Development and validation of a 30-item short adaptation of the Mood and Anxiety Symptoms Questionnaire (MASQ)

Cerebrospinal fluid metabolomics, lipidomics and serine pathway dysfunction in myalgic encephalomyelitis/chronic fatigue syndroome (ME/CFS)

We proposed that cerebrospinal fluid would provide objective evidence for disrupted brain metabolism in myalgic encephalomyelitis/chronic fatigue syndroome (ME/CFS). The concept of postexertional malaise (PEM) with disabling symptom exacerbation after limited exertion that does not respond to rest is a diagnostic criterion for ME/CFS. We proposed that submaximal exercise provocation would cause additional metabolic perturbations. The metabolomic and lipidomic constituents of cerebrospinal fluid from separate nonexercise and postexercise cohorts of ME/CFS and sedentary control subjects were contrasted using targeted mass spectrometry (Biocrates) and frequentist multivariate general linear regression analysis with diagnosis, exercise, gender, age and body mass index as independent variables. ME/CFS diagnosis was associated with elevated serine but reduced 5-methyltetrahydrofolate (5MTHF). One carbon pathways were disrupted. Methylation of glycine led to elevated sarcosine but further methylation to dimethylglycine and choline was decreased. Creatine and purine intermediates were elevated. Transaconitate from the tricarboxylic acid cycle was elevated in ME/CFS along with essential aromatic amino acids, lysine, purine, pyrimidine and microbiome metabolites. Serine is a precursor of phospholipids and sphingomyelins that were also elevated in ME/CFS. Exercise led to consumption of lipids in ME/CFS and controls while metabolites were consumed in ME/CFS but generated in controls. The findings differ from prior hypometabolic findings in ME/CFS plasma. The novel findings generate new hypotheses regarding serine-folate-glycine one carbon and serine-phospholipid metabolism, elevation of end products of catabolic pathways, shifts in folate, thiamine and other vitamins with exercise, and changes in sphingomyelins that may indicate myelin and white matter dysfunction in ME/CFS.

Community Norms for the Symptom Questionnaire (SQ-48): Normalised T-Scores and Percentile Rank Order Scores

Use of standardised scores, such as T-scores and percentile rank order scores, enhances measurement-based care. They facilitate communication between therapists and clients about test results, particularly for multidimensional measures such as the Symptoms Questionnaire (SQ-48). By transforming raw scores into a common metric, clinicians can more easily interpret and discuss patient profiles of scores on the various scales of the measure. This study explored the advantages and disadvantages of standardised scores and percentile ranks, with a specific focus on T-scores, utilising cross-sectional data from a general population sample (N = 516) and a clinical sample (N = 242). We outline various approaches for establishing T-scores and provide illustrative examples. The analysis of the SQ-48 revealed the necessity of first normalising raw scores to obtain accurate T-scores. Normalisation based on an IRT model is deemed superior, but formulas converting summed scale scores provide a good approximation. Regarding percentile rank order scores, we demonstrated that clinical percentiles offer more meaningful interpretations than population-based percentiles, due to restriction of range for the latter among clinical subjects. Gender and age group differences were identified, with significantly higher scores for women and individuals aged 55 and older. Benefits of normalised T-scores and the need for gender- and age-specific norms for the SQ-48 are discussed.

Exertional Exhaustion (Post-Exertional Malaise, PEM) Evaluated by the Effects of Exercise on Cerebrospinal Fluid Metabolomics-Lipidomics and Serine Pathway in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome

Post-exertional malaise (PEM) is a defining condition of myalgic encephalomyelitis (ME/CFS). The concept requires that a provocation causes disabling limitation of cognitive and functional effort ("fatigue") that does not respond to rest. Cerebrospinal fluid was examined as a proxy for brain metabolite and lipid flux and to provide objective evidence of pathophysiological dysfunction. Two cohorts of ME/CFS and sedentary control subjects had lumbar punctures at baseline (non-exercise) or after submaximal exercise (post-exercise). Cerebrospinal fluid metabolites and lipids were quantified by targeted Biocrates mass spectrometry methods. Significant differences between ME/CFS and control, non-exercise vs. post-exercise, and by gender were examined by multivariate general linear regression and Bayesian regression methods. Differences were found at baseline between ME/CFS and control groups indicating disease-related pathologies, and between non-exercise and post-exercise groups implicating PEM-related pathologies. A new, novel finding was elevated serine and its derivatives sarcosine and phospholipids with a decrease in 5-methyltetrahydrofolate (5MTHF), which suggests general dysfunction of folate and one-carbon metabolism in ME/CFS. Exercise led to consumption of lipids in ME/CFS and controls while metabolites were consumed in ME/CFS but generated in controls. In general, the frequentist and Bayesian analyses generated complementary but not identical sets of analytes that matched the metabolic modules and pathway analysis. Cerebrospinal fluid is unique because it samples the choroid plexus, brain interstitial fluid, and cells of the brain parenchyma. The quantitative outcomes were placed into the context of the cell danger response hypothesis to explain shifts in serine and phospholipid synthesis; folate and one-carbon metabolism that affect sarcosine, creatine, purines, and thymidylate; aromatic and anaplerotic amino acids; glucose, TCA cycle, trans-aconitate, and coenzyme A in energy metabolism; and vitamin activities that may be altered by exertion. The metabolic and phospholipid profiles suggest the additional hypothesis that white matter dysfunction may contribute to the cognitive dysfunction in ME/CFS.

Translational assessment of anhedonia components: Significant associations between reward anticipation measured via behavioural task performance, daily smartphone reports, and general anhedonia questionnaires

Anhedonia, a reduction in pleasure in previously enjoyed activities, is a hallmark feature of depression and is also of transdiagnostic relevance to many psychiatric disorders. Treatment and measurement of anhedonia are significant challenges. We examine anhedonia components, combining experimental training, with multimodal anhedonia assessment, comprising standard questionnaire instruments, a widely-used behavioural task, and daily reports of reward experience. Seventy-eight adults (74.4% female) completed both positive and negative cognitive bias modification training, a laboratory-based behavioural measure of reward anticipation and motivation, the Effort-Expenditure for Reward Task (EEfRT), and seven days of experience sampling via their smartphones. We found no evidence that cognitive bias modification training affected choices to engage in the high-effort trials on the EEfRT task, theorised to reflect reward anticipation. We also did not find the expected associations between baseline measures of anhedonia and reward sensitivity and response to training. Behavioural performance on the low probability EEfRT trials indicating higher reward anticipation was significantly associated with daily reports of anticipated reward. Daily reported reward anticipation and consumption were also associated with the questionnaire measure of anhedonia. Our findings demonstrate that traditional anhedonia questionnaire measures, and a laboratory-based measure of an anhedonia component, can translate to reported experiences of reward in real-world contexts. We demonstrate the specificity of associations between the laboratory measure, designed to measure reward anticipation and not consumption, and real-world reports.

Changes in tripartite dimensions of anxiety and depression in emerging adults before and during COVID-19

OBJECTIVE

Using the tripartite model of anxiety and depression, we examined general distress (common to anxiety/depression), anxious arousal (uniquely anxiety), and anhedonic depression (uniquely depressive) symptoms before and during the pandemic in emerging adults, who may experience higher levels of distress as a result of the COVID-19 pandemic relative to others.

PARTICIPANTS

Emerging adults (n = 89, 53% White) ages 18-24, participated in four data waves (Baseline: Fall 2017-Fall 2018; January 2020; July 2020; January 2021).

METHODS

We estimated covariance pattern models with various patterns of residual correlation, (selecting the best-fitting structure) and patterns of change (i.e., stable, linear, and quadratic).

RESULTS

Scores in all tripartite dimensions were elevated at baseline; anxious arousal remained elevated, while depression-specific symptoms decreased over time.

CONCLUSIONS

Findings contribute to a fine-grained approach to understanding emotional distress relating to the COVID-19 pandemic, proving potentially useful in conceptualizing the mental health of emerging adults in relation to disruptive life events.

Associations between tripartite dimensions of internalizing symptoms and transition readiness in a sample of emerging adults with and without chronic physical health conditions

OBJECTIVE

Theoretical models note psychosocial functioning as a key influence on transition readiness skills (TRS) among emerging adults (EA), but little is known about the relative importance of unique vs. shared anxiety and depressive dimensions, operationalized according to Clark and Watson's (1991) tripartite model, in contributing to TRS. Moreover, although development of TRS is important for all EA, few studies have examined whether the strength of relationships between internalizing symptoms and TRS vary between EA with and without chronic physical health conditions (CHC). Given the links between suboptimal TRS and adverse health outcomes, additional research is needed. This study examined individual and additive associations between three internalizing symptom dimensions (anxious arousal, anhedonic depression, and general distress) and TRS, as well as the moderating role of CHC status.

METHOD

One hundred twenty-six EA completed an online survey measuring TRS and internalizing symptoms. The sample was 70.6% women, 39.7% of minoritized racial identity, and 21.2% Hispanic ethnicity. The mean participant age was 21.23 years.

RESULTS

In two of three regression models, anhedonic depression alone was significantly related to TRS. CHC moderated the relationship between internalizing and TRS in only two of nine models. In both cases, internalizing symptoms were negatively associated with TRS for those without CHCs, but not for those with CHCs.

CONCLUSIONS

Assessment of anhedonic depression may be particularly useful in identifying youth at risk for suboptimal TRS regardless of CHC status. Moreover, interventions such as behavioral activation to improve TRS skill attainment warrant additional investigation.

Osteoarthritis with depression: mapping publication status and exploring hotspots

Depression is a common psychological complication in osteoarthritis (OA) patients, and its incidence gets more and more attention year by year worldwide. This study investigates the association between OA and depression through a bibliometric analysis of published studies. It aims to identify leading authors, institutions, and countries to highlight research hotspots and suggest potential future directions. We collected publications on OA and depression from 1994 to 2024 using the Web of Science Core Collection (WOSCC) database. Bibliographic information, including authorship, country of origin, citation frequency, and visualizations, was generated using VOSviewer, R software, and CiteSpace. A total of 2,342 articles were identified. The United States led in publications with 906 articles, Boston University was the most prolific institution with 56 publications, BMC Musculoskeletal Disorders was the top journal with 71 publications, and Stefania Maggi was the most productive author with 19 publications. The primary research hotspots identified were: "The relationship between depression and OA," "Disability and prevalence," and "Characteristics of older people suffering depression after OA." Predicted future research frontiers include: "Treating depression in OA patients with multimorbidity," "Psychometric properties of instruments for assessing depression and anxiety in OA patients," "Depression or anxiety in patients with surgical intervention," and "Other mental diseases in OA patients." This bibliometric analysis underscores the importance of understanding the link between OA and depressive disorders, potentially guiding new research directions.

Who is more willing to engage in social rejection? The roles of self-esteem, rejection sensitivity, and negative affect in social rejection decisions

How do self-schemas and their consequences guide would-be-rejectors? When making decisions about whether to reject, individuals consider the difficulty and emotional consequences of rejecting, and both considerations are likely to involve self-schemas. In three preregistered studies, we examine the roles of self-esteem, rejection sensitivity, and symptoms of depression and anxiety in rejection decisions. In an initial set of studies (N1a = 214, N1b = 264), participants forecast their willingness to reject and their emotional responses in friendship (Study 1a) and romantic (Study 1a-1b) vignettes. In Study 2 (N2 = 259), participants who recently rejected rated that experience on the same measures. Correlates of negative self-schema were associated with negative emotions. Self-esteem, rejection sensitivity, and general distress were associated with forecasted difficulty rejecting, but only anxiety and general distress were associated with retrospectively reported increased difficulty. Taken together, psychological distress may decrease willingness to reject in a way that participants cannot predict.

Personalized brain circuit scores identify clinically distinct biotypes in depression and anxiety

There is an urgent need to derive quantitative measures based on coherent neurobiological dysfunctions or 'biotypes' to enable stratification of patients with depression and anxiety. We used task-free and task-evoked data from a standardized functional magnetic resonance imaging protocol conducted across multiple studies in patients with depression and anxiety when treatment free (n = 801) and after randomization to pharmacotherapy or behavioral therapy (n = 250). From these patients, we derived personalized and interpretable scores of brain circuit dysfunction grounded in a theoretical taxonomy. Participants were subdivided into six biotypes defined by distinct profiles of intrinsic task-free functional connectivity within the default mode, salience and frontoparietal attention circuits, and of activation and connectivity within frontal and subcortical regions elicited by emotional and cognitive tasks. The six biotypes showed consistency with our theoretical taxonomy and were distinguished by symptoms, behavioral performance on general and emotional cognitive computerized tests, and response to pharmacotherapy as well as behavioral therapy. Our results provide a new, theory-driven, clinically validated and interpretable quantitative method to parse the biological heterogeneity of depression and anxiety. Thus, they represent a promising approach to advance precision clinical care in psychiatry.

Biological sex and hormonal contraceptive associations with drug cue reactivity in cannabis use disorder

Biological sex differences in Cannabis Use Disorder (CUD) progression, cannabis withdrawal severity, and pharmacotherapy response have been reported, suggesting that CUD mechanisms may differ by sex. Drug cue reactivity is an established predictor of drug use behavior, but the literature on sex differences in drug cue reactivity is mixed, including in CUD. One possible moderator of sex differences in drug cue reactivity is hormonal contraceptive (HC) use. The aim of the present study was to test whether sex differences in neural cannabis cue reactivity and craving varied by female HC use in a CUD sample. As part of a larger study, 152 adults reporting frequent cannabis use completed a drug cue reactivity task during electrocenphalogram recording. Late positive potential (LPP) amplitude modulation by cannabis cues was used to measure neural cue reactivity. Craving after the cue reactivity task was also assessed. Males (n = 74) and naturally-cycling females (n = 26), who did not differ from each other, showed significantly greater LPP enhancement to cannabis vs. neutral cues compared to HC-using females (n = 52), an effect mostly driven by neutral cues. Craving was significantly higher in naturally-cycling but not HC-using females compared to males, but only in covariate-unadjusted analyses. Exploratory analyses of HC and menstrual phase characteristics indicate a progesterone-related mechanism may underlie HC effects on cannabis cue reactivity. The present study's results suggest that mixed findings on drug cue reactivity sex differences may be due to variability in HC use, which has implications for sex-specific models of CUD progression and treatment.

Leadership Styles Experienced During Military Service Predict Later Anhedonic Depressive Symptoms and Self-Efficacy in Veterans With Alcohol Use Disorder

INTRODUCTION

Lifetime and past-year alcohol use disorder (AUD) prevalence is significantly higher in US Armed Services Veterans than in non-veterans across adulthood. This study examined the associations of perceived transformational leadership styles (TLS) experienced during military service and anhedonic depression and self-efficacy related to confidence to abstain or reduce alcohol consumption in Veterans seeking treatment for AUD. The ramifications of perceived leadership styles on multiple aspects of follower psychiatric functioning, including depressive and PTSD symptomatology, during and after military service, may be substantial and enduring. Higher anhedonic depression and lower abstinence self-efficacy are related to increased risk of relapse after treatment. We predicted Veterans, in treatment for AUD, who reported higher perceived levels of transformational leadership during military service, demonstrate lower anhedonic depressive symptoms and higher alcohol abstinence self-efficacy.

MATERIALS AND METHODS

Veterans with AUD (n = 60; 50 ± 14 years of age) were recruited from residential treatment at the VA Palo Alto Health Care System. All procedures were approved by the VA Palo Alto Health Care System and Stanford University institutional review boards. A series of mediation analyses were completed with The Multifactor Leadership Questionnaire measures of TLS (average across leadership measures [transformational leadership average; TLS average]) as predictor and the Alcohol Abstinence Self-Efficacy Scale, Mood and Anxiety Symptom Questionnaire, anhedonic depression subscale, as dependent measures. PTSD Checklist for DSM-5 score was tested as a mediator variable.

RESULTS

Higher reported perceived TLS average during military service was significantly related to lower anhedonic depressive symptoms. Higher TLS average was related to higher self-efficacy to resist alcohol use in contexts involving experience of physical issues and withdrawal/cravings and urges. These relationships were not mediated by PTSD symptomatology or duration of military service, age, education, time since military service, military branch, combat exposure, or current psychiatric diagnosis.

CONCLUSIONS

The significant associations of perceived TLS during military service with anhedonic depression and alcohol use self-efficacy are clinically relevant because these measures are associated with relapse risk after AUD treatment. Further study of the implications of perceived TLS during military service for AUD and other substance use disorder treatment outcome is warranted in Veterans.

Objectification and body esteem: age group patterns in women's psychological functioning

OBJECTIVES

Sexual objectification is related to negative outcomes for young adult women, but whether sexual objectification operates similarly for women in mid-life or older adulthood is less clear. Our aim was to assess self-objectification and sexually objectifying experiences for women in two different age groups, 18-27 and 48-90 and, further, test the relationship between objectification and psychological functioning. Based on objectification theory, we hypothesized that young adults would report higher self-objectification and sexually objectifying experiences compared to women in the older group. We further expected that these age differences would be related to body esteem and psychological functioning.

METHODS

We surveyed 218 women regarding their sexually objectifying experiences and self-objectification, as well as body esteem, global self-esteem, and mood/anxiety, all outcomes theoretically expected to be related to sexual objectification and self-objectification.

RESULTS

Sexually objectifying experiences and self-objectification were correlated with lower body esteem, lower global self-esteem, and higher mood/anxiety symptoms. Further, older women reported lower objectification and better psychological functioning. Tests of serial mediation showed that the relationship between age and two outcomes (self-esteem and mood/anxiety symptoms) was mediated by self-objectification and body esteem, while the model using experiences of sexually objectifying experiences was not supported.

CONCLUSION

Older women differed from younger women in the impact of self-objectification. We discuss these outcomes referencing age patterns and objectification theory.

Development of a multivariate prediction model for antidepressant resistant depression using reward-related predictors

Introduction

Individuals with depression who do not respond to two or more courses of serotonergic antidepressants tend to have greater deficits in reward processing and greater internalizing symptoms, yet there is no validated self-report method to determine the likelihood of treatment resistance based on these symptom dimensions.

Methods

This online case-control study leverages machine learning techniques to identify differences in self-reported anhedonia and internalizing symptom profiles of antidepressant non-responders compared to responders and healthy controls, as an initial proof-of-concept for relating these indicators to medication responsiveness. Random forest classifiers were used to identify a subset from a set of 24 reward predictors that distinguished among serotonergic medication resistant, non-resistant, and non-depressed individuals recruited online (N = 393). Feature selection was implemented to refine model prediction and improve interpretability.

Results

Accuracies for full predictor models ranged from .54 to .71, while feature selected models retained 3-5 predictors and generated accuracies of .42 to .70. Several models performed significantly above chance. Sensitivity for non-responders was greatest after feature selection when compared to only responders, reaching .82 with 3 predictors. The predictors retained from feature selection were then explored using factor analysis at the item level and cluster analysis of the full data to determine empirically driven data structures.

Discussion

Non-responders displayed 3 distinct symptom profiles along internalizing dimensions of anxiety, anhedonia, motivation, and cognitive function. Results should be replicated in a prospective cohort sample for predictive validity; however, this study demonstrates validity for using a limited anhedonia and internalizing self-report instrument for distinguishing between antidepressant resistant and responsive depression profiles.

Vagally-mediated HRV as a marker of trait rumination in healthy individuals? A large cross-sectional analysis

The tendency to ruminate (i.e., repetitive, self-referential, negative thoughts) is a maladaptive form of emotional regulation and represents a transdiagnostic vulnerability factor for stress-related psychopathology. Vagally-mediated heart rate variability (vmHRV) provides a non-invasive, surrogate measure of vagal modulation of the heart, and higher HRV is considered an indicator of susceptibility, or ability to respond to stress. Past research has suggested a link between trait rumination and vmHRV; however, inconsistent results exist in healthy individuals. In this study, we investigated the association between the tendency to ruminate, brooding, and reflection (using the Ruminative Response Scale) with vmHRV measured at baseline in a healthy population using a large cross-sectional dataset (N = 1189, 88% female; mean age = 21.55, ranging from 17 to 48 years old), which was obtained by combining samples of healthy individuals from different studies from our laboratory. The results showed no cross-sectional correlation between vmHRV and trait rumination (confirmed by Bayesian analysis), even after controlling for important confounders such as gender, age, and depressive symptoms. Also, a non-linear relationship was rejected. In summary, based on our results in a large sample of healthy individuals, vmHRV is not a marker of trait rumination (as measured by the Ruminative Response Scale).

Does Emotion-Related Impulsivity Relate to Specific ADHD Symptom Dimensions, and Do the Effects Generalize Across Comorbid Internalizing and Externalizing Syndromes?

BACKGROUND

Recent work highlights the role of emotion dysregulation in the pathology of Attention-Deficit/Hyperactivity Disorder (ADHD). As such, emotion-related impulsivity (ERI), the trait-like tendency toward disinhibited thoughts (Pervasive Influence of Feelings, PIF) and actions (Feelings Trigger Action, FTA) during heightened emotional states, may be particularly relevant. We explored whether Inattention (IN) and Hyperactivity/Impulsivity (HI), two core symptom dimensions of ADHD, would relate to distinct facets of ERI, and whether externalizing and internalizing symptoms would moderate these relations.

METHOD

Using structural equation modeling, we examined hypotheses among 364 adults recruited for high internalizing and externalizing symptoms.

RESULTS

We identified significant paths for FTA regressed on HI and PIF regressed on IN, supporting our hypotheses about main effects. Moderating paths were not significant.

CONCLUSIONS

IN and HI correlate with distinct forms of ERI, These effects appear to generalize across co-occurring internalizing and externalizing symptoms. Theoretical and clinical implications are discussed.

Associations Between Direct and Indirect Forms of Racism Exposure and Stress-Induced Inflammatory Response and Health in Pregnancy

Theory and research suggest chronic direct and indirect exposures to racism impact health, and stress-responsive inflammation may play a role in these paths. This study examines links between forms of racism-related stress, salivary markers of inflammation during acute psychosocial stress, and perinatal mental and physical health in a racially heterogenous sample. Pregnant people (n = 108, 27% non-white) self-reported personal and vicarious exposure to racism (racial microaggressions, online racism, overt racial/ethnic discrimination) and racial collective self-esteem, as well as affective symptoms and general physical health. Five saliva samples collected before and after the Trier Social Stress Test were assayed for pro-inflammatory cytokines and C-reactive protein. Results revealed associations between racism-related stress and greater inflammatory reactivity/delayed recovery to acute stress, between racial collective self-esteem and lower levels of inflammation, and between profiles of inflammatory responses to stress and mental and physical symptoms. We discuss implications for understanding perinatal health disparities.

Neurophysiological error processing and addiction self-awareness correlates of reduced insight in cannabis use disorder

BACKGROUND AND AIMS

Cannabis use disorder (CUD) prevalence has increased, while perceived risks of cannabis use and CUD treatment need have decreased. Chronic cannabis use may also impair the neural and behavioral mechanisms of insight, further hampering treatment-seeking. This study aimed to measure whether CUD is characterized by reduced self-monitoring in drug-related contexts (objectively-assessed insight), subserved by functional neural abnormalities in error-processing and manifested clinically as decreased awareness of the need to change.

DESIGN

Case-control laboratory study was used.

SETTING

University setting was in Alabama, USA.

PARTICIPANTS

There were 42 CUD participants and 47 age-, sex-, and nicotine use-matched controls.

MEASUREMENTS

Participants completed a probabilistic choice task, adapted for the first time for CUD, in which they selected pleasant, unpleasant, neutral, and cannabis-related images according to their preference. Reduced versus accurate insight was operationalized as the correspondence between self-reported and actual most chosen image type. Neurophysiological error-processing during an inhibitory control task was recorded using electroencephalography. Participants with CUD completed measures of cannabis problem recognition and motivation to change.

FINDINGS

Compared with controls, the CUD group made significantly more cannabis selections on the choice task (mean difference [MD] = 8.11, 95% confidence interval [CI] [4.88 11.35], p < 0.001) and had significantly reduced insight into cannabis choice (odds ratio [OR] = 9.69, 95% CI [1.06 88.65], p = 0.04). CUD participants with reduced insight on the choice task had significantly decreased neurophysiological reactivity to errors on the inhibitory control task (error-related negativity) compared with CUD participants with accurate insight (MD = 2.64 μV, 95% CI [0.74 μV 4.54 μV], p = 0.008) and controls (MD = 4.05 μV, 95% CI [1.29 μV 6.80 μV], p = 0.005). Compared with CUD participants with accurate insight on the choice task, CUD participants with reduced insight reported significantly less agreement that they had a cannabis problem (MD = -5.06, 95% CI [-8.49-1.62], p = 0.003).

CONCLUSIONS

People with CUD who show reduced insight on a drug-related choice task may also have decreased early neural error-processing and less cannabis problem recognition.

Parsing patterns of reward responsiveness: Initial evidence from latent profile analysis

Variation in reward responsiveness has been linked to psychopathology. Reward responsiveness is a complex phenomenon that encompasses different temporal dimensions (i.e., reward anticipation or consumption) that can be measured using multiple appetitive stimuli. Furthermore, distinct measures, such as neural and self-report measures, reflect related but distinct aspects of reward responsiveness. To understand reward responsiveness more comprehensively and better identify deficits in reward responsiveness implicated in psychopathology, we examined ways multiple measures of reward responsiveness jointly contribute to distinct psychological problems by using latent profile analysis. Specifically, we identified three profiles of reward responsiveness among 139 female participants based on their neural responses to money, food, social acceptance, and erotic images and self-reported responsiveness to reward anticipation and consumption. Profile 1 (n = 30) exhibited blunted neural responses to social rewards and erotic images, low self-reported reward responsiveness, but average neural responses to monetary and food rewards. Profile 2 (n = 71) showed elevated neural response to monetary rewards, average neural responses to other stimuli, and average self-reported reward responsiveness. Profile 3 (n = 38) showed more variable neural responses to reward (e.g., hypersensitivity to erotic images, hyposensitivity to monetary rewards), and high self-reported reward responsiveness. These profiles were differentially associated with variables generally linked to aberrations in reward responsiveness. For example, Profile 1 was most strongly associated with anhedonic depression and social dysfunction, whereas Profile 3 was associated with risk-taking behaviors. These preliminary findings may help to elucidate ways different measures of reward responsiveness manifest within and across individuals and identify specific vulnerabilities for distinct psychological problems.

Different trajectories of depression, anxiety and anhedonia symptoms in the first 12 months of the COVID-19 pandemic in a UK longitudinal sample

BACKGROUND

While studies from the start of the COVID-19 pandemic have described initial negative effects on mental health and exacerbating mental health inequalities, longer-term studies are only now emerging.

METHOD

In total, 34 465 individuals in the UK completed online questionnaires and were re-contacted over the first 12 months of the pandemic. We used growth mixture modelling to identify trajectories of depression, anxiety and anhedonia symptoms using the 12-month data. We identified sociodemographic predictors of trajectory class membership using multinomial regression models.

RESULTS

Most participants had consistently low symptoms of depression or anxiety over the year of assessments (60%, 69% respectively), and a minority had consistently high symptoms (10%, 15%). We also identified participants who appeared to show improvements in symptoms as the pandemic progressed, and others who showed the opposite pattern, marked symptom worsening, until the second national lockdown. Unexpectedly, most participants showed stable low positive affect, indicating anhedonia, throughout the 12-month period. From regression analyses, younger age, reporting a previous mental health diagnosis, non-binary, or self-defined gender, and an unemployed or a student status were significantly associated with membership of the stable high symptom groups for depression and anxiety.

CONCLUSIONS

While most participants showed little change in their depression and anxiety symptoms across the first year of the pandemic, we highlight the divergent responses of subgroups of participants, who fared both better and worse around national lockdowns. We confirm that previously identified predictors of negative outcomes in the first months of the pandemic also predict negative outcomes over a 12-month period.

The association between persistent cognitive difficulties and depression and functional outcomes in people with major depressive disorder

BACKGROUND

Cognitive symptoms are common during and following episodes of depression. Little is known about the persistence of self-reported and performance-based cognition with depression and functional outcomes.

METHODS

This is a secondary analysis of a prospective naturalistic observational clinical cohort study of individuals with recurrent major depressive disorder (MDD; N = 623). Participants completed app-based self-reported and performance-based cognitive function assessments alongside validated measures of depression, functional disability, and self-esteem every 3 months. Participants were followed-up for a maximum of 2-years. Multilevel hierarchically nested modelling was employed to explore between- and within-participant variation over time to identify whether persistent cognitive difficulties are related to levels of depression and functional impairment during follow-up.

RESULTS

508 individuals (81.5%) provided data (mean age: 46.6, s.d.: 15.6; 76.2% female). Increasing persistence of self-reported cognitive difficulty was associated with higher levels of depression and functional impairment throughout the follow-up. In comparison to low persistence of objective cognitive difficulty (<25% of timepoints), those with high persistence (>75% of timepoints) reported significantly higher levels of depression (B = 5.17, s.e. = 2.21, p = 0.019) and functional impairment (B = 4.82, s.e. = 1.79, p = 0.002) over time. Examination of the individual cognitive modules shows that persistently impaired executive function is associated with worse functioning, and poor processing speed is particularly important for worsened depressive symptoms.

CONCLUSIONS

We replicated previous findings of greater persistence of cognitive difficulty with increasing severity of depression and further demonstrate that these cognitive difficulties are associated with pervasive functional disability. Difficulties with cognition may be an indicator and target for further treatment input.

The influence of aerobic exercise on model-based decision making in women with posttraumatic stress disorder

Individuals with PTSD often exhibit deficits in executive functioning. An unexplored aspect of neurocognitive functions associated with PTSD is the type of learning system engaged in during decision-making. A model-free (MF) system is habitual in nature and involves trial-and-error learning that is often updated based on the most recent experience (e.g., repeat action if rewarded). A model-based (MB) system is goal-directed in nature and involves the development of an abstract representation of the environment to facilitate decisions (e.g., choose sequence of actions according to current contextual state and predicted outcomes). The existing neurocognitive literature on PTSD suggests the hypothesis of greater reliance on MF vs MB learning strategies when navigating their environment. While MF systems may be more cognitively efficient, they do not afford flexibility when making prospective predictions about likely outcomes of different decision-tree branches. Emerging research suggests that an acute bout of aerobic exercise improves certain aspects of neurocognition, and thereby could promote the utilization of MB over MF systems during decision making, although prior research has not yet tested this hypothesis. Accordingly, the current study administered a lab-based two-stage Markov decision-making task capable of discriminating MF vs MB decision making, in order to determine if moderate-intensity aerobic exercise (either shortly after or 30-minutes after the exercise bout has ended) promotes greater engagement in MB behavioral strategies compared to light-intensity aerobic exercise in adult women with and without PTSD (N=61). Results revealed that control women generally displayed higher levels of MB behavior that was further increased following immediate exercise, particularly moderate-intensity exercise. By contrast, the PTSD group generally displayed lower levels of MB behavior, and exhibited greater MB behavior when completing the task following moderate-intensity aerobic exercise compared to light-intensity aerobic exercise regardless of whether there was a short or long delay between exercise and the task. Additionally, women with PTSD demonstrated less impairment in MB decision-making compared to controls following moderate-intensity aerobic exercise. These results suggest that an acute bout of moderate-intensity aerobic exercise boosts MB behavior in women with PTSD, and suggests that aerobic exercise may play an important role in enhancing cognitive outcomes for PTSD.

Preliminary clinical and cost effectiveness of augmented depression therapy versus cognitive behavioural therapy for the treatment of anhedonic depression (ADepT): a single-centre, open-label, parallel-group, pilot, randomised, controlled trial

Background

Anhedonia (reduced interest/pleasure) symptoms and wellbeing deficits are core to depression and predict a poor prognosis. Current depression psychotherapies fail to target these features adequately, contributing to sub-optimal outcomes. Augmented Depression Therapy (ADepT) has been developed to target anhedonia and wellbeing. We aimed to establish clinical and economic proof of concept for ADepT and to examine feasibility of a future definitive trial comparing ADepT to Cognitive Behavioural Therapy (CBT).

Methods

In this single-centre, open-label, parallel-group, pilot randomised controlled trial, adults meeting diagnostic criteria for a current major depressive episode, scoring ≥10 on the Patient Health Questionnaire (PHQ-9) and exhibiting anhedonic features (PHQ-9 item 1 ≥ 2) were recruited primarily from high intensity Improving Access to Psychological Therapy (IAPT) service waiting lists in Devon, UK. Participants were randomised to receive 20 sessions of CBT or ADepT, using a mimimisation algorithm to balance depression severity and antidepressant use between groups. Treatment was delivered in an out-patient university-based specialist mood disorder clinic. Researcher-blinded assessments were completed at intake and six, 12, and 18 months. Co-primary outcomes were depression (PHQ-9) and wellbeing (Warwick Edinburgh Mental Wellbeing Scale) at 6 months. Primary clinical proof-of-concept analyses were intention to treat. Feasibility (including safety) and health economic analyses used complete case data. This trial is registered at the ISRCTN registry, ISRCTN85278228.

Findings

Between 3/29/2017 and 7/31/2018, 82 individuals were recruited (102% of target sample) and 41 individuals were allocated to each arm. A minimum adequate treatment dose was completed by 36/41 (88%) of CBT and 35/41 (85%) of ADepT participants. There were two serious adverse events in each arm (primarily suicide attempts; none of which were judged to be trial- or treatment-related), with no other evidence of harms. Intake and six-month primary outcome data was available for 37/41 (90%) CBT participants and 32/41 (78%) ADepT participants. Between-group effects favoured ADepT over CBT for depression (meanΔ = -1.35, 95% CI = -3.70, 1.00, d = 0.23) and wellbeing (meanΔ = 2.64, 95% CI = -1.71, 6.99, d = 0.27). At 18 months, the advantage of ADepT over CBT was preserved and ADepT had a >80% probability of cost-effectiveness.

Interpretation

These findings provide proof of concept for ADepT and warrant continuation to definitive trial.

Funding

NIHR Career Development Fellowship.

Feeling up or feeling down: Verticality preferences in personality, pathology, and well-being

Theories of mental functioning have suggested its metaphoric basis. Drawing from theories of this type as well as from recent extensions of such theories to the personality processing realm, participants in three studies (total N = 452) were asked to indicate their relative preferences for the spatial concepts of up versus down, given that verticality metaphors are frequently used to conceptualize states related to emotion and well-being. Up-preferring individuals were more extraverted and approach-motivated (Study 1), whereas down-preferring individuals were more depressed (Studies 1 and 2). Higher levels of vertical preference were also predictive of affective well-being in a daily diary protocol (Study 3) and these relationships operated in both between-person and within-person terms. Metaphors, which liken the intangible to the tangible, may play a significant role in shaping experience and verticality metaphors, in particular, appear to provide insights into the processes that that support happiness versus its absence.

Canonical correlation analysis in high dimensions with structured regularization

Canonical correlation analysis (CCA) is a technique for measuring the association between two multivariate data matrices. A regularized modification of canonical correlation analysis (RCCA) which imposes an ℓ2 penalty on the CCA coefficients is widely used in applications with high-dimensional data. One limitation of such regularization is that it ignores any data structure, treating all the features equally, which can be ill-suited for some applications. In this article we introduce several approaches to regularizing CCA that take the underlying data structure into account. In particular, the proposed group regularized canonical correlation analysis (GRCCA) is useful when the variables are correlated in groups. We illustrate some computational strategies to avoid excessive computations with regularized CCA in high dimensions. We demonstrate the application of these methods in our motivating application from neuroscience, as well as in a small simulation example.

Salivary cortisol levels and appraisals of daily hassles across dimensions of the tripartite model of anxiety and depression in emerging adults

The objective of this study was to investigate how cortisol levels and appraisals of daily hassles differ across tripartite dimensions of depression and anxiety in emerging adults. Data collected from a sample of undergraduate students at a large Midwestern university was used to investigate these aims. This included salivary cortisol data collected over four days, scores on a measure of the tripartite model of anxiety and depression, and scores on a measure of daily hassles administered everyday for two weeks. Generalized estimating equations and multilevel modeling techniques were used to analyze data. Elevated cortisol levels during the awakening period and the evening period, lower total levels across the day, steeper diurnal slopes, and elevated levels of negative affect and physiological hyperarousal predicted experiences of daily hassles. Tripartite dimensions were unrelated to cortisol indices. The present study demonstrates the utility of modeling multiple cortisol indices and provides evidence of differential associations between physiological and phenomenological indices of stress.

Examining a window of vulnerability for affective symptoms in the mid-luteal phase of the menstrual cycle

Particular phases of the menstrual cycle may exacerbate affective symptoms for females with a diagnosed mental health disorder. However, there are mixed findings regarding whether affective symptoms change across the menstrual cycle in females without a clinical diagnosis. The window of vulnerability model proposes that natural increases in ovarian hormones in the mid-luteal phase of the menstrual cycle lead to systematic changes in brain networks associated with affective processing. Consequently, the model posits that females may experience stress more intensely and remember negative events more readily in the mid-luteal phase, increasing their risk for higher affective symptoms. Using a 35-day longitudinal study design, we tested the window of vulnerability model in a non-clinical sample. We tracked naturally cycling females' daily stress and three types of affective symptoms: anxious apprehension, anxious arousal, and anhedonic depression. Using multilevel modeling, we simultaneously modeled within- and between-person associations among stress and menstrual phase for each affective symptom. We found increased anhedonic depression in the mid-luteal phase but not anxious apprehension or anxious arousal. Moreover, we detected a positive association between within- and between-person stress and anxious apprehension and anhedonic depression, but not anxious arousal. These associations were not stronger in the mid-luteal phase. Overall, we provide weak evidence for a window of vulnerability for affective symptoms in the mid-luteal phase of the menstrual cycle. Our findings suggest that stress is a better predictor of fluctuations in affective symptoms than the menstrual cycle. Moreover, our findings highlight the importance of measuring multiple negative affective symptoms because they may be differentially related to stress and the menstrual cycle.

When self comes to a wandering mind: Brain representations and dynamics of self-generated concepts in spontaneous thought

Self-relevant concepts are major building blocks of spontaneous thought, and their dynamics in a natural stream of thought are likely to reveal one's internal states that are important for mental health. Here, we conducted a functional magnetic resonance imaging experiment (n = 62) to examine brain representations and dynamics of self-generated concepts in the context of spontaneous thought using a newly developed free association-based thought sampling task. The dynamics of conceptual associations were predictive of individual differences in general negative affectivity, replicating across multiple datasets (n = 196). Reflecting on self-generated concepts strongly engaged brain regions linked to autobiographical memory, conceptual processes, emotion, and autonomic regulation, including the medial prefrontal and medial temporal subcortical structures. Multivariate pattern-based predictive modeling revealed that the neural representations of valence became more person-specific as the level of perceived self-relevance increased. Overall, this study sheds light on how self-generated concepts in spontaneous thought construct inner affective states and idiosyncrasies.

Social Network Changes and Disclosure Responses after Sexual Assault

Social support after sexual assault is important for recovery, but violence and recovery may also challenge relationships. We examined functional and structural social support changes following sexual assault and their association with mental health. College women (N=544) with and without a sexual assault history completed a cross-sectional survey assessing current and past egocentric social networks. Functional support (perceived global support, assault disclosure, perceived helpfulness of responses) and structural support (network density, size, retention) were examined. Multilevel models revealed that, relative to non-survivors, survivors reported smaller, less dense past networks, but similarly sized current networks. Survivors retained less of their networks than non-survivors, and network members who provided unhelpful responses to disclosure were less likely to be retained. Structural equation modeling revealed that, among survivors, perceived unhelpful responses to disclosure and a greater loss of network members were associated with worse mental health. Findings suggest that survivors may experience a restructuring of social networks following sexual assault, especially when network members respond in unhelpful ways to disclosure. Although survivors appeared to build new relationships, this restructuring was associated with more mental health problems. It is possible that interventions to improve post-assault social network retention may facilitate recovery.

The effects of perceived stress and anhedonic depression on mnemonic similarity task performance

Previous research has demonstrated hippocampal alterations in individuals experiencing elevated stress. The Mnemonic Similarity Task (MST) is a hippocampal-dependent task sensitive to age-related hippocampal decline, but it is unknown how performance on this task is related to one's experience of daily stress. We conducted separate discovery and replication analyses in 510 participants who completed the MST across four different Mechanical Turk studies. We hypothesized that higher scores on the Perceived Stress Scale would be associated with poorer discrimination of "lure" items from previously seen targets - a behavioral index of pattern separation - but not with recognition memory. The zero-order relationship between perceived stress and lure discrimination was not significant in the discovery or replication sample. Exploratory analyses involving anhedonic depression symptoms (from the Mood and Anxiety Symptoms Questionnaire) revealed a robust perceived stress*anhedonic depression interaction in the discovery sample that was confirmed in the replication sample. In both samples, individuals with low but not high anhedonic depression symptoms showed an inverse association between perceived stress and lure discrimination ability. Contrary to hypotheses, a similar interaction was observed for recognition memory. The novel association between perceived stress and behavioral pattern separation suggests a candidate behavioral process associated with stress-related hippocampal deficits. The specificity of this effect for individuals with low anhedonic depression symptoms - and the lack of behavioral specificity - highlight the need for additional research to unpack the clinical and neurobiological significance of these findings.

Childhood trauma and its impact on depressive and anxiety symptomatology in adulthood: A 6-year longitudinal study

BACKGROUND

Childhood trauma (CT) is a risk factor for depressive and anxiety disorders. However, whether CT is more strongly linked to specific clinical features of these disorders remains inconclusive. The current study comprehensively examined cross-sectional and longitudinal associations between CT and depressive/anxiety symptomatology in a large adult sample with current and remitted depressive and/or anxiety disorders.

METHODS

Baseline (n = 1803), 2-year (n = 1735), 4-year (n = 1585), and 6-year follow-up (n = 1475) data from the Netherlands Study of Depression and Anxiety were used. CT (emotional neglect, emotional/physical/sexual abuse) was assessed at baseline, while depressive/anxiety symptomatology with relevant dimensions (e.g., mood/cognitive, melancholic, general distress, and somatic depression) was assessed at each wave using self-reported questionnaires. Linear regressions and linear mixed models determined cross-sectional and longitudinal associations.

RESULTS

Individuals with CT, especially, severe CT, compared to those without CT, had significantly higher scores in overall depressive symptomatology (Cohen's d = 0.674), mood/cognitive depression (d = 0.691), melancholic depression (d = 0.587), general distress (d = 0.561), and somatic depression severity (d = 0.549). Differences were lower, but still highly significant for anxiety (d = 0.418), worry (d = 0.362), and fear/phobic symptomatology (d = 0.359). Effects were consistent across CT types and maintained over six years.

LIMITATIONS

Retrospectively-reported CT.

CONCLUSIONS

CT is a risk factor for depressive and anxiety symptomatology across all dimensions and enduring over multiple years. Screening for CT is essential to identify individuals at risk for more severe and chronic manifestations of affective disorders.

Dietary Factors, Time of the Week, Physical Fitness and Saliva Cortisol: Their Modulatory Effect on Mental Distress and Mood

Background: The purpose of the study was to assess the effect of diet quality and physical fitness on saliva cortisol, mood, and mental distress. These relationships were compared between a peak weekday (Wednesday) and a weekend day (Saturday) when mood may fluctuate. Methods: Forty-eight healthy college students participated in the study. Participants completed the Mood and Anxiety Symptom (MASQ) and Kessler Psychological Distress Scale 10 questionnaires on Wednesday and Saturday and recorded their diet for three days. Saliva was collected before and after a workout for cortisol extraction. Results: SA had significantly higher saliva cortisol levels post-workout but lower MASQ scores on Saturday (p < 0.05). There was a very significant association between MASQ scores on Wednesday (p = 0.005), which became less significant on Saturday. In addition, lower BMI values and high-fat consumption were associated with higher cortisol levels after exercise (p < 0.05). Conclusions: There is a strong link between dietary factors, cortisol levels, mood, and time of the week. In addition, our results suggest that saliva cortisol levels may not be directly linked to negative affect but are influenced by diet quality when mental distress exists. In addition, physical fitness may play a role in improving mood during weekends.

Development and validation of 21-item outcome inventory (OI-21)

Background

Outcome measurement is important for monitoring patients' progress. The study aimed to develop an outcome inventory (OI) for clinical use in routine practice in psychiatric services and to examine the psychometric properties of the newly developed OI.

Methods

48 items measuring anxiety, depression, interpersonal difficulties, and somatization were collected. Factor analysis was used to reduce the number of items. The final OI consisting of 21 items was then examined for psychometric properties among 1302 participants, 880 were nonclinical and 422 clinical patients. Tests included confirmatory factor analysis, internal consistency, test-retest reliability, convergent and discriminant validity, and diagnostic ability for major depression. Responsiveness was compared between baseline and 3-month follow-up.

Results

Confirmatory factor analysis revealed the OI-21 demonstrated the designated four components. Cronbach's alpha was good to excellent for all subjects with good test-retest reliability, concurrent validity, convergent and discriminant validity. It demonstrated area under the ROC curve of 0.89 indicating good diagnostic performance. Sensitivity to change after 3 months was observed in both types of treatment. However, interpersonal difficulties were sensitive to change in those receiving additional psychotherapy.

Conclusion

OI-21 demonstrated its validity, reliability, and sensitivity to change. It constitutes a promising tool for outcome assessment in nonclinical populations and among psychiatric patients.

Neural substrates of emotional conflict with anxiety in major depressive disorder: Findings from the Establishing Moderators and biosignatures of Antidepressant Response in Clinical Care (EMBARC) randomized controlled trial

BACKGROUND

The brain circuitry of depression and anxiety/fear is well-established, involving regions such as the limbic system and prefrontal cortex. We expand prior literature by examining the extent to which four discrete factors of anxiety (immediate state anxiety, physiological/panic, neuroticism/worry, and agitation/restlessness) among depressed outpatients are associated with differential responses during reactivity to and regulation of emotional conflict.

METHODS

A total of 172 subjects diagnosed with major depressive disorder underwent functional magnetic resonance imaging while performing an Emotional Stroop Task. Two main contrasts were examined using whole brain voxel wise analyses: emotional reactivity and emotion regulation. We also evaluated the association of these contrasts with the four aforementioned anxiety factors.

RESULTS

During emotional reactivity, participants with higher immediate state anxiety showed potentiated activation in the rolandic operculum and insula, while individuals with higher levels of physiological/panic demonstrated decreased activation in the posterior cingulate. No significant results emerged for any of the four factors on emotion regulation. When re-analyzing these statistically-significant brain regions through analyses of a subsample with (n = 92) and without (n = 80) a current anxiety disorder, no significant associations occurred among those without an anxiety disorder. Among those with an anxiety disorder, results were similar to the full sample, except the posterior cingulate was associated with the neuroticism/worry factor.

CONCLUSIONS

Divergent patterns of task-related brain activation across four discrete anxiety factors could be used to inform treatment decisions and target specific aspects of anxiety that involve intrinsic processing to attenuate overactive responses to emotional stimuli.

Sensemaking by Employees in Essential versus Non-essential Professions During the COVID-19 Crisis: A Comparison of Effects of Change Communication and Disruption Cues on Mental Health, Through Interpretations of Identity Threats and Work Meaningfulness

This study examines the implications of categorizing workers into essential and non-essential groups due to disruptions in work associated with-and the quality of organizational change communication about-the COVID-19 pandemic. Specifically, we examine how these cues trigger identity threats and influence the meaningfulness of work, consequently affecting the mental health of workers (anxiety, distress, and depression). The results show that change communication reduces identity threat, while also increasing meaningfulness of work, for both work categories. However, the disruptions increase identity threat only for non-essential workers. Conversely, identity threat increases two of the three mental health issues while meaningfulness of work reduces two of them. The study contributes to our growing understanding of the pervasive, though subtle, implications of COVID-19 for the workplace by showing how a process of employee sensemaking and organizational change communication directly and indirectly influence important dimensions of mental health.

Smartphone-Based Neuropsychological Assessment in Parkinson's Disease: Feasibility, Validity, and Contextually Driven Variability in Cognition

OBJECTIVES

The prevalence of neurodegenerative disorders demands methods of accessible assessment that reliably captures cognition in daily life contexts. We investigated the feasibility of smartphone cognitive assessment in people with Parkinson's disease (PD), who may have cognitive impairment in addition to motor-related problems that limit attending in-person clinics. We examined how daily-life factors predicted smartphone cognitive performance and examined the convergent validity of smartphone assessment with traditional neuropsychological tests.

METHODS

Twenty-seven nondemented individuals with mild-moderate PD attended one in-lab session and responded to smartphone notifications over 10 days. The smartphone app queried participants 5x/day about their location, mood, alertness, exercise, and medication state and administered mobile games of working memory and executive function.

RESULTS

Response rate to prompts was high, demonstrating feasibility of the approach. Between-subject reliability was high on both cognitive games. Within-subject variability was higher for working memory than executive function. Strong convergent validity was seen between traditional tests and smartphone working memory but not executive function, reflecting the latter's ceiling effects. Participants performed better on mobile working memory tasks when at home and after recent exercise. Less self-reported daytime sleepiness and lower PD symptom burden predicted a stronger association between later time of day and higher smartphone test performance.

CONCLUSIONS

These findings support feasibility and validity of repeat smartphone assessments of cognition and provide preliminary evidence of the effects of context on cognitive variability in PD. Further development of this accessible assessment method could increase sensitivity and specificity regarding daily cognitive dysfunction for PD and other clinical populations.

Emotion-related impulsivity predicts increased anxiety and depression during the COVID-19 pandemic

INTRODUCTION

Emotion-related impulsivity, defined by poor constraint in the face of emotion, is related to internalizing symptoms, cross-sectionally and longitudinally. Internalizing symptoms, though, are profoundly tied to stress reactivity, and little is known about how emotion-related impulsivity relates to stress reactivity.

METHOD

Taking advantage of a sample that had completed measures of depression, anxiety, suicidal ideation, and two forms of emotion-related impulsivity before the pandemic, we asked participants to complete three weekly follow-up internalizing assessments early in the pandemic.

RESULTS

Among the 150 participants, pre-pandemic emotion-related impulsivity scores predicted higher depression, anxiety, general distress, and suicidal ideation during the COVID-19 pandemic. Controlling for pre-pandemic scores, one form of emotion-related impulsivity (Feelings Trigger Action) predicted increased anxiety and general distress. We also examined how pre-pandemic emotion-related impulsivity was moderated by weekly COVID-related stress. One form of emotion-related impulsivity (Pervasive Influence of Feelings) predicted internalizing symptoms at low stress levels, and a different form (Feelings Trigger Action) predicted internalizing symptoms at higher stress levels.

LIMITATIONS

Limitations include the small sample size, the absence of repeat measures of impulsivity, the attrition of individuals with more internalizing symptoms, and the reliance on self-rated measures.

CONCLUSIONS

Forms of emotion-related impulsivity predict increases in anxiety and distress over time, but the interactions with stress levels appear to vary. Emotion-related impulsivity can be addressed with accessible intervention tools, suggesting the promise of broader screening for those at risk for internalizing symptoms during periods of high stress.

Cognitive Effort Exertion Enhances Electrophysiological Responses to Rewarding Outcomes

Recent work has highlighted neural mechanisms underlying cognitive effort-related discounting of anticipated rewards. However, findings on whether effort exertion alters the subjective value of obtained rewards are inconsistent. Here, we provide a more nuanced account of how cognitive effort affects subsequent reward processing in a novel task designed to assess effort-induced modulations of the Reward Positivity, an event-related potential indexing reward-related neural activity. We found that neural responses to both gains and losses were significantly elevated in trials requiring more versus less cognitive effort. Moreover, time-frequency analysis revealed that these effects were mirrored in gain-related delta, but not in loss-related theta band activity, suggesting that people ascribed more value to high-effort outcomes. In addition, we also explored whether individual differences in behavioral effort discounting rates and reward sensitivity in the absence of effort may affect the relationship between effort exertion and subsequent reward processing. Together, our findings provide evidence that cognitive effort exertion can increase the subjective value of subsequent outcomes and that this effect may primarily rely on modulations of delta band activity.

Mental health in the UK Biobank: A roadmap to self-report measures and neuroimaging correlates

The UK Biobank (UKB) is a highly promising dataset for brain biomarker research into population mental health due to its unprecedented sample size and extensive phenotypic, imaging, and biological measurements. In this study, we aimed to provide a shared foundation for UKB neuroimaging research into mental health with a focus on anxiety and depression. We compared UKB self-report measures and revealed important timing effects between scan acquisition and separate online acquisition of some mental health measures. To overcome these timing effects, we introduced and validated the Recent Depressive Symptoms (RDS-4) score which we recommend for state-dependent and longitudinal research in the UKB. We furthermore tested univariate and multivariate associations between brain imaging-derived phenotypes (IDPs) and mental health. Our results showed a significant multivariate relationship between IDPs and mental health, which was replicable. Conversely, effect sizes for individual IDPs were small. Test-retest reliability of IDPs was stronger for measures of brain structure than for measures of brain function. Taken together, these results provide benchmarks and guidelines for future UKB research into brain biomarkers of mental health.

Trait Anxiety Mediates Impulsivity and Suicidal Ideation in Depression During COVID-19 Pandemic

Suicidality in patients with major depressive disorder (MDD) has been an urgent affair during the COVID-19 pandemic. It is well-established that impulsivity and trait anxiety are two risk factors for suicidal ideation. However, literature is still insufficient on the relationships among impulsivity, (state/trait) anxiety and suicidal ideation in individuals with MDD. The present study aims to explore the relationships of these three variables in MDD patients during the COVID-19 pandemic through three scales, including Barrett Impulsivity Scale (BIS), State-Trait Anxiety Scale (STAI) and Self-rating Idea of Suicide Scale (SIOSS). Sixty-three MDD patients (low SIOSS group and high SIOSS group, which were split by the mean score of SIOSS) and twenty-seven well-matched healthy controls were analyzed. Our results showed that the high SIOSS group had higher trait anxiety (p < 0.001, 95% CI = [-19.29, -5.02]) but there was no difference in state anxiety (p = 0.171, 95% CI = [-10.60, 1.25]), compared with the low SIOSS group. And the correlation between impulsivity and suicidal ideation was significant in MDD patients (r = 0.389, p = 0.002), yet it was not significant in healthy controls (r = 0.285, p = 0.167). Further, mediation analysis showed that trait anxiety significantly mediate impulsivity and suicidal ideation in patients with depression (total effect: β = 0.304, p = 0.002, 95% CI = [0.120, 0.489]; direct effect: β = 0.154, p = 0.076, 95% CI = [-0.169, 0.325]), indicating impulsivity influenced suicidal ideation through trait anxiety in MDD patients. In conclusion, our results suggested that trait anxiety might mediate the association of impulsivity and suicidal ideation in MDD patients. Clinicians may use symptoms of trait anxiety and impulsivity for screening when actively evaluating suicidal ideation in MDD patients, especially in the setting of COVID-19 pandemic.

Longitudinal Effects of Distress and Its Management During COVID-19 Lockdown in Spain

Introduction: The COVID-19 pandemic that hit Spain during March 2020 forced the strict confinement of the population for 2 months. The objectives of this study were (a) to assess the magnitude and duration of the influence of confinement on people's Distress, (b) to study the temporal sequence of stress, and (c) to show how different day-to-day activities and personal variables influence perceived Distress levels. Method: A daily registration was completed by 123 people, with ages ranging from 21 to 75 years old ( X ¯ = 43, SD = 10 years), of which there were 40 men (32%) and 83 females (68%). During 45 days of lockdown, from March 19th to May 3rd, participants were asked to respond to a socio-demographic survey and make daily records comprising the MASQ-D30 and some day-to-day behaviors. Pooled time series was applied to establish what effect time had on the dependent variable. Results: Distress has a 14-day autoregressive function and gender, physical activity, sexual activity, listening to music, and teleworking also influence Distress. It has been hypothesized that the intercept presents variability at level 2 (individual), but it has not been significant. Interactions between Gender-Telecommuting, and Gender-Physical Activity were observed. Approximately 66% of the variance of Distress was explained (R 2 = 0.663). Discussion: At the beginning of the lockdown, the average levels of Distress were well above the levels of the end (z = 3.301). The individuals in the sample have followed a very similar process in the development of Distress. During the lockdown, the "memory" of Distress was 2 weeks. Our results indicate that levels of Distress depend on activities during lockdown. Interactions exist between gender and some behavioral variables that barely influence Distress in men but decrease Distress in women. The importance of routine maintenance and gender differences must be considered to propose future interventions during confinement.

Convergence, preliminary findings and future directions across the four human connectome projects investigating mood and anxiety disorders

In this paper we provide an overview of the rationale, methods, and preliminary results of the four Connectome Studies Related to Human Disease investigating mood and anxiety disorders. The first study, "Dimensional connectomics of anxious misery" (HCP-DAM), characterizes brain-symptom relations of a transdiagnostic sample of anxious misery disorders. The second study, "Human connectome Project for disordered emotional states" (HCP-DES), tests a hypothesis-driven model of brain circuit dysfunction in a sample of untreated young adults with symptoms of depression and anxiety. The third study, "Perturbation of the treatment resistant depression connectome by fast-acting therapies" (HCP-MDD), quantifies alterations of the structural and functional connectome as a result of three fast-acting interventions: electroconvulsive therapy, serial ketamine therapy, and total sleep deprivation. Finally, the fourth study, "Connectomes related to anxiety and depression in adolescents" (HCP-ADA), investigates developmental trajectories of subtypes of anxiety and depression in adolescence. The four projects use comparable and standardized Human Connectome Project magnetic resonance imaging (MRI) protocols, including structural MRI, diffusion-weighted MRI, and both task and resting state functional MRI. All four projects also conducted comprehensive and convergent clinical and neuropsychological assessments, including (but not limited to) demographic information, clinical diagnoses, symptoms of mood and anxiety disorders, negative and positive affect, cognitive function, and exposure to early life stress. The first round of analyses conducted in the four projects offered novel methods to investigate relations between functional connectomes and self-reports in large datasets, identified new functional correlates of symptoms of mood and anxiety disorders, characterized the trajectory of connectome-symptom profiles over time, and quantified the impact of novel treatments on aberrant connectivity. Taken together, the data obtained and reported by the four Connectome Studies Related to Human Disease investigating mood and anxiety disorders describe a rich constellation of convergent biological, clinical, and behavioral phenotypes that span the peak ages for the onset of emotional disorders. These data are being prepared for open sharing with the scientific community following screens for quality by the Connectome Coordinating Facility (CCF). The CCF also plans to release data from all projects that have been pre-processed using identical state-of-the-art pipelines. The resultant dataset will give researchers the opportunity to pool complementary data across the four projects to study circuit dysfunctions that may underlie mood and anxiety disorders, to map cohesive relations among circuits and symptoms, and to probe how these relations change as a function of age and acute interventions. This large and combined dataset may also be ideal for using data-driven analytic approaches to inform neurobiological targets for future clinical trials and interventions focused on clinical or behavioral outcomes.

Longitudinal associations between internalizing symptoms, social behavior, and social perceptions in the initial months of the COVID-19 pandemic: Findings from a transdiagnostic community sample

BACKGROUND

Burgeoning evidence suggests that loneliness during the COVID-19 pandemic is tied to high levels of depression and anxiety. The current study is unique, though, in examining which facets of social behavior and perceived social quality are most tied to internalizing symptoms using longitudinal data, including a pre-pandemic baseline, collected from a community sample of adults with pre-existing mental health concerns (analyzed n = 144).

METHODS

Participants completed measures of depressive and anxious symptoms pre-pandemic, followed by three weekly surveys during the pandemic. We distinguished four social variables: in-person social engagement, remote social engagement, social disruption, and social distress. OLS and mixed-effects regression models examined 1) pre-pandemic baseline symptoms as predictors of social functioning during the pandemic and 2) time-lagged associations between symptoms and social functioning during the pandemic.

RESULTS

Social behavior and social perceptions were dissociable. Baseline depressive, but not anxious, symptoms predicted greater social distress during the pandemic. Both anxious and depressive symptoms were predicted by social variables, but the specific associations differed: depressive symptoms were related to perceived social quality, whereas anxious symptoms were more tied to reported social behavior.

LIMITATIONS

We relied on self-report indices, and causality should not be inferred directly from these correlational data.

CONCLUSIONS

Overall, our results indicate that it is possible to follow social guidelines and even to spend relatively few hours socializing with close others, while still feeling connected and rewarded; however, people who struggle with depression and anhedonia were particularly vulnerable to distressing feelings of social disconnection amid the pandemic.

Common and specific determinants of 9-year depression and anxiety course-trajectories: A machine-learning investigation in the Netherlands Study of Depression and Anxiety (NESDA)

BACKGROUND

Given the strong relationship between depression and anxiety, there is an urge to investigate their shared and specific long-term course determinants. The current study aimed to identify and compare the main determinants of the 9-year trajectories of combined and pure depression and anxiety symptom severity.

METHODS

Respondents with a 6-month depression and/or anxiety diagnosis (n=1,701) provided baseline data on 152 sociodemographic, clinical and biological variables. Depression and anxiety symptom severity assessed at baseline, 2-, 4-, 6- and 9-year follow-up, were used to identify data-driven course-trajectory subgroups for general psychological distress, pure depression, and pure anxiety severity scores. For each outcome (class-probability), a Superlearner (SL) algorithm identified an optimally weighted (minimum mean squared error) combination of machine-learning prediction algorithms. For each outcome, the top determinants in the SL were identified by determining variable-importance and correlations between each SL-predicted and observed outcome (ρ_pred) were calculated.

RESULTS

Low to high prediction correlations (ρ_pred: 0.41-0.91, median=0.73) were found. In the SL, important determinants of psychological distress were age, young age of onset, respiratory rate, participation disability, somatic disease, low income, minor depressive disorder and mastery score. For course of pure depression and anxiety symptom severity, similar determinants were found. Specific determinants of pure depression included several types of healthcare-use, and of pure-anxiety course included somatic arousal and psychological distress.

LIMITATIONS

Limited sample size for machine learning.

CONCLUSIONS

The determinants of depression- and anxiety-severity course are mostly shared. Domain-specific exceptions are healthcare use for depression and somatic arousal and distress for anxiety-severity course.

Unique neurocircuitry activation profiles during fear conditioning and extinction among women with posttraumatic stress disorder

BACKGROUND

Neurocircuitry models of posttraumatic stress disorder (PTSD) suggest specific alterations in brain structures linked with fear conditioning and extinction. Most models assume a unitary pattern of neurocircuitry dysfunction in PTSD and little attention has focused on defining unique profiles of neurocircuitry engagement (i.e., biotypes), despite known clinical heterogeneity in PTSD. Here, we aim to address this gap using a data-driven approach to characterize unique neurocircuitry profiles among women with PTSD.

METHODS

Seventy-six women with PTSD related to assaultive violence exposure competed a task during fMRI that alternated between fear conditioning, where a geometric shape predicted the occurrence of an electric shock, and fear extinction, where the geometric shape no longer predicted electric shock. A multivariate clustering analysis was applied to neurocircuitry patterns constrained within an a priori mask of structures linked with emotion processing. Resulting biotypes were compared on clinical measures of neurocognition, trauma exposure, general mental health symptoms, and PTSD symptoms and on psychophysiological responding during the task.

RESULTS

The clustering analysis identified three biotypes (BT), differentiated by patterns of engagement within salience, default mode, and visual processing networks. BT1 was characterized by higher working memory, fewer general mental health symptoms, and low childhood sexual abuse, and lower PTSD symptom severity. BT2 was characterized by lower verbal IQ but better extinction learning as defined by psychophysiology and threat expectancy. BT3 was characterized by low childhood sexual abuse, anxious arousal, and re-experiencing symptoms.

CONCLUSION

This data demonstrates unique profiles of neurocircuitry engagement in PTSD, each associated with different clinical characteristics, and suggests further research defining distinct biotypes of PTSD. Clinicaltrials.gov, https://clinicaltrials.gov/ct2/home, NCT02560389.

Prefrontal tDCS Attenuates Self-Referential Attentional Deployment: A Mechanism Underlying Adaptive Emotional Reactivity to Social-Evaluative Threat

Social-evaluative threat (SET) - a situation in which one could be negatively evaluated by others - elicits profound (psycho)physiological reactivity which, if chronically present and not adaptively regulated, has deleterious effects on mental and physical health. Decreased self-awareness and increased other-awareness are understood to be an adaptive response to SET. Attentional deployment - the process of selectively attending to certain aspects of emotional stimuli to modulate emotional reactivity - is supported by fronto-parietal and fronto-limbic networks, with the dorsolateral prefrontal cortex being a central hub. The primary aim of the current study was to investigate the effects of active (versus sham) prefrontal transcranial direct current stimulation (tDCS) on self and other-attentional deployment during the exposure to a SET context. Seventy-four female participants received active or sham tDCS and were subsequently exposed to a rigged social feedback paradigm. In this paradigm a series of social evaluations were presented together with a photograph of the supposed evaluator and a self- photograph of the participant, while gaze behavior (time to first fixation, total fixation time) and skin conductance responses (SCRs; a marker of emotional reactivity) were measured. For half of the evaluations, participants could anticipate the valence (negative or positive) of the evaluation a priori. Analyses showed that participants receiving active tDCS were (a) slower to fixate on their self-photograph, (b) spent less time fixating on their self-photograph, and (c) spent more time fixating on the evaluator photograph. During unanticipated evaluations, active tDCS was associated with less time spent fixating on the evaluation. Furthermore, among those receiving active tDCS, SCRs were attenuated as a function of slower times to fixate on the self-photograph. Taken together, these results suggest that in a context of SET, prefrontal tDCS decreases self-attention while increasing other-attention, and that attenuated self-referential attention specifically may be a neurocognitive mechanism through which tDCS reduces emotional reactivity. Moreover, the results suggest that tDCS reduces vigilance toward stimuli that possibly convey threatening information, corroborating past research in this area.

Neuroticism vulnerability factors of anxiety symptoms in adolescents and early adults: an analysis using the bi-factor model and multi-wave longitudinal model

Background

Neuroticism and stress are important vulnerability factors in the development and outcome of anxiety symptoms. However, as neuroticism is a heterogeneity trait, it is still unclear how different neuroticism factors contribute to anxiety symptoms independently or in conjunction with stress. Thus, different factors of neuroticism were extracted in the present longitudinal study using the bi-factor model. The prediction effect of these different factors on anxiety symptoms and their combined effects with stress in both adolescent and adult samples were examined.

Method

Participants (592 adolescents and 638 young adults) in Hunan China were included. In the initial assessment in our longitudinal study, participants were asked to complete measurements that assessed neuroticism, stress, and anxiety symptoms. Next, a monthly assessment of stress and anxiety symptoms was completed for the subsequent 6 months. The bi-factor model was used to extract different factors of neuroticism. The hierarchical linear model was used to analyze longitudinal multi-wave data.

Result

Several model fit indices were used to evaluate the bi-factor model fit for neuroticism (adolescent: Tucker-Lewis index (TLI) = 0.957, comparative fit index (CFI) = 0.973, RMSEA = 0.040, Chi-Square = 80.471; early adults: TLI = 0.957, CFI = 0.973, RMSEA = 0.042, Chi-Square = 88.465). The results of hierarchical linear modeling analyses indicated that the general factor of neuroticism possessed a predictive effect on anxiety symptoms (adolescents: F = 36.77, p < 0.0001, early adults: F = 30.44, p < 0.0001); The negative effect factor only had the prediction effect on anxiety symptoms in early adults (adolescents: F = 0.65, p > 0.05; early adults: F = 4.84, p < 0.05); No prediction of self-reproach factor was found on anxiety symptoms (adolescents: F = 3.79, p > 0.05; early adults: F = 0.02, p > 0.05); the interactive effects of the general factor and stress on anxiety symptoms were only found in early adulthood (adolescents: F = 0.13, p > 0.05; early adults: F = 11.55, p < 0.01).

Conclusion

Our results suggested that the bi-factor model achieved a satisfactory fit for neuroticism measurement and supported that the anxiety symptoms were induced by the main effects of the general factor in both age samples and the negative factor only in adults. The general factor of neuroticism, but not the negative factor could make an additive effect for anxiety symptoms in face of stress, which meant that the homogeneity of neuroticism played a more significant role in further anxiety symptoms than heterogeneity when coping with stress.

E-cigarettes use prior to smoking combustible cigarettes among dual users: The roles of social anxiety and E-cigarette outcome expectancies

E-cigarette use is prevalent, and rates of use continue to increase. Although e-cigarettes are often used to help combustible users quit or reduce smoking, some use e-cigarettes in the absence of combustible cigarettes, increasing risk for smoking combustible cigarettes. Yet, little research has examined individual vulnerability factors implicated in transitioning from exclusive e-cigarettes use to dual use of combustible cigarettes. Social anxiety may be one such factor given it is related to a variety of negative smoking-related outcomes. Thus, the current study tested whether social anxiety was related to using e-cigarettes before smoking combustibles among 226 current undergraduate dual users (use both e-cigarettes and combustible cigarettes). Most dual users reported initiating with e-cigarettes (67%). Those who initiated with e-cigarettes reported statistically significantly greater negative reinforcement (d = 0.59) and weight control expectancies (d = 0.37) and greater social anxiety (d = 0.37) than those who initiated with combustibles. Social anxiety was indirectly related to e-cigarette initiation via negative and weight control expectancies. Findings add to a growing literature that dual users initiated with e-cigarettes and extend understanding of this phenomenon by identifying that socially anxious persons may be especially vulnerable to doing so, at least partially due to expectations regarding e-cigarette's ability to manage negative affect and/or weight.

Contextual goal-dependent attention flexibility or rule-based learning? An investigation of a new attention flexibility paradigm

BACKGROUND & OBJECTIVES

Deficits in the ability to process contextual changes have been proposed to be crucial for emotion dysregulation. A recent study found evidence for the role of contextual changes in exacerbating attention switching towards valence-specific goals using a novel attention flexibility paradigm. Despite the task indicating good reliability, the role of rule-based learning has not been clarified in this paradigm. Therefore, we examined whether the novel attention flexibility task is an index of context-based attention switching or does it reflect impact of rule-based learning on attention.

METHOD

We employed a neutral version of the attention flexibility task. A sample of dysphoric and non-dysphoric participants were introduced to neutral contexts which required them to shift between neutral categories of pictures depending upon the cueing shape.

RESULTS

There was an existence of a switch cost for shifting between different rules owing to the features of the rules. Further, non-dysphorics were faster at set-shifting between different rules as compared to dysphoric individuals. However, unlike in the affective version of the attention flexibility task, we found no significant differences between dysphoric and non-dysphoric individuals in attention switching patterns owing to switching between different rules.

LIMITATIONS

Although the current study aimed to replicate the design of the previous study, a depressed patient sample must be employed to further clarify the different aspects of the attention flexibility paradigm.

CONCLUSION

Our findings were able to clarify the non-existent role of rule-based learning in the attention flexibility paradigm.

Self-Report Measures of Anhedonia and Approach Motivation Weakly Correspond to Anhedonia and Depression Assessed via Clinical Interviews

Self-report scales are popular tools for measuring anhedonic experiences and motivational deficits, but how well do they reflect clinically significant anhedonia? Seventy-eight adults participated in face-to-face structured diagnostic interviews: 22 showed clinically significant anhedonia, and 18 met criteria for depression. Analyses of effect sizes comparing the anhedonia and depression groups to their respective controls found large effects, as expected, for measures of depressive symptoms, but surprisingly weak effect sizes (all less than d=.50) for measures of general, social, or physical anhedonia, behavioral activation, and anticipatory and consummatory pleasure. Measures of Neuroticism and Extraversion distinguished the anhedonic and depressed groups from the controls at least as well as measures of anhedonia and motivation. Taken together, the findings suggest that caution is necessary when extending self-report findings to populations with clinically significant symptoms.