Low trait anxiety, high resilience, and their interaction as possible predictors for treatment response in patients with depression

Factors influencing stress and resilience among Egyptian medical students: a multi-centric cross-sectional study

BACKGROUND

Psychological stress is a common psychological comorbidity among medical students and worsens their quality of life. Psychological resilience is thought to have a protective role against stress. However, evidence regarding the prevalence of stress and resilience alongside their associated factors is scarce, especially in the Middle East. This is the first multicenter, cross-sectional study to investigate resilience and stress among Egyptian medical students.

METHODS

The current cross-sectional study was conducted on 2465 university students in seven public universities in Egypt. The universities were selected using the simple randomization method. The data was collected using a self-administered questionnaire consisting of four parts: demographic data, socioeconomic tool represented in the Family Affluence Scale (FAS), the Kessler Psychological Distress Scale (K10), and the Brief Resilience Scale (BRS). Data was analyzed in SPSS version 26 software.

RESULTS

The majority of the students were stressed (86.5%), most of whom had severe stress (48.9%). Most of the students had low resilience (49.9%), while only 3.2% had high resilience. In the logistic regression analysis, being a female, living alone, spending long hours on social media, and thinking of suicide or leaving medicine were associated with being stressed and having low resilience. Medical students with low resilience were significantly more liable to stress [Adjusted odds ratio (AOR) = 3.667, confidence interval (CI): 2.709-4.965, P = 0.000], and vice versa [AOR = 3.709, CI: 2.746-5.009, P = 0.000]. Interestingly, high socioeconomic status showed a significant association with high resilience (P = 0.004); nonetheless, it was not associated with stress (P = 0.993). Academic grades were not associated with both the level of stress and resilience. Aging, being in clinical or academic stages, smoking, having a chronic disease, and being financially-supported are neither associated with stress nor resilience.

CONCLUSIONS

The present study revealed that Egyptian medical students had low resilience and high stress, with a significant relationship between both of them. Further investigations via longitudinal study design to understand the resilience-stress relationship are recommended. Developing and implementing resilience-improving strategies in medical schools is highly recommended to decrease the prevalence of stress and its subsequent burdens.

Structural Brain Connectivity and Treatment Improvement in Mood Disorder

Background: The treatment of depressive episodes is well established, with clearly demonstrated effectiveness of antidepressants and psychotherapies. However, more than one-third of depressed patients do not respond to treatment. Identifying the brain structural basis of treatment-resistant depression could prevent useless pharmacological prescriptions, adverse events, and lost therapeutic opportunities. Methods: Using diffusion magnetic resonance imaging, we performed structural connectivity analyses on a cohort of 154 patients with mood disorder (MD) and 77 sex- and age-matched healthy control (HC) participants. To assess illness improvement, the patients with MD went through two clinical interviews at baseline and at 6-month follow-up and were classified based on the Clinical Global Impression-Improvement score into improved or not-improved (NI). First, the threshold-free network-based statistics (NBS) was conducted to measure the differences in regional network architecture. Second, nonparametric permutations tests were performed on topological metrics based on graph theory to examine differences in connectome organization. Results: The threshold-free NBS revealed impaired connections involving regions of the basal ganglia in patients with MD compared with HC. Significant increase of local efficiency and clustering coefficient was found in the lingual gyrus, insula, and amygdala in the MD group. Compared with the NI, the improved displayed significantly reduced network integration and segregation, predominately in the default-mode regions, including the precuneus, middle temporal lobe, and rostral anterior cingulate. Conclusions: This study highlights the involvement of regions belonging to the basal ganglia, the fronto-limbic network, and the default mode network, leading to a better understanding of MD disease and its unfavorable outcome.

Trait anxiety predicting the developmental trajectories of depression symptoms in children: The mediating role of attentional control

Trait anxiety and attentional control are important factors related to depression symptoms. The study investigated how trait anxiety and attentional control predicted the trajectories of depression symptoms during the transition into early adolescence. The mediating effect of attentional control on the relationship of trait anxiety to the trajectories of depression symptoms was also examined. Children of 9 to 10 years were recruited at Time 1. Trait anxiety, attentional control, and depression symptoms were assessed at Time 1. Depression symptoms were measured at three follow-up assessments across 18 months. Latent class growth modeling revealed high (14.4%) and low (85.6%) trajectories of depression symptoms. Higher trait anxiety and lower attentional control predicted a higher likelihood of showing the trajectory of high depressive symptoms. Attentional control mediated the relationship of trait anxiety to the trajectory membership of depression symptoms. The findings had important implications for the association of trait anxiety with the trajectory membership of depression symptoms and highlighted the importance of attentional control in the development of depression symptoms for children with high trait anxiety.

DNA methylation levels of the serotonin transporter gene are not associated with the outcome of highly standardized one-session exposure-based fear treatment

Epigenetic alterations are regarded as a potential mechanism mediating the effects of environmental risk factors on vulnerability for a range of mental health problems. Recent studies have addressed the question whether DNA methylation patterns predict the outcome of psychological interventions and whether treatment effects might be associated with changes of DNA methylation. We assessed phobic fear symptoms, treatment-relevant traits and treatment response in 308 adults free of psychotropic medication - highly fearful of either spiders, blood-injury-injections, dental-treatments or heights - all subjected to highly standardized exposure-based one-session fear treatment. DNA methylation level of the promotor region of the serotonin transporter gene (SLC6A4) was assessed in either saliva samples (spider and dental treatment fear cohorts) or oral mucosa (BII, heights) to check whether possible effects are independent of the surrogate tissue examined. Moreover, in order to examine possible DNA methylation by genotype effects, patients were assessed for genetic variation of the serotonin transporter-linked polymorphic region (5-HTTLPR). DNA methylation levels were neither associated with pre-treatment fear levels, treatment relevant traits or treatment outcome data even when allelic variation of the 5HTTLPR was considered. Overall DNA methylation levels were higher in saliva samples compared to buccal samples. In saliva samples there was a small pre- to post-treatment increase in DNA methylation, which, however, was also not associated with the investigated phenotypes. We conclude that DNA methylation of SLC6A4 is no suitable biomarker for response efficacy to highly standardized one-session exposure-based fear treatments.

Psychological Resilience and Suicide Attempt in Patients With Bipolar Disorder: An Exploratory Study

BACKGROUND

Patients with bipolar affective disorder (BPAD) have a suicide risk of up to 30 times higher than the general population. There is increasing interest in analyzing the effects of resilience in psychiatric diseases and its relationship to other factors such as suicide risk.

AIM

The main objective of this study was to analyze the relationship between psychological resilience and suicide attempts, along with other relevant clinical and sociodemographic variables in euthymic patients with BPAD.

METHODS

Eighty six outpatients, more than 18 years old, mostly men (60.5%) with BPAD type 1, 2, mixed, and unspecified, in euthymic phase receiving antidepressant and/or euthimizing treatment, participated in the study. Sociodemographic and clinical variables were assessed by means of a questionnaire and psychological resilience by means of Connor-Davidson's 10-item Resilience Scale.

RESULTS

Patients with previous autolytic attempts scored significantly lower in resilience than those who had not attempted suicide (T = 3.30; p ≤ .001; 20.61 ± 6.58 vs. 26.52 ± 7.29). Patients diagnosed with BPAD scored significantly lower than other samples of university participants, workers, and the unemployed. The number of depressive episodes experienced was negatively and significantly associated with resilience scores (r = -.28; p < .01).

CONCLUSIONS

Patients diagnosed with BPAD who had made autolytic attempts had lower resilience scores than those who had not made them and lower scores than other general nonpsychiatric samples. The promotion of resilience in patients diagnosed with BPAD would facilitate a more adaptive and positive coping with the disease and their recovery process.

The relationship of negative life events, trait-anxiety and depression among Chinese university students: A moderated effect of self-esteem

BACKGROUND

Negative life events are major triggers for depression. How individual physical qualities and psychological resources affect the relationship between negative life events and depression in college students remains to be studied. Therefore, we constructed a structural equation model to explore the mediating effect of trait anxiety and the moderating effect of self-esteem in the relationship between negative life events and depression among college students.

METHODS

A total of 6224 Chinese college students (aged 16-25) in Jiangxi Province in the central area of China completed the online survey. A moderated mediation model was tested to verify the hypothesis.

RESULTS

The mediation analysis showed a significant indirect effect of negative life events on depression through trait-anxiety. Mediation was moderated by self-esteem, which significantly interacted with negative life events to reduce their effect on both anxiety and depression.

LIMITATIONS

All measures were self-reported. The cross-sectional design only provides evidence of correlation.

CONCLUSIONS

The results in this study revealed that self-esteem as a component of psychological defense mechanism to reduce the harm of environmental threats to individuals. Low self-esteem college students are more likely to have adverse effects when experiencing low-level life events. University mental health education reduces the effects of negative life events on trait anxiety and depression of college students by raising their self-esteem levels.

Development of a model to predict antidepressant treatment response for depression among Veterans

BACKGROUND

Only a limited number of patients with major depressive disorder (MDD) respond to a first course of antidepressant medication (ADM). We investigated the feasibility of creating a baseline model to determine which of these would be among patients beginning ADM treatment in the US Veterans Health Administration (VHA).

METHODS

A 2018-2020 national sample of n = 660 VHA patients receiving ADM treatment for MDD completed an extensive baseline self-report assessment near the beginning of treatment and a 3-month self-report follow-up assessment. Using baseline self-report data along with administrative and geospatial data, an ensemble machine learning method was used to develop a model for 3-month treatment response defined by the Quick Inventory of Depression Symptomatology Self-Report and a modified Sheehan Disability Scale. The model was developed in a 70% training sample and tested in the remaining 30% test sample.

RESULTS

In total, 35.7% of patients responded to treatment. The prediction model had an area under the ROC curve (s.e.) of 0.66 (0.04) in the test sample. A strong gradient in probability (s.e.) of treatment response was found across three subsamples of the test sample using training sample thresholds for high [45.6% (5.5)], intermediate [34.5% (7.6)], and low [11.1% (4.9)] probabilities of response. Baseline symptom severity, comorbidity, treatment characteristics (expectations, history, and aspects of current treatment), and protective/resilience factors were the most important predictors.

CONCLUSIONS

Although these results are promising, parallel models to predict response to alternative treatments based on data collected before initiating treatment would be needed for such models to help guide treatment selection.

Threat Appraisal, Resilience, and Health Behaviors in Recovered COVID-19 Patients: The Serial Mediation of Coping and Meaning-Making

Research indicates that both cognitive appraisal and personal resources can noticeably influence health behaviors, as individuals modify their health convictions and practices on the basis of threat appraisal, personality, and meaning. The aim of the current study was to investigate whether coping strategies and meaning-making can serially mediate the relationship of threat appraisal and resilience with health behaviors in recovered COVID-19 patients. Self-report measures of threat appraisal, resilience, coping, meaning-making, and health behaviors were completed by 266 participants (aged 17 to 78, 51.5% female) who had recovered from COVID-19. The serial mediation analysis showed that the relationship of threat appraisal and resilience with health behaviors was mediated by problem-focused coping, meaning-focused coping, and meaning-making, but not by emotion-focused coping. These results suggest that associations among threat perception, resilience, and health behavior depend to some extent on the interplay of coping and meaning-making, which reveals their unique role in the process of recovery from COVID-19, with potential implications for health interventions.

Resilience to depression: Implication for psychological vaccination

From the vulnerability perspective, we often ask the question "why someone suffers from depression?" Despite outstanding achievements along this line, we still face high occurrence or recurrence and unsatisfied therapeutic efficacy of depression, suggesting that solely focusing on vulnerability perspective is insufficient to prevent and cure depression. Importantly, although experiencing same adversity, most people do not suffer from depression but manifest certain resilience, which could be used to prevent and cure depression, however, the systematic review is still lack. Here, we propose the concept "resilience to depression" to emphasize resilient diathesis against depression, by asking the question "why someone is exempted from depression?" Research evidence of resilience to depression has been reviewed systematically: positive cognitive style (clear purpose in life, hopefulness, et al.), positive emotion (emotional stability, et al.), adaptive behavior (extraversion, internal self-control, et al.), strong social interaction (gratitude and love, et al.), and neural foundation (dopamine circuit, et al.). Inspired by these evidence, "psychological vaccination" could be achieved by well-known real-world natural-stress vaccination (mild, controllable, and adaptive of stress, with help from parents or leaders) or newly developed "clinical vaccination" (positive activity intervention for current depression, preventive cognitive therapy for remitted depression, et al.), both of which aim to enhance the resilient psychological diathesis against depression, through events or training. Potential neural circuit vaccination was further discussed. This review calls for directing attention to resilient diathesis against depression, which offers a new thinking "psychological vaccination" in both prevention and therapy of depression.

Eating disorder psychopathology and resilience in Iranian college students: A network analysis

OBJECTIVE

Eating disorder (ED) psychopathology is common among Iranian college students. Resilience (i.e., the ability to bounce back and adapt in the face of adverse and stressful conditions) has been found to be a protective factor against ED psychopathology in the West. However, no research to date has examined resilience as a protective factor against ED psychopathology in Iran. The current study used network analysis to examine an ED and resilience network in an Iranian sample.

METHOD

Participants were Iranian college students (N = 478) who completed the Farsi-Eating Disorder Examination-Questionnaire and Farsi-Brief Resilience Scale. We estimated a network of ED symptoms and resilience processes and identified central and bridge symptoms.

RESULTS

Central ED and resilience nodes were discomfort in seeing one's own body, feeling guilty about eating due to shape/weight, and thinking about shape and weight making it difficult to concentrate. Having a hard time making it through stressful events bridged with binge eating and fear of losing control over eating.

CONCLUSION

Processes related to managing stress and binge eating appear to maintain the association between ED symptoms and resilience processes.

Can resilience promote calling among Chinese nurses in intensive care units during the COVID-19 pandemic? The mediating role of thriving at work and moderating role of ethical leadership

Background

Nurses working in the intensive care unit (ICU) clung tenaciously to their job during the COVID-19 pandemic in spite of enduring stressed psychological and physical effects as a result of providing nursing care for the infected patients, which indicates that they possessed a high degree of professionalism and career calling. The aim of this study was to explain the associations between resilience, thriving at work, and ethical leadership influencing the calling of ICU nurses.

Methods

From December 2020 to January 2021 during the COVID-19 pandemic, a cross-sectional survey of 15 provinces in China was conducted using an online questionnaire. A total of 340 ICU nurses (effective response rate: 64.89%) completed sufficient responses to be used in the study. Sociodemographic factors, job demographic factors, resilience, calling, thriving at work, and ethical leadership were assessed using the questionnaire. General linear modeling (GLM), hierarchical linear regression (HLR) analysis, and generalized additive model (GAM) were performed to examine all the considered research hypotheses.

Results

Resilience was positively and significantly associated with calling. Moreover, thriving at work partially mediated the relationship between resilience and calling. The indirect effect of resilience on calling was 0.204 (p < 0.0001), and the direct effect of resilience on calling through thriving at work was 0.215 (p < 0.0001). The total effect of resilience on calling was 0.419 (p < 0.0001). In addition, ethical leadership played a moderating role in the relationship between resilience and calling (β = 0.16, p < 0.05).

Conclusion

Greater resilience can positively predict increased calling among Chinese ICU nurses during the COVID-19 pandemic. Moreover, thriving at work is a mechanism that partly transmits the positive effects of resilience on calling. Overall, nurses possessing greater resilience tend to maintain thriving at work in the face of such adversity, further resulting in subsequently increased calling. Besides, findings suggest that there is stronger influence of resilience on calling among nurses working in an organization managed by an ethical leader. The current findings may offer two insights for nursing practitioners and policymakers in the postpandemic world. First, resilience training and intervention are necessary to foster nurses' sense of thriving at work in the nursing industry, further promoting career calling. Second, better training and effort on the development of ethical leadership for leaders in nursing practice are essential to encourage followers to engage in social learning of ethical behaviors and abiding by normatively appropriate conduct, further enacting prosocial values and expressing moral emotions.

Mental Health Prevention and Promotion-A Narrative Review

Extant literature has established the effectiveness of various mental health promotion and prevention strategies, including novel interventions. However, comprehensive literature encompassing all these aspects and challenges and opportunities in implementing such interventions in different settings is still lacking. Therefore, in the current review, we aimed to synthesize existing literature on various mental health promotion and prevention interventions and their effectiveness. Additionally, we intend to highlight various novel approaches to mental health care and their implications across different resource settings and provide future directions. The review highlights the (1) concept of preventive psychiatry, including various mental health promotions and prevention approaches, (2) current level of evidence of various mental health preventive interventions, including the novel interventions, and (3) challenges and opportunities in implementing concepts of preventive psychiatry and related interventions across the settings. Although preventive psychiatry is a well-known concept, it is a poorly utilized public health strategy to address the population's mental health needs. It has wide-ranging implications for the wellbeing of society and individuals, including those suffering from chronic medical problems. The researchers and policymakers are increasingly realizing the potential of preventive psychiatry; however, its implementation is poor in low-resource settings. Utilizing novel interventions, such as mobile-and-internet-based interventions and blended and stepped-care models of care can address the vast mental health need of the population. Additionally, it provides mental health services in a less-stigmatizing and easily accessible, and flexible manner. Furthermore, employing decision support systems/algorithms for patient management and personalized care and utilizing the digital platform for the non-specialists' training in mental health care are valuable additions to the existing mental health support system. However, more research concerning this is required worldwide, especially in the low-and-middle-income countries.

The effect of psychological interventions on fear of cancer recurrence in breast cancer survivors: A systematic review and meta-analysis

AIM

To evaluate the effectiveness of psychological interventions in reducing fear of cancer recurrence in breast cancer survivors.

DESIGN

A systematic review and meta-analysis.

DATA SOURCES

PubMed, Embase, Cochrane Central Register of Controlled Trials, CINAHL, Scopus, PsycINFO, Web of Science and ClinicalTrials.gov were searched for relevant studies published from 1 January 1976 to 28 November 2020.

METHODS

Eligible randomized controlled trials on psychological interventions for reducing fear of cancer recurrence in breast cancer survivors were included in meta-analysis. Review Manager 5.4 was used to conduct the meta-analysis, and the fear of cancer recurrence score was calculated by using standardized mean differences and 95% confidence intervals. Risk of bias was assessed with the Cochrane risk-of-bias tool. Quality of evidence, sensitivity analyses, and subgroup analyses were also conducted.

RESULTS

This systematic review included 16 randomized controlled trials. We found psychological interventions significantly reduced fear of cancer recurrence. Subgroup analyses indicated that mindfulness and acceptance therapy-based interventions reduced fear of cancer recurrence, whereas cognitive-behavioural therapy combined with psychoeducation did not. Interventions with three to eight sessions were effective, while interventions with nine or more sessions were not. Face-to-face interventions were effective, whereas online interventions were not. The quality of evidence for fear of cancer recurrence was evaluated as moderate due to moderate heterogeneity in the included studies.

CONCLUSIONS

Psychological interventions were effective in reducing fear of cancer recurrence in breast cancer survivors. Mindfulness and acceptance therapy-based interventions and short-term interventions are recommended. Future well-designed randomized controlled trials aiming to examine the effectiveness of psychological interventions in reducing fear of cancer recurrence are needed.

IMPACT

The findings of this systematic review may guide the development of psychological interventions and encourage the use of psychological interventions for reducing fear of cancer recurrence in breast cancer survivors.

Synergistic effects of resilience and serum ghrelin levels on the 12-week pharmacotherapeutic response in patients with depressive disorders

BACKGROUND

This study investigated the individual and combined effects of self-reported resilience and serum ghrelin levels on 12-week remission in outpatients with depressive disorders who received antidepressant treatment.

METHODS

The Connor-Davidson Resilience Scale (CDRS) score and serum ghrelin levels were assessed at baseline in 1,094 patients. The patients initially received antidepressant monotherapy. Patients with an insufficient response or uncomfortable side effects received alternative treatments every 3 weeks (at 3, 6, and 9 weeks). Subsequently, 12-week remission, defined as a Hamilton Depression Rating Scale (HAMD) score of ≤ 7, was evaluated. The individual and combined effects of the CDRS score (low vs. high) and serum ghrelin level (low vs. high) on 12-week remission were analyzed using logistic regression models after adjusting for relevant covariates.

RESULTS

The individual effects of the CDRS score and serum ghrelin level on 12-week remission were not statistically significant. However, the high-CDRS, high-ghrelin group had a significantly higher 12-week remission rate compared to the low-CDRS, low-ghrelin group.

CONCLUSIONS

The combination of the CDRS score and serum ghrelin level is useful for predicting 12-week remission in patients with depressive disorders receiving pharmacotherapy.

Association of treatment procedures and resilience to symptom load three-years later in a clinical sample of adolescent psychiatric patients

BACKGROUND

We aimed to examine symptom load in a clinical adolescent population at three-year follow-up and explore associations with standard care treatment procedures and resilience factors upon first presenting at Child and Adolescent Mental Health Services.

METHODS

This study is part of a prospective longitudinal cohort study: The Health Survey in Department of Children and Youth, St. Olavs hospital, Norway. A clinical population of 717 (43.5% of eligible) adolescents aged 13-18 years participated in the first study visit (T₁, 2009-2011). Of these, 447 adolescents with psychiatric disorders, with treatment history from medical records and self-reported resilience factors (Resilience Scale for Adolescents; READ) at T₁, reported symptom load (Achenbach System of Empirically Based Assessment - Youth Self Report; YSR) three years later aged 16-21 years (T₂).

RESULT

At T₁, 93.0% received individual treatment. The frequency of psychotherapy and medication varied by disorder group and between genders. Overall, psychotherapy was more frequent among girls, whereas medication was more common among boys. Total READ mean value (overall 3.5, SD 0.8), ranged from patients with mood disorders (3.0, SD 0.7) to patients with Attention Deficit Hyperactivity disorder (3.7, SD 0.7), and was lower for girls than boys in all diagnostic groups. At T₂, the YSR Total Problem mean T-score ranged across the diagnostic groups (48.7, SD 24.0 to 62.7, SD 30.2), with highest symptom scores for those with mood disorders at T₁, of whom 48.6% had T-scores in the borderline/clinical range (≥60) three years later. Number of psychotherapy sessions was positively associated and Total READ score was negatively associated with the YSR Total Problems T-score (regression coefficient β = 0.5, CI (0.3 to 0.7), p < 0.001 and β = - 15.7, CI (- 19.2 to - 12.1), p < 0.001, respectively). The subscale Personal Competence was associated with the lowest Total Problem score for both genders.

CONCLUSIONS

Self-reported symptom load was substantial after three years, despite comprehensive treatment procedures. Higher self-reported resilience characteristics were associated with lower symptom load after three years. These results highlight the burden of adolescent psychiatric disorders, the need for extensive interventions and the importance of resilience factors for a positive outcome.

Relationship Between Mental Health, Resilience, and Physical Activity in Older Adults: A 2-Year Longitudinal Study

The aim of this study was to longitudinally investigate the association between resilience and mental health in older adults and to determine the influence of physical activity on this relationship. A total of 291 older adults were included in a 2-year follow-up study. Adjusted linear regression models evaluated the association between resilience at baseline and mental health after 2 years in sufficiently and insufficiently physically active older adults. A negative correlation was found between resilience at baseline and depression, anxiety, and stress after 2 years for the overall sample. This association changed after stratifying the group. Sufficiently physically active individuals made greater use of the resilience components "Self-Sufficiency" and "Perseverance," whereas insufficiently physically active individuals made greater use of "Meaning of Life" and "Existential Singularity." Physical activity can influence the relationship between resilience and mental health. These results can help guide the devising of more effective interventions for this age group.

Predictive Validity of Resilience in the Treatment of Individuals With Anxiety and Depressive Disorders

The current study sought to evaluate the predictive validity of resilience among individuals with anxiety and/or depressive disorders. Receiver operating characteristics were calculated for each of the 25-item and 10-item versions of the Connor-Davidson Resilience Scale, evaluated against psychological distress and treatment response, at screening and post-treatment. New referrals to an anxiety and related disorders clinic were recruited for this purpose (N = 672 at screening, N = 349 post-treatment). Robust cross-sectional associations between resilience and psychological distress and treatment response were noted and were strongest at post-treatment. However, the related sensitivity (63% to 66% at screening, 69% to 76% post-treatment), specificity (78% to 83% at screening, approximately 73% post-treatment), and areas under the curve (AUC; approximately 73% at screening, 78% to 82% post-treatment) were modest. Furthermore, there was minimal support for resilience as a predictor of recovery using the longitudinal data (sensitivity and specificity could not be determined, with AUC of approximately 68% for psychological distress and 56% for treatment response). Although a relatively large homogeneous sample was available for this study, analyses of specific diagnostic subgroups may offer valuable further insight. [Journal of Psychosocial Nursing and Mental Health Services, 59(7), 35-41.].

Initial white matter connectivity differences between remitters and non-remitters of patients with panic disorder after 6 months of pharmacotherapy

Panic disorder (PD) is a harmful mental condition that causes relapsed and persistent impairment. In the treatment of PD, the prognosis for PD should be considered. However, the relationship between pharmacotherapy and biomarkers, for predicting a better response through neuroimaging, is a little known. The purpose of the present study was to examine whether there would be the initial white matter (WM) regions associated with the remission in 6 months. A total of 104 patients with PD were investigated in the study. After six months, there were 17 remission patients with PD and 81 non-remission patients. The Panic Disorder Severity Scale, Albany Panic and Phobia Questionnaire, Anxiety Sensitivity Inventory-Revised, Beck Anxiety Inventory, and Beck Depression Inventory were assessed for all patients at baseline. We compared the diffusion indices between remission and non-remission group at 6 months using Tract-Based Spatial Statistics. The results showed that the fractional anisotropy (FA) values were significantly higher in the non-remitter group compared with those in the remitter group in the WM regions, such as the posterior corona radiata and superior longitudinal fasciculus, at the 6 month evaluation. The logistic regression analysis with clinical symptom severity and FA values of the WM regions as covariates showed that FA values in those regions and the Beck Depression Inventory-II predicted poor remission. This study suggests that posterior corona radiata and superior longitudinal fasciculus are related to potential predictive factors of 6-month remission in patients with PD. WM regions associated with the long-term remission should be verified with further investigations.

A Network Model of Positive Resources, Temperament, Childhood Trauma, and Comorbid Symptoms for Patient with Depressive Disorders

OBJECTIVE

Temperament, positive resources, childhood trauma, and other clinical comorbid symptoms are related to depressive symptom severity. Here, we used network analysis to examine the interrelations between these clinical factors in patients with depressive disorders.

METHODS

Patients with depressive disorders (n=454) completed self-report questionnaires evaluating clinical symptoms, childhood trauma, temperament, and positive resources. To identify network pattern and the most central aspect, we performed network analysis and centrality analyses. First, we analyzed the network pattern in total participants. Second, we established two groups of those with severe depressive symptoms and those with mild depressive symptoms and compared their network patterns.

RESULTS

Deficient optimism and depression were the central factors in the network of total participants. In the group with severe depressive symptoms, lack of social support and childhood emotional trauma showed high centrality. Deficient social support and other positive resources played central roles in the group with mild depressive symptoms.

CONCLUSION

Network pattern of psychological factors was different between those with mild or severe depression. Lack of positive resources is an important factor in psychological processes in both mild and severe depression. However, childhood emotional trauma may play a relatively important role in patients with severe depressive symptoms.

Do patients' resilience and subjective illness representation predict the outcome of a routine inpatient treatment program of major depressive disorder?

Adopting a personalized medicine approach beyond genetic/epigenetic profiling within psychiatric diagnostic and treatment is challenging. For the first time, we studied the influence of two patient resources (resilience and illness representation) on the success of an inpatient treatment of major depressive disorder (MDD). Using a 5-week observational real-world-study, the treatment- success was measured by the difference between the subjective depression- severity (according to the German short form of Beck's Depression-Inventory) at baseline (i.e., days four to six post-admission) and study- endpoint. In the intention-to-treat sample (n = 60, 47.3 ± 12.8 years old; 58% females), the patients' illness representation [measured by the "Krankheitskonzeptskala" (KK)] did not predict their treatment- success. The KK-dimension 'trust-in-doctors' was associated with resilience but not with the treatment-success. Albeit, the patients' resilience (determined by Resilience- Scale, 11-item-version (RS-11)) negatively predicted their positive treatment- success (b = - 0.09, p = 0.017, f² = 0.11). This influence of resilience on treatment- success was completely mediated by the baseline-depression- severity. This means, patients with low resilience reported high baseline-depression- levels which predicted a significant positive treatment- success. And, patients with high resilience reported low baseline-depression-levels which predicted no relevant or even negative inpatient treatment-success. The latter "high-resilience"- group (n = 27) was especially interesting. Remarkably, these patients appeared to have experienced within the first four-to-six inpatient treatment-days an "early sudden gain" against their considerable MDD- burden that initially had led to their admission. Thus, a stronger resilience might serve as a proxy of the development of an early MDD-relief as well as of lower baseline-depression- levels. Further studies are warranted to support the value of a patient's resilience to predict his treatment response and inpatient treatment duration.

How anxious did you feel during lockdown? The roles resilience, living environment, and gender play on the level of anxiety state during pandemic isolation

In the unique context of the coronavirus disease 2019 (COVID-19) pandemic, researchers and clinicians alike drew attention to the risks involved by physical and social isolation for mental health. Factors like resilience, gender, urban/rural environment, or preexisting anxiety can impact anxious states produced by home forced isolation. Based on these, we assumed that: i) there are significant differences in the level of anxiety (state) during the pandemic, depending on the living area of the subjects; ii) gender plays a moderating role in the relationship between resilience and anxiety; and iii) anxiety (trait), experiential avoidance, resilience, and family connectedness, determine the level of anxiety (state). The MemoryLab team conducted the present study on 495 subjects (n=411 women, age between 18 and 65). Of these, 350 live in large and medium urban areas, 63 in small urban areas, and 82 in rural areas. As instruments, we used The State-Trait Anxiety Inventory (STAI 2.0), The Acceptance and Action Questionnaire 2 (AAQ-2), The Aggression Questionnaire (AQ), The Family Connectedness Questionnaire, and Connor-Davidson Resilience Scale 10 (CD-RISC-10), as well as the standard division of living areas according to community size. Data collection took place online during the spring peak of the pandemic. According to ANOVA analysis, people living in small urban areas have a higher level of anxiety. The difference is significant compared to those living in large and medium cities and villages. Gender has no moderating role in the relationship between resilience and the anxiety state. Also, experiential avoidance, anxiety (trait), and resilience play a significant role on the level of anxiety (state), measured during social isolation. The results could be an important indicator for understanding psychological mechanisms guiding interventions to support the communities effectively.

Structural abnormalities associated with poor outcome of a major depressive episode: The role of thalamus

An identification of precise biomarkers contributing to poor outcome of a major depressive episode (MDE) has the potential to improve therapeutic strategies by reducing time to symptomatic relief. In a cross-sectional volumetric study with a 6 month clinical follow-up, we performed baseline brain grey matter volume analysis between 2 groups based on illness improvement: 27 MDD patients in the "responder" (R) group (Clinical Global Impression- Improvement (CGI-I) score ≤ 2) and 30 in the "non-responder" (NR) group (CGI-I > 2), using a Voxel Based-Morphometry analysis. NR had significantly smaller Grey Matter (GM) volume in the bilateral thalami, in precentral gyrus, middle temporal gyrus, precuneus and middle cingulum compared to R at baseline. Additionally, they exhibited significant greater GM volume increase in the left anterior lobe of cerebellum and posterior cingulate cortex. The latter result was not significant when participants with bipolar disorder were excluded from the analysis. NR group had higher baseline anxiety scores. Our study has pointed out the role of thalamus in prognosis of MDE. These findings highlight the involvement of emotion regulation in the outcome of MDE. The present study provides a step towards the understanding of neurobiological processes of treatment resistant depression.

Older Adults' Gender, Age and Physical Activity Effects on Anxiety, Optimism, Resilience and Engagement

The purpose of the study was to understand the effects of gender and age on anxiety, optimism, resilience and engagement in a group of older adults. An observational, quantitative, descriptive and transversal design was used with non-probabilistic sampling. Descriptive statistical analyses, reliability tests (Cronbach's alpha) and linear correlation tests (Pearson's) were performed, and the development of multivariate linear regression models was conducted. Female participants in the sample had higher levels in anxiety and pessimism, while male participants scored higher in optimism, engagement and resilience. Participants who practiced physical activity (PA) had better scores in optimism, engagement and resilience. The sample comprised 55.1% men and 44.9% women, between the ages of 51 and 93, with an average of 68.1 years, all participants completed the questionnaire Anxiety Scale-2 (SAS-2) the Revised Life Orientation Test (LOT-R) the short version of the Utrecht Work Engagement Scale questionnaire (UWES-9) the short version of the CD-RISC. As for marital status, there were significant differences between single participants and romantic partner. Singles participants showed higher levels of anxiety than their married counterparts, while those in a relationship scored higher in optimism, engagement and resilience. The model was statistically significant F (9;352) = 14.6; p < 0.001, explaining 27% of the variance in optimism. The data indicated that PA practice and living with a partner in an inland area is associated with less anxiety, which may have implications for programs and activities designed for older adults.

Elevated Amygdala Activity in Young Adults With Familial Risk for Depression: A Potential Marker of Low Resilience

BACKGROUND

Amygdala overactivity has been frequently observed in patients with depression, as well as in nondepressed relatives of patients with depression. A remaining unanswered question is whether elevated amygdala activity in those with familial risk for depression is related to the presence of subthreshold symptoms or to a trait-level vulnerability for illness.

METHODS

To examine this question, functional magnetic resonance imaging data were collected in nondepressed young adults with (family history [FH+]) (n = 27) or without (FH-) (n = 45) a first-degree relative with a history of depression while they viewed images of "looming" or withdrawing stimuli (faces and cars) that varied in salience by virtue of their apparent proximity to the subject. Activation of the amygdala and 2 other regions known to exhibit responses to looming stimuli, the dorsal intraparietal sulcus (DIPS) and ventral premotor cortex (PMv), were measured, as well as levels of resilience, anxiety, and psychotic and depressive symptoms.

RESULTS

Compared with the FH- group, the FH+ group exhibited significantly greater responses of the amygdala, but not the dorsal intraparietal sulcus or ventral premotor cortex, to looming face stimuli. Moreover, amygdala responses in the FH+ group were negatively correlated with levels of resilience and unrelated to levels of subthreshold symptoms of psychopathology.

CONCLUSIONS

These findings indicate that elevated amygdala activity in nondepressed young adults with a familial history of depression is more closely linked to poor resilience than to current symptom state.

Relation of the Psychological Constructs of Resilience, Mindfulness, and Self-Compassion on the Perception of Physical and Mental Health

Purpose

Health factors that enhance an individual’s ability to perceive and maintain health and well-being are referred to as “health assets”. Of these assets, resilience, mindfulness and self-compassion are considered to be of special importance. The objective of this study was to analyze the association between these psychological constructs on the perception of physical and mental health in a general population.

Patients and methods

A descriptive and analytical cross-sectional study was conducted with 845 participating subjects. The outcome variable was the individual´s perception of physical and mental health, measured using the SF-36 questionnaire. The independent variables were: sociodemographic variables, medical information, physical activity performance (using the International Physical Activity Questionnaire), tobacco and alcohol consumption, anxiety and/or depression (using the Goldberg Anxiety and Depression Scale), resilience (using the Connor-Davidson Resilience Scale), mindfulness (with the Five Facets of Mindfulness Questionnaire Short Form) and self-compassion (using the Self-compassion scale-short form). A correlation analysis, simple linear regression and multiple linear regression were carried out, controlling for the influence of the distinct independent variables.

Results

The constructs of resilience, mindfulness and self-compassion are significant, in the perception of both physical and mental health. Other factors appearing in the multiple regression are gender, age, educational level, physical activity and tobacco consumption, in a positive or negative sense.

Conclusion

The study of these associations is fundamental for the understanding of underlying regulation processes of healthy lifestyles in the general population.

Anxiety during ketamine infusions is associated with negative treatment responses in major depressive disorder

About 20 to 30 percent of patients with Major Depressive Disorder (MDD) do not respond to standard treatment and are considered treatment-resistant. The N-methyl-d-aspartate (NMDA) glutamate receptor antagonist ketamine has demonstrated rapid antidepressant effects in treatment-resistant MDD, but it is unknown whether its acute psychological effects are related to the later antidepressant effect. Therefore, we investigated the association between antidepressant responses to ketamine and the quality of ketamine-induced psychological experiences in MDD. A total of 31 patients (M = 49.5 ± 11.2 years, 16 women) were treated with three ketamine infusions per week (0.5 mg/ kg over 40 min) administered for two consecutive weeks. Depression severity was assessed using the Montgomery-Åsberg Depression Rating Scale (MADRS) at baseline, after four and 24 h and at end of treatment. The 5-Dimensional Altered States of Consciousness Rating Scale (5D-ASC) was applied four hours after the first infusion to assess the subjective quality of acute psychological effects. Patients with a ≥ 50% MADRS reduction from baseline to end of treatment were considered as responders. After six infusions, 17 of 31 patients (55%) showed a response to ketamine treatment, while 14 patients (45%) had no response. Anxiety-related experiences induced by ketamine were significantly higher in non-responders. Percentage MADRS reduction after four hours and individual levels of ketamine-induced anxiety were predictive of a response at end of treatment. The study demonstrated the considerable impact of ketamine-induced anxiety on the antidepressant efficacy of ketamine. It underpins the importance of considering patients' subjective experiences and underlines the possibility of a phenotypic response predictor.

Resilience and depression/anxiety symptoms in multiple sclerosis and neuromyelitis optica spectrum disorder

BACKGROUND

Depression and anxiety are common in multiple sclerosis (MS) and recently, studies on these symptoms in neuromyelitis optica spectrum disorder (NMOSD) are increasing. Previous studies suggest that these symptoms have negative effects on the quality of life. Resilience has garnered more interest as one of the protective factors that works to prevent psychiatric symptoms in past decades. There exist a few studies, however, regarding the effects of resilience on these psychiatric symptoms in MS/NMOSD.

OBJECTIVE

The aim of this study was to clarify the relationships between resilience, psychiatric symptoms, and QOL in patients with MS/NMOSD.

METHOD

Seventy-seven patients with MS/NMOSD participated in this study. They completed several questionnaires (Beck Depression Inventory-Second edition, Hospital Anxiety and Depression Scale, the Japanese version of the Resilience scale [RS], and Japanese version of Multiple Sclerosis Quality of Life-54). We also collected demographic and clinical data including age, sex, physical disability level (measured with the Expanded Disability Status Scale [EDSS]), and disease duration of the participants.

RESULTS

The EDSS scores showed significant negative correlations with QOL, unlike disease duration, which did not correlate with either the psychiatric symptoms or QOL. Additionally, there was no significant correlation between RS scores and EDSS scores or disease duration. We also found that resilience showed a significant negative correlation with psychiatric symptoms, and positive correlation with QOL.

CONCLUSION

These results suggest that resilience may serve to prevent or reduce depression/anxiety symptoms and maintain the QOL regardless of the physical disability level.

Resilience linked to personality dimensions, alexithymia and affective symptoms in motor functional neurological disorders

OBJECTIVE

Reduced resilience, a construct associated with maladaptive stress coping and a predisposing vulnerability for Functional Neurological Disorders (FND), has been under-studied compared to other neuropsychiatric factors in FND. This prospective case-control study investigated self-reported resilience in patients with FND compared to controls and examined relationships between resilience and affective symptoms, personality traits, alexithymia, health status and adverse life event burden.

METHODS

50 individuals with motor FND and 47 healthy controls participated. A univariate test followed by a logistic regression analysis investigated group-level differences in Connor-Davidson Resilience Scale (CD-RISC) scores. For within-group analyses performed separately in patients with FND and controls, univariate screening tests followed by multivariate linear regression analyses examined factors associated with self-reported resilience.

RESULTS

Adjusting for age, gender, education status, ethnicity and lifetime adverse event burden, patients with FND reported reduced resilience compared to controls. Within-group analyses in patients with FND showed that individual-differences in mental health, extraversion, conscientiousness, and openness positively correlated with CD-RISC scores; post-traumatic stress disorder symptom severity, depression, anxiety, alexithymia and neuroticism scores negatively correlated with CD-RISC scores. Extraversion independently predicted resilience scores in patients with FND. In control subjects, univariate associations were appreciated between CD-RISC scores and gender, personality traits, anxiety, alexithymia and physical health; conscientiousness independently predicted resilience in controls.

CONCLUSION

Patients with FND reported reduced resilience, and CD-RISC scores covaried with other important predisposing vulnerabilities for the development of FND. Future research should investigate if the CD-RISC is predictive of clinical outcomes in patients with FND.

The Role of Physical Activity in the Association Between Resilience and Mental Health in Older Adults

The aim of this study is to evaluate the relationship between resilience and mental health in older adults and how physical activity influences that relationship. A cross-sectional study was carried out with 312 older adults (179 active and 133 sedentary classified by IPAQ). Considering the whole sample, an inverse relationship was found for resilience (Wagnild-Young's Resilience Scale) with depression and stress (DASS-21). Among the sedentary, in spite of there not being an association between total resilience and mental health, there was an inverse relationship for the "meaning of life" component of the resilience and depression scale. For the active group, there was a relationship between total resilience and its components with depression and stress, but not for the "meaning of life" component of the resilience scale. Physical activity played an important role in the relationship between resilience and depression, showing that active and sedentary people use different components of resilience.

Resilience dimensions and mental health outcomes in bipolar disorder in a follow-up study

The individual process of resilience has been related to positive outcomes in mental disorders. We aimed (a) to identify the resilience domains from the Resilience Questionnaire for Bipolar Disorder that are associated cross sectionally and longitudinally with mental health outcomes in bipolar disorder (BD) and (b) to explore cross-lagged associations among resilience factors. A clinical adult sample of 125 patients diagnosed with BD (62.10% female, mean age = 46.13, SD = 10.89) gave their informed consent and completed a battery of disease-specific tools on resilience, personal recovery, symptomatology, psychosocial functioning, and quality of life, at baseline and at follow-up (n = 63, 58.10% female, mean age = 45.13, SD = 11.06, participation rate = 50.40%). Resilience domains of self-management of BD, turning point, self-care, and self-confidence were significantly associated with mental health indicators at baseline. In addition, self-confidence at baseline directly predicted an increase in personal recovery at follow-up, and self-confidence improvement mediated the relationship between interpersonal support and self-care at baseline and personal recovery at follow-up. These findings highlight that resilience domains are significantly associated with positive mental health outcomes in BD and that some predict personal recovery at follow-up. Moreover, some resilience factors improve other resilience factors over time.

Does Problem Focused Coping Buffer the Effects of Trait Anxiety on Depressive Symptoms of Chronic Urticaria Patients?

The present study examined the moderating role of problem-focused coping in trait anxiety-depressive symptoms' relationship in patients with chronic urticaria (CU). Eighty-eight CU patients, who applied to an outpatient clinic of Clinical Immunology and Allergic Diseases, filled out a questionnaire set including State-Trait Anxiety Inventory, Ways of Coping Inventory, and Beck Depression Inventory. The results suggested that CU patients high on trait anxiety reported more depressive symptoms, and the ones using more problem-focused coping (PFC) strategies reported less depressive symptoms. Also, PFC strategies moderated trait anxiety-depressive symptoms relation. Accordingly, PFC strategies did not lead to any significant difference in CU patients who were low on trait anxiety in terms of the level of depressive symptoms. However, CU patients with high trait anxiety experienced significantly less depressive symptoms if they used more PFC strategies. The findings were discussed in the light of the relevant literature.

Longitudinal associations between resilience and quality of life in eating disorders

OBJECTIVE

This study examined the longitudinal reciprocal associations between resilience factors, quality of life (QoL) domains, and symptoms of eating disorders (EDs). Hypotheses included predictive paths from resilience factors of "acceptance of self and life" and "personal competence" to increased QoL and predictive paths from previous levels of QoL to resilience.

METHOD

A total of 184 patients with EDs (mean age = 29.55, SD = 9.17, 94.8% women) completed measures of resilience, QoL, and EDs symptoms over three waves spaced six month apart. Hypotheses were tested by path analysis.

RESULTS

Resilience factors predicted improvements in psychological health and social relationship domains of QoL and a reduction of ED symptoms over time. In addition, psychological health increased acceptance of self and life consistently over time, whereas physical health increased the competence component of resilience.

DISCUSSION

The relationships between resilience factors and QoL are reciprocal, with several mediational paths. A spiral of recursive influences between resilience factors and QoL can take place in people with EDs. This possibility offers new perspectives to understanding the process of recovery in patients with ED.

Influence of trait anxiety, child maltreatment, and adulthood life events on depressive symptoms

BACKGROUND

Various personality traits mediate the association between childhood stress and depressive symptoms in adulthood. The aim of this study was to clarify the indirect effects of the experience of child maltreatment on depressive symptoms and appraisal of life events in adulthood through trait anxiety.

SUBJECTS AND METHODS

A total of 404 participants who were volunteer subjects from the community were studied using the following self-administered questionnaire surveys: Patient Health Questionnaire-9, which measures depressive symptoms; State-Trait Anxiety Inventory Form Y, which measures trait anxiety; the Child Abuse and Trauma Scale, which measures child maltreatment; and Life Experiences Survey, which measures negative and positive appraisal of adulthood life events.

RESULTS

Structural equation modeling demonstrated that the experience of child maltreatment increased depressive symptoms in adulthood as well as the negative appraisal of life events in adulthood through an increase in trait anxiety. Furthermore, trait anxiety affected depressive symptoms in adulthood through its influence on the negative appraisal of adulthood life events. The following indirect effect was also significant: the experience of child maltreatment increased the negative appraisal of adulthood life events via trait anxiety and subsequently influenced adult depressive symptoms.

LIMITATIONS

The subjects of this study are volunteer subjects from the community including healthy people, and hence the results may not be generalizable to major depressive patients. Recall bias should be considered when interpreting the results. Because this study is a cross-sectional study, the causality between the experience of child maltreatment and depression is not clear.

CONCLUSION

This study suggests that trait anxiety may play a mediating role in the influence of the experience of child maltreatment on depressive symptoms in adulthood and negative appraisal of adulthood life events.

Physical neglect during childhood alters white matter connectivity in healthy young males

BACKGROUND

Childhood adversity (CA) leads to greater vulnerability for psychopathology by causing structural as well as functional brain abnormalities. Recent findings on gray matter effects point towards the importance of identifying CA outcome as a function of different CA types, varying in the dimensions of threat and deprivation. Using diffusion tensor imaging, we investigate whether different forms of CA impact differently on white matter connectivity in a healthy cohort not confounded by other aspects of disease.

METHODS

In 120 healthy young males, we assessed different forms of maltreatment during childhood with the Childhood Trauma Questionnaire (CTQ). Fractional anisotropy (FA) and mean diffusivity (MD) images were generated and projected onto a white matter skeleton using tract-based spatial statistics. Correlational analysis between FA, MD, and CTQ subscores was then performed using voxelwise statistics.

RESULTS

Of all CTQ-subscores, only physical neglect (PN) predicted a decrease of FA but not MD in the bilateral anterior thalamic radiation around the middle frontal gyrus and the right inferior fronto-occipital fasciculus, the inferior longitudinal fasciculus, the cingulum and precuneus. Reduced FA in the posterior cingulum was related to the effects of PN during childhood on anxiety levels at trend level.

CONCLUSIONS

PN may have severe consequences and should be considered equally important to more active forms of abuse. FA changes, particularly in the cingulum, actually appear to a functional consequence and are linked to trait anxiety, a personality dimension that is suggested to be a transdiagnostic risk factor of affective disorders. Potentially this reveals a mechanistic chain that forms one pathyway from CA to disease.

Outcomes of Acute Partial Hospital Treatment: Comparison of Two Programs and a Waiting List Control

OBJECTIVE

To investigate the effectiveness of acute, very brief partial hospital treatment, and the comparative benefits of different types of partial hospitalization programs (PHPs), this exploratory study examined changes in psychiatric symptoms and elements of cognitive functioning during an acute PHP compared with a waiting list control, and also compared such changes in 2 PHPs that treated similar patient groups but used different treatment approaches.

METHODS

Patients were admitted to 2 PHPs, one utilizing cognitive-behavioral therapy and the other interpersonal and existential psychotherapy. Assessments were collected at the start of a waiting list control period, as well as at admission to and discharge from the PHP. In both programs, patients completed self-report assessments of anxiety (Beck Anxiety Inventory), depression (Beck Depression Inventory), hopelessness (Beck Hopelessness Scale), and resilience (Dispositional Resilience Scale) at admission and discharge; a subset of cognitive-behavioral therapy patients completed the same measures while on a waiting list.

RESULTS

During acute partial hospitalization (mean length of stay, 5.3±3.0 d), patients (N=2000) improved significantly (Cohen d=0.39 to 1.1) on all 4 measures of symptom severity and cognitive functioning. Although some changes were observed in the subjects on the 2-week waiting list, they were less than during a 1-week PHP admission. No significant differences in outcomes were found between the 2 PHPs.

CONCLUSIONS

Across 2 different acute PHPs, significant reductions in symptom severity and improvements in elements of cognitive functioning were observed. Findings indicate that acute PHP treatment may produce moderate-sized treatment effects in a 1-week period that seem unrelated to specific psychotherapeutic methods.

Anxiety among adults with a history of childhood adversity: Psychological resilience moderates the indirect effect of emotion dysregulation

BACKGROUND

Adverse childhood experiences (ACEs) have been widely identified as risk factors for increased symptoms of anxiety across the lifespan. Little is known, however, about the processes by which ACEs set the stage for increased symptoms of anxiety in adulthood. The current study evaluated whether emotion dysregulation and psychological resilience influence the association between ACEs and symptoms of anxiety.

METHODS

A sample of adult primary care patients (N=4006) completed self-report measures related to ACEs, symptoms of anxiety, emotion dysregulation, and psychological resilience.

RESULTS

A moderated mediation analysis showed that emotion dysregulation mediated the association between ACEs and anxiety symptoms, and that the strength of this effect varied as a function of psychological resilience. Specifically, the influence of ACEs on emotional dysregulation was stronger among individuals with low levels of psychological resilience than among those with high levels of psychological resilience. These findings remained significant when controlling for a range of sociodemographic variables in the model.

LIMITATIONS

Cross-sectional designs preclude inferences about causality and self-report data may be susceptible to reporting biases. Other psychological variables that may be relevant to the current results, such as protective factors in childhood, were not assessed.

CONCLUSIONS

These results have implications for the conceptualization of ACEs, emotion dysregulation, and psychological resilience in etiological models of anxiety. They also highlight the relevance of ACEs, emotion dysregulation, and psychological resilience to the detection, treatment, and prevention of anxiety disorders.

Differential effects of circadian typology on sleep-related symptoms, physical fatigue and psychological well-being in relation to resilience

Various physiological and psychological functions are influenced by circadian typology (CT), which was reported to be related to resilience. However, few studies have assessed the effects of CT in relation to resilience. The aim of the present study was to assess the influence of CT on sleep-related symptoms, physical fatigue and psychological well-being in relation to resilience. The present study included a total of 1794 healthy hospital employees, and they completed the Morningness-Eveningness Questionnaire, Connor-Davidson Resilience Scale, Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, Fatigue Severity Scale, Hospital Anxiety and Depression Scale and World Health Organization Quality of Life Scale Abbreviated Version. Subjects with evening type showed lower sleep quality, more daytime sleepiness and physical fatigue than neither types and morning types. Additionally, evening types were more depressed and anxious and reported a poorer quality of life. CT was found to be a significant predictor of sleep quality, but CT was minimally associated with physical fatigue and psychological well-being in the regression analysis. Instead, resilience was substantially related to all of the variables measured. In conclusion, CT independently predicts sleep quality, but the effects of CT on physical fatigue and psychological well-being are negligible compared to those of resilience.

Childhood parental bonding affects adulthood trait anxiety through self-esteem

INTRODUCTION

The association between trait anxiety and parental bonding has been suggested. However, the mechanism remains uncertain and there is no study focused on general adult population. We investigated the association and the mechanism between childhood parental bonding and adulthood trait anxiety in the general adult population.

MATERIAL AND METHODS

A cross-sectional retrospective survey was conducted in 2014 with 853 adult volunteers from the general population. The Parental Bonding Instrument, Rosenberg Self-Esteem Scale, and State-Trait Anxiety Inventory Form Y (STAI-Y) were self-administered. Structural equation modelling was used for the analysis.

RESULTS

Childhood parental bonding affected adulthood trait anxiety indirectly mediated by self-esteem. Trait anxiety was decreased by parental care and increased by parental overprotection through self-esteem. This model explained 51.1% of the variability in STAI-Y trait anxiety scores.

CONCLUSIONS

This study suggests an important role of self-esteem as a mediator between childhood parental bonding and adulthood trait anxiety.

Sociodemographic factors and health conditions associated with the resilience of people with chronic diseases: a cross sectional study

OBJECTIVE

to investigate the association between resilience and sociodemographic variables and the health of people with chronic kidney disease and / or type 2 diabetes mellitus.

METHOD

a cross-sectional observational study performed with 603 people with chronic kidney disease and / or type 2 diabetes mellitus. A tool to collect socio-demographic and health data and the Resilience Scale developed by Connor and Davidson were applied. A descriptive and multivariate analysis was performed.

RESULTS

the study participants had on average 61 years old (SD= 13.2), with a stable union (52.24%), religion (96.7%), retired (49.09%), with primary education (65%) and income up to three minimum wages. Participants with kidney disease showed less resilience than people with diabetes.

CONCLUSION

the type of chronic illness, disease duration, body mass index and religious beliefs influenced the resilience of the study participants.

Depressive Symptoms and Associated Psychosocial Factors among Adolescent Survivors 30 Months after 2008 Wenchuan Earthquake: A Follow-Up Study

Purpose: This study longitudinally investigated the changes of depressive symptoms among adolescent survivors over 2 years and a half after the 2008 Wenchuan earthquake in China, as well as the predictive effects of demographic characteristics, earthquake exposure, negative life events, social support, and dispositional resilience on the risk of depressive symptoms at two time points after the earthquake.

Methods: Participants were 1573 adolescent survivors (720 males and 853 females, mean age at initial survey = 15.00 ± 1.26 years), whose depressive symptoms were assessed at 6 months (T_6m) and 30 months (T_30m) post-earthquake. Data on demographics, earthquake exposure, and dispositional resilience were collected at T_6m. Negative life events and social support were measured at T_6m and 24 months (T_24m) post-earthquake.

Results: The prevalence rates of probable depression, 27.5 at T_6m and 27.2% at T_30m, maintained relatively stable over time. Female gender was related with higher risk of depressive symptoms at both T_6m and T_30m, while being only child could only predict higher risk of depressive symptoms at T_30m. Negative life events and social support at T_6m, as well as earthquake exposure, were concurrently associated with increased risk of depressive symptoms at T_6m, but not associated with the risk of depressive symptoms at T_30m, while negative life events and social support at T_24m could predict depressive symptoms at T_30m, all of which suggested that these variables may have strong but short-term effect on adolescents’ depressive symptoms post-earthquake. Besides, dispositional resilience was evidenced as a relatively stable negative predictor for depressive symptoms.

Conclusions: These findings could inform mental health professionals regarding how to screen adolescent survivors at high risk for depression, so as to provide them with timely and appropriate mental health services based on the identified risk and protective factors for depressive symptoms.

Is trait resilience characterized by specific patterns of attentional bias to emotional stimuli and attentional control?

BACKGROUND AND OBJECTIVES

Attentional processes have been suggested to play a crucial role in resilience defined as positive adaptation facing adversity. However, research is lacking on associations between attentional biases to positive and threat-related stimuli, attentional control and trait resilience.

METHODS

Data stem from the follow-up assessment of a longitudinal study investigating mental health and related factors among German soldiers. Trait resilience was assessed with the Connor-Davidson Resilience Scale and attentional control with the Attentional Control Scale. A subset of n = 198 soldiers also completed a dot probe task with happy, neutral and threatening faces.

RESULTS

Attentional control was positively related to trait resilience. Results revealed no associations between both attentional biases and trait resilience. However, there was a negative association between attentional bias to threat and trait resilience when attentional control was low and a positive association between attentional bias to threat and trait resilience when attentional control was high. No such associations were found for attentional bias to positive stimuli.

LIMITATIONS

Generalizability to other populations may be limited since we exclusively focused on male soldiers. Also, the cross-sectional design does not allow for causal conclusions.

CONCLUSIONS

Findings suggest that attentional processing may promote trait resilience. Future research on preventive interventions should consider these findings.

Effects of religiosity and spirituality on the treatment response in patients with depressive disorders

BACKGROUND

Few studies have investigated the roles of religiosity and spirituality in predicting treatment response among psychiatric patients with depressive disorders.

METHODS

In total, 232 outpatients with depressive disorders completed measurements of psychological symptoms, religiosity, and spirituality at baseline. A response was defined as Clinical Global Impression-Improvement scale (CGI-I) score of 1 or 2 at the last visit during a 6-month treatment period. Univariate analyses and logistic regression analysis were used to identify predictors of treatment response.

RESULTS

In univariate analyses, treatment response was associated with marital status, longer treatment duration, less severe baseline symptoms, higher personal importance of religion, and higher spirituality. In logistic regression analysis, subjective important considerations for religion and spirituality were significantly related with treatment response after controlling for marital status, treatment duration, and baseline symptom severity. Of these variables, spirituality remained a significant predictor in the final model.

CONCLUSIONS

These findings suggest that higher spirituality may independently contribute to favorable treatment responses among depressed patients in addition to other demographic and clinical factors.

Ego-resiliency reloaded: a three-component model of general resiliency

Ego-resiliency (ER) is a capacity that enables individuals to adapt to constantly changing environmental demands. The goal of our research was to identify components of Ego-resiliency, and to test the reliability and the structural and convergent validity of the refined version of the ER11 Ego-resiliency scale. In Study 1 we used a factor analytical approach to assess structural validity and to identify factors of Ego-resiliency. Comparing alternative factor-structures, a hierarchical model was chosen including three factors: Active Engagement with the World (AEW), Repertoire of Problem Solving Strategies (RPSS), and Integrated Performance under Stress (IPS). In Study 2, the convergent and divergent validity of the ER11 scale and its factors and their relationship with resilience were tested. The results suggested that resiliency is a double-faced construct, with one function to keep the personality system stable and intact, and the other function to adjust the personality system in an adaptive way to the dynamically changing environment. The stability function is represented by the RPSS and IPS components of ER. Their relationship pattern is similar to other constructs of resilience, e.g. the Revised Connor-Davidson Resilience Scale (R-CD-RISC). The flexibility function is represented by the unit of RPSS and AEW components. In Study 3 we tested ER11 on a Hungarian online representative sample and integrated the results in a model of general resiliency. This framework allows us to grasp both the stability-focused and the plasticity-focused nature of resiliency.

Resilience and impulsivity in euthymic patients with bipolar disorder

BACKGROUND

Stress plays an important role in the onset and recurrence of bipolar disorder (BD). Resilience is the ability to cope with stress or adversity. Few studies have examined resilience in BD, and this study aimed to investigate the clinical correlates of resilience in euthymic patients with BD.

METHODS

A total of 62 outpatients with BD type I, II, and not otherwise specified (NOS) who were in remission and 62 healthy individuals matched with the BD group in terms of age and sex were recruited. All participants completed the Connor-Davidson Resilience Scale and Barratt Impulsiveness Scale. A psychiatrist interviewed the subjects to assess clinical characteristics. Multiple linear regression analysis was used to determine factors associated with resilience.

RESULTS

The BD group had significantly higher levels of impulsivity and lower levels of resilience compared with the control group. Degree of impulsivity, number of depressive episodes, Clinical Global Impression (CGI) scores, and length of education were significantly correlated with resilience. Attention impulsivity, non-planning impulsivity, and number of depressive episodes were associated with low levels of resilience, even when age, sex, length of education, and CGI scores were controlled.

LIMITATIONS

Because tertiary hospital patients were recruited, the generalizability of the findings is limited.

CONCLUSIONS

This study shows that low levels of resilience are related to high levels of impulsivity and to an increased number of depressive episodes in euthymic patients with BD. Given the reciprocal relationship between resilience and impulsivity, efforts to enhance resilience and reduce impulsivity may make important contributions to the treatment of patients with BD.