. The current study is one of the first to apply network intervention analysis to examine the putative change processes of a psychotherapy.

METHODS

Using data from a randomized trial of ACT versus minimally-enhanced usual care for anxious cancer survivors, we computed pre-to post-intervention (n = 113) residualized change scores on anxiety-related outcomes (general anxiety symptoms, cancer-related trauma symptoms, and fear of cancer recurrence) and putative processes of the intervention (experiential avoidance, self-compassion, and emotional approach coping). We estimated a network model with intervention condition and residualized change scores as nodes.

RESULTS

Contrary to the expectation that intervention effects would pass indirectly to outcomes via processes, network analysis indicated that two anxiety-related outcomes of the trial may have acted as primary mechanisms of the intervention on other outcome and process variables.

CONCLUSIONS

Network intervention analysis facilitated flexible evaluation of ACT's change processes, and offers a new way to test whether change occurs as theorized in psychotherapies.

Examining the temporal dynamics of anxiety and depressive symptoms during a therapist-supported, smartphone-based intervention for depression: Longitudinal observational study

OBJECTIVE

This study examined the temporal dynamics of anxiety and depressive symptoms during a 12-week therapist-supported, smartphone-delivered digital health intervention for symptoms of depression and anxiety.

METHODS

A total of 290 participants were included in the present analyses (age Mean = 39.64, SD = 10.25 years; 79% female; 54% self-reported psychotropic medication use). Linear mixed models were used to examine the concurrent anxiety-depression association and (2) the lead-lag anxiety-depression relationship, with greater anxiety predicted to precede an increase in depression.

RESULTS

In support of Hypothesis 1, greater anxiety during the current biweekly assessment was associated with greater depressive symptoms during the current biweekly assessment. In support of Hypothesis 2, greater anxiety during the prior biweekly assessment was associated with greater depressive symptoms during the current biweekly assessment but not vice-versa.

CONCLUSION

These findings demonstrate that anxiety and depressive symptoms may overlap and fluctuate in concert, with anxiety symptoms predicting subsequent depressive symptoms but not vice-versa. With sensitivity to study limitations, implications for future intervention designs are discussed.

Daily dynamics and mechanisms of anxious symptomatology in the general population: A network study during the COVID-19 pandemic

To understand the interplay between anxiety symptoms and their maintaining psychological processes in the population, an analysis of longitudinal within-person relationships is required. A sample of 1706 individuals completed daily measures during a 40-day period with strict mitigation protocols. Data of 1368 individuals who completed at least 30 assessments were analyzed with the multilevel vector autoregressive (mlVAR) model. This model estimates a temporal, a contemporaneous, and a between-person network. Uncontrollability of worry, generalized worry, fear of being infected, fear of significant others being infected, and threat monitoring had the highest outstrength within the temporal network, indicating that daily fluctuations in these components were the most predictive of next-day fluctuations in other components. Of specific connections, both fear of self and fear of close others being infected predicted generalized worry and threat monitoring. In turn, generalized worry and threat monitoring engaged in several positive feedback loops with other anxiety symptoms and processes. Also, intolerance of uncertainty was predictive of other components. The findings align with the mechanisms both in the metacognitive therapy (MCT) model and in the intolerance of uncertainty model of generalized anxiety disorder (GAD).

Dynamics of daily positive and negative affect and relations to anxiety and depression symptoms in a transdiagnostic clinical sample

BACKGROUND

Despite interest in transdiagnostic dimensional approaches to psychopathology, little is known about the dynamic interplay of affecting and internalizing symptoms that cut across diverse mental health disorders. We examined within-person reciprocal effects of negative and positive affect (NA, PA) and symptoms (depression and anxiety), and their between-person associations with affective dynamics (i.e., affect inertia).

METHODS

Individuals currently receiving treatment for psychological disorders (N = 776) completed daily assessments of affect and symptoms across 14 treatment days (average). We used dynamic structural equation modeling to examine daily affect-symptom dynamics.

RESULTS

Within-person results indicated NA-symptom reciprocal effects; PA only predicted subsequent depression symptoms. After accounting for changes in mean symptoms and affect over time, NA-anxiety and PA-depression relations remained particularly robust. Between-person correlations indicated NA inertia was positively associated with NA-symptom effects; PA inertia was negatively associated with PA-symptoms effects.

CONCLUSIONS

Results suggest that transdiagnostic affective treatment approaches may be more useful for reducing internalizing symptoms by decreasing NA compared to increasing PA. Individual differences in resistance to shifting out of affective states (i.e., high NA vs. PA inertia) may be a useful marker for developing tailored interventions.

The relationship between anxiety and depression under the pandemic: The role of life meaning

Introduction

COVID-19 is a stressor creating much anxiety for the general public, such as anxiety related to possible infection, social distancing, financial strain and uncertainty. As the scientific literature shows that there is an intimate relationship between anxiety and depression, it is important to ask whether anxiety is related to depression under the pandemic and whether spirituality indexed by life meaning can moderate the relationship between anxiety and depression. According to theories highlighting the importance of life meaning, relative to people with a higher level of life meaning, the relationship between anxiety and depression would be stronger in people with a lower level of life meaning.

Methods

Empirically, we collected data in two waves (i.e., before and after the first wave of COVID-19, respectively) from 4,981 adolescents recruited in Sichuan, China. Then, the 41-item “Screen for Child Anxiety Related Emotional Disorders” was employed to measure anxiety symptoms, 20-item “Center for Epidemiological Studies-Depression Scale” was utilized to examine depression symptoms, and the “Spirituality Subscale of the Chinese Positive Youth Development Scale” for assessing life meaning.

Results

We found that anxiety significantly predicted depression at each wave and across time. Second, controlling for Wave 1 depression scores, results showed that a drop in Wave 1 anxiety predicted a drop in depressive symptoms over time. Regarding the relationship between meaning in life and depression, spirituality indexed by meaning in life negatively predicted depression at each wave and over time, and predicted change in depression across time. Finally, multiple regression analyses showed that life meaning moderated the predictive effect of anxiety on depression.

Discussion

The findings support the thesis that spirituality serves as a protective factor for psychological morbidity in Chinese adolescents. The study also suggests the importance of helping adolescents to develop life meaning under COVID-19.

Associations between trait and state perceived stress and daily moods: COVID-19 stressful experiences as a moderator

Drastically disrupting daily routines, the global pandemic of COVID-19 has posed critical mental health threats to adolescents and young adults worldwide. Many of the extant empirical findings, however, have focused on individuals' psychological adjustment during the initial phase of the pandemic. It is less clear how COVID-19 stressful experiences impact young people's daily lives in the post-pandemic "new normal." Drawing on 7-day diary reports, the present study fills this gap by examining: (1) how daily perceived stress impacted daily emotional adjustment; and (2) the moderating effects of COVID-19 stressful experiences on these associations among 582 Chinese young adults (M age = 18.12, SD = .65; 69% females). Results indicated that higher levels of both trait (i.e., average levels) and state (i.e., daily fluctuations) perceived stress were associated with greater negative and anxious moods, and that prior pandemic-related experiences exacerbated the adverse impact of both trait and state perceived stress on daily moods. Specifically, young adults reporting greater COVID-19 stressful experiences demonstrated poorer emotional adjustment (i.e., lower levels of positive mood and higher levels of negative mood) on days when they had more fluctuations in perceived stress; the aggravating impact was stronger when the average levels of perceived stress were higher. By illuminating the moderating effects of COVID-19 stressful experiences, this study contributes to the limited, but burgeoning, research examining the prolonged impact of the COVID-19 health crisis on daily emotional adjustment in post-pandemic life.

The Affective Consequences of Minority Stress Among Bisexual, Pansexual, and Queer (Bi+) Adults: A Daily Diary Study

Bisexual, pansexual, and queer (bi+) individuals are at increased risk for depression and anxiety. These disparities are hypothesized to be due to the unique, minority-specific stressors that they experience. Prior research supports that bi+ stressors are associated with depression and anxiety, but nearly all studies have been cross-sectional, limiting our understanding of how experiencing bi+ stress influences individuals' levels of depression and anxiety as they occur in their day-to-day lives. To address this gap, we examined the daily associations between bi+ stressors (discrimination, internalized stigma, rejection sensitivity, and identity concealment) and depressed/anxious mood in a 28-day diary study. Participants were 208 bi+ individuals who completed daily measures of bi+ stressors and depressed/anxious mood. We tested unlagged (same-day) and lagged (next-day) associations, and we also tested whether internalized stigma, rejection sensitivity, and identity concealment functioned as mechanisms underlying the daily associations between discrimination and depressed/anxious mood. Participants reported higher depressed/anxious mood on days when they reported higher discrimination, internalized stigma, rejection sensitivity, and identity concealment. There were significant unlagged indirect effects of discrimination on depressed and anxious mood via internalized stigma and rejection sensitivity, and there was also a significant unlagged indirect effect of discrimination on anxiety via identity concealment. However, none of the lagged associations were significant. Results suggest that bi+ stress is related to same-day, but not next-day, depressed/anxious mood. The nonsignificant lagged associations could reflect that bi+ individuals are using adaptive coping skills in response to bi+ stress, or that other experiences throughout the day have stronger influences on next-day mood.

Psychological Well-Being During the Second Wave of COVID-19 Pandemic: The Mediation Role of Generalized Anxiety

Introduction

The outbreak of the COVID-19 has largely impacted individuals’ health and lifestyles. This study aimed to investigate people’s psychological well-being during the second phase of the COVID-19 pandemic.

Methods

We selected six indicators of psychological well-being: fear of COVID-19, loneliness, social interaction anxiety, generalized anxiety, PTSD, and depression. A sample of 231 Italian participants (56.3% women), with a mean age of 32.7 (SD=12.61), completed an online survey from February to March 2021, during the so called “second wave”. It included the Fear of COVID-19 Scale (FCV-19S), the UCLA Loneliness Scale- Version 3, the Generalized Anxiety Disorder 7-item Scale (GAD-7), the Patient Health Questionnaire-9 (PHQ-9), the Impact of Event Scale–Revised (IES-R), and the Social Interaction Anxiety Scale (SIAS).

Results

Apart from loneliness, women reported lower levels of psychological well-being than men. Fairly good associations between all the detected variables were found. Based on a mediation model evaluation (in which generalized anxiety was introduced as a mediator in the relationship between fear of COVID-19, PTSD, loneliness, social interaction anxiety, and depression), except for social interaction anxiety, total and partial mediation effects suggested that generalized anxiety played a crucial role in exacerbating depressive symptoms during the pandemic.

Conclusion

Our outcomes may expand the knowledge about the psychological well-being during the pandemic experience, with a focus on the mediating role of generalized anxiety.

Sustained threat and phasic fear in the laboratory and cognitive-emotional processes of anxiety in everyday life - An ambulatory assessment study

Fear is a phasic state of apprehension to an imminent threat, whereas anxiety is a more sustained state of expecting a potential threat leading to tension and worry. The NPU-threat test is a laboratory startle paradigm allowing a reliable and valid assessment of both, fear- and anxiety-potentiated reactions. It is suggested to differentiate between anxiety disorders, but little is known on associations with everyday life experiences of cognitive-emotional processes regarding anxiety in non-clinical samples. In the present project, the NPU-threat test was applied in three studies with (1) unselected healthy individuals, (2) participants with extreme manifestations of trait anxiety (low vs. high) and (3) individuals preparing for a high-stakes exam. Self-reported states of emotionality and worry were assessed during a four-day ambulatory assessment (AA). Overall, NPU-threat test measures did not significantly differ between studies, while the AA dependent measures were sufficiently sensitive to capture differences between groups. However, there was no significant association between psychophysiological measures of the NPU-threat test and AA state measures across participants. In participants recruited for low vs. high trait anxiety we found an association with AA worry and emotionality, but no interaction with potentiated startle. The present findings do not support the idea of a link between our laboratory biomarker and adaptive regulation of cognitive-emotional states in everyday life in healthy individuals. We speculate that an association between laboratory physiological measures and everyday experience of anxious states may be detectable in clinical samples.

Relationships between worry and depressive symptoms during two group therapies for generalized anxiety disorder

ABSTRACT Objective: Generalized anxiety disorder (GAD) is a chronic and disabling disorder associated with various impairments and shows a significant prevalence in the worldwide and Brazilian populations. This study aimed to investigate the longitudinal relationship of two symptoms relevant to the disorder (worry and depressive symptoms) in the context of a randomized clinical trial (RCT) by using a cross-lagged panel model (CLPM) analysis. Methods: A total of 92 adult patients with GAD were randomized to receive ten sessions of either acceptance‐based group behavioral therapy (ABBT) or nondirective supportive group therapy (NDST). Treatment had four time-point measures. Worries were measured using the Penn State Worry Questionnaire (PSWQ), and depression was measured using the Depression Anxiety Stress Scales (DASS-D). Results: The NDST model revealed significant paths from worry to depression (first wave) and from depression to worry (second wave). There was no other significant cross-lagged effect. These data show that there was an influence between symptoms only during one of the treatment groups, and without a homogeneous and constant pattern in any of the cross-lagged routes. Conclusion: A supportive group psychotherapy potentially interferes with the pattern of the direct relationship between worries and depressive symptoms in adults with GAD.

Temporal associations among loneliness, anxiety, and depression during the COVID-19 pandemic period

Numerous studies have reported that individuals' loneliness, anxiety, and depression levels increased during the COVID-19 pandemic period. However, reciprocal associations among loneliness, anxiety, and depression, as well as gender differences in these associations, have not been investigated. Therefore, temporal associations among loneliness, anxiety, and depression and gender differences in these associations were examined in a longitudinal study during the COVID-19 pandemic period. The loneliness, anxiety, and depression levels of 458 university students were evaluated at three timepoints (T1, T2, and T3) during the COVID-19 pandemic period in China. The timepoints were separated by 1 month. Cross-lagged panel designs were used to examine reciprocal associations among loneliness, anxiety, and depression as well as the stability and gender differences of these associations. Cross-lagged panel analysis revealed that T1 depression positively predicted T2 anxiety and loneliness, T1 loneliness positively predicted T2 depression, T2 anxiety positively predicted T3 depression, T2 depression positively predicted T3 anxiety and loneliness, T2 loneliness positively predicted T3 depression, and T1 loneliness positively predicted T3 anxiety through the mediating role of T2 depression. No gender differences were observed in the cross-lagged associations. During the COVID-19 pandemic period, loneliness and depression predicted each other across time, and loneliness predicted anxiety across time, mediated by depression. No gender differences were observed in the cross-lagged associations among loneliness, anxiety, and depression.

Anxiety and Depression: The Moderating Effects of Attention to Emotion and Emotional Clarity

Anxiety and depression are the most common mental health problems. They often occur together and significantly affect well-being and daily functioning. However, it is unclear to what extent the two dimensions of meta-mood knowledge play a role in their comorbidity. Therefore, the aim of the current study was to examine the role of attention to emotion and emotional clarity in the relationship between anxiety and depression. A sample of 256 adults aged 32–66 years ( M = 46.21, SD = 5.53; 82.03% women) completed questionnaires on anxiety, depression, and meta-mood knowledge. Results showed that emotional clarity buffered the relationship between anxiety and depression. In addition, all combinations of attention to emotion and emotional clarity showed a significant and positive relationship with anxiety and depression symptom severity, with one exception. Interestingly, there was no statistically significant relationship between anxiety and depression when attention to emotion was low and emotional clarity was high. This last condition was interpreted as beneficial rather than detrimental, which in turn could help promote psychological resilience to better cope with emotional difficulties. Given these findings, this study highlights the role of attention to emotion and emotional clarity in assessing anxiety and risk of comorbid depression.

Is Posttraumatic Growth Helpful in Overcoming Mental Health Disorders Due to COVID-19?: The Moderating Effect of Posttraumatic Growth in the Relationship Between COVID-19 and Psychological Health

The aim of this study was to investigate the effects of restrictions and concerns related to the coronavirus disease 2019 (COVID-19) on depression, anxiety, and committed action, and examine whether posttraumatic growth (PTG) serves as a protective factor for mental health. In particular, this study evaluated the moderating effects of PTG on the changes in levels of anxiety, depression, and committed action according to changes in COVID-19-related restrictions and concerns using a short-term longitudinal design. The Posttraumatic Growth Inventory was administered to 100 adults with significant traumatic experience living in the Republic of Korea, and the participants were asked to complete diary questionnaires on anxiety, depression, committed action, and restrictions and concerns pertaining to COVID-19. The results showed that anxiety and depression decreased, and committed action increased with an increase in PTG. These results highlight a complex relationship between restrictions and concerns related to COVID-19 and psychological health; based on the results, we discussed the positive impact of PTG on psychological health.

The GAD-7 and the PHQ-8 exhibit the same mathematical pattern of item responses in the general population: analysis of data from the National Health Interview Survey

Background

Recent studies have shown that, among the general population, responses to depression-rating scales follow a common mathematical pattern. However, the mathematical pattern among responses to the items of the Generalized Anxiety Disorder-7 (GAD-7) is currently unknown. The present study investigated whether item responses to the GAD-7, when administered to the general population, follow the same mathematical distribution as those of depression-rating scales.

Methods

We used data from the 2019 National Health Interview Survey (31,997 individuals), which is a nationwide survey of adults conducted annually in the United States. The patterns of item responses to the GAD-7 and the Patient Health Questionnaire-8 (PHQ-8), respectively, were analyzed inductively.

Results

For all GAD-7 items, the frequency distribution for each response option (“not at all,” “several days,” “more than half the days,” and “nearly every day,” respectively) was positively skewed. Line charts representing the responses to each GAD-7 item all crossed at a single point between “not at all” and “several days” and, on a logarithmic scale, showed a parallel pattern from “several days” to “nearly every day.” This mathematical pattern among the item responses was identical to that of the PHQ-8. This characteristic pattern of the item responses developed because the values for the “more than half the days” to “several days” ratio were similar across all items, as were the values for the “nearly every day” to “more than half the days” ratio.

Conclusions

Our results suggest that the symptom criteria of generalized anxiety disorder and major depression have a common distribution pattern in the general population.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40359-021-00657-9.

Invasive Electrophysiology for Circuit Discovery and Study of Comorbid Psychiatric Disorders in Patients With Epilepsy: Challenges, Opportunities, and Novel Technologies

Intracranial electroencephalographic (iEEG) recordings from patients with epilepsy provide distinct opportunities and novel data for the study of co-occurring psychiatric disorders. Comorbid psychiatric disorders are very common in drug-resistant epilepsy and their added complexity warrants careful consideration. In this review, we first discuss psychiatric comorbidities and symptoms in patients with epilepsy. We describe how epilepsy can potentially impact patient presentation and how these factors can be addressed in the experimental designs of studies focused on the electrophysiologic correlates of mood. Second, we review emerging technologies to integrate long-term iEEG recording with dense behavioral tracking in naturalistic environments. Third, we explore questions on how best to address the intersection between epilepsy and psychiatric comorbidities. Advances in ambulatory iEEG and long-term behavioral monitoring technologies will be instrumental in studying the intersection of seizures, epilepsy, psychiatric comorbidities, and their underlying circuitry.

Early childhood experiences and cognitive risk factors for anxiety symptoms among college students

Data indicate that adverse childhood experiences (ACEs) are a risk factor for cognitive and attentional vulnerabilities. A vulnerability linked to these impairments is repetitive negative thinking (RNT), and data suggest that RNT and anxiety symptoms may be moderated by attentional control. The current study investigated the effect of these risk factors on symptoms of anxiety. Participants: College students (N = 376) were recruited from a university. Methods: Participants were administered questionnaires online to assess retrospective ACEs, current RNT, attentional control, and anxiety symptoms. Results: There was an indirect effect of ACEs on anxiety symptoms through RNT. High attentional control moderated the indirect effects, such that high compared to low attentional control was associated with an increased effect of RNT on anxiety symptoms. Conclusions: Increased ACEs may be a risk factor for RNT among college students. Combined with high attentional control, these may be risk factors for anxiety symptoms.

Association between Bullying Victimization and Symptoms of Depression among Adolescents: A Moderated Mediation Analysis

BACKGROUND

Bullying victimization and its effect on symptoms of depression have received attention from researchers, but few studies have considered the potential mechanism. The aim of this study was to examine a moderated mediation model for the association between bullying victimization and depressive symptoms in terms of it being mediated by social anxiety, and investigated whether sleep duration would show moderating effects in this relationship.

METHODS

In this study, there were 2956 students, who completed three questionnaires, including a bullying victimization scale, as well as a social anxiety and epidemiologic studies depression scale.

RESULTS

Bullying victimization's effects on depressive symptoms were mediated by social anxiety. Furthermore, sleep duration moderated the relationship between bullying victimization and depressive symptoms.

CONCLUSIONS

The research contributes by clarifying the mechanisms underlying the relationship between bullying victimization and depressive symptoms.

Immediate and Long-Term Effects of an 8-Week Digital Mental Health Intervention on Adults With Poorly Managed Type 2 Diabetes: Protocol for a Randomized Controlled Trial

Background

Diabetes is a leading cause of years of life lost and accounts for approximately one-fourth of health care dollars spent in the United States. Many of these costs are related to poor medication adherence and lack of self-care behaviors and are thus preventable. Depression, which is more prevalent among people with diabetes than in the general population, predicts poorer management of one’s diabetes, whereas positive affect predicts engaging in more positive health behaviors. Consequently, interventions that improve depression and positive affect may also improve diabetes-related outcomes among people with diabetes. Although preliminary research on the impact of such interventions among people with diabetes is promising, these studies focused primarily on in-person interventions, have had small samples, and lack long-term follow-up.

Objective

This study aims to examine the short- and long-term effects of a digital therapeutic platform focused on mental health among adults with poorly managed type 2 diabetes and elevated levels of depression.

Methods

This is a randomized controlled trial in which adults with a type 2 diabetes diagnosis, elevated hemoglobin A_1c (HbA_1c) levels (≧7), and moderate to severe depressive symptoms will be randomly assigned to a positive emotion regulation skills intervention group or a sham digital intervention with only psychoeducational content. The study will take place over 14 months, including the 8-week intervention (or control) delivered via a digital therapeutic platform (Happify Health) and follow-up assessments at 3, 6, and 12 months postintervention. Throughout the intervention and for 1 week at each postintervention follow-up, participants will complete daily assessments of diabetes-related distress, diabetes regimen adherence, and mood. Our primary outcome, HbA_1c, will be self-reported every 3 months throughout the study. Secondary and exploratory outcomes will be assessed at baseline; at 8 weeks; and at 3, 6, and 12 months postintervention.

Results

Recruitment is expected to begin in June 2020. Participants will begin the study as they are recruited and will finish in waves. The final wave of data collection from the 8-week intervention is expected for winter 2020, with the completion of the 12-month follow-up in winter 2021.

Conclusions

Although previous research suggests that in-person psychological interventions have promising effects on both psychological and physical outcomes among adults with diabetes, digital interventions can be advantageous because they are easily scalable and reduce many barriers that prevent people from seeking treatment. This trial will provide important information about the effects of a digital mental health intervention among adults with type 2 diabetes, assessing both short- and long-term effects of this intervention on HbA1c, depressive symptoms, and other diabetes-specific outcomes. If successful, this may introduce a scalable intervention that would help reduce some of the preventable costs associated with diabetes.

Trial Registration

ClinicalTrials.gov NCT04068805; https://clinicaltrials.gov/ct2/show/NCT04068805.

International Registered Report Identifier (IRRID)

PRR1-10.2196/18578

Prevalence and factors associated with anxiety and depression in older adults: Gender differences in psychosocial indicators

BACKGROUND

With increasing numbers of people living into old age, health functioning and good quality of life are central to public health policy in aging. However, quality of life for many elders is undermined by anxiety and depression. Understanding gender differences in the determinants of anxiety and depression symptoms is crucial to policy and practice.

OBJECTIVE

To examine gender-specific symptom subtypes of later-life anxiety and depression, in relation to their socio-demographic, social and health context.

METHOD

Cross-sectional study using data from The Irish Longitudinal Study on Ageing (TILDA, 2009-2011). Latent class analysis defined gender-specific symptom profiles for anxiety and depression. Correlates of latent classes were analysed using logistic regression, assessing associations between socio-demographic factors; social indicators and health indicators.

RESULTS

Four classes of self-reported anxiety and depression were derived: 'low', 'comorbidity', 'anxiety and subthreshold depression' and 'anxiety' only. With males 8% were comorbid, 26% subthreshold and 26% with anxiety only. With female 12% were comorbid, 27% subthreshold and 29% with anxiety only. While symptom expression may relate to stress from common ageing, our findings show clear gradations of symptoms associated with a range of social and health indicators.

CONCLUSION

Our findings support the actuality of comorbid depression and anxiety with further evidence for anxiety and subthreshold depression. A sizeable subgroup confirms that many older people experience anxiety only. Our study indicates the need for a more sensitive recognition of needs and a more nuanced policy agenda for older people towards improving the quality of their social life.

Socio-demographic and psychiatric risk factors in incident and persistent depression: An analysis in the occupational cohort of ELSA-Brasil

BACKGROUND

Depression is a main source of disability worldwide. Identifying risk factors associated with incident and persistent episodes could inform clinical practice and hence mitigate their burden. However, previous research has focused on populations from developed countries. Thus, we evaluated sociodemographic risk factors and psychiatric comorbidities associated with incident and persistent depression in a large Brazilian occupational cohort.

METHODS

We examined baseline (2008-2010, n = 15,105) and follow-up (2012-2014) data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Based on the presence of depression diagnosis at two timepoints, we diagnosed persistent and incident depression. Simple and multiple logistic regression analyses were employed to explore risk factors associated with incident and persistent depression. As gender is associated with the exposure and outcome variables, analyses stratified by gender were also conducted.

RESULTS

Presence of any anxiety disorder, obsessive-compulsive disorder, and female gender were significant (p < 0.001) risk factors for depression incidence (odds ratios of 2.59, 3.6, and 1.82, respectively) and persistence (odds ratios of 6.94, 14.37, and 2.85, respectively) in multiple models, whereas having university degree decreased the odds of depression incidence (0.74) and persistence (0.45). In stratified analyses, the effects of low education were only evident in women.

LIMITATIONS

Brief depressive episodes could not be measured by our assessments.

CONCLUSION

In this occupational cohort, female gender, low education and psychiatric comorbidities were associated with unfavorable depression courses. Interventions targeting comorbidities could prevent depression incidence and persistence.

Attentional Bias for Threat and Anxiety: The Role of Loneliness

Objective: There is literature to suggest that anxious individuals may be lonely. Attentional bias for threat (ABT), a mechanism implicated in the core symptoms of anxiety, has been linked to loneliness in a separate line of work. The primary aim of this study was to examine the role of loneliness in the association between ABT and anxiety. Method: An unselected sample of 260 individuals (196 Female; Mean Age = 22.43) completed measures of loneliness, ABT (a dot probe task), and anxiety. Two possible models of the role of loneliness in the ABT-anxiety link were tested using hierarchical regression analysis: (1) A moderation model (the ABT-anxiety link is moderated by loneliness), and (2) A proxy model (the ABT-anxiety link is better explained by loneliness). Results: In support of the latter model, ABT no longer predicted anxiety after the effects of loneliness had been accounted for. Additionally, ABT was associated with anxiety only when indexed using sadness-related scenes (but not fear-related scenes). Conclusions: Loneliness may be one important source of exaggerated threat appraisals which underpin the association between ABT and anxiety. Different classes of negative stimuli may be differentially sensitive to anxiety and should be a point of consideration in future research.

Internalizing symptoms and cannabis and alcohol use: Between- and within-person risk pathways with coping motives

OBJECTIVE

To test reciprocal associations among internalizing symptoms (depression and social anxiety), using alcohol and cannabis to cope, and use-related problems.

METHOD

The study utilized a community sample (N = 387, 55% female; majority non-Hispanic Caucasian (83.1%) or African American (9.1%) and a longitudinal design that spanned 17 to 20 years of age, and distinguished within- and between-person associations using latent curve models with structured residuals.

RESULTS

Reciprocal prospective within-person associations were supported for alcohol, such that elevated depression symptoms were associated with increased alcohol coping motivates 1 year later, which, in turn, was associated with subsequent increased depression symptoms. Bidirectional associations were not supported for social anxiety, although high levels of social anxiety were associated with elevated levels of coping drinking 1 year later. Cannabis coping motives were associated with exacerbation of depression, but not social anxiety symptoms, 1 year later. Between- and within-person contemporaneous associations suggested that depression and social anxiety were more strongly associated with coping than social/enhancement motives, and that coping motives were associated with use-related problems.

CONCLUSION

Findings suggest that alcohol coping motivates exacerbate rather than ameliorate depression symptoms, which, in turn, leads to greater reliance on alcohol to cope. There was more consistent support for associations with substance use-related problems for depression than for social anxiety. Both between- and within-person associations may be useful for identifying targets and timing of coping-oriented interventions. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Cyberbullying and depression among Chinese college students: A moderated mediation model of social anxiety and neuroticism

BACKGROUND

Cyberbullying is a serious social issue that can cause a number of psychological and behavioral problems for perpetrators and victims. Previous studies have shown that adolescent victims of cyberbullying are more likely to exhibit depressive symptoms. However, few studies have investigated the relationship between the perpetration of cyberbullying and depression, or the mediating and moderating mechanisms underlying this relationship.

METHODS

A questionnaire survey was conducted among 476 college students to investigate the relationships between cyberbullying perpetration and depression, the mediating role of social anxiety, and the moderating role of neuroticism.

RESULTS

The results showed that cyberbullying perpetration had a significant and positive predictive effect on depression. Social anxiety partially mediated this relationship. The direct predictive effect of cyberbullying perpetration on depression, and the relation between social anxiety and depression, were both moderated by neuroticism. Cyberbullying perpetration had a greater impact on depression for college students with lower levels of neuroticism and the predictive function of social anxiety on depression was stronger for individuals with low levels of neuroticism too. But neuroticism did not moderate the association between cyberbullying perpetration and social anxiety.

LIMITATIONS

This study focused only on the individual variables influencing the relationship between cyberbullying perpetration and depression, and did not examine interpersonal or environmental variables. Also, the cross-sectional research design means that causality cannot be deduced from the results.

CONCLUSIONS

Cyberbullying perpetration can predict depression directly, and also indirectly via the mediating role of social anxiety. Neuroticism moderates the relation both between cyberbullying and depression, and between social anxiety and depression. These findings provide new perspectives for the treatment and prevention of depression among college students.

The Differential Time-Varying Effect Model (DTVEM): A tool for diagnosing and modeling time lags in intensive longitudinal data

With the recent growth in intensive longitudinal designs and the corresponding demand for methods to analyze such data, there has never been a more pressing need for user-friendly analytic tools that can identify and estimate optimal time lags in intensive longitudinal data. The available standard exploratory methods to identify optimal time lags within univariate and multivariate multiple-subject time series are greatly underpowered at the group (i.e., population) level. We describe a hybrid exploratory-confirmatory tool, referred to herein as the Differential Time-Varying Effect Model (DTVEM), which features a convenient user-accessible function to identify optimal time lags and estimate these lags within a state-space framework. Data from an empirical ecological momentary assessment study are then used to demonstrate the utility of the proposed tool in identifying the optimal time lag for studying the linkages between nervousness and heart rate in a group of undergraduate students. Using a simulation study, we illustrate the effectiveness of DTVEM in identifying optimal lag structures in multiple-subject time-series data with missingness, as well as its strengths and limitations as a hybrid exploratory-confirmatory approach, relative to other existing approaches.

Risk factors of geriatric depression in rural China based on a generalized estimating equation

ABSTRACTBackground:The number of elderly individuals living in China is increasing rapidly. The aim of this study was to examine the potential risk factors of geriatric depression in rural areas.

METHODS

A repeated cross-sectional study was conducted between January 2015 and October 2016 in rural China. Nine hundred forty-five elderly individuals were included in both investigations. A generalized estimating equation (GEE) was used to examine the relationships between geriatric depression and socio-demographics, the number of chronic diseases, ADL (Activity of Daily Living) disability, cognitive impairment, and anxiety.

RESULTS

Among the participants, the majority was female (61.4%) and illiterate (81.5%) and had a general economic status (63.0%) and more than two kinds of chronic diseases (62.9%). The bivariate analysis indicated that geriatric depression was associated with social support, education level, economic status, ADL disability, anxiety disorders, and cognitive impairment at both survey time points. The GEE results showed that poor economic status (OR = 8.294, p < 0.001), the presence of more than two chronic diseases (OR = 1.681, p = 0.048), ADL disability (OR = 2.184, p < 0.001), cognitive impairment (OR = 1.921, p < 0.001), and anxiety (OR = 5.434, p < 0.001) were risk factors for geriatric depression in rural China; better social support (OR = 0.924, 95% CI = 0.899-0.949, p < 0.001) was found to be a protective factor.

CONCLUSIONS

Geriatric depression in rural China was associated with several socio-demographic, physical, and mental factors. Targeted interventions are essential to improve the psychological health of aged individuals in rural China.

Independent and relative effects of stress, depressive symptoms, and affect on college students' daily health behaviors

Stress and depressive symptoms are associated with maladaptive health behavior practices such as unhealthy eating, sedentary behavior, insufficient sleep, and substance use. The relative and interactive effects of stress and depressive symptoms on health behavior practices are less well understood. The present study examined these processes in a daily diary study of 127 college students. Results from hierarchical generalized linear models indicated that depressive symptoms, and chronic and daily stress, but not acute stressful life events, were significantly associated with a composite score of daily maladaptive health behavior engagement (depressive symptoms b = .01, SE= .00, p < .01; chronic stress, b = .03, SE= .01, p < .01; daily stress, b = .01, SE= .01, p = .02); unexpectedly, the effect of stress on health behaviors was not moderated by depressive symptoms. Additionally, results demonstrated that the effect of depressive symptoms on health behaviors was mediated by fluctuations in daily negative affect. These results bear implications for intervention during a crucial period in the development of mental and physical health.

Insomnia mediates the longitudinal relationship between anxiety and depressive symptoms in a nationally representative sample of adolescents

BACKGROUND

Anxiety and depression are commonly comorbid with each other, with anxiety often temporally preceding the development of depression. Although increasingly research has begun to investigate the role of sleep problems in depression, no study has examined insomnia as a mediator in the longitudinal relationship between anxiety and subsequent depression.

METHODS

The current study utilizes data from Waves I, II, and IV of the National Longitudinal Study of Adolescent to Adult Health, a nationally representative prospective study conducted over a 14-year period (n = 20,745, 50.5% female, M age at Wave I = 16.20). Participants completed portions of the Center for Epidemiologic Studies Depression Scale at Waves I and IV to assess depressive symptoms, a six-item anxiety measure at Wave I, and three items assessing insomnia, sleep quality, and sleep duration at Wave II.

RESULTS

Structural equation modeling indicated that insomnia and unrestful sleep significantly mediated the relationship between anxiety and subsequent depression. The relationship between anxiety and depression was not significantly mediated by sleep duration.

CONCLUSIONS

Findings suggest that anxiety may increase risk for the development of later depression through insomnia.

Daily antecedents and consequences of nightly sleep

Sleep can serve as both cause and consequence of individuals' everyday experiences. We built upon prior studies of the correlates of sleep, which have relied primarily on cross-sectional data, to examine the antecedents and consequences of sleep using a daily diary design. Specifically, we assessed the temporal sequence between nightly sleep and daily psychosocial stressors. Parents employed in a US information technology company (n = 102) completed eight consecutive daily diaries at both baseline and 1 year later. In telephone interviews each evening, participants reported on the previous night's sleep hours, sleep quality and sleep latency. They also reported daily work-to-family conflict and time inadequacy (i.e. perceptions of not having enough time) for their child and for themselves to engage in exercise. Multi-level models testing lagged and non-lagged effects simultaneously revealed that sleep hours and sleep quality were associated with next-day consequences of work-to-family conflict and time inadequacy, whereas psychosocial stressors as antecedents did not predict sleep hours or quality that night. For sleep latency, the opposite temporal order emerged: on days with more work-to-family conflict or time inadequacy for child and self than usual, participants reported longer sleep latencies than usual. An exception to this otherwise consistent pattern was that time inadequacy for child also preceded shorter sleep hours and poorer sleep quality that night. The results highlight the utility of a daily diary design for capturing the temporal sequences linking sleep and psychosocial stressors.

Anxiety and depression: toward overlapping and distinctive features

This Special Issue of Cognition and Emotion addresses one of the cardinal concerns of affective science, which is overlapping and distinctive features of anxiety and depression. A central finding in the study of anxiety and depression is that they are moderately highly correlated with each other. This leads us to the question: What is behind this co-occurrence? Possible explanations relate to poor discriminant validity of measures; both emotional states are associated with negative affect; stressful life events; impaired cognitive processes; they share a common biological/genetic diathesis. However, despite a set of common (nonspecific) features, anxiety and depression are clearly not identical emotional states. Differences between them might be best viewed, for example, through their heterogeneous and multi-layered nature, adaptive functions and relations with regulatory processes, positive affect, and motivation or complex cognitive processes. In this introduction we consider several approaches (e.g. functional approach; tripartite model and content-specificity hypothesis) to which most research in this Special Issue is relevant. In addition, we have asked contributors to this Special Issue to indicate how their own studies on comparisons between anxiety and depression and models on anxiety and depression move this area of research to more mature science with applicability.

Depressive Symptoms and the Anticipation and Experience of Uplifting Events in Everyday Life

OBJECTIVE

Despite proliferation of laboratory-based studies examining reward functioning in depression, few studies have examined these processes in everyday life. We addressed this shortcoming by exploring experience and anticipation of uplifting experiences under ecologically valid conditions METHOD: One hundred fifty-seven young adults, oversampled for depressive symptoms, completed a 14-day diary tracking mood in relation to recent and anticipated positive events RESULTS: Consistent with studies supporting "mood-brightening" effects in depression, participants with greater baseline dysphoria showed stronger associations between elevated daily uplifts and lower daily depressive symptoms, particularly when events were interpersonal in nature. Baseline dysphoria was associated with lower daily anticipation of positive next-day experiences; however, when dysphoric individuals did anticipate positive experiences, they experienced greater reductions in depressed mood CONCLUSION: Results suggest that despite reward processing deficits found in laboratory studies, dysphoric individuals show improvements in mood in conjunction with anticipation and consumption of uplifting events in daily life.

Perceived emotional social support in bereaved spouses mediates the relationship between anxiety and depression

BACKGROUND

Prior research has shown that anxiety symptoms predict later depression symptoms following bereavement. Nevertheless, no research has investigated mechanisms of the temporal relationship between anxiety and later depressive symptoms or examined the impact of depressive symptoms on later anxiety symptoms following bereavement.

METHODS

The current study examined perceived emotional social support as a possible mediator between anxiety and depressive symptoms in a bereaved sample of older adults (N =250). Anxiety and depressive symptoms were measured at Wave 1 (immediately after bereavement), social support was measured at Wave 2 (18 months after bereavement), and anxiety and depressive symptoms were also measured at Wave 3 (48 months after bereavement).

RESULTS

Using Bayesian structural equation models, when controlling for baseline depression, anxiety symptoms significantly positively predicted depressive symptoms 48 months later, Further, perceived emotional social support significantly mediated the relationship between anxiety symptoms and later depressive symptoms, such that anxiety symptoms significantly negatively predicted later emotional social support, and emotional social support significantly negatively predicted later depressive symptoms. Also, when controlling for baseline anxiety, depressive symptoms positively predicted anxiety symptoms 48 months later. However, low emotional social support failed to mediate this relationship.

CONCLUSIONS

Low perceived emotional social support may be a mechanism by which anxiety symptoms predict depressive symptoms 48 months later for bereaved individuals.

Predicting the transition from anxiety to depressive symptoms in early adolescence: Negative anxiety response style as a moderator of sequential comorbidity

BACKGROUND

Anxiety often precedes depression. The anxiety response styles theory of comorbidity suggests anxious individuals with a tendency to ruminate or make hopeless attributions about anxiety symptoms (negative anxiety response styles [NARS]) are more vulnerable to subsequent depressive symptoms. However, this theory has never been tested in adolescence, when the anxiety-depression transition may frequently occur, or using an extended (one-year) follow-up period.

METHOD

128 early adolescent girls (M=12.39 years) participated with caregivers in a one-year longitudinal study. At baseline and follow-up, participants completed diagnostic interviews and self-report measures assessing child NARS and brooding rumination.

RESULTS

T1 NARS predicted longitudinal elevations in depressive symptoms and increased associations between T1 anxiety and T2 depressive symptoms.

LIMITATIONS

This study examines anxiety and depression comorbidity using a community sample. The sample is relatively low on sociodemographic diversity.

CONCLUSIONS

Results support the anxiety response styles theory, with potential implications for early identification of anxious youth at risk for later development of comorbid depression.

Depressed mood in individuals with schizophrenia: A comparison of retrospective and real-time measures

Depressed mood is prevalent among individuals with schizophrenia, leading to difficulties in functioning. Typically, depressed mood is evaluated using retrospective assessments during which individuals are asked to recall their mood during the past week or month. However, as individuals with schizophrenia may display memory difficulties, the results of such assessments may be biased, potentially leading to inaccurate clinical characterizations and/or suboptimal treatment. Our aim was to assess the potential impact of long-term memory on depressed mood in individuals with schizophrenia. Employing an Experience Sampling Method (ESM) approach, 51 individuals with schizophrenia and 22 healthy controls rated their momentary emotions up to 10 times/day over a two-day period, along with retrospective measures of depressed mood, long-term memory, quality of life, social functioning, and symptoms. ESM assessment of real-time depressed mood demonstrated discriminant and convergent validity. Among the schizophrenia group, there was a significant correlation between the real-time and retrospective measures of depressed mood. However, once variance due to long-term memory was controlled, the relationship between the real-time and retrospective measure was no longer significant. The findings suggest that a real-time measure of depressed mood may allow overcoming some of the limitations associated with long-term memory difficulties common among individuals with schizophrenia.

A clinical trial of cranial electrotherapy stimulation for anxiety and comorbid depression

BACKGROUND

Anxiety disorders are among the most prevalent mental disorders and are usually treated with medication and/or psychotherapy. When anxiety disorders are accompanied with comorbid depression, this further complicates the treatment process. Medication compliance is a common problem due to adverse side effects and new and effective treatments that have minimal side effects are needed for the treatment of anxiety and depression. This study used a randomized, double-blind, sham controlled design to examine the effectiveness of CES as a treatment for anxiety disorders and comorbid depression in a primary care setting. The study was registered at clinicaltrials.gov, NCT01533415.

METHODS

One hundred and fifteen participants, age 18 years and over, with a primary diagnosis of an anxiety disorder were enrolled from February 2012 to December 2012 The Hamilton Rating Scale for Anxiety (HAM-A) and the Hamilton Depression Rating Scale17 (HAM-D17) were used for baseline and outcome measures at weeks one, three, and five. Response to treatment was defined as a reduction of ≥50% or more on these measures.

RESULTS

Analysis of covariance revealed a significant difference between the active CES group and the sham CES group on anxiety (p=0.001, d=0.94) and on depression (p=0.001, d=0.78) from baseline to endpoint of study in favor of the active CES group.

CONCLUSIONS

CES significantly decreases anxiety and comorbid depression. Subjects reported no adverse events during the study.

Avoidance mediates the relationship between anxiety and depression over a decade later

Anxiety and depression are often highly correlated with each other. To explain this connection, the present study examined the longitudinal relationship between earlier anxiety and later depression, using avoidance as a mediator and trauma as a moderator. Participants (N=6504 adolescents) completed baseline measures of anxiety and depression, a measure of avoidance one year later, a measure of trauma six to eight years later, and a measure of depression 12-14 years later. Analyzed with structural equation models, the results showed that anxiety predicted later depression, and this relationship was partially mediated by avoidance. The relationship between avoidance and depression was not moderated by trauma. Together, these findings suggest that anxiety may influence later depression through avoidance, and this relationship remains unaffected by experiencing a traumatic experience.

Does relational dysfunction mediate the association between anxiety disorders and later depression? Testing an interpersonal model of comorbidity

BACKGROUND

Anxiety disorders tend to precede onset of comorbid depression. Several researchers have suggested a causal role for anxiety in promoting depressive episodes, but few studies have identified specific mechanisms. The current study proposes an interpersonal model of comorbidity, where anxiety disorders disrupt interpersonal functioning, which in turn elevates risk for depression.

METHODS

At age 15 (T1), 815 adolescents oversampled for maternal depression completed diagnostic interviews, social chronic stress interviews, and self-report measures. At age 20 (T2), participants repeated all measures and reported on self-perceived interpersonal problems. At approximately age 23 (T3), a subset of participants (n = 475) completed a self-report depressive symptoms measure.

RESULTS

Consistent with other samples, anxiety disorders largely preceded depressive disorders. Low sociability and interpersonal oversensitivity mediated the association between T1 social anxiety disorder and later depression (including T2 depressive diagnosis and T3 depressive symptoms), controlling for baseline. Interpersonal oversensitivity and social chronic stress similarly mediated the association between generalized anxiety disorder before age 15 and later depression.

CONCLUSIONS

Interpersonal dysfunction may be one mechanism through which anxiety disorders promote later depression, contributing to high comorbidity rates.

Cognitive and Interpersonal Moderators of Daily Co-Occurrence of Anxious and Depressed Moods in Generalized Anxiety Disorder

Anxiety and depression co-occur, both at the disorder and symptom levels, and within anxiety disorders, fluctuations in daily anxious mood correspond temporally to fluctuations in depressed mood. However, little is known about the factors or conditions under which anxiety and depressive symptoms are most likely to co-occur. The current study investigated the role of cognitive factors (daily rumination and cognitive attributions about anxiety symptoms) and interpersonal functioning (daily perceived rejection, support, criticism, and interpersonal problems) as moderators of the daily association between anxious and depressed moods. Fifty-five individuals with generalized anxiety disorder completed a 21-day diary assessing daily mood and cognitive and interpersonal functioning. Ratings of anxious and depressed mood were more closely associated on days when participants ruminated about their anxiety or viewed anxiety symptoms more negatively. Furthermore, anxious mood predicted later depressed mood on days when participants reported greater interpersonal problems and more perceived rejection. Results suggest that cognitive and interpersonal factors may elevate the likelihood of anxiety-depression co-occurrence.