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Koszycki D, Guérin E, DiMillo J, Bradwejn J. Randomized trial of cognitive behaviour group therapy and a mindfulness‐based intervention for social anxiety disorder: Preliminary findings. Clin Psychol Psychother 2020; 28:200-218. [DOI: 10.1002/cpp.2502] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 07/05/2020] [Accepted: 08/18/2020] [Indexed: 01/07/2023]
Affiliation(s)
- Diana Koszycki
- Faculty of Education (Counselling Psychology) University of Ottawa Ottawa Ontario Canada
- Faculty of Medicine (Psychiatry) University of Ottawa Ottawa Ontario
- Montfort Hospital Institut du Savoir Montfort Ottawa Ontario Canada
- University of Ottawa Brain and Mind Research Institute Ottawa Ontario Canada
| | - Eva Guérin
- Montfort Hospital Institut du Savoir Montfort Ottawa Ontario Canada
| | - Julia DiMillo
- Montfort Hospital Institut du Savoir Montfort Ottawa Ontario Canada
| | - Jacques Bradwejn
- Faculty of Medicine (Psychiatry) University of Ottawa Ottawa Ontario
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Sibrava NJ, Bjornsson AS, Pérez Benítez ACI, Moitra E, Weisberg RB, Keller MB. Posttraumatic stress disorder in African American and Latinx adults: Clinical course and the role of racial and ethnic discrimination. ACTA ACUST UNITED AC 2020; 74:101-116. [PMID: 30652903 DOI: 10.1037/amp0000339] [Citation(s) in RCA: 95] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Research has suggested that African American and Latinx adults may develop posttraumatic stress disorder (PTSD) at higher rates than White adults, and that the clinical course of PTSD in these minority groups is poor. Factors that may contribute to higher prevalence and poorer outcome in these groups are sociocultural factors and racial stressors, such as experiences with discrimination. To date, however, no research has explored the relationship between experiences with discrimination and risk for PTSD, and very little research has examined the course of illness for PTSD in African American and Latinx samples. The present study examined these variables in the only longitudinal clinical sample of 139 Latinx and 152 African American adults with anxiety disorders, the Harvard/Brown Anxiety Research Project-Phase II. Over 5 years of follow-up, remission rates for African Americans and Latinx adults with PTSD in this sample were 0.35 and 0.15, respectively, and reported frequency of experiences with discrimination significantly predicted PTSD diagnostic status in this sample, but did not predict any other anxiety or mood disorder. These findings demonstrate the chronic course of PTSD in African American and Latinx adults, and highlight the important role that racial and ethnic discrimination may play in the development of PTSD among these populations. Implications for an increased focus on these sociocultural stressors in the assessment and treatment of PTSD in African American and Latinx individuals are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
- Nicholas J Sibrava
- Department of Psychology, Baruch College, The City University of New York
| | | | | | - Ethan Moitra
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University
| | | | - Martin B Keller
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University
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Stiles JA, Chatterton ML, Le LKD, Lee YY, Whiteford H, Mihalopoulos C. The cost-effectiveness of stepped care for the treatment of anxiety disorders in adults: A model-based economic analysis for the Australian setting. J Psychosom Res 2019; 125:109812. [PMID: 31442844 DOI: 10.1016/j.jpsychores.2019.109812] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 08/10/2019] [Accepted: 08/13/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To evaluate the cost-effectiveness of stepped care compared to care as usual (CAU) for the treatment of adults with mild-to-moderate anxiety disorders from a health sector perspective in the Australian setting. METHOD A decision tree model was constructed to estimate the cost per disability adjusted life year (DALY) averted over a 12-month time horizon. The model compared a three-step stepped care intervention to CAU. Stepped care included an initial phase of guided self-help, followed by face-to-face cognitive behavioural therapy, and pharmacotherapy as the final step. The model adopted a health sector perspective, used epidemiological parameters and disability weights obtained from the Global Burden of Disease Study 2013. Effect sizes were derived from a randomized trial of stepped care and a longitudinal cohort study. Costs were expressed in 2013 Australian dollars (A$). Multivariate probabilistic and univariate sensitivity analyses were performed. RESULTS Stepped care was found to be cost-effective compared to CAU with an incremental cost-effective ratio of A$3093 per DALY averted. One-hundred percent of the uncertainty iterations fell below the A$50,000 per DALY averted willingness-to-pay threshold commonly used in Australia. The evaluation was most sensitive to changes in diagnosis rates and effect sizes. CONCLUSION A three-step model of stepped care appears to be cost-effective for the treatment of adults with mild to moderate anxiety disorders from the Australian health sector perspective. These results can provide some assurance to decision-makers that stepped care represents an efficient use of health care resources.
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Affiliation(s)
- Jay A Stiles
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Australia; National Ageing Research Institute, Parkville, Australia.
| | | | - Long Khanh-Dao Le
- Deakin Health Economics, Deakin University, Geelong, Victoria, Australia
| | - Yong Yi Lee
- School of Public Health, The University of Queensland, Herston, Australia; Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, Australia
| | - Harvey Whiteford
- School of Public Health, The University of Queensland, Herston, Australia; Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, Australia; Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
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Moitra E, Duarte-Velez Y, Lewis-Fernández R, Weisberg RB, Keller MB. Examination of ataque de nervios and ataque de nervios like events in a diverse sample of adults with anxiety disorders. Depress Anxiety 2018; 35:1190-1197. [PMID: 30328649 DOI: 10.1002/da.22853] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 09/26/2018] [Accepted: 10/03/2018] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Ataque de nervios (ataque) represents a cultural syndrome of paroxysmic symptoms that is described as an expression of distress among Latinx (gender-inclusive term for people of Latin-American descent). Some ataques are symptomatically similar to DSM-5-defined panic attacks, but also may include acute anger, grief, suicidal/violent behavior, or dissociation, and can last for hours or even days. Ataques usually occur after stressors and can trigger the mobilization of social support networks. Although described as a cultural syndrome, two studies showed that ataque-like events can occur in non-Latinx individuals. However, neither of the previous studies examined these events in psychiatric samples and both were hindered by methodological shortcomings. METHODS The present study examined lifetime prevalence of ataques and ataque-like events in an ethnically/racially diverse sample of 245 adults with anxiety disorders to better understand acute reactions to stressors across cultures. RESULTS Controlling for previously established correlates of ataque, results showed that Latinx were significantly more likely to report ever having an ataque (B = 1.41; P = 0.001; OR = 4.10 [95% CI: 1.72-9.80]), but events were reported by some non-Latinx African Americans and Whites. Anxiety sensitivity was also a significant predictor. Across the three groups, minor differences were found in symptoms, severity, or precipitants of attacks. CONCLUSIONS Findings suggest that Latinx are more likely to experience ataques but that stressors can trigger similar symptoms in non-Latinx. However, more research is needed to understand the meaning of these attacks within non-Latinx groups as the explanations, connotations, and help-seeking expectations regarding ataque are connected to Latinx cultures.
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Affiliation(s)
- Ethan Moitra
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Yovanska Duarte-Velez
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Roberto Lewis-Fernández
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York, New York
| | - Risa B Weisberg
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island.,Department of Family Medicine, Alpert Medical School of Brown University, Providence, Rhode Island.,VA Boston Healthcare System, Boston, Massachusetts.,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
| | - Martin B Keller
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island
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Askland KD, Garnaat S, Sibrava NJ, Boisseau CL, Strong D, Mancebo M, Greenberg B, Rasmussen S, Eisen J. Prediction of remission in obsessive compulsive disorder using a novel machine learning strategy. Int J Methods Psychiatr Res 2015; 24:156-69. [PMID: 25994109 PMCID: PMC5466447 DOI: 10.1002/mpr.1463] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 12/19/2014] [Accepted: 02/23/2015] [Indexed: 12/27/2022] Open
Abstract
The study objective was to apply machine learning methodologies to identify predictors of remission in a longitudinal sample of 296 adults with a primary diagnosis of obsessive compulsive disorder (OCD). Random Forests is an ensemble machine learning algorithm that has been successfully applied to large-scale data analysis across vast biomedical disciplines, though rarely in psychiatric research or for application to longitudinal data. When provided with 795 raw and composite scores primarily from baseline measures, Random Forest regression prediction explained 50.8% (5000-run average, 95% bootstrap confidence interval [CI]: 50.3-51.3%) of the variance in proportion of time spent remitted. Machine performance improved when only the most predictive 24 items were used in a reduced analysis. Consistently high-ranked predictors of longitudinal remission included Yale-Brown Obsessive Compulsive Scale (Y-BOCS) items, NEO items and subscale scores, Y-BOCS symptom checklist cleaning/washing compulsion score, and several self-report items from social adjustment scales. Random Forest classification was able to distinguish participants according to binary remission outcomes with an error rate of 24.6% (95% bootstrap CI: 22.9-26.2%). Our results suggest that clinically-useful prediction of remission may not require an extensive battery of measures. Rather, a small set of assessment items may efficiently distinguish high- and lower-risk patients and inform clinical decision-making.
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Affiliation(s)
- Kathleen D Askland
- Department of Psychiatry and Human Behavior, Butler Hospital/Warren Alpert School of Medicine, Brown University, Providence, RI, USA
| | - Sarah Garnaat
- Department of Psychiatry and Human Behavior, Butler Hospital/Warren Alpert School of Medicine, Brown University, Providence, RI, USA
| | - Nicholas J Sibrava
- Department of Psychology, Baruch College - The City University of New York, New York, USA
| | - Christina L Boisseau
- Department of Psychiatry and Human Behavior, Butler Hospital/Warren Alpert School of Medicine, Brown University, Providence, RI, USA
| | - David Strong
- Department of Family and Preventive Medicine, University of California, San Diego, CA, USA
| | - Maria Mancebo
- Department of Psychiatry and Human Behavior, Butler Hospital/Warren Alpert School of Medicine, Brown University, Providence, RI, USA
| | - Benjamin Greenberg
- Department of Psychiatry and Human Behavior, Butler Hospital/Warren Alpert School of Medicine, Brown University, Providence, RI, USA
| | - Steve Rasmussen
- Department of Psychiatry and Human Behavior, Butler Hospital/Warren Alpert School of Medicine, Brown University, Providence, RI, USA
| | - Jane Eisen
- Department of Psychiatry and Human Behavior, Butler Hospital/Warren Alpert School of Medicine, Brown University, Providence, RI, USA
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Benítez CIP, Sibrava NJ, Wood LK, Bjornsson AS, Zlotnick C, Weisberg R, Keller MB. Posttraumatic stress disorder in African Americans: a two year follow-up study. Psychiatry Res 2014; 220:376-83. [PMID: 25086766 PMCID: PMC4351655 DOI: 10.1016/j.psychres.2014.07.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Revised: 07/08/2014] [Accepted: 07/11/2014] [Indexed: 11/27/2022]
Abstract
The present study was a prospective, naturalistic, longitudinal investigation of the two year course of posttraumatic stress disorder (PTSD) in a sample of African Americans with anxiety disorders. The study objectives were to examine the two year course of PTSD and to evaluate differences between African Americans with PTSD and anxiety disorders and African Americans with anxiety disorders but no PTSD with regard to comorbidity, psychosocial impairment, physical and emotional functioning, and treatment participation. The participants were 67 African Americans with PTSD and 98 African Americans without PTSD (mean age 41.5 years, 67.3% female). Individuals with PTSD were more likely to have higher comorbidity, lower functioning, and they were less likely to seek treatment than those with other anxiety disorders but no PTSD. The rate of recovery from PTSD over two years was 0.10 and recovery from comorbid Major Depressive Disorder was 0.55. PTSD appears to be persistent over time in this population. The rates of recovery were lower than what has been reported in previous longitudinal studies with predominantly non-Latino Whites. It is imperative to examine barriers to treatment and factors related to treatment engagement for this population.
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Affiliation(s)
- Carlos I. Pérez Benítez
- Department of Educational and Psychological Studies, University of Miami, Coral Gables, Fl, USA,Correspondence concerning this article should be addressed to Carlos I. Pérez Benítez, Department of Educational and Psychological Studies, University of Miami, 1507 Levante Avenue, 318-B Max Orovitz Bldg., Coral Gables, FL, 33146, USA. Telephone: 305.284.1146, Fax: 305.284.3003,
| | - Nicholas J. Sibrava
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Laura Kohn Wood
- Department of Educational and Psychological Studies, University of Miami, Coral Gables, Fl, USA
| | | | - Caron Zlotnick
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Risa Weisberg
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Martin B. Keller
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
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Bjornsson AS, Sibrava NJ, Beard C, Moitra E, Weisberg RB, Benítez CIP, Keller MB. Two-year course of generalized anxiety disorder, social anxiety disorder, and panic disorder with agoraphobia in a sample of Latino adults. J Consult Clin Psychol 2014; 82:1186-92. [PMID: 24731232 DOI: 10.1037/a0036565] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE It is imperative to study the clinical course of anxiety disorders among Latinos, given the implications for culturally sensitive treatment in this population. The current study is the first prospective, observational, longitudinal study of anxiety disorders among Latinos. METHOD Data are reported on 139 adult Latinos (M age = 34.65 years, SD = 10.98, 70.5% female) diagnosed with social anxiety disorder (SAD; n = 86), generalized anxiety disorder (GAD; n = 90), or panic disorder with agoraphobia (PDA; n = 62). The participants were interviewed with standardized clinical interviews at intake and annually over 2 years of follow-up. Probabilities of recovery were calculated using standard survival analysis methods. RESULTS The 2-year recovery rates in this study were 0.07 for SAD, 0.14 for GAD, 0.03 for PDA, and 0.50 for major depressive disorder (MDD). Overall functioning, social adjustment, and life satisfaction in this sample were poor. CONCLUSIONS The recovery rates for anxiety disorders in this Latino sample were markedly low. Although caution must be used in comparing these data with prior longitudinal studies, these recovery rates seem to be much lower than in non-Latino White samples. However, the clinical course of MDD in this sample was similar to its course among non-Latino Whites, invoking the pressing question of whether there is something about the experience of anxiety disorders (but not MDD) among Latinos that makes them more impairing and persistent. The answer to that question should inform future treatment development for this population.
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Affiliation(s)
| | - Nicholas J Sibrava
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University
| | | | - Ethan Moitra
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University
| | - Risa B Weisberg
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University
| | | | - Martin B Keller
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University
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Moitra E, Lewis-Fernández R, Stout RL, Angert E, Weisberg RB, Keller MB. Disparities in psychosocial functioning in a diverse sample of adults with anxiety disorders. J Anxiety Disord 2014; 28:335-43. [PMID: 24685821 PMCID: PMC4028956 DOI: 10.1016/j.janxdis.2014.02.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Revised: 02/14/2014] [Accepted: 02/25/2014] [Indexed: 11/24/2022]
Abstract
Anxiety disorders are associated with psychosocial functional impairments, but no study has compared how these impairments might vary by ethno-racial status. We examined whether minority status was uniquely associated with functional impairments in 431 adults with anxiety disorders. Functioning was measured in the rater-assessed domains of: Global Assessment of Functioning (GAF); global psychosocial functioning; work, relationship, and recreational functioning; and, self-reported: life satisfaction, mental health functioning, physical functioning, and disability status. After controlling for demographic and clinical variables, results revealed evidence of disparities, whereby African Americans (AAs), particularly those with low income, had worse GAF, worse global psychosocial functioning, and were more likely to be disabled compared to non-Latino Whites. Latinos, particularly those with low income, had worse global psychosocial functioning than non-Latino Whites. Results suggest AAs and Latinos are at increased risk for functional impairments not better accounted for by other demographic or clinical variables.
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Affiliation(s)
- Ethan Moitra
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, USA.
| | - Roberto Lewis-Fernández
- Department of Psychiatry, Columbia University and New York State Psychiatric Institute, 1051 Riverside Drive, Unit 69, New York, NY 10032, USA.
| | - Robert L Stout
- Pacific Institute for Research and Evaluation, 1005 Main Street, Unit 8120, Pawtucket, RI 02860, USA.
| | - Erica Angert
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, USA.
| | - Risa B Weisberg
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, USA; Department of Family Medicine, Alpert Medical School of Brown University, USA.
| | - Martin B Keller
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, USA.
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Sibrava NJ, Beard C, Bjornsson AS, Moitra E, Weisberg RB, Keller MB. Two-year course of generalized anxiety disorder, social anxiety disorder, and panic disorder in a longitudinal sample of African American adults. J Consult Clin Psychol 2013; 81:1052-62. [PMID: 24041233 DOI: 10.1037/a0034382] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Anxiety disorders are the most common group of psychiatric disorders in adults. In addition to high prevalence, anxiety disorders are associated with significant functional impairment, and published research has consistently found them to have a chronic course. To date, very little research has explored the clinical characteristics and prospective course of anxiety disorders in racial and ethnic minority samples. The aims of this article are to present clinical and demographic characteristics at intake and prospective 2-year course findings in a sample of African American adults. METHOD Data are presented from 152 African Americans diagnosed with generalized anxiety disorder (GAD, n = 94), social anxiety disorder (SAD, n = 85), and panic disorder with agoraphobia (PDA, n = 77) who are participating in the Harvard/Brown Anxiety Research Project-Phase II (HARP-II). HARP-II is an observational, prospective, longitudinal study of the course of anxiety disorders. Participants were interviewed at intake and annually for 2 years of follow-up. Probabilities of recovery over 2 years of follow-up were calculated using standard survival analysis methods. RESULTS AND CONCLUSIONS Survival analyses revealed a chronic course for all anxiety disorders, with rates of recovery of 0.23, 0.07, and 0.00 over 2 years for GAD, SAD, and PDA, respectively. These rates of recovery were lower than those reported in predominantly non-Latino White longitudinal samples, especially for SAD and PDA, suggesting that anxiety disorders may have a more chronic course for African Americans, with increased psychosocial impairment and high rates of comorbid Axis-I disorders. Clinical implications of these findings are discussed.
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Affiliation(s)
- Nicholas J Sibrava
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University
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