1
|
He J, Kurita K, Yoshida T, Matsumoto K, Shimizu E, Hirano Y. Comparisons of the amplitude of low-frequency fluctuation and functional connectivity in major depressive disorder and social anxiety disorder: A resting-state fMRI study. J Affect Disord 2024; 362:425-436. [PMID: 39004312 DOI: 10.1016/j.jad.2024.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 06/20/2024] [Accepted: 07/11/2024] [Indexed: 07/16/2024]
Abstract
BACKGROUND Studies comparing the brain functions of major depressive disorder (MDD) and social anxiety disorder (SAD) at the regional and network levels remain scarce. This study aimed to elucidate their pathogenesis using neuroimaging techniques and explore biomarkers that can differentiate these disorders. METHODS Resting-state fMRI data were collected from 48 patients with MDD, 41 patients with SAD, and 82 healthy controls. Differences in the amplitude of low-frequency fluctuations (ALFF) among the three groups were examined to identify regions showing abnormal regional spontaneous activity. A seed-based functional connectivity (FC) analysis was conducted using ALFF results as seeds and different connections were identified between regions showing abnormal local spontaneous activity and other regions. The correlation between abnormal brain function and clinical symptoms was analyzed. RESULTS Patients with MDD and SAD exhibited similar abnormal ALFF and FC in several brain regions; notably, FC between the right superior frontal gyrus (SFG) and the right posterior supramarginal gyrus (pSMG) in patients with SAD was negatively correlated with depressive symptoms. Furthermore, patients with MDD showed higher ALFF in the right SFG than HCs and those with SAD. LIMITATION Potential effects of medications, comorbidities, and data type could not be ignored. CONCLUSION MDD and SAD showed common and distinct aberrant brain function patterns at the regional and network levels. At the regional level, we found that the ALFF in the right SFG was different between patients with MDD and those with SAD. At the network level, we did not find any differences between these disorders.
Collapse
Affiliation(s)
- Junbing He
- Research Center for Child Mental Development, Chiba University, Chiba, Japan; Department of Cognitive Behavioral Physiology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Kohei Kurita
- Research Center for Child Mental Development, Chiba University, Chiba, Japan; United Graduate School of Child Development, Osaka University, Suita, Japan
| | - Tokiko Yoshida
- Research Center for Child Mental Development, Chiba University, Chiba, Japan; United Graduate School of Child Development, Osaka University, Suita, Japan
| | - Koji Matsumoto
- Department of Radiology, Chiba University Hospital, Chiba, Japan
| | - Eiji Shimizu
- Research Center for Child Mental Development, Chiba University, Chiba, Japan; Department of Cognitive Behavioral Physiology, Graduate School of Medicine, Chiba University, Chiba, Japan; United Graduate School of Child Development, Osaka University, Suita, Japan
| | - Yoshiyuki Hirano
- Research Center for Child Mental Development, Chiba University, Chiba, Japan; United Graduate School of Child Development, Osaka University, Suita, Japan.
| |
Collapse
|
2
|
Guo L, Awiphan R, Wongpakaran T, Kanjanarat P, Wedding D. Social Anxiety among Middle-Aged Teachers in Secondary Education Schools. Eur J Investig Health Psychol Educ 2024; 14:2390-2403. [PMID: 39194952 DOI: 10.3390/ejihpe14080158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Revised: 08/13/2024] [Accepted: 08/14/2024] [Indexed: 08/29/2024] Open
Abstract
BACKGROUND This study aimed to investigate the prevalence of social anxiety symptoms (SASs) and its associated factors among middle-aged teachers in secondary education schools. METHODS A cross-sectional survey was conducted from December 2023 to March 2024 among 341 secondary education schoolteachers aged 45-59 in Chiang Mai, Thailand, involving an online survey. Effects of psychosocial variables on SASs were investigated, including attachment anxiety, attachment avoidance, neuroticism and extraversion personality traits, loneliness, perceived social stress, job burnout, and anxiety and depression. Multiple linear regression was used to identify predictors of SASs. RESULTS This study found that 98 out of 341 (28.7%) teachers presented SASs. Multiple linear regression analysis showed that marital status (β = 0.103, 95% CI [0.437, 3.404]), income (β = 0.087, 95% CI [0.049, 3.758]), extraversion (β = -0.179, 95% CI [-0.573, -0.198]), attachment anxiety (β = 0.165, 95% CI [0.106, 0.359]), attachment avoidance (β = 0.145, 95% CI [0.066, 0.243]), depression (β = 0.242, 95% CI [0.248, 0.862]), loneliness (β = 0.182, 95% CI [0.099, 0.580]), and perceived social stress (β = 0.235, 95% CI [0.131, 0.373]) were significant predictors of SASs, explaining 51.1% of the variance. CONCLUSION This study discovered a relatively high prevalence of SASs among middle-aged secondary schoolteachers.
Collapse
Affiliation(s)
- Lihan Guo
- Master of Science Program (Mental Health), Multidisciplinary and Interdisciplinary School (MIdS), Chiang Mai University, Chiang Mai 50200, Thailand
| | - Ratanaporn Awiphan
- Master of Science Program (Mental Health), Multidisciplinary and Interdisciplinary School (MIdS), Chiang Mai University, Chiang Mai 50200, Thailand
- Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai 50200, Thailand
- Pharmacoepidemiology and Statistics Research Center (PESRC), Faculty of Pharmacy, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Tinakon Wongpakaran
- Master of Science Program (Mental Health), Multidisciplinary and Interdisciplinary School (MIdS), Chiang Mai University, Chiang Mai 50200, Thailand
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Penkarn Kanjanarat
- Master of Science Program (Mental Health), Multidisciplinary and Interdisciplinary School (MIdS), Chiang Mai University, Chiang Mai 50200, Thailand
- Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai 50200, Thailand
- Pharmacoepidemiology and Statistics Research Center (PESRC), Faculty of Pharmacy, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Danny Wedding
- Master of Science Program (Mental Health), Multidisciplinary and Interdisciplinary School (MIdS), Chiang Mai University, Chiang Mai 50200, Thailand
- Department of Clinical and Humanistic Psychology, Saybrook University, Pasadena, CA 91103, USA
- Department of Psychology, University of Missouri-Saint Louis, St. Louis, MO 63121, USA
| |
Collapse
|
3
|
Babicola L, Mancini C, Riccelli C, Di Segni M, Passeri A, Municchi D, D'Addario SL, Andolina D, Cifani C, Cabib S, Ventura R. A mouse model of the 3-hit effects of stress: Genotype controls the effects of life adversities in females. Prog Neuropsychopharmacol Biol Psychiatry 2023; 127:110842. [PMID: 37611651 DOI: 10.1016/j.pnpbp.2023.110842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 08/14/2023] [Accepted: 08/17/2023] [Indexed: 08/25/2023]
Abstract
Helplessness is a dysfunctional coping response to stressors associated with different psychiatric conditions. The present study tested the hypothesis that early and adult adversities cumulate to produce helplessness depending on the genotype (3-hit hypothesis of psychopathology). To this aim, we evaluated whether Chronic Unpredictable Stress (CUS) differently affected coping and mesoaccumbens dopamine (DA) responses to stress challenge by adult mice of the C57BL/6J (B6) and DBA/2J (D2) inbred strains depending on early life experience (Repeated Cross Fostering, RCF). Three weeks of CUS increased the helplessness expressed in the Forced Swimming Test (FST) and the Tail Suspension Test by RCF-exposed female mice of the D2 strain. Moreover, female D2 mice with both RCF and CUS experiences showed inhibition of the stress-induced extracellular DA outflow in the Nucleus Accumbens, as measured by in vivo microdialysis, during and after FST. RCF-exposed B6 mice, instead, showed reduced helplessness and increased mesoaccumbens DA release. The present results support genotype-dependent additive effects of early experiences and adult adversities on behavioral and neural responses to stress by female mice. To our knowledge, this is the first report of a 3-hit effect in an animal model. Finally, the comparative analyses of behavioral and neural phenotypes expressed by B6 and D2 mice suggest some translationally relevant hypotheses of genetic risk factors for psychiatric disorders.
Collapse
Affiliation(s)
- Lucy Babicola
- IRCCS Fondazione Santa Lucia, Rome, Italy; Dept. of Psychology and Center "Daniel Bovet", Sapienza University, Rome 00184, Italy
| | - Camilla Mancini
- University of Camerino, School of Pharmacy, Pharmacology Unit, Camerino, Italy
| | - Cristina Riccelli
- Dept. of Psychology and Center "Daniel Bovet", Sapienza University, Rome 00184, Italy
| | - Matteo Di Segni
- IRCCS Fondazione Santa Lucia, Rome, Italy; Dept. of Psychology and Center "Daniel Bovet", Sapienza University, Rome 00184, Italy
| | - Alice Passeri
- Dept. of Psychology and Center "Daniel Bovet", Sapienza University, Rome 00184, Italy
| | - Diana Municchi
- IRCCS Fondazione Santa Lucia, Rome, Italy; Dept. of Psychology and Center "Daniel Bovet", Sapienza University, Rome 00184, Italy
| | | | - Diego Andolina
- IRCCS Fondazione Santa Lucia, Rome, Italy; Dept. of Psychology and Center "Daniel Bovet", Sapienza University, Rome 00184, Italy
| | - Carlo Cifani
- University of Camerino, School of Pharmacy, Pharmacology Unit, Camerino, Italy
| | - Simona Cabib
- IRCCS Fondazione Santa Lucia, Rome, Italy; Dept. of Psychology and Center "Daniel Bovet", Sapienza University, Rome 00184, Italy.
| | - Rossella Ventura
- IRCCS Fondazione Santa Lucia, Rome, Italy; IRCCS San Raffaele, Rome, Italy.
| |
Collapse
|
4
|
Adams GC, Wrath AJ, Mela M, DesRoches A, Adams S, Andreen A, McKenna A. Childhood trauma as a mediator between attachment and recidivism risk: A study of Canadian offenders with mental disorders. BEHAVIORAL SCIENCES & THE LAW 2023; 41:96-108. [PMID: 36856141 DOI: 10.1002/bsl.2612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 01/20/2023] [Accepted: 02/08/2023] [Indexed: 06/03/2023]
Abstract
The current study aimed to explore the relationships between attachment and childhood trauma on recidivism risk in a sample of Canadian offenders with mental disorder (OMDs). N = 56 OMDs completed the Adverse Childhood Experiences (ACE) questionnaire, a measure of adult attachment (Experiences in Close Relationships Scale), and interview to determine recidivism risk (Level of Service/Case Management Inventory; LS/CMI). The variables of interest had small to moderate correlations. Multivariable regression analysis found that ACE scores but not attachment insecurity were associated with LS/CMI scores. Mediation analyses demonstrated that ACE scores fully mediated the association between attachment anxiety and attachment avoidance and recidivism risk. Results demonstrate that as exposure to diverse ACEs increased so did the risk to recidivate and this exposure mediated the relationship between attachment insecurity and recidivism risk. This study highlights the necessity of addressing both attachment insecurity and the experience of ACE when providing psychiatric services to OMDs.
Collapse
Affiliation(s)
- G Camelia Adams
- Department of Psychiatry, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Andrew J Wrath
- Department of Psychiatry, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Mansfield Mela
- Department of Psychiatry, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Andrea DesRoches
- Department of Psychiatry, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Stephen Adams
- Department of Psychiatry, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | - Anne McKenna
- Community Advisor, Saskatoon, Saskatchewan, Canada
| |
Collapse
|
5
|
Rajkumar RP. Comorbid depression and anxiety: Integration of insights from attachment theory and cognitive neuroscience, and their implications for research and treatment. Front Behav Neurosci 2022; 16:1104928. [PMID: 36620859 PMCID: PMC9811005 DOI: 10.3389/fnbeh.2022.1104928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022] Open
|
6
|
Li K, Ren L, Zhang L, Liu C, Zhao M, Zhan X, Li L, Luo X, Feng Z. Social anxiety and depression symptoms in Chinese left-behind children after the lifting of COVID-19 lockdown: A network analysis. Int J Soc Psychiatry 2022:207640221141784. [PMID: 36511138 PMCID: PMC9749067 DOI: 10.1177/00207640221141784] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Returning to social life after the lifting of COVID-19 lockdown may increase risk of social anxiety, which is highly co-morbid with depression. However, few studies have reported the association between them. AIMS To explore the complex relationship between social anxiety and depression symptoms in left-behind children after the lifting of the COVID-19 lockdown. METHODS A cross-sectional survey was conducted 6 months after the lockdown removal. A total of 3,107 left-behind children completed the survey with a mean age of 13.33 and a response rate of 87.77%. Depression and social anxiety severity were assessed by the DSM-5 Patient Health Questionnaire for Adolescents and the DSM-5 Social Anxiety Disorder Questionnaire, respectively. The symptom-level association between the two disorders was examined using network analysis. RESULTS After the lifting of COVID-19 lockdown, the prevalence of depression and social anxiety in left-behind children was 19.57% and 12.36%, respectively, with a co-morbidity rate of 8.98%. Network analysis showed that "Social tension" and "Social avoidance" had the greatest expected influence; "Humiliation" and "Motor" were bridge symptom nodes in the network. The directed acyclic graph indicated that "Social fright" was at the upstream of all symptoms. CONCLUSION Attention should be paid to social anxiety symptoms in left-behind children after the lifting of COVID-19 lockdown. Prevention and intervention measures should be taken promptly to reduce the comorbidity of social anxiety and depression symptoms in the left-behind children after the lifting of lockdown.
Collapse
Affiliation(s)
- Kuiliang Li
- Department of Medical English, School of Basic Medical Sciences, Army Medical University, Chongqing, China.,School of Psychology, Army Medical University, Chongqing, China
| | - Lei Ren
- Department of Military Medical Psychology, Fourth Military Medical University, Xi' an, China
| | - Lei Zhang
- Department of Medical English, School of Basic Medical Sciences, Army Medical University, Chongqing, China
| | - Chang Liu
- BrainPark, Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Clayton, Australia
| | - Mengxue Zhao
- School of Psychology, Army Medical University, Chongqing, China
| | - Xiaoqing Zhan
- Department of Medical English, School of Basic Medical Sciences, Army Medical University, Chongqing, China
| | - Ling Li
- College of General Education, Chongqing Water Resources and Electric Engineering College, Chongqing, China
| | - Xi Luo
- Department of Medical English, School of Basic Medical Sciences, Army Medical University, Chongqing, China
| | - Zhengzhi Feng
- School of Psychology, Army Medical University, Chongqing, China
| |
Collapse
|
7
|
Recollection of childhood trauma changes according to the shift in individual attachment rather than psychiatric diagnosis. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2022. [DOI: 10.1016/j.jadr.2022.100382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|
8
|
Social anxiety disorder with comorbid major depression - why fearful attachment style is relevant. J Psychiatr Res 2022; 147:283-290. [PMID: 35114512 DOI: 10.1016/j.jpsychires.2022.01.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 12/17/2021] [Accepted: 01/09/2022] [Indexed: 11/22/2022]
Abstract
Individuals with social anxiety disorder (SAD) often suffer from comorbid major depressive disorder (MDD), which goes along with increased clinical and functional impairment. There has been little research on underlying differences regarding childhood adversities and attachment styles between individuals with SAD with and without comorbid MDD. In the present study, the consecutive sample comprised 612 SCID-diagnosed participants. Of these, n = 472 (62.3% women, 40.7 ± 13.8 years) showed SAD and comorbid MDD (SAD-MDD group) and n = 140 (47.9% women, 43.7 ± 14.7 years) showed just SAD (SAD group). The two groups were compared regarding SAD symptom severity (Social Phobia Inventory; SPIN), childhood adversities (Adverse Childhood Experience Questionnaire; ACE) and attachment styles (Attachment Style Questionnaire, ASQ). The SAD-MDD group reported significantly more severe SAD symptoms (p = .002, d = 0.30), more childhood adversities (p < .001, d = 0.35) and a higher level of fearful attachment style (p < .001, d = 0.30). Group significantly moderated the association between fearful attachment style and SAD symptom severity (β = .292, p < .05) but not between preoccupied attachment style and SAD symptom severity (β = -.184, p = .124; R2adj = .168, p < .05). Fearful attachment style mediated the association between childhood adversities and SAD symptom severity in the SAD-MDD group. Our study could identify a specific significance of fearful attachment style for the association between negative childhood experiences and social anxiety symptoms in SAD-MDD. Findings have specific implications for the therapeutic relationship.
Collapse
|
9
|
Tan TX, Liu Y, Zhang Q, Li G, Chen X, Li J. Affective Representation of Early Relationships with Parents and Current Anxiety and Depression. The Journal of Genetic Psychology 2022; 183:235-249. [PMID: 35220918 DOI: 10.1080/00221325.2022.2043231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Research on the role of early relationships with parents on youth's anxiety and depression, especially in collectivist societies such as China, is limited. To fill this gap, we investigated the unique role of early relationship with mothers and fathers, respectively, in Chinese youth's anxiety and depression outcomes. The participants were 347 Chinese college students from 20 provinces. They first separately rated the frequency of experiencing 13 emotions (e.g., anger) from recalling early relationships with their mothers and fathers, then completed the Zung Self-Rating Anxiety Scale and the Zung Self-Rating Depression Scale. Logistic regression was performed to determine the unique contribution of early relationships with mothers and fathers, respectively, to the participants' clinical-level anxiety and depression. Based on the final model of our logistical regression, we found that an increase in negative affective representation of early relationship with the mother was associated with a higher likelihood of clinical level anxiety (OR = 3.58; 95% CI = 1.32-9.70), while an increase in positive affective representation of early relationship with the mother was associated with a lower likelihood of clinical-level depression (OR = 0.47; 95% CI = 0.25-0.87). Furthermore, an increase in negative affective representation of early relationship with the father was associated with a higher likelihood of clinical-level anxiety (OR = 3.36; 95% CI = 1.37-8.26) and depression (OR = 3.68; 95% CI = 1.59-8.52), above and beyond their affective representation of early relationship with the mother.
Collapse
Affiliation(s)
- Tony Xing Tan
- Educational and Psychological Studies, University of South Florida, Tampa, USA
| | - Yanhong Liu
- Department of Counseling & Human Services, Syracuse University, Syracuse, USA
| | - Qiumei Zhang
- School of Public Health, Jining Medical University, Jining, China
| | - Gen Li
- Educational and Psychological Studies, University of South Florida, Tampa, USA
| | - Xiongying Chen
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders & the Advanced Innovation Center for Human Brain Protection, Beijing Anding Hospital, School of Mental Health, Capital Medical University, Beijing, China
| | - Jun Li
- State Key Laboratory of Cognitive Neuroscience and Learning & IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
| |
Collapse
|
10
|
Qiu H, Wang L, Zeng X, Pan J. Comorbidity patterns in depression: A disease network analysis using regional hospital discharge records. J Affect Disord 2022; 296:418-427. [PMID: 34606805 DOI: 10.1016/j.jad.2021.09.100] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 08/31/2021] [Accepted: 09/26/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Depression is a psychiatric disorder with a high comorbidity burden; however, previous comorbidity studies predominately focused on a few common diseases and relied on self-reported data. We aimed to investigate the comorbid status of depression concerning the entire spectrum of chronic diseases using network analysis. METHOD Totally, 22,872 depressed inpatients and one-to-one matched controls were enrolled in the retrospective study. Hospital discharge records were aggregated to measure the comorbidities, where those with a prevalence ≥ 1% were selected for further analysis. Based on the co-occurrence frequency, sex- and age-specific comorbidity networks in depressed patients were constructed and the results were compared with the controls. Louvain algorithm was used to detect the highly interlinked communities. RESULTS Depressed patients had 4 comorbidities on average, and 84.4% had at least one comorbidity. The comorbidity network in depression cases was more complex than controls (connections of 839 vs. 369). Intricate but distinct communities appeared within the comorbidity network in depressed patients, where the largest community included cerebrovascular diseases, chronic ischaemia heart disease, atherosclerosis and osteoporosis. Sex-specific central diseases existed, and cardiovascular diseases were the major central diseases to both gender. The older the depressed patients, the more severe the central diseases in the comorbidity network. LIMITATIONS The causality of the observed interactions could not be determined. CONCLUSIONS The application of network analysis on longitudinal healthcare datasets to assess comorbidity patterns can supplement the traditional clinical study approaches. The findings would improve our understanding of depression-related comorbidities and enhance the integrated management of depression.
Collapse
Affiliation(s)
- Hang Qiu
- School of Computer Science and Engineering, University of Electronic Science and Technology of China, Chengdu, China; Big Data Research Center, University of Electronic Science and Technology of China, Chengdu, China.
| | - Liya Wang
- Big Data Research Center, University of Electronic Science and Technology of China, Chengdu, China
| | - Xianrong Zeng
- Department of Neurology, Sichuan Provincial People's Hospital, Chengdu, China
| | - Jingping Pan
- Health Information Center of Sichuan Province, Chengdu, China
| |
Collapse
|
11
|
Radetzki PA, Wrath AJ, Le T, Adams GC. Alexithymia is a mediating factor in the relationship between adult attachment and severity of depression and social anxiety. J Affect Disord 2021; 295:846-855. [PMID: 34706455 DOI: 10.1016/j.jad.2021.08.057] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 07/20/2021] [Accepted: 08/24/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Major depressive disorder (MDD) and social anxiety disorder (SAD) are commonly occurring conditions, either alone or together (MDD-SAD). Recent research linked insecure attachment and alexithymia to MDD and/or SAD, indicating that the way affected individuals relate interpersonally and their ability to identify and communicate emotions are pertinent issues. The current study investigated the mediating role of alexithymia in the relationship between insecure attachment and severity of MDD and SAD symptoms. METHOD Using the SCID-I, participants (N=159) were identified as MDD-only (n=43), MDD-SAD (n=56), or a healthy control (n=60). Participants completed measures of adult attachment, depression, social anxiety and alexithymia (defined as difficulty identifying and describing feelings). A two-step mediation analysis approach recommended by Shrout and Bolger determined if alexithymia mediates the relationship between attachment-depression and attachment-social anxiety. RESULTS While alexithymia was high in MDD-only and MDD-SAD groups, individuals with MDD-SAD had significantly greater difficulty describing feelings. Alexithymia was a full mediator between attachment avoidance and depression, but only a partial mediator between attachment anxiety and depression. Meanwhile, alexithymia was a partial mediator for both attachment dimensions and social anxiety. LIMITATIONS Causal inferences regarding insecure attachment, alexithymia, and MDD and SAD cannot be assumed given the cross-sectional data. The 'externally oriented thinking' component in alexithymia was also excluded from analyses due to low reliability. CONCLUSION The results suggest emotional awareness and expression play a role in the illness severity for MDD and SAD-particularly in those with high attachment avoidance, offering a possible target for treatment and prevention strategies.
Collapse
Affiliation(s)
| | - Andrew J Wrath
- Department of Psychiatry, University of Saskatchewan, Canada
| | - Thuy Le
- Department of Psychiatry, University of Saskatchewan, Canada
| | - G Camelia Adams
- Department of Psychiatry, University of Saskatchewan, Canada.
| |
Collapse
|
12
|
Herstell S, Betz LT, Penzel N, Chechelnizki R, Filihagh L, Antonucci L, Kambeitz J. Insecure attachment as a transdiagnostic risk factor for major psychiatric conditions: A meta-analysis in bipolar disorder, depression and schizophrenia spectrum disorder. J Psychiatr Res 2021; 144:190-201. [PMID: 34678669 DOI: 10.1016/j.jpsychires.2021.10.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 10/04/2021] [Accepted: 10/10/2021] [Indexed: 01/15/2023]
Abstract
Insecure attachment has been suggested as a major risk factor for mental health problems as well as a key element for the development and trajectory of psychiatric disorders. The aim of this meta-analysis was to assess whether insecure attachment constitutes a global transdiagnostic risk factor in bipolar disorder, depression, and schizophrenia spectrum disorders. We conducted a PRISMA-based systematic quantitative review to explore the prevalence of insecure attachment among patients of three representative psychiatric disorders - major depression, schizophrenia spectrum disorders and bipolar disorder - in comparison with healthy controls (HC) from a transdiagnostic point of view. Effect sizes on differences of anxious, avoidant and insecure prevalence were calculated based on 40 samples including a total of n = 2927 individuals. Overall, results indicated a large effect on prevalence of insecure attachment across all disorders compared to HC (k = 30, g = 0.88, I2 = 71.0%, p < 0.001). In a transdiagnostic comparison, the only difference was found in avoidant attachment, which was significantly lower (p = 0.04) compared to HC in the schizophrenia spectrum disorder subgroup (k = 10, g = 0.31, I2 = 76.60%, p < 0.0001) than the depression subgroup subgroup (k = 12, g = 0.83, I2 = 46.65%, p < 0.0001). The lack of further transdiagnostic differences between three distinct psychiatric disorders corroborates insecure attachment as a general vulnerability factor to psychopathology. Our findings warrant further investigations, which should explore the pathways from attachment insecurity towards psychopathology. Insecure attachment likely has implications on assessment, prediction and treatment of psychiatric patients.
Collapse
Affiliation(s)
- Simon Herstell
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
| | - Linda T Betz
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
| | - Nora Penzel
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany; Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Nußbaumstraße 7, 80336, Munich, Germany.
| | - Ruth Chechelnizki
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
| | - Laura Filihagh
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
| | - Linda Antonucci
- Department of Education, Psychology and Communication - University of Bari Aldo Moro, Piazza Umberto I, 1, 70121, Bari BA, Italy; Department of Basic Medical Sciences, Neuroscience and Sense Organs - University of Bari Aldo Moro, Piazza Umberto I, 1, 70121, Bari BA, Italy.
| | - Joseph Kambeitz
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
| |
Collapse
|
13
|
Küçükparlak İ, Karaş H, Kaşer M, Yildirim EA. The Relationship of Theory of Mind and Attachment Characteristics with Disease Severity in Social Anxiety Disorder. ACTA ACUST UNITED AC 2021; 58:63-67. [PMID: 33795955 DOI: 10.29399/npa.27169] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 07/17/2020] [Indexed: 11/07/2022]
Abstract
Introduction The aim of our study is to compare the attachment characteristics and the theory of mind abilities measured by the Eyes Test between social anxiety disorder (SAD) patients and healthy controls. Another aim of our study is to investigate the relationship between attachment characteristics, theory of mind abilities and disease severity in patients with SAD. Method 47 consecutive patients with SAD and 50 healthy controls were recruited for the study. Sociodemographic data form, SCID-I Structured Clinical Interview form Patient Version, Beck Depression Inventory (BDI), Reading Mind in the Eyes Test (Eye Test), Liebowitz Social Anxiety Scale (LSAS), Experiences in Close Relationship Inventory (ECR) and State-Trait Anxiety Inventory (STAI) were administered to all participants. Results The BDI, LSAS anxiety and avoidence, ECR and anxiety and avoidance, STAI state and trait anxiety scores of the SAD group were higher than the controls, but the Eyes Test scores were lower. It was observed that the Eyes Test score difference between the two groups survived when controlled for BDI and STAI state and trait anxiety scores. In the SAD group, both ECR anxiety and avoidance scores were associated with LSAS anxiety and avoidance scores. Eyes Test scores were associated with LSAS anxiety and avoidance scores. In regression analysis, it was observed that the Eyes Test, ECR anxiety and avoidance scores effected both the LSAS anxiety and the LSAS avoidance scores. Conclusion In SAD patients, the theory of mind functions was impaired when compared to healthy controls, and this difference has been found to be independent of anxiety or depression levels. Attachment anxiety and avoidance dimensions have negative effects on SAD disease severity. The fact that the theory of mind ability is inversely related with SAD severity suggests that interventions to improve social cognition might have a potential to decrease the severity of disease in SAD.
Collapse
Affiliation(s)
| | - Hakan Karaş
- İstanbul Gelişim University, Psychology Department, İstanbul, Turkey
| | - Muzaffer Kaşer
- Cambridge University, Psychiatry Department, Cambridgeshire and Peterborough NHS Foundation, Cambridge, UK
| | - Ejder Akgün Yildirim
- Prof. Dr. Bakırköy Mental Health and Neurological Diseases Training and Research Hospital Psychiatry Department, İstanbul, Turkey
| |
Collapse
|
14
|
Attachment impacts cortisol awakening response in chronically depressed individuals. Psychoneuroendocrinology 2020; 120:104778. [PMID: 32585509 DOI: 10.1016/j.psyneuen.2020.104778] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 05/01/2020] [Accepted: 06/11/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Early life experiences shape individual attachment, creating a template for regulating emotions in interpersonal situations, likely to persist across the lifespan. Research has shown that individual attachment creates vulnerability for depression, and also impacts the Hypothalamic-Pituitary-Adrenal (HPA) axis. Still, the relationship between attachment and the HPA axis in depressed individuals is unclear. Cortisol awakening response (CAR) has been recently investigated as a possibly useful physiological marker related to attachment insecurity and depression risk. However, research exploring the relationship between the CAR and attachment in individuals with chronic depression in either the presence or the absence of comorbid anxiety is lacking. The purpose of the current study was to fill this gap, by comparing the CAR in individuals with chronic depression with/without comorbid anxieties and controls. In addition, we also wanted to explore the relationship between attachment and the CAR in this group and to explore their predictive role for later depression severity. METHODS Individuals experiencing a current depressive episode at least six months in length (cMDD; n = 63) and healthy controls (HC; n = 57) were enrolled in the study (total n = 120). Participants completed a structured clinical diagnostic interview (SCID-I) as well as measures of depression severity (Beck Depression Inventory-II (BDI-II) and Hamilton Rating Scale for Depression) and attachment dimensions (Experiences in Close Relationships scale; ECR) at baseline. In addition, participants provided salivary samples at four time points (i.e. 0 (S1), 30, 45 and 60 min) following awakening on two consecutive days. S1 cortisol, the area under the curve with respect to ground (AUCg) and increase (AUCi) were calculated based on the average values across both days. The HC and cMDD groups were compared on all measures. The CAR for individuals with cMDD alone (n = 14) and individuals with cMDD with two or more comorbid anxiety disorders (cMDD ≥ 2Anx; n = 30) were also compared. A subset of participants (n = 59) agreed to return for follow up one year later. Participants returning for follow up repeated the BDI-II and ECR. No salivary samples were collected at follow-up. RESULTS The cMDD group had significantly lower S1 cortisol and AUCg compared to the HC group (both p ≤ 0.02). cMDD and cMDD ≥ 2Anx groups did not differ in their CAR. Regression analyses revealed that depression severity and the attachment interaction term was associated with lower S1 and AUCg cortisol (p < 0.01). Greater attachment avoidance was positively associated with S1 cortisol (p = 0.02), while mean awakening time on sample days was negatively associated with S1 cortisol. We also found a significant interaction between the attachment dimensions such that at low levels of attachment anxiety, attachment avoidance had a positive relationship with S1 cortisol and AUCg. The opposite relationship existed when attachment anxiety was high. Higher baseline BDI-II score and higher baseline attachment anxiety were predictive of higher scores on the BDI-II one-year later (both p < 0.05). CONCLUSIONS The current findings bring evidence that depression severity is associated with blunting of the CAR irrespective of the comorbid status with anxiety disorders. In addition, attachment avoidance may protect against the CAR blunting in individuals with low attachment anxiety. However, individuals with high attachment anxiety and avoidance might have additional CAR blunting. Attachment anxiety might be a good predictor of future depression severity.
Collapse
|
15
|
Martínez-Quintana E, Girolimetti A, Jiménez-Rodríguez S, Fraguela-Medina C, Rodríguez-González F, Tugores A. Prevalence and predictors of psychological distress in congenital heart disease patients. J Clin Psychol 2020; 76:1705-1718. [PMID: 32149405 DOI: 10.1002/jclp.22948] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To determine psychological distress in congenital heart disease (CHD) patients. METHODS Cross-sectional study among consecutive CHD patients recruited from a single hospital outpatient clinic to determine anxiety and depression according to the Hospital Anxiety and Depression Scale (HADS) questionnaire. RESULTS One hundred and sixty-nine CHD patients [29 (19-39) years old, 100 (59%) males] were studied. A total of 25% and 9% of CHD patients showed anxiety and depression symptoms, respectively. Patients with an HADS score ≥ 8 had a significantly worse New York Heart Association (NYHA) functional class, needed more psychological support, had more mental health history, and took more anxiolytic/antidepressant medication than the CHD patients with an HADS score below 8. A worse NYHA functional class [OR, 1.88 (1.01-3.52)] proved to be a predictor of a borderline/abnormal HADS score. CONCLUSION Psychological distress has a high prevalence among CHD patients and having an NYHA Class II and III is a significant predictor of an HADS score ≥ 8.
Collapse
Affiliation(s)
- Efrén Martínez-Quintana
- Cardiology Service, Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas de Gran Canaria, Spain.,Medical and Surgical Sciences Department, Faculty of Health Sciences, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Angela Girolimetti
- Medical and Surgical Sciences Department, Faculty of Health Sciences, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Sara Jiménez-Rodríguez
- Medical and Surgical Sciences Department, Faculty of Health Sciences, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Carla Fraguela-Medina
- Medical and Surgical Sciences Department, Faculty of Health Sciences, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Fayna Rodríguez-González
- Ophthalmology Service, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | - Antonio Tugores
- Research Unit, Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas de Gran Canaria, Spain
| |
Collapse
|
16
|
Abstract
PURPOSE OF REVIEW The alternative model for personality disorders in DSM-5 and the upcoming ICD-11 stimulated an increased interest in the concept of personality functioning for the diagnosis of personality disorders. Furthermore, the impact of personality functioning on other mental disorders has become the focus of recent research efforts. The purpose of this review is to provide a comprehensive and critical study of the empirical literature on the relationship between personality functioning and anxiety disorders. RECENT FINDINGS Recent studies predominantly show a positive association of anxiety symptoms and disorders with an impairment in personality functioning. However, no evidence was found for different levels of personality functioning according to the type of anxiety disorder. Anxiety disorders can occur at all levels of personality organization. SUMMARY Anxiety disorders are associated with significant impairment in personality functioning. As the underlying personality structure is known to play a crucial role for treatment outcome, the evaluation of personality functioning should be a central part of a comprehensive diagnostic process and treatment planning in patients with anxiety disorders.
Collapse
|
17
|
A longitudinal exploration of the impact of social anxiety and individual attachment on depression severity. J Affect Disord 2019; 257:250-256. [PMID: 31301628 DOI: 10.1016/j.jad.2019.07.051] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 04/23/2019] [Accepted: 07/04/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Research suggests that insecure attachment and early onset of social anxiety disorder (SAD) create vulnerability for future depression. The current study explores the mediating role of social anxiety symptoms in the relationship between attachment and depression at baseline and one year later. The study also looks at the longitudinal impact of changes in attachment and social anxiety, on depression severity. METHODS Participants (n = 162) completed structured clinical interviews and measures of depression, social anxiety, and adult attachment. A subsample of the participants (n = 77) returned for a follow-up one year later and repeated the measures. Mediation analysis and multivariate linear regression were performed to examine the relationships between depression, social anxiety, and attachment. RESULTS Social anxiety was a full mediator of the relationship between attachment avoidance and depression severity at baseline but only a partial mediator at one-year follow-up. Social anxiety was a partial mediator of the relationship between attachment anxiety and depression severity at both baseline and follow-up. Lower baseline depression levels, improvement in social anxiety and improvement in attachment avoidance over the next year, predicted lower levels of depression at follow-up. LIMITATIONS The study did not gather information regarding the treatments received between baseline and follow-up. CONCLUSIONS Social anxiety plays a significant role in mediating the vulnerability towards severe depression in insecurely attached individuals. Treating social anxiety, particularly in individuals with avoidant attachment, might decrease the severity of future depression. In addition, interventions targeting attachment avoidance in youth might aid primary prevention strategies.
Collapse
|
18
|
Sackl-Pammer P, Jahn R, Özlü-Erkilic Z, Pollak E, Ohmann S, Schwarzenberg J, Plener P, Akkaya-Kalayci T. Social anxiety disorder and emotion regulation problems in adolescents. Child Adolesc Psychiatry Ment Health 2019; 13:37. [PMID: 31583014 PMCID: PMC6771087 DOI: 10.1186/s13034-019-0297-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 09/17/2019] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Social anxiety disorder (SAD) in adolescents may be associated with the use of maladaptive emotion regulation (ER) strategies. The present study examined the use of maladaptive and adaptive ER strategies in adolescents with SAD. METHODS 30 adolescents with SAD (CLIN) and 36 healthy adolescents for the control group (CON) aged between 11 and 16 years were assessed with the standardized questionnaires PHOKI (Phobiefragebogen für Kinder und Jugendliche) for self-reported fears as well as FEEL-KJ (Fragebogen zur Erhebung der Emotionsregulation bei Kindern und Jugendlichen) for different emotion regulation strategies. RESULTS Compared to controls, adolescents with SAD used adaptive ER strategies significantly less often, but made use of maladaptive ER strategies significantly more often. There was a significant positive correlation between maladaptive ER and social anxiety in adolescents. Examining group differences of single ER strategy use, the CLIN and CON differed significantly in the use of the adaptive ER strategy reappraisal with CLIN reporting less use of reappraisal than CON. Group differences regarding the maladaptive ER strategies withdrawal and rumination, as well as the adaptive ER strategy problem-solving were found present, with CLIN reporting more use of withdrawal and rumination and less use of problem-solving than CON. CONCLUSIONS Promoting adaptive emotion regulation should be a central component of psychotherapy (cognitive behavioral therapy-CBT) for social anxiety in adolescents from the beginning of the therapy process. These findings provide rationale for special therapy programs concentrating on the establishment of different adaptive ER strategies (including reappraisal). As an increased use of maladaptive ER may be associated with SAD in adolescents, it may be paramount to focus on reduction of maladaptive ER (for example withdrawal and rumination) from the beginning of the psychotherapy process. Incorporating more ER components into psychotherapy (CBT) could increase the treatment efficacy. Further investigations of the patterns of emotion regulation in specific anxiety groups like SAD in adolescents is needed to continue to optimize the psychotherapy (CBT) concept.
Collapse
Affiliation(s)
- Petra Sackl-Pammer
- 0000 0000 9259 8492grid.22937.3dDepartment of Child and Adolescent Psychiatry, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Rebecca Jahn
- 0000 0000 9259 8492grid.22937.3dDepartment for Psychiatry and Psychotherapy, Clinical Division of Social Psychiatry, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Zeliha Özlü-Erkilic
- 0000 0000 9259 8492grid.22937.3dOutpatient Clinic of Transcultural Psychiatry and Migration Induced Disorders in Childhood and Adolescence, Department of Child and Adolescent Psychiatry, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Eva Pollak
- 0000 0000 9259 8492grid.22937.3dDepartment of Child and Adolescent Psychiatry, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Susanne Ohmann
- 0000 0000 9259 8492grid.22937.3dDepartment of Child and Adolescent Psychiatry, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Julia Schwarzenberg
- 0000 0000 9259 8492grid.22937.3dDepartment of Child and Adolescent Psychiatry, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Paul Plener
- 0000 0000 9259 8492grid.22937.3dDepartment of Child and Adolescent Psychiatry, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Türkan Akkaya-Kalayci
- 0000 0000 9259 8492grid.22937.3dOutpatient Clinic of Transcultural Psychiatry and Migration Induced Disorders in Childhood and Adolescence, Department of Child and Adolescent Psychiatry, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| |
Collapse
|