Psychometric properties of the Overall Anxiety Severity and Impairment Scale (OASIS) among psychiatric outpatients

Internet videoconferencing delivered cognitive behaviour therapy for generalized anxiety disorder: A randomized controlled trial

OBJECTIVE

Generalized anxiety disorder (GAD) is a chronic mental health condition that results in significant individual and societal burden. Cognitive-behaviour therapy (CBT) therapy is an effective treatment for GAD, however, many individuals experience logistical barriers when accessing evidence-based care. Remote treatments may help to reduce these barriers, however, currently, there are few studies examining the efficacy of high-intensity remote methods for GAD treatment. The current study aims to examine the efficacy of CBT delivered via videoconferencing (VCBT) for GAD using a randomized controlled trial design comparing an immediate treatment group to a waitlist control.

METHOD

Seventy-eight adults (M age = 36.92; SD = 12.92; 84.4% female) with GAD were enrolled in the study.

RESULTS

Those in the treatment group demonstrated a statistically significant reduction in GAD symptoms from pre-treatment to post-treatment (d = 1.03) and pre-treatment to 3-month follow-up (d = 1.50). Large between-group effect sizes were also observed at post-treatment (d = .80). Twenty-five participants (64.10%) in the VCBT group no longer met diagnostic criteria for GAD at post-treatment, and 26/39 (66.67%) no longer met criteria at 3-month follow-up. Ninety-six per cent of participants were satisfied with the treatment.

CONCLUSION

The results contribute towards advancing our knowledge on the efficacy and acceptability of VCBT for patients with GAD.

The relationship between expressive suppression, therapeutic bond, and treatment outcomes of a positive affect intervention for adults with anxiety and/or depression

Expressive suppression (ES; reducing emotional expression) is linked with reduced social connectedness in individuals with anxiety or depression. One implication is that people who use ES may have difficulty establishing a bond with their therapist which may impede clinical improvement. We examined this hypothesis in 33 adults with clinically elevated anxiety or depression receiving treatment focused on enhancing positive thoughts, emotions, and behaviors. At baseline, participants rated ES for positive and negative emotions during a standardized conversation task designed to generate connectedness. They also rated measures of early (session 3) perceived therapeutic bond and treatment outcomes (i.e. positive affect and social connectedness). ES of positive (r = -.39, p = .018), but not negative (r = .06, p = .747), emotions was negatively associated with therapeutic bond. Therapeutic bond mediated the relationship between greater ES of positive emotions during affiliation and lower post-treatment positive affect, 95% bias-corrected bootstrap confidence interval [-0.021, -0.000], adjusted for pre-treatment positive affect, as well as lower post-treatment social connectedness [-0.397, -0.015]; however, the indirect effect was not significant when accounting for pre-treatment social connectedness (p > .05). ES of positive emotions may be an important factor in the development of therapeutic bond and therefore treatment outcomes for individuals with anxiety or depression.

A randomized controlled safety and feasibility trial of floatation-REST in anxious and depressed individuals

BACKGROUND

Reduced Environmental Stimulation Therapy via floatation (floatation-REST) is a behavioral intervention designed to attenuate exteroceptive sensory input to the nervous system. Prior studies in anxious and depressed individuals demonstrated that single sessions of floatation-REST are safe, well-tolerated, and associated with an acute anxiolytic and antidepressant effect that persists for over 48 hours. However, the feasibility of using floatation-REST as a repeated intervention in anxious and depressed populations has not been well-investigated.

METHODS

In this single-blind safety and feasibility trial, 75 individuals with anxiety and depression were randomized to complete six sessions of floatation-REST in different formats: pool-REST (weekly 1-hour float sessions), pool-REST preferred (float sessions with flexibility of duration and frequency), or an active comparator (chair-REST; weekly 1-hour sessions in a Zero Gravity chair). Feasibility (primary outcome) was assessed via an 80% rate of adherence to the assigned intervention; tolerability via study dropout and duration/frequency of REST utilization; and safety via incidence of adverse events and ratings about the effects of REST.

RESULTS

Of 1,715 individuals initially screened, 75 participants were ultimately randomized. Six-session adherence was 85% for pool-REST (mean, M = 5.1 sessions; standard deviation, SD = 1.8), 89% for pool-REST preferred (M = 5.3 sessions; SD = 1.6), and 74% for chair-REST (M = 4.4 sessions; SD = 2.5). Dropout rates at the end of the intervention did not differ significantly between the treatment conditions. Mean session durations were 53.0 minutes (SD = 12.3) for pool-REST, 75.4 minutes (SD = 29.4) for pool-REST preferred, and 58.4 minutes (SD = 4.3) for chair-REST. There were no serious adverse events associated with any intervention. Positive experiences were endorsed more commonly than negative ones and were also rated at higher levels of intensity.

CONCLUSIONS

Six sessions of floatation-REST appear feasible, well-tolerated, and safe in anxious and depressed individuals. Floatation-REST induces positively-valenced experiences with few negative effects. Larger randomized controlled trials evaluating markers of clinical efficacy are warranted.

CLINICAL TRIAL REGISTRATION IDENTIFIER

NCT03899090.

Experiential avoidance in participants with borderline personality disorder and other personality disorders

BACKGROUND

The present study has descriptive and predictive aims. The descriptive aims were to determine if participants with borderline personality disorder (BPD) reported higher levels of experiential avoidance (EA) than participants with other personality disorders (OPD) as well as determine if non-recovered participants with BPD reported higher levels of EA than participants with BPD who have recovered symptomatically and psychosocially. The predictive aim was to determine if the level of EA reported by participants with BPD was predicted by the severity of aspects of childhood or adult adversity and/or aspects of temperament.

METHODS

The Overall Anxiety Severity and Impairment Scale (OASIS) was administered to 248 participants at 24-year follow-up in the McLean Study of Adult Development (MSAD). Adversity and temperament were assessed during index admission using interviews (Revised Childhood Experience Questionnaire [CEQ-R], Adult History Interview [AHI], and the NEO-FFI self-report measure).

RESULTS

Participants with BPD reported significantly higher levels of EA than those with OPD. Within the BPD group, non-recovered participants reported significantly higher levels of EA than recovered participants. Severity of childhood sexual abuse and lower levels of extraversion were found to be significant multivariate predictors of levels of EA in those with BPD.

CONCLUSIONS

Taken together, these results suggest that EA is a serious problem for participants with BPD, particularly those who have not recovered. They also suggest that both the severity of childhood adversity and a temperament marked by lower levels of extroversion are significantly related to levels of EA reported by participants with BPD.

Online cognitive bias modification for interpretation to reduce anxious thinking during the COVID-19 pandemic

Anxiety disorders are highly prevalent, and rates increased during the COVID-19 pandemic. However, most individuals with elevated anxiety do not access treatment due to barriers such as stigma, cost, and availability. Digital mental health programs, such as cognitive bias modification for interpretation (CBM-I), hold promise in increasing access to care. Before widely disseminating CBM-I, we must rigorously test its effectiveness and determine whom it is best positioned to benefit. The present study (which is a substudy of a parent trial) compared CBM-I against psychoeducation offered through the public website MindTrails, and also tested whether baseline anxiety tied to COVID-19 influenced the rate of change in anxiety and interpretation bias during and after each intervention. Adults with moderate-to-severe anxiety symptoms were randomly assigned to complete five sessions of either CBM-I or psychoeducation as part of a larger trial, and 608 enrolled in this substudy after Session 1. As predicted (https://osf.io/2dyzr), CBM-I was superior to psychoeducation at reducing anxiety symptoms (on the OASIS but not the DASS-21-AS: d = -0.31), reducing negative interpretation bias (d range = -0.34 to -0.43), and increasing positive interpretation bias (d = 0.79) by the end of treatment. Results also indicated that individuals higher (vs. lower) in baseline COVID-19 anxiety had stronger decreases in anxiety symptoms while receiving CBM-I but weaker decreases in anxiety symptoms (on the DASS-21-AS) while receiving psychoeducation. These findings suggest that CBM-I may be a useful anxiety-reduction tool for individuals experiencing higher anxiety tied to uncertain events such as the COVID-19 pandemic.

Young men and anxiety: Resisting, reckoning and responding

Anxiety is the most prevalent mental disorder experienced by young men, and when untreated, is predictive of co-morbid mental health challenges and suicide. Despite the rising prevalence, there is a conspicuous absence of qualitative research to distil and theorise young men's anxiety. Twenty-five young Australian men (15-25 years), who had been diagnosed with an anxiety disorder or self-reported anxiety symptoms, took part in individual semi-structured interviews. Interviews were transcribed verbatim and analysed using a constructivist grounded theory approach. A three-process grounded theory (Resisting-Reckoning-Responding; Triple R Anxiety Model) depicted young men's experiences of anxiety, gilded and guided by their masculine socialisation. Initially, young men noticed somatic symptoms (i.e., headaches, nausea and myalgia) but did not connect these symptoms to anxiety. Avoiding anxiety (e.g., denying, distracting) proved unhelpful in the longer term and as symptoms diffused, a subsequent process of reckoning anxiety (i.e., meaning making) ensued. As young men gained insight to the life limiting bounds of their anxiety, some were prompted towards actions of acceptance, seeking help proactively and employing strength-based adaptive coping strategies. This theoretical conceptualisation of young men's anxiety has the capacity to enhance identification and treatment efforts, improving young men's mental health outcomes across the lifespan.

Overall Anxiety Severity and Impairment Scale (OASIS) and Overall Depression Severity and Impairment Scale (ODSIS): Adaptation and Validation in Buenos Aires, Argentina

Background

The OASIS and ODSIS scales are two transdiagnostic brief 5-item instruments designed to assess the severity and functional impairment associated with symptoms of anxiety and depression, respectively. The present study aimed to adapt and validate the online versions of both scales in Buenos Aires, Argentina.

Method

A sample of 344 women and men from the general population of Buenos Aires completed a test battery consisting of the OASIS, the ODSIS, the Beck Depression Inventory (BDI), the Beck Anxiety Inventory (BAI), the Positive and Negative Affect Scale (PANAS) and the Multicultural Quality of Life Index (MQLI). Descriptive statistics and item discrimination of both scales were analyzed, as well as their factorial structure, internal consistency, and convergent and discriminant validity, using the R programming language.

Results

The results showed a unidimensional factorial structure, excellent internal consistency, and adequate construct validity for both the OASIS and the ODSIS.

Conclusion

These results supports the use of both scales as valid and reliable instruments to assess severity and interference due to anxiety and depression in the general population of Buenos Aires, Argentina.

Psychometric evaluation and Rasch analyses of the German Overall Anxiety Severity and Impairment Scale (OASIS-D)

The Overall Anxiety Severity and Impairment Scale (OASIS) is a 5-item self-report measure that captures symptoms of anxiety and associated functional impairments. This study evaluates a German version (OASIS-D) that was administered to a convenience sample of 1398 primary care patients of whom 419 were diagnosed with panic disorder with/without agoraphobia. Psychometric properties were analyzed using classical test theory as well as probabilistic test theory. Factor analyses suggested a unitary (latent) factor structure. The internal consistency was good to excellent. Convergent as well as discriminant validity with other self-report measures was found. A sum score (range 0-20) of ≥ 8 emerged as optimal cut-score for screening purposes. A difference score of ≥ 5 was indicative of reliable individual change. A Rasch analysis of local item independence suggested response dependency between the first two items. Rasch analyses of measurement invariance detected noninvariant subgroups associated with age and gender. Analyses of validity and optimal cut-off score were solely based on self-report measures, which may have introduced method effects. In sum, the findings support the transcultural validity of the OASIS and indicate its applicability to naturalistic primary care settings. Caution is warranted when using the scale to compare groups that differ in age or gender.

Long-term impact of the COVID-19 pandemic on use behavior and risk perceptions of college student E-cigarette users

Objective: Work examining the long-term impact of the COVID-19 pandemic on e-cigarette use among college students is limited. Therefore, the current study examined differences in college student e-cigarette users' changes in use behavior and risk perceptions as the pandemic continues. Participants: 129 undergraduate current e-cigarette users (Mage = 19.68, SD = 1.85; 72.1% female; 85.3% White). Methods: Participants completed an online survey between October 2020 and April 2021. Results: In terms of changes in frequency of e-cigarette use, 30.5% of participants increased their use and 23.4% decreased their use. Greater e-cigarette dependence and anxiety were associated with increased use. Nearly half of e-cigarette users reported increased motivation to quit, and 32.5% had made at least one quit attempt. Conclusions: A substantial number of students increased their e-cigarette use as a result of the COVID-19 pandemic. Cessation efforts targeting increased anxiety and dependence may be useful in this population.

Childhood Trauma Predicts Positive Expressive Suppression During Social Affiliation in Adults With Anxiety and/or Depression: Implications for Social Functioning

Experiencing childhood trauma (CT) can create barriers for developing relationships and is a risk factor for anxiety and depression. Expressive suppression (ES; i.e., reducing expression associated with experiencing emotions) might explain the link between CT and relationship formation difficulties. We examined the association between (1) CT and ES during a dyadic paradigm intended to facilitate connectedness between unacquainted partners and (2) ES and desire for future interaction (DFI). Individuals with an anxiety or depressive disorder diagnosis (N = 77) interacted with a trained confederate; partners answered a series of increasingly intimate questions about themselves. Participant ES for positive and negative emotions, and participant and confederate DFI were collected during the task. Participants completed global anxiety, depression, and CT measures. CT correlated with positive (r = .35, p = .002), but not negative, ES (r = .13, p = .273). In a multiple linear regression model, CT predicted positive ES beyond symptom variables and gender, β = .318, t = 2.59, p = .012. Positive ES correlated with participant (r = -.38, p = .001) and confederate DFI (r = -.40, p<.01); and predicted participant DFI beyond symptom variables and ethnicity, β = -.358, t = -3.18, p = .002, and confederate DFI, β = -.390, t = -3.51, p = .001, beyond symptom variables. Mediation analyses suggested positive ES accounted for the relationship between greater CT severity and less desire for future interaction from participants, 95%CI [-0.26, -0.02], and confederates, [-0.38, -0.01]. Positive ES may be an important factor in the reduced capacity to form new social relationships for individuals with a history of CT, anxiety, and depression.

A Czech version of the Overall Anxiety Severity and Impairment Scale (OASIS): standardization and psychometric properties

BACKGROUND

The Overall Anxiety Severity and Impairment Scale (OASIS) is a transdiagnostic measure that assesses severity and impairment associated with anxiety disorders. However, its psychometric properties were primarily examined in English-speaking or western countries. Therefore, this study aims to examine its psychometric parameters in the Czech Republic.

METHODS

A large representative sample (n = 1738), a clinical sample (n = 57) and a retest sample (n = 20) were used. In addition to the OASIS, conventional measures of anxiety, depression, personality traits, self-esteem, life satisfaction, and other scales were also administered. Moreover, we examined the latent structure, reliability, validity, and the cut-off score for the Reliable Change Index (RCI) and the Clinically Significant Change Index (CSI).

RESULTS

Higher anxiety was found in females, religious non-church members, and students. The Confirmatory Factor Analysis supported the adequate fit of the unidimensional solution: x2(4) = 3.20; p < 0.525; CFI = 1.000; TLI = 1.000;RMSEA = 0, SRMR = 0. The measurement equivalence examination indicated that the OASIS measures anxiety invariantly between males and females. The validity of the OASIS was supported by positive associations with neuroticism, depression, perceived stress, guilt, shame, and the established anxiety measures. The internal consistency was excellent (Cronbach's alpha = 0.96, McDonald's omega = 0.96). The test-retest reliability was acceptable (r = 0.66). The cut-off for the CSI is 6 and the RCI is 5.32.

CONCLUSIONS

The OASIS represents a reliable and valid instrument for assessing anxiety in adults. Due to its shortness, excellent psychometric properties, and percentile norms, it is especially useful for short and accurate screening of anxiety and mapping therapeutic changes in clinical practice.

Internet videoconferencing delivered cognitive behavior therapy for generalized anxiety disorder: protocol for a randomized controlled trial

Background

Generalized anxiety disorder (GAD) is a chronic mental health condition that results in a significant individual and societal burden. While cognitive behavioral therapy (CBT) is well established as an efficacious treatment for GAD, many patients experience logistical barriers when accessing face-to-face CBT. Remotely delivered treatments remove many of these barriers. Despite emerging evidence demonstrating the efficacy of remotely delivered CBT for GAD, studies examining the efficacy of remote methods for GAD that are analogous to standard face-to-face treatment, in particular synchronous treatments such as CBT delivered via online videoconferencing (VCBT), are needed.

Methods

The authors propose a two-group randomized controlled trial comparing the efficacy of VCBT for GAD against a waitlist control group. The recruitment target will be 78 adults with primary GAD of at least moderate severity. The manualized high-intensity VCBT intervention will be delivered weekly over a 10-week period. After treatment completion, waitlist participants will receive the same VCBT delivered in a brief format (i.e., weekly over a 5-week period). Treatment for both groups will be delivered in real time via an online teleconferencing platform. Outcome measures will be administered at baseline, mid-treatment, post-treatment, and 3-month follow-up.

Discussion

This trial will report findings on the efficacy of a remote synchronous high-intensity VCBT intervention for GAD. The results have the potential to contribute towards advancing our knowledge on the evidence base for GAD, as well as increase the dissemination of VCBT for GAD.

Trial registration

Australian New Zealand Clinical Trials Registry ACTRN12621000786897. Registered on 22 June 2021

Changes in Internalizing Symptoms and Anxiety Sensitivity Among College Students During the COVID-19 Pandemic

The early months of the COVID-19 pandemic saw significant increases in symptoms of anxiety and depression, particularly among college students. However, research has not examined how internalizing symptoms in this population have changed as the pandemic has continued into its second year. Further, there has yet to be an examination of potential changes in transdiagnostic vulnerability factors. Therefore, the purpose of the current repeated cross-sectional study was to examine differences by term in undergraduates’ symptoms of depression, anxiety, worry, social anxiety, and anxiety sensitivity in the Spring 2020 (n = 251), Fall 2020 (n = 427), and Spring 2021 (n = 256) semesters. Results indicated that there were significant increases in depression, anxiety, worry, and anxiety sensitivity from Spring 2020 to Fall 2020 that were maintained through the Spring 2021 semester, and levels of social anxiety were significantly higher in Spring 2021 compared to Spring 2020. These findings suggest that the mental health impacts of the COVID-19 pandemic on college students have continued beyond the initial months, and colleges and universities will need to develop comprehensive plans to adequately address college students’ mental health needs.

Psychometric evaluation of a caregiver-report adaptation of the Overall Anxiety Severity and Impairment Scale (OASIS) for use with youth populations

Background Despite progress in youth anxiety assessment, there is need for a measure that is simultaneously (a) free, (b) brief, (c) focused broadly on anxiety and avoidance severity, frequency, and interference, and (d) concerned with the past week. The adult overall anxiety severity and impairment scale (OASIS) was adapted to yield a caregiver-report of past week youth anxiety and interference (OASIS-Y). Methods In a sample of diverse youth seeking anxiety services (N = 132; 67% racial/ethnic minority) and their caregivers, analyses examined the OASIS-Y factor structure, internal consistency, and convergent and divergent validity. Hierarchical linear modeling in a participant subset examined OASIS-Y sensitivity to treatment-related change. Results OASIS-Y internal consistency was high and confirmatory factor analysis supported a single-factor structure similar to that found in adults. OASIS-Y convergent validity was supported by a medium-sized association with an established, commercially available measure of youth anxiety, and divergent validity was supported by the absence of unique associations with measures of youth attention and externalizing problems. In a sample subset, session-by-session OASIS-Y scores significantly declined across treatment, and declined at a steeper rate among treatment "responders" versus "non-responders," providing evidence of OASIS-Y sensitivity to treatment-related change. Limitations This study focused on a clinical sample and cannot speak to OASIS-Y performance in community settings. Shared method-variance may have also influenced findings. Conclusions This study offers the first psychometric evaluation of the OASIS-Y, and underscores the promising clinical utility of the measure for assessing past week youth anxiety and impairment and for supporting routine outcome monitoring.

Spanish Adaptation of the Overall Anxiety and Depression Severity and Impairment Scales in University Students

The lifetime prevalence of emotional disorders in Spain is 4.1% for anxiety and 5.2% for depression, increasing among university students. Considering the scarcity of screenings with adequate psychometric properties, this study aims to explore the validity evidence of the Overall Anxiety/Depression Severity and Impairment Scales (OASIS and ODSIS). A total of 382 university students from the general population were assessed on anxiety and depressive symptoms, as well as quality of life. The one-dimensional structure of both the OASIS and ODSIS explained 87.53% and 90.60% of variance, with excellent internal consistency (α = 0.94 and 0.95, respectively) and optimal cut-offs of 4 and 5, respectively. Both scales show a significant moderate association with other measures of anxiety, depression and quality of life. The OASIS and ODSIS have shown good reliability and sound validity evidence that recommend their use for the assessment and early detection of anxiety and depressive symptoms, and associated quality of life impairment in Spanish youth.

The Abbreviated Overall Anxiety Severity and Impairment Scale (OASIS) and the Abbreviated Overall Depression Severity and Impairment Scale (ODSIS): Psychometric Properties and Evaluation of the Czech Versions

Short and effective tools for measuring depression, anxiety and their resulting impairments are lacking in the Czech language. The abbreviated versions of the Overall Anxiety Severity and Impairment Scale (OASIS) and the Overall Depression Severity and Impairment Scale (ODSIS) show very good psychometric properties in English and other languages, and can be used in different settings for research or clinical purposes. The aim of this study was the psychometric evaluation and validation of the Czech versions of the abbreviated forms of both tools in the general population. A nationally representative sample of 2912 participants (age = 48.88, SD = 15.56; 55% female) was used. The non-parametric testing of the differences between sociodemographic groups revealed a higher level of anxiety and depression in students, females and religious respondents. Confirmatory Factor Analysis suggested a good fit for the unidimensional model of the OASIS: x2(4) = 38.28; p < 0.001; TLI = 0.999; CFI = 0.997; RMSEA = 0.078; SRMR = 0.027 and the ODSIS: x2(4) = 36.54; p < 0.001; TLI = 0.999; CFI = 0.999; RMSEA = 0.076; SRMR = 0.021 with the data. Both scales had an excellent internal consistency (OASIS: Cronbach's alpha = 0.95, McDonald's omega = 0.95 and ODSIS: Cronbach's alpha = 0.95, McDonald's omega = 0.95). A clinical cut-off of 15 was identified for the OASIS and a cut-off of 12 for the ODSIS. The study showed good validity for both scales. The Czech versions of the abbreviated OASIS and ODSIS were short and valid instruments for measuring anxiety and depression.

Harnessing mobile technology to reduce mental health disorders in college populations: A randomized controlled trial study protocol

About a third of college students struggle with anxiety, depression, or an eating disorder, and only 20-40% of college students with mental disorders receive treatment. Inadequacies in mental health care delivery result in prolonged illness, disease progression, poorer prognosis, and greater likelihood of relapse, highlighting the need for a new approach to detect mental health problems and engage college students in services. We have developed a transdiagnostic, low-cost mobile mental health targeted prevention and intervention platform that uses population-level screening to engage college students in tailored services that address common mental health problems. We will test the impact of this mobile mental health platform for service delivery in a large-scale trial across 20+ colleges. Students who screen positive or at high-risk for clinical anxiety, depression, or an eating disorder and who are not currently engaged in mental health services (N = 7884) will be randomly assigned to: 1) intervention via the mobile mental health platform; or 2) referral to usual care (i.e., campus health or counseling center). We will test whether the mobile mental health platform, compared to referral, is associated with improved uptake, reduced clinical cases, disorder-specific symptoms, and improved quality of life and functioning. We will also test mediators, predictors, and moderators of improved mental health outcomes, as well as stakeholder-relevant outcomes, including cost-effectiveness and academic performance. This population-level approach to service engagement has the potential to improve mental health outcomes for the millions of students enrolled in U.S. colleges and universities.

Personnel Well-Being in the Helsinki University Hospital during the COVID-19 Pandemic-A Prospective Cohort Study

In March 2020, strict measures took place in Finland to limit the COVID-19 pandemic. Majority of Finnish COVID-19 patients have been located in southern Finland and consequently cared for at the Hospital District of Helsinki and Uusimaa (HUS) Helsinki University Hospital. During the pandemic, HUS personnel’s psychological symptoms are followed via an electronic survey, which also delivers information on psychosocial support services. In June 2020, the baseline survey was sent to 25,494 HUS employees, 4804 (19%) of whom answered; altogether, 62.4% of the respondents were nursing staff and 8.9% were medical doctors. While the follow-up continues for a year and a half, this report shares the sociodemographic characteristics of the respondents and the first results of psychological symptoms from our baseline survey. Out of those who were directly involved in the pandemic patient care, 43.4% reported potentially traumatic COVID-19 pandemic-related events (PTEs) vs. 21.8% among the others (p < 0.001). While over a half of the personnel were asymptomatic, a group of respondents reported PTEs and concurrent depression, insomnia, and anxiety symptoms. This highlights the need to ensure appropriate psychosocial support services to all traumatized personnel; especially, nursing staff may require attention.

Treatment for anxiety: Mindfulness meditation versus escitalopram (TAME): Design of a randomized, controlled non-inferiority trial

Anxiety disorders (generalized anxiety disorder, social anxiety disorder, panic disorder, and agoraphobia) are common, distressing, and impairing. While pharmacotherapy and psychotherapy are first-line treatment strategies for anxiety disorders, many patients are reluctant to take psychiatric medication, and many prefer to avoid any kind of mental health treatment due to stigma or distrust of traditional medical care. We present the trial protocol for the first study comparing first-line medication treatment with Mindfulness-Based Stress Reduction (MBSR), a popular mindfulness meditation training program, for the treatment of anxiety disorders. We will use a non-inferiority, comparative effectiveness trial design, in which individuals with diagnosed anxiety disorders will be randomized to either pharmacotherapy with escitalopram or MBSR for 8 weeks of treatment. Treatment outcome will be based on gold standard symptom severity measures assessed by trained independent evaluators blind to treatment allocation. Secondary outcomes will include key symptom and function measures, as well as tolerability and satisfaction with treatment. Findings will provide crucial information to inform decision making about the relative benefits of MBSR versus a first line medication for anxiety disorders by patients, medical care providers, healthcare insurers and other stakeholders.

Threat and benign interpretation bias might not be a unidimensional construct

The tendency for individuals to interpret ambiguous information in a threatening way is theorised to maintain anxiety disorders. Recent findings suggest that positive and negative interpretation biases may have unique effects. This study tested the relationships between threat and benign biases with state and trait anxiety and quality of life, and whether individual differences moderate these relationships. N = 699 individuals with elevated trait anxiety symptoms completed web-based measures of interpretation bias, trait anxiety, state anxiety, and quality of life. Results demonstrated that threat interpretations predicted state anxiety, trait anxiety, and quality of life. Benign interpretations also predicted quality of life. However, benign interpretations only weakly (or not at all) predicted state and trait anxiety. Individual differences (e.g. gender, race, ethnicity, age) did not moderate findings. Results emphasise the need to consider benign and threat biases separately, both in cognitive models of anxiety and experimental designs.

Psychometric properties and validation of the Spanish versions of the overall anxiety and depression severity and impairment scales

BACKGROUND

Anxiety and depressive disorders are the most frequent disorders for which patients seek care in public health settings in Spain. This study aimed at validating the Overall Anxiety Severity and Impairment Scale (OASIS) and the Overall Depression Severity and Impairment Scale (ODSIS), which are brief screening scales for anxiety and depression consisting of only five items each.

METHODS

The study was conducted in a Spanish clinical sample receiving outpatient mental health treatment (N = 339). A subsample of participants (n = 219) was assessed before and after receiving a course of cognitive-behavioral treatment.

RESULTS

The results revealed excellent internal consistency estimates (Cronbach's alpha for the OASIS and the ODSIS was 0.87 and 0.94, respectively), along with promising convergent and discriminant validity and test-criterion relationships (i.e., moderate correlation with other measures of depression and anxiety, as well as with neuroticism, quality of life, adjustment, and negative affect). A one-dimensional structure was obtained for the OASIS and the ODSIS. The ROC analyses indicated an area under the curve of 0.83 for the OASIS and the ODSIS when predicting moderate-to-severe anxiety and depression, respectively. Good sensitivity to therapeutic change was also evidence and the analysis of the sensitivity as a function of 1-specificity area suggested a cutoff value of 10 for both scales.

LIMITATIONS

Inter-rater reliability of diagnoses with the ADIS-IV interview could not be investigated and the results obtained may not be generalizable to other samples and health settings.

CONCLUSIONS

The availability of these two short and psychometrically sound measures should make screening of anxiety and depressive symptoms in routine care more feasible.

Mental Health Differences Between Older and Younger Lesbian, Gay, Bisexual, and Transgender Veterans: Evidence of Resilience

OBJECTIVE

To examine health and identity differences between older (50+) and younger (< 50) lesbian, gay, bisexual, and transgender (LGBT) veterans.

METHODS

Participants (N = 254) completed an internet survey assessing depression, anxiety, alcohol use, identity, minority stress, and outness. T tests and logistic regression were used to analyze results.

RESULTS

Older LGBT veterans reported less alcohol use (p < .01) than younger counterparts. No age differences in depression or anxiety were reported. Older participants reported LGBT identity as more central to their overall identity (p < .01) and having less minority stress (p < .05), than younger participants.

CONCLUSIONS

Compared to younger LGBT veterans, older LGBT veterans appeared more resilient over stressors that can impact mental health. Overall older LGBT veterans experienced less alcohol use and reported less minority stress than younger veterans. LGBT identity was more central to older veterans' overall identity than younger Veterans.

CLINICAL IMPLICATIONS

LGBT veterans may experience stressors that can impact mental health, although older LGBT veterans show remarkable resilience. Clinicians should assess sexual orientation and gender identity, as well as veteran status, of patients in order to best evaluate their health risks and strengths.

A brief online transdiagnostic measure: Psychometric properties of the Overall Anxiety Severity and Impairment Scale (OASIS) among Spanish patients with emotional disorders

The Overall Anxiety Severity and Impairment Scale (OASIS) is a self-report questionnaire designed to evaluate the severity and functional impairment associated with anxiety. Given its transdiagnostic nature, it can be used indistinctly across anxiety and depressive disorders. In this study, the psychometric properties of the online version of the OASIS were evaluated in a Spanish clinical sample with emotional disorders. Patients (n = 583) with anxiety (n = 250) and depression (n = 333) with a mean age of 37.21 (SD = 12.22), underwent a diagnostic interview and questionnaires assessing anxiety, depression, positive and negative affect, and quality of life. Factorial structure, internal consistency, convergent and discriminant validity, cutoff scores, and sensitivity to change were analyzed. Confirmatory Factor Analysis yielded a unidimensional factor structure, consistent with previous validations of the instrument. The analyses showed good internal consistency and adequate convergent and discriminant validity, as well as sensitivity to change. A cutoff score of 7.5 was found to meet the criteria used in this study to select the optimal cutoff point. Overall, in this study, the psychometric properties of the online version of the OASIS were found to be appropriate. The brevity and ease of use of the OASIS support its adequacy as a valid measure of anxiety severity and impairment in Spanish clinical samples with anxiety and depression.

Transdiagnostic Therapy

Transdiagnostic cognitive-behavioral (CBT) therapy is a modified form of CBT designed to be applicable with patients across the range of anxiety and related emotional disorders. Based on emerging genetic, neurologic, developmental, cognitive, and behavioral science, transdiagnostic CBT may alleviate barriers to dissemination and accessibility by providing a single treatment approach across diagnoses. Data from clinical trials and metaanalyses suggest treatment efficacy that is comparable with traditional CBT approaches, with possibly superior efficacy among patients with multiple comorbid anxiety and emotional diagnoses. Limitations in the evidence base and remaining areas for future research are discussed.