1
|
Rabin C. Longitudinal study of the role of COVID worry versus general anxiety in predicting vaccination and other COVID-preventive behaviors. Psychol Health 2024:1-12. [PMID: 38419472 DOI: 10.1080/08870446.2024.2323764] [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: 07/27/2023] [Accepted: 02/21/2024] [Indexed: 03/02/2024]
Abstract
OBJECTIVE The COVID-19 pandemic highlighted the critical role of public engagement in health protective behaviors (e.g. masking, vaccination) to reduce viral spread and impact. Future public health efforts may be facilitated by identifying factors that impact the likelihood of adopting these behaviors. This study evaluated whether COVID-specific worry and/or generalized anxiety predicted subsequent uptake of COVID-19 vaccination and engagement in other COVID-preventive behaviors. METHOD AND MEASURES Participants (N = 205) completed an online survey in July 2020, shortly after the onset of the pandemic, and a follow-up survey, over a year later, after vaccines were available to the public. RESULTS Findings indicate that those reporting greater COVID-worry on the initial survey were more likely to get vaccinated against COVID-19 by the follow-up survey and to report greater engagement in COVID-protective behaviors at both timepoints. By contrast, lower levels of generalized anxiety predicted greater likelihood of vaccination by follow-up and greater engagement in other COVID-protective behaviors on the initial survey. CONCLUSIONS These findings suggest that worry about a specific health threat may have a protective function, motivating protective behavior, whereas elevated levels of generalized anxiety appear to undermine health protective behavior and should be aggressively addressed.
Collapse
Affiliation(s)
- Carolyn Rabin
- Clinical Psychology Department, William James College, Newton, MA, USA
| |
Collapse
|
2
|
Kilkelly TJ, Palmer J, Kreashko L. Improving Mental Health Outcomes in Adolescent Patients With Universal Anxiety Screening in an Outpatient Pediatric Primary Care Office: A Quality Improvement Project. J Pediatr Health Care 2023; 37:688-695. [PMID: 37715758 DOI: 10.1016/j.pedhc.2023.08.005] [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: 04/25/2023] [Revised: 08/17/2023] [Accepted: 08/17/2023] [Indexed: 09/18/2023]
Abstract
INTRODUCTION In the wake of the cultural and mental health consequences that arose since the COVID-19 pandemic, primary care providers must be able to assess and initiate treatment of anxiety disorders in the pediatric population. Only 59% of children with a diagnosable anxiety disorder are identified and receive treatment. This quality improvement project aimed to evaluate the implementation of universal anxiety screening using the General Anxiety Disorder-7 tool in pediatric primary care. METHODS Screening was performed on adolescents (aged 12-18 years) to evaluate the frequency and acceptability of tool administration and identification of anxiety and referrals to mental health care for treatment. Employing a pretest-posttest design, the effect of universal anxiety screening for adolescents was measured at well-child visits. RESULTS Anxiety screening and anxiety diagnosis rates were significantly increased post-implementation. DISCUSSION Universal screening for anxiety was efficacious in the project setting for identifying cases of anxiety.
Collapse
|
3
|
Vaillancourt M, Busseuil D, D'Antono B. Severity of psychological distress over five years differs as a function of sex and presence of coronary artery disease. Aging Ment Health 2022; 26:762-774. [PMID: 33764244 DOI: 10.1080/13607863.2021.1901262] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Psychological distress is more prevalent and severe among patients with coronary artery disease (CAD) compared to healthy individuals. Little is known regarding its time course, and whether these differences extend to individuals with non-cardiovascular (CV) illnesses. This study examined the presence, severity, and time course of psychological distress in men and women with CAD and those of similarly aged individuals suffering from non-CV conditions. METHODS 1229 individuals (61% men; meanage = 60.4 ± 7.0 years) with stable CAD or non-CV illnesses reported on social support, hostility, stress, anxiety and depression at baseline as well as 4.8 ± 0.8 years later. Analyses involved mixed (Sex*CAD status*Time) repeated measures analyses (controlling for relevant covariates), as well as Chi-square and McNemar analyses. RESULTS Women with CAD reported more symptoms of depression compared to other participants at both evaluations (p's < 0.01), and reported more symptoms of anxiety and stress compared to others at T1 (p's < 0.05). At T2, perceived stress remained significantly greater among women with CAD compared to men (p's < 0.01), though differences in anxiety were no longer significant. Men reported more hostility than women (p = 0.001). CAD women fell within the clinical range for depression (p < 0.001), anxiety (p = 0.001), and stress (p = 0.030) more frequently compared to others at T1, and for depression (p = 0.009) and stress (p = 0.002) at T2. CONCLUSIONS The evolution of patient distress differed as a function of the measure examined, their sex, and/or CV status. While psychological distress was prevalent among these patients with diverse health conditions, women with CAD were particularly and chronically vulnerable.
Collapse
Affiliation(s)
- Monica Vaillancourt
- Research Center, Montreal Heart Institute, Montreal, Canada.,Department of Psychology, Université de Montréal, Montreal, Canada
| | - David Busseuil
- Research Center, Montreal Heart Institute, Montreal, Canada
| | - Bianca D'Antono
- Research Center, Montreal Heart Institute, Montreal, Canada.,Department of Psychology, Université de Montréal, Montreal, Canada
| |
Collapse
|
4
|
Chan JZ, Fernandes MF, Hashemi A, Grewal RS, Mardian EB, Bradley RM, Duncan RE. Age-associated increase in anxiety-like behavior in Lpaatδ/Agpat4 knockout mice. CURRENT RESEARCH IN BEHAVIORAL SCIENCES 2021. [DOI: 10.1016/j.crbeha.2021.100042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
|
5
|
Thabrew H, Stasiak K, Kumar H, Naseem T, Frampton C, Merry S. A Cognitive Behavioral Therapy-, Biofeedback-, and Game-Based eHealth Intervention to Treat Anxiety in Children and Young People With Long-Term Physical Conditions (Starship Rescue): Co-design and Open Trial. JMIR Serious Games 2021; 9:e26084. [PMID: 34559053 PMCID: PMC8501411 DOI: 10.2196/26084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 02/11/2021] [Accepted: 05/13/2021] [Indexed: 01/20/2023] Open
Abstract
Background Approximately 10%-12% of New Zealand children and young people have long-term physical conditions (chronic illnesses) and are more likely to develop psychological problems, particularly anxiety and depression. Delayed treatment leads to worse health care and poorer long-term outcomes. Recently, eHealth interventions, especially those based on principles of cognitive behavioral therapy and biofeedback, have been shown to be moderately effective in reducing anxiety. However, these modalities have rarely been combined. Young people have expressed a preference for well-designed and technology-based support to deal with psychological issues. Objective This study aims to co-design and evaluate the acceptability and usability of a cognitive behavioral therapy and biofeedback-based, 5-module eHealth game called Starship Rescue and to provide preliminary evidence regarding its effectiveness in addressing anxiety and quality of life in young people with long-term physical conditions. Methods Starship Rescue was co-designed with 15 children and young people from a tertiary hospital in New Zealand. Following this, 24 others aged 10-17 years participated in an open trial of the game, accessing it over an 8-week period. The acceptability of the game to all participants was assessed using a brief, open-ended questionnaire. More detailed feedback was obtained from a subset of 10 participants via semistructured interviews. Usability was evaluated via device-recorded frequency and duration of access on completion of the game and the System Usability Scale. Anxiety levels were measured at baseline, completion, and 3 months after completion of the game using the Generalized Anxiety Disorder 7-item scale and Spence Child Anxiety Scale, and at the start of each module and on completion using an embedded Likert visual analog scale. Quality of life was measured at baseline, completion, and 3 months after completion using the Pediatric Quality of Life Inventory scale. Results Users gave Starship Rescue an overall rating of 5.9 out of 10 (range 3-10) and a mean score of 71 out of 100 (SD 11.7; minimum 47.5; maximum 90) on the System Usability Scale. The mean period for the use of the game was just over 11 weeks (78.8 days, 13.5 hours, 40 minutes). Significant reductions in anxiety were noted between the start and end of the game on the Generalized Anxiety Disorder 7-item scale (−4.6; P<.001), Spence Child Anxiety Scale (−9.6; P=.005), and the Likert visual analog scales (−2.4; P=.001). Quality of life also improved on the Pediatric Quality of Life Inventory scale (+4.3; P=.04). All changes were sustained at the 3-month follow-up. Conclusions This study provides preliminary evidence for Starship Rescue as an acceptable, usable, and effective eHealth intervention for treating anxiety in young people with long-term physical conditions. Further evaluation is planned via a randomized controlled trial. Trial Registration Australian New Zealand Clinical Trials Network Registry (ANZCTR) ACTRN12616001253493; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=371443
Collapse
Affiliation(s)
- Hiran Thabrew
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Karolina Stasiak
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Harshali Kumar
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | | | | | - Sally Merry
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| |
Collapse
|
6
|
Bokma WA, Batelaan NM, Penninx BW, van Balkom AJ. Evaluating a dimensional approach to treatment resistance in anxiety disorders: A two-year follow-up study. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2021. [DOI: 10.1016/j.jadr.2021.100139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
7
|
Liu Z, Li P, Yin H, Li M, Yan J, Ma C, Ding H, Li Q, Huang Z, Yan Y, Kou C, Hu M, Wen J, Chen S, Jia C, Huang Y, Xu G. Future Trends in Disability and Its Determinants Among Chinese Community Patients With Anxiety Disorders: Evidence From a 5-Year Follow-Up Study. Front Psychiatry 2021; 12:777236. [PMID: 34955923 PMCID: PMC8695844 DOI: 10.3389/fpsyt.2021.777236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 11/11/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Anxiety disorders (ADs) are a group of disorders with a high disability rate and bring a huge social burden. In China, information on future trends in the disability among community ADs patients and its determinants are rare. The objectives of this study are to describe the future trends in the disability among ADs patients living in community and to investigate the determinants of the disability. Methods: Participants diagnosed with 12-month ADs in the China Mental Health Survey (CMHS) were followed up by telephone from April to June 2018 to assess the future trends in the disability in a 5-year interval using the World Health Organization's Disability Assessment Schedule 2.0. The disability rate was reported and its determinants were analyzed by complex sample design multivariate logistic regression. Results: Totally 271 patients were interviewed by telephone and 33 informants finished proxy interviews. The disability rates were 45.9% and 14.3% among ADs patients at baseline and during the follow-up. Patients with general anxiety disorder (GAD) or agoraphobia with/without panic disorder (AGP) had the lower decrease and higher disability during the follow-up than patients with other subtypes. Patients aged in middle age (aged 40-49 years old, OR = 11.12, 95% CI: 4.16-29.72), having disability at baseline (OR = 7.18, 95% CI: 1.37-37.73), having comorbidity with three or more physical diseases (OR = 9.27, 95% CI: 2.48-34.71), and having comorbidity with other mental disorders (OR = 3.97, 95% CI: 1.13-13.96) had higher disability during the follow-up. Conclusions: The disability rate tends to decrease among ADs patients living in communities. Treatment priority should be given for ADs patients with disability and those in middle age. Treatments for the comorbidity of other mental disorders or physical diseases should be considered when treating anxiety.
Collapse
Affiliation(s)
- Zhaorui Liu
- National Clinical Research Center for Mental Disorders & Key Laboratory of Mental Health, Peking University Sixth Hospital (Institute of Mental Health), Ministry of Health (Peking University), Beijing, China
| | - Peijun Li
- Mental Health Center of Tianjin Medical University, Tianjin Anding Hospital, Tianjin, China
| | - Huifang Yin
- Mental Health Center of Tianjin Medical University, Tianjin Anding Hospital, Tianjin, China
| | - Minghui Li
- Mental Health Center of Tianjin Medical University, Tianjin Anding Hospital, Tianjin, China
| | - Jie Yan
- School of Government, Peking University, Beijing, China
| | - Chao Ma
- National Clinical Research Center for Mental Disorders & Key Laboratory of Mental Health, Peking University Sixth Hospital (Institute of Mental Health), Ministry of Health (Peking University), Beijing, China
| | - Hua Ding
- Institute of Social Science Survey, Peking University, Beijing, China
| | - Qiang Li
- Institute of Social Science Survey, Peking University, Beijing, China
| | - Zhengjing Huang
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Beijing, China
| | - Yongping Yan
- Department of Epidemiology, The Fourth Military Medical University, Xi'an, China
| | - Changgui Kou
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - Mi Hu
- Xiangya School of Public Health, Changsha, China
| | - Jing Wen
- Department of Epidemiology and Health Statistics, School of Public Health and Management at Ningxia Medical University, Yinchuan, China
| | - Shulin Chen
- Department of Psychological and Behavior Science, Zhejiang University, Hangzhou, China
| | - Cunxian Jia
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University & Shandong University Center for Suicide Prevention Research, Jinan, China
| | - Yueqin Huang
- National Clinical Research Center for Mental Disorders & Key Laboratory of Mental Health, Peking University Sixth Hospital (Institute of Mental Health), Ministry of Health (Peking University), Beijing, China
| | - Guangming Xu
- Mental Health Center of Tianjin Medical University, Tianjin Anding Hospital, Tianjin, China
| |
Collapse
|
8
|
Whitworth SR, Bruce DG, Starkstein SE, Davis TME, Skinner TC, Davis WA, Bucks RS. Risk factors and outcomes of anxiety symptom trajectories in type 2 diabetes: the Fremantle Diabetes Study Phase II. Diabet Med 2020; 37:1688-1695. [PMID: 32531090 DOI: 10.1111/dme.14344] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/05/2020] [Indexed: 12/11/2022]
Abstract
AIM To identify determinants and outcomes of 4-year trajectories of anxiety symptoms in a community-based cohort with type 2 diabetes. METHODS Some 1091 participants in the Fremantle Diabetes Study-Phase II with type 2 diabetes completed the Generalized Anxiety Disorder Scale at baseline and biennially for 4 years, in addition to psychological, biomedical and self-management measures. Latent growth mixture modelling identified trajectories of anxiety symptom severity, and regression models determined predictors of trajectory membership and associated outcomes. RESULTS Two distinct groups of participants were identified: those with continuously low-no anxiety symptoms (87%) and those with improving but consistently high anxiety symptoms (elevated anxiety; 13%). Higher HbA1c and BMI, macrovascular complications and a history of generalized anxiety and/or major depressive disorder increased the risk of elevated anxiety. Elevated anxiety did not predict change in health-related outcomes over time. Elevated anxiety and depression symptoms were highly comorbid and those with both displayed the most persistent anxiety symptoms. CONCLUSIONS A subgroup of individuals with type 2 diabetes are at risk of persistently elevated anxiety symptoms. Routine monitoring of the severity of psychological symptoms over time in this population should facilitate earlier and more intensive mood management.
Collapse
Affiliation(s)
- S R Whitworth
- School of Psychological Science, University of Western Australia, Perth, Western Australia, Australia
| | - D G Bruce
- School of Medicine and Pharmacology, Fremantle Hospital, University of Western Australia, Perth, Western Australia, Australia
| | - S E Starkstein
- School of Psychiatry and Clinical Neuroscience, University of Western Australia, Perth, Western Australia, Australia
| | - T M E Davis
- School of Medicine and Pharmacology, Fremantle Hospital, University of Western Australia, Perth, Western Australia, Australia
| | - T C Skinner
- Institute for Psychology, Centre for Health and Society, University of Copenhagen, Copenhagen, Denmark
| | - W A Davis
- School of Medicine and Pharmacology, Fremantle Hospital, University of Western Australia, Perth, Western Australia, Australia
| | - R S Bucks
- School of Psychological Science, University of Western Australia, Perth, Western Australia, Australia
| |
Collapse
|
9
|
Palmer CA, Alfano CA. Anxiety modifies the emotional effects of sleep loss. Curr Opin Psychol 2020; 34:100-104. [DOI: 10.1016/j.copsyc.2019.12.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 12/09/2019] [Accepted: 12/10/2019] [Indexed: 12/17/2022]
|
10
|
Achieving complete mental health despite a history of generalized anxiety disorders: Findings from a large, nationally representative Canadian survey. J Affect Disord 2020; 265:687-694. [PMID: 32090786 DOI: 10.1016/j.jad.2019.12.004] [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: 12/31/2018] [Revised: 12/03/2019] [Accepted: 12/04/2019] [Indexed: 01/06/2023]
Abstract
Ideally, the clinical goal for individuals with a history of anxiety disorder is not only to remit from the disorder, but also to reach optimal well-being. This broader concept of recovery aligns with Keyes' concept of complete mental health (CMH), including presence of happiness or life satisfaction, and social and psychological well-being, and absence of any past year mental illness including anxiety disorders, depressive disorders, substance dependence and suicidal ideation. This study's aim was to identify factors associated with CMH in a population-based sample of Canadians with a previous diagnosis of Generalized Anxiety Disorder (GAD) (n = =2128), of whom 40% are currently in CMH. Data were from the 2012 Canadian Community Health Survey-Mental Health (response rate=68.9%). The World Health Organization version of the Composite International Diagnostic Interview (WHOCIDI) scales were used to define lifetime and past-year GAD. Factors associated with complete mental health include female gender, older age, being married, reporting good to excellent physical health, being free of chronic insomnia, being able to manage household activities without difficulties, using religion or spirituality to cope, having a confidant, and never having had a major depressive disorder nor substance dependence. Results of this study suggest many with a history of anxiety disorders can achieve CMH and point to factors that appear to facilitate this process.
Collapse
|
11
|
Bokma WA, Wetzer GAAM, Gehrels JB, Penninx BWJH, Batelaan NM, van Balkom ALJM. Aligning the many definitions of treatment resistance in anxiety disorders: A systematic review. Depress Anxiety 2019; 36:801-812. [PMID: 31231925 PMCID: PMC6771798 DOI: 10.1002/da.22895] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 03/19/2019] [Accepted: 03/22/2019] [Indexed: 12/16/2022] Open
Abstract
Anxiety Disorders often show a chronic course, even when treated with one of the various effective treatments available. Lack of treatment effect could be due to Treatment Resistance (TR). Consensus on a definition for TR Anxiety Disorders (TR-AD) is highly needed as currently many different operationalizations are in use. Therefore, generalizability in current TR-AD research is suboptimal, hampering improvement of clinical care. The objective of this review is to evaluate the currently used definitions of TR-AD by performing a systematic review of available literature. Out of a total of n = 13 042, 62 studies that operationalized TR-AD were included. The current review confirms a lack of consensus on TR-AD criteria. In 62.9% of the definitions, TR was deemed present after the first treatment failure. Most studies (93.0%) required pharmacological treatment failures, whereas few (29.0%) required psychological treatment failures. However, criteria for what constitutes "treatment failure" were not provided in the majority of studies (58.1%). Definitions for minimal treatment duration ranged from at least 4 weeks to at least 6 months. Almost half of the TR-AD definitions (46.8%) required elevated anxiety severity levels in TR-AD. After synthesis of the results, the consensus definition considers TR-AD present after both at least one first-line pharmacological and one psychological treatment failure, provided for an adequate duration (at least 8 weeks) with anxiety severity remaining above a specified threshold. This definition could contribute to improving course prediction and identifying more targeted treatment options for the highly burdened subgroup of TR-AD patients.
Collapse
Affiliation(s)
- Wicher A. Bokma
- Department of Psychiatry, Amsterdam UMCVrije Universiteit, Psychiatry, Amsterdam Public Health Research InstituteAmsterdamThe Netherlands,GGZ inGeest Specialized Mental Health CareAmsterdamThe Netherlands
| | - Guido A. A. M. Wetzer
- Department of Psychiatry, Amsterdam UMCVrije Universiteit, Psychiatry, Amsterdam Public Health Research InstituteAmsterdamThe Netherlands,GGZ inGeest Specialized Mental Health CareAmsterdamThe Netherlands
| | - Jurriaan B. Gehrels
- Department of Psychiatry, Amsterdam UMCVrije Universiteit, Psychiatry, Amsterdam Public Health Research InstituteAmsterdamThe Netherlands,GGZ inGeest Specialized Mental Health CareAmsterdamThe Netherlands
| | - Brenda W. J. H. Penninx
- Department of Psychiatry, Amsterdam UMCVrije Universiteit, Psychiatry, Amsterdam Public Health Research InstituteAmsterdamThe Netherlands,GGZ inGeest Specialized Mental Health CareAmsterdamThe Netherlands
| | - Neeltje M. Batelaan
- Department of Psychiatry, Amsterdam UMCVrije Universiteit, Psychiatry, Amsterdam Public Health Research InstituteAmsterdamThe Netherlands,GGZ inGeest Specialized Mental Health CareAmsterdamThe Netherlands
| | - Anton L. J. M. van Balkom
- Department of Psychiatry, Amsterdam UMCVrije Universiteit, Psychiatry, Amsterdam Public Health Research InstituteAmsterdamThe Netherlands,GGZ inGeest Specialized Mental Health CareAmsterdamThe Netherlands
| |
Collapse
|
12
|
Zainal NH, Newman MG. Relation between cognitive and behavioral strategies and future change in common mental health problems across 18 years. JOURNAL OF ABNORMAL PSYCHOLOGY 2019; 128:295-304. [PMID: 31045412 PMCID: PMC6707366 DOI: 10.1037/abn0000428] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Major depressive disorder (MDD), generalized anxiety disorder (GAD), and panic disorder (PD), constitute common mental disorders that may have chronic and disabling courses. Cognitive and behavioral theories posit that lack of engagement in certain strategies (goal persistence, self-mastery, positive reappraisal) increases vulnerability toward these disorders. Further, scar effect theories assert that experiencing more of these disorders may diminish engagement in such strategies within individuals across time. However, dynamic longitudinal associations between cognitive-behavioral strategies (CBS) and disorder counts across adulthood are not well understood. Using bivariate latent difference score models, this study aimed to test the dynamic trajectories between disorder counts and each CBS across 18 years. Participants were 3,294 community-dwelling adults ages 45.62 years (SD = 11.41, range = 20-74; 54.61% female) who took part in 3 waves of measurement spaced 9 years apart. Self-mastery, disorder counts, and their change were not significantly related. However, higher within-subject increase in goal persistence (but not self-mastery or positive reappraisal) led to greater future decline in disorder counts, but not vice versa. Last, within individuals, greater prior levels of goal persistence and positive reappraisal predicted larger subsequent reduction in disorder counts, and vice versa. The reciprocal, bidirectional associations between specific CBS (goal persistence, positive reappraisal) and disorder counts support both vulnerability and scar models of depression and anxiety. Treatments for MDD, GAD, and PD should attempt to enhance perseverance and optimism. Theoretical and clinical implications are further discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
Collapse
|
13
|
A Comparison of Death Anxiety, Intolerance of Uncertainty and Self-Esteem as Predictors of Social Anxiety Symptoms. BEHAVIOUR CHANGE 2019. [DOI: 10.1017/bec.2019.11] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
AbstractThis study sought to examine the role of death anxiety as a transdiagnostic predictor of social anxiety symptomatology compared to self-esteem and intolerance of uncertainty, and to examine the relationship between measures of intrinsic and extrinsic religiosity and death anxiety. A total of 591 participants, 445 females, average age 38.0 years (SD = 14.5), completed an online survey including background questions, the Depression, Anxiety and Stress Scale, the Social Interaction Anxiety and Social Phobia Scale, the Rosenberg Self-Esteem Scale, the Intolerance of Uncertainty Scale, the Santa Clara Strength of Religious Faith Questionnaire, the Spirituality Scale, and the Death Anxiety Scale. No significant, independent relationship was found between death anxiety and social anxiety symptomatology, although self-esteem and intolerance of uncertainty were significant predictors of both measures of social anxiety, confirming the importance of these key transdiagnostic mediators as predictors of social anxiety symptomatology. A strong negative correlation was found between death anxiety and measures of both intrinsic and extrinsic religiosity in this general population sample not selected for high religious affiliation.
Collapse
|
14
|
Cox RC, Sterba SK, Cole DA, Upender RP, Olatunji BO. Time of day effects on the relationship between daily sleep and anxiety: An ecological momentary assessment approach. Behav Res Ther 2018; 111:44-51. [PMID: 30300779 PMCID: PMC6250589 DOI: 10.1016/j.brat.2018.09.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 09/10/2018] [Accepted: 09/29/2018] [Indexed: 11/22/2022]
Abstract
Previous research has linked sleep disturbance to anxiety. However, evidence for this relation has been inconsistent, largely limited to retrospective reports that do not account for daily variability, and silent on when the association is most pronounced. Thus, the present study utilized ecological momentary assessment (EMA) to examine the effects of daily deviations in total sleep time (TST) and person-average TST on anxiety and whether these effects varied as a function of time of day in a sample of unselected adults (N = 138). Results indicate that the amount of TST on a given night, relative to personal average TST, negatively predicted anxiety, and this relation was significant in the morning and afternoon, but not evening. In contrast, person-average TST was unrelated to average anxiety. Relations between TST and anxiety did not differ across objective (e.g., actigraphy) and subjective (e.g., sleep diary) measures. Furthermore, the pattern of results remained the same when controlling for previous day's anxiety and were not bidirectional. These findings suggest that getting less sleep than is typical for the individual predicts subsequent anxiety, and this effect is particularly strong in the morning. Average sleep duration may be less important to the experience of anxiety than deviations from that average. These findings highlight the importance of EMA to examine how and when variability in sleep confers vulnerability for anxiety symptoms.
Collapse
Affiliation(s)
- Rebecca C Cox
- Department of Psychology, Vanderbilt University, 301 Wilson Hall, 111 21st Avenue South, Nashville, TN, 37240, USA.
| | - Sonya K Sterba
- Department of Psychology, Vanderbilt University, 301 Wilson Hall, 111 21st Avenue South, Nashville, TN, 37240, USA
| | - David A Cole
- Department of Psychology, Vanderbilt University, 301 Wilson Hall, 111 21st Avenue South, Nashville, TN, 37240, USA
| | - Raghu P Upender
- Department of Psychology, Vanderbilt University, 301 Wilson Hall, 111 21st Avenue South, Nashville, TN, 37240, USA
| | - Bunmi O Olatunji
- Department of Psychology, Vanderbilt University, 301 Wilson Hall, 111 21st Avenue South, Nashville, TN, 37240, USA
| |
Collapse
|
15
|
Yatham S, Sivathasan S, Yoon R, da Silva TL, Ravindran AV. Depression, anxiety, and post-traumatic stress disorder among youth in low and middle income countries: A review of prevalence and treatment interventions. Asian J Psychiatr 2018; 38:78-91. [PMID: 29117922 DOI: 10.1016/j.ajp.2017.10.029] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 10/27/2017] [Accepted: 10/30/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Low and middle income countries (LMICs) not only have the majority of the world's population but also the largest proportion of youth. Poverty, civil conflict and environmental stressors tend to be endemic in these countries and contribute to significant psychiatric morbidity, including depression, anxiety and post-traumatic stress disorder (PTSD). However, mental health data from LMICs is scarce, particularly data on youth. Evaluation of such information is crucial for planning services and reducing the burden of disability. This paper reviews the published data on the prevalence and randomized trials of interventions for depression, anxiety and PTSD in youth in LMICs. METHODS PubMed and Google Scholar were searched for articles published in English up to January 2017, using the keywords: Low/middle income country, depression, anxiety, post-traumatic stress disorder, child, youth, adolescent, prevalence, treatment, intervention, and outcomes. RESULTS The few prevalence studies in LMICs reported rates of up to 28% for significant symptoms of depression or anxiety among youth, and up to 87% for symptoms of PTSD among youth exposed to traumatic experienences, though these rates varied widely depending on several factors, including the assessments tools used. Most rigorous interventions employed some form or variation of CBT, with mixed results. Studies using other forms of psychosocial interventions appear to be heterogeneous and less rigorous. CONCLUSIONS The mental health burden due to depression and anxiety disorders in youth is substantial in LMICs, with high needs but inadequate services. Youth specific services for early detection and cost-effective interventions are needed.
Collapse
Affiliation(s)
- Swetha Yatham
- University of British Columbia, Canada (Currently St. George's Medical School, University of London, United Kingdom)
| | | | - Rosalia Yoon
- University of Toronto and Centre for Addiction and Mental Health, Canada
| | - Tricia L da Silva
- University of Toronto and Centre for Addiction and Mental Health, Canada
| | - Arun V Ravindran
- University of Toronto and Centre for Addiction and Mental Health, Canada.
| |
Collapse
|
16
|
Axmon A, Björne P, Nylander L, Ahlström G. Psychiatric diagnoses in older people with intellectual disability in comparison with the general population: a register study. Epidemiol Psychiatr Sci 2018; 27:479-491. [PMID: 28228177 PMCID: PMC6137377 DOI: 10.1017/s2045796017000051] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 01/27/2017] [Indexed: 01/14/2023] Open
Abstract
AIMS To describe the occurrence of psychiatric diagnoses in a specialist care setting in older people with intellectual disability (ID) in relation to those found in the same age group in the general population. METHOD A cohort of people with ID (n = 7936), aged 55 years or more in 2012, was identified, as was an age and sex-matched cohort from the general population (n = 7936). Information regarding psychiatric diagnoses during 2002-2012 was collected from the National Patient Register, which contains records from all inpatient care episodes and outpatient specialist visits in Sweden. The mean age at the start of data collection (i.e. January 1st, 2002) was 53 years (range 44-85 years). RESULTS Seventeen per cent (n = 1382) of the people in the ID cohort had at least one psychiatric diagnosis recorded during the study period. The corresponding number in the general population cohort was 10% (n = 817), which translates to an odds ratio (OR) of 1.84. The diagnoses recorded for the largest number of people in the ID cohort were 'other' (i.e. not included in any of the diagnostic groups) psychiatric diagnoses (10% of the cohort had at least one such diagnosis recorded) and affective disorders (7%). In the general population cohort, the most common diagnoses were affective disorders (4%) and alcohol/substance-abuse-related disorders (4%). An increased odds of having at least one diagnosis was found for all investigated diagnoses except for alcohol/substance-abuse-related disorders (OR = 0.56). The highest odds for the ID cohort was found for diagnosis of psychotic disorder (OR = 10.4) followed by attention deficit/hyperactive disorder (OR = 3.81), dementia (OR = 2.71), personality disorder (OR = 2.67), affective disorder (OR = 1.74) and anxiety disorder (OR = 1.36). People with ID also had an increased odds of psychiatric diagnoses not included in any of these groups (OR = 8.02). The percentage of people with ID who had at least one diagnosis recorded during the study period decreased from more than 30% among those aged 55-59 years in 2012 (i.e. born 1953-1957) to approximately 20% among those aged 75+ years in 2012 (i.e. born in or before 1937). CONCLUSIONS Older people with ID seem to be more likely to have psychiatric diagnoses in inpatient or outpatient specialist care than their peers in the general population. If this is an effect of different disorder prevalence, diagnostic difficulties or differences in health care availability remains unknown. More research is needed to understand the diagnostic and treatment challenges of psychiatric disorders in this vulnerable group.
Collapse
Affiliation(s)
- A. Axmon
- Department of Occupational and Environmental Medicine, Lund University, SE-221 00 Lund, Sweden
| | - P. Björne
- Research and Development Unit, City Office, City of Malmö, Sweden
| | - L. Nylander
- Department of Clinical Sciences/Psychiatry, Lund University, Lund, Sweden
- Gillberg Neuropsychiatry Centre, University of Gothenburg, Göteborg, Sweden
| | - G. Ahlström
- Department of Health Sciences, Lund University, Lund, Sweden
| |
Collapse
|
17
|
Lim JA, Lee YI, Jang JH, Choi SH. Investigating effective treatment factors in brief cognitive behavioral therapy for panic disorder. Medicine (Baltimore) 2018; 97:e12422. [PMID: 30235717 PMCID: PMC6160091 DOI: 10.1097/md.0000000000012422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Numerous studies have provided evidence for the effectiveness of cognitive behavioral therapy (CBT) on panic disorders (PDs). There has also been growing attention on brief CBT with regard to delivering intensive treatment efficiently. This study investigated the essential parts of mindfulness-based brief CBT to optimize treatment benefits.A total of 37 patients were retrospectively enrolled in this study. They were recruited from the anxiety/panic/fear clinic of Seoul National University Hospital. The patients participated in group CBT once a week for a total of 4 sessions over a 4-week period, when they were assessed using the Panic Disorder Severity Scale (PDSS), Anxiety Sensitivity Index-Revised (ASI-R), Albany Panic and Phobia Questionnaire (APPQ), State-Trait Anxiety Inventory (STAI), Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), and Yale-Brown Obsessive Compulsive Scale (Y-BOCS) before and after brief CBT. Twenty-nine patients completed the 1-month follow-up.There were significant reductions in PDSS (P < .001), ASI-R-fear of respiratory symptoms (P = .006), ASI-R-fear of publicly observable anxiety reaction (P = .002), ASI-R-fear of cardiovascular symptoms (P < .001), ASI-R-fear of cognitive dyscontrol (P = .001), ASI-R-Total (P < .001), APPQ-Agoraphobia (P = .003), APPQ-Total (P = .028), STAI-State anxiety (P < .001), STAI-Trait anxiety (P = .002), BAI (P = .003), and BDI (P < .001) scores. We also found significant associations between ASI-R-fear of cardiovascular symptoms, ASI-R-Total, and changes in PDSS scores. A stepwise multiple linear regression analysis indicated that anxiety sensitivity for fear of cardiovascular symptoms predicted an improvement in panic severity (β = 0.513, P = .004).Our findings suggested that behavioral aspects, especially physiological symptom control, needed to be considered in brief, intensive CBT for PD. The results also suggested that a mindfulness-based brief CBT approach might be particularly helpful for patients with PD who have severe cardiovascular symptoms.
Collapse
Affiliation(s)
- Jae-A Lim
- Department of Psychiatry, Seoul National University Hospital
| | | | - Joon Hwan Jang
- Department of Psychiatry, Seoul National University Hospital
- Department of Medicine, Seoul National University College of Medicine
| | - Soo-Hee Choi
- Department of Psychiatry, Seoul National University Hospital
- Department of Psychiatry and Institute of Human Behavioral Medicine in SNU-MRC, Seoul National University College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
18
|
Zainal NH, Newman MG. Executive function and other cognitive deficits are distal risk factors of generalized anxiety disorder 9 years later. Psychol Med 2018; 48:2045-2053. [PMID: 29224581 PMCID: PMC6707521 DOI: 10.1017/s0033291717003579] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The cognitive model (Hirsch & Mathews, 2012) and attentional control theory (Eysenck & Derakshan, 2011) postulate that compromised executive function (EF) and other cognitive constructs are negatively linked to increased excessive and uncontrollable worry, the core symptom of generalized anxiety disorder (GAD). However, the prospective link between neuropsychological constructs and GAD are not well understood. METHODS A nationally representative sample of 2605 community-dwelling adults whose average age was 55.20 (s.d. = 11.41, range 33-84; 56.31% females) participated at baseline and 9-year follow-up. Baseline neuropsychological function and symptoms were measured using the Brief Test of Adult Cognition by Telephone and Composite International Diagnostic Interview - Short Form. Multivariate Poisson and negative binomial regression analyses were conducted with 11 baseline covariates entered simultaneously: age, gender, years of formal education, perceived control, hypertension/diabetes, body mass index, exercise status, as well as GAD severity, panic disorder severity, and depression severity. Those with baseline GAD were also removed. RESULTS Lower Time 1 composite global cognition z-score independently predicted higher Time 2 GAD severity and diagnosis [odds ratio (OR) 0.60, 95% confidence interval (CI) 0.40-0.89, p = 0.01]. Poor inhibition, set-shifting, working memory (WM) updating, inductive reasoning, and global cognition sequentially forecasted heightened GAD. However, processing speed, verbal WM, verbal fluency, and episodic memory did not predict future GAD. CONCLUSION Global cognition, inductive reasoning, inhibition, set-shifting, and WM updating EF impairments may be distal risk factors for elevated GAD nearly a decade later.
Collapse
Affiliation(s)
- Nur Hani Zainal
- Department of Psychology,The Pennsylvania State University,University Park,PA 16802,USA
| | - Michelle G Newman
- Department of Psychology,The Pennsylvania State University,University Park,PA 16802,USA
| |
Collapse
|
19
|
Rasmussen H, Rosness TA, Bosnes O, Salvesen Ø, Knutli M, Stordal E. Anxiety and Depression as Risk Factors in Frontotemporal Dementia and Alzheimer's Disease: The HUNT Study. Dement Geriatr Cogn Dis Extra 2018; 8:414-425. [PMID: 38476883 PMCID: PMC10928810 DOI: 10.1159/000493973] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 09/21/2018] [Indexed: 03/14/2024] Open
Abstract
Background The roles of both anxiety and depression as risk factors for frontotemporal dementia (FTD) and Alzheimer's disease (AD) have not been previously investigated together. Objective To study anxiety and depression as independent risk factors for FTD and AD. Methods Eighty-four patients with FTD and 556 patients with AD were compared with 117 cognitively healthy (CH), elderly individuals. Both cases and controls were participants in the second Health Study of Nord-Trøndelag (HUNT2) from 1995 to 1997, in which depression and anxiety were assessed with the Hospital Anxiety and Depression Scale (HADS). Results Significant associations were found between anxiety and FTD and between depression and AD. A significantly increased risk of developing FTD was observed in patients who had reported anxiety on the HADS (p = 0.017) (odds ratio [OR]: 2.947, 95% confidence interval [CI]: 1.209-7.158) and a significantly increased risk of developing AD was observed in patients who had reported depression on the HADS (p = 0.016) (OR: 4.389, 95% CI: 1.311-14.690). Conclusion Our study findings suggest that anxiety and depression may play different roles as risk factors for FTD and AD.
Collapse
Affiliation(s)
- Hege Rasmussen
- Namsos Hospital, Clinic for Mental Health and Substance Abuse, Nord-Trøndelag Hospital Trust (HNT), Namsos, Norway
- Department of Mental Health, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Tor Atle Rosness
- The Faculty of Mathematics and Natural Sciences, School of Pharmacy, University of Oslo, Oslo, Norway
| | - Ole Bosnes
- Namsos Hospital, Clinic for Mental Health and Substance Abuse, Nord-Trøndelag Hospital Trust (HNT), Namsos, Norway
| | - Øyvind Salvesen
- Department of Public Health and General Practice, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Marlen Knutli
- Levanger Hospital, Department of Research, Nord-Trøndelag Hospital Trust (HNT), Levanger, Norway
| | - Eystein Stordal
- Namsos Hospital, Clinic for Mental Health and Substance Abuse, Nord-Trøndelag Hospital Trust (HNT), Namsos, Norway
- Department of Mental Health, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| |
Collapse
|
20
|
Altunoz U, Kokurcan A, Kirici S, Bastug G, Ozel-Kizil ET. Clinical characteristics of generalized anxiety disorder: older vs. young adults. Nord J Psychiatry 2018; 72:97-102. [PMID: 29065768 DOI: 10.1080/08039488.2017.1390607] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Generalized anxiety disorder (GAD) is one of the most common anxiety disorders in older people. Although GAD in older adults seems to differ in many aspects like clinical presentation, severity and treatment response, there is a paucity of comparative research. AIMS The aim of the study is to compare the clinical presentation of GAD between older and young adults. METHODS One hundred and two non-demented older patients (age ≥65) and 64 young patients (age <45) who were diagnosed with GAD according to the DSM-IV-TR criteria were included to the study. Socio-demographic Data Form, the Structured Clinical Interview for DSM Disorders-1 (SCID-1), the Questionnaire for the Suggested Behavioral Criteria of GAD for DSM-5, the Hamilton Depression Scale (HAM-D), the Generalized Anxiety Disorder Severity Scale (GADSS) and the Sheehan Disability Scale (SDS) were applied to both groups. RESULTS AND CONCLUSIONS Older GAD patients had more disturbances of sleep, less reassurance seeking behaviors, higher rates of depression and higher depression severity when compared to the young patients. Although older people seemed to have a lower severity of GAD, they had higher disability due to worries. Older patients worried more about their own health and family well-being, whereas young patients worried more about future and other's health.
Collapse
Affiliation(s)
- Umut Altunoz
- a Department of Transcultural Psychiatry & Psychotherapy , Wahrendorff Clinic , Hannover , Germany
| | - Ahmet Kokurcan
- b Psychiatry Clinic , Corum Sungurlu State Hospital , Corum , Turkey
| | - Sevinc Kirici
- c Department of Psychiatry, Geriatric Psychiatry Unit , Ankara University School of Medicine , Ankara , Turkey
| | - Gulbahar Bastug
- d Vocational School of Health , Ankara University , Ankara , Turkey
| | - Erguvan Tugba Ozel-Kizil
- c Department of Psychiatry, Geriatric Psychiatry Unit , Ankara University School of Medicine , Ankara , Turkey
| |
Collapse
|
21
|
Thabrew H, Stasiak K, Merry S. Protocol for Co-Design, Development, and Open Trial of a Prototype Game-Based eHealth Intervention to Treat Anxiety in Young People With Long-Term Physical Conditions. JMIR Res Protoc 2017; 6:e171. [PMID: 28939545 PMCID: PMC5630692 DOI: 10.2196/resprot.7250] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Revised: 06/20/2017] [Accepted: 07/14/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Approximately 10% to 12% of New Zealand young people (and 21% of Maori young people) have long-term physical conditions and are more likely to develop psychological problems, particularly anxiety and depression. Delayed treatment leads to worse management of physical conditions, school absence, and poorer long-term outcomes. Recently, electronic health (eHealth) interventions have been shown to be as good as face-to-face therapy and biofeedback techniques have been shown to enhance relaxation during the treatment of anxiety. In addition, young people with long-term physical conditions have expressed a preference for more technologically based support, including game-based interventions, to deal with psychological issues, particularly anxiety. OBJECTIVE The aim of this study is to develop a prototype game-based eHealth intervention to address anxiety in young people with long-term physical conditions. The game will be based on the principles of cognitive behavior therapy (CBT) and will integrate a module of biofeedback-based relaxation. METHODS During the first phase of the study, up to 48 young people with long-term physical conditions aged 13 to 18 years, attending a tertiary pediatric hospital will be invited to participate in a 3-stage series of co-design workshops. Following the design, development, and refinement of a working prototype, during the second phase of the study, a further 20 young people with long-term physical conditions and anxiety will be recruited from the same location to participate in an open pilot trial to evaluate its acceptability, usability, and preliminary efficacy. RESULTS Changes in anxiety will be measured using the Generalized Anxiety Disorder 7-item scale (GAD-7) and the Spence Child Anxiety Scales (SCAS) at the end of every module (recommended to be completed weekly), post intervention, and 3 months later. Usability of the intervention will be measured using the System Usability Scale (SUS) and by measuring frequency and quantity of use of the intervention. Acceptability of the intervention will be assessed using brief, open-ended questionnaires and semi-structured interviews, the data from which will be analyzed using a general inductive approach. Recruitment to the study commenced in January 2017 and data collection will be completed by the end of December 2017. CONCLUSIONS If acceptable and useful, this game-based eHealth intervention may offer a cost-effective and clinically useful intervention for addressing the psychological needs of over 16,000 young people with long term health conditions in New Zealand. TRIAL REGISTRATION Australian New Zealand Clinical Trials Network Registry (ANZCTR): ACTRN12616001253493p; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=371443 (Archived by WebCite at http://www.webcitation.org/6sYB716lf).
Collapse
Affiliation(s)
- Hiran Thabrew
- University of Auckland, Department of Psychological Medicine, Auckland, New Zealand
| | - Karolina Stasiak
- University of Auckland, Department of Psychological Medicine, Auckland, New Zealand
| | - Sally Merry
- University of Auckland, Department of Psychological Medicine, Auckland, New Zealand
| |
Collapse
|
22
|
Pattern of structural brain changes in social anxiety disorder after cognitive behavioral group therapy: a longitudinal multimodal MRI study. Mol Psychiatry 2017; 22:1164-1171. [PMID: 27922605 DOI: 10.1038/mp.2016.217] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 09/05/2016] [Accepted: 10/11/2016] [Indexed: 12/13/2022]
Abstract
Social anxiety disorder (SAD) is characterized by fears of social and performance situations. Cognitive behavioral group therapy (CBGT) has in general positive effects on symptoms, distress and avoidance in SAD. Prior studies found increased cortical volumes and decreased fractional anisotropy (FA) in SAD compared with healthy controls (HCs). Thirty-three participants diagnosed with SAD attended in a 10-week CBGT and were scanned before and after therapy. We applied three neuroimaging methods-surface-based morphometry, diffusion tensor imaging and network-based statistics-each with specific longitudinal processing protocols, to investigate CBGT-induced structural brain alterations of the gray and white matter (WM). Surface-based morphometry revealed a significant cortical volume reduction (pre- to post-treatment) in the left inferior parietal cortex, as well as a positive partial correlation between treatment success (indexed by reductions in Liebowitz Social Anxiety Scale) and reductions in cortical volume in bilateral dorsomedial prefrontal cortex. Diffusion tensor imaging analysis revealed a significant increase in FA in bilateral uncinate fasciculus and right inferior longitudinal fasciculus. Network-based statistics revealed a significant increase of structural connectivity in a frontolimbic network. No partial correlations with treatment success have been found in WM analyses. For, we believe, the first time, we present a distinctive pattern of longitudinal structural brain changes after CBGT measured with three established magnetic resonance imaging analyzing techniques. Our findings are in line with previous cross-sectional, unimodal SAD studies and extent them by highlighting anatomical brain alterations that point toward the level of HCs in parallel with a reduction in SAD symptomatology.
Collapse
|
23
|
The effects of adaptive working memory training and mindfulness meditation training on processing efficiency and worry in high worriers. Behav Res Ther 2017; 89:1-13. [DOI: 10.1016/j.brat.2016.11.002] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 11/01/2016] [Accepted: 11/06/2016] [Indexed: 01/19/2023]
|
24
|
Abstract
Recently, death anxiety, or dread of death, has been proposed as a key transdiagnostic process underlying the anxiety disorders, depressive disorders, somatic disorders, and trauma and stressor-related disorders. In fact, it has been argued that death anxiety underlies all psychopathology, and is more fundamental than perfectionism, a process which was previously considered the root of mental illness. However, there has been a paucity of research examining the relationship between death anxiety and the eating disorders, although these conditions have been found to be strongly related to perfectionism. The present study therefore aimed to examine whether death anxiety is related to disordered eating, and whether death anxiety is a better predictor of disordered eating than perfectionism. A sample of 164 participants (132 female), average age 33.55 years (SD= 15.45 years), completed an online survey comprising background questions (age, sex, diagnosed psychiatric disorder), the Eating Attitudes Test — 26 item version (EAT-26), the Almost Perfect Scale — Revised (APS-R), the Rosenberg Self-Esteem Scale (RSES), and the Death Anxiety Scale (DAS). The findings of a hierarchical multiple regression analysis with EAT-26 as the dependent variable, age entered at Step 1, the RSES and APS-R entered at Step 2, and the DAS entered at Step 3 showed that only death anxiety and self-esteem were independent predictors of disordered eating at Step 3. A simultaneous multiple regression analysis was subsequently run with age and the APS-R alone as predictors of EAT-26 scores. This analysis showed that perfectionism was only a predictor of disordered eating when death anxiety and self-esteem were not included in the regression model. Death anxiety and self-esteem both appear to be important transdiagnostic processes.
Collapse
|
25
|
Keefe JR, Mao JJ, Soeller I, Li QS, Amsterdam JD. Short-term open-label chamomile (Matricaria chamomilla L.) therapy of moderate to severe generalized anxiety disorder. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2016; 23:1699-1705. [PMID: 27912871 PMCID: PMC5589135 DOI: 10.1016/j.phymed.2016.10.013] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 09/28/2016] [Accepted: 10/23/2016] [Indexed: 05/06/2023]
Abstract
BACKGROUND Conventional drug treatments for Generalized Anxiety Disorder (GAD) are often accompanied by substantial side effects, dependence, and/or withdrawal syndrome. A prior controlled study of oral chamomile (Matricaria chamomilla L.) extract showed significant efficacy versus placebo, and suggested that chamomile may have anxiolytic activity for individuals with GAD. HYPOTHESIS We hypothesized that treatment with chamomile extract would result in a significant reduction in GAD severity ratings, and would be associated with a favorable adverse event and tolerability profile. STUDY DESIGN We report on the open-label phase of a two-phase randomized controlled trial of chamomile versus placebo for relapse-prevention of recurrent GAD. METHODS Subjects with moderate to severe GAD received open-label treatment with pharmaceutical-grade chamomile extract 1500mg/day for up to 8 weeks. Primary outcomes were the frequency of clinical response and change in GAD-7 symptom scores by week 8. Secondary outcomes included the change over time on the Hamilton Rating Scale for Anxiety, the Beck Anxiety Inventory, and the Psychological General Well Being Index. Frequency of treatment-emergent adverse events and premature treatment discontinuation were also examined. RESULTS Of 179 subjects, 58.1% (95% CI: 50.9% to 65.5%) met criteria for response, while 15.6% prematurely discontinued treatment. Significant improvement over time was also observed on the GAD-7 rating (β=-8.4 [95% CI=-9.1 to -7.7]). A similar proportion of subjects demonstrated statistically significant and clinically meaningful reductions in secondary outcome ratings of anxiety and well-being. Adverse events occurred in 11.7% of subjects, although no serious adverse events occurred. CONCLUSION Chamomile extract produced a clinically meaningful reduction in GAD symptoms over 8 weeks, with a response rate comparable to those observed during conventional anxiolytic drug therapy and a favorable adverse event profile. Future comparative effectiveness trials between chamomile and conventional drugs may help determine the optimal risk/benefit of these therapies for patients suffering from GAD.
Collapse
Affiliation(s)
- John R Keefe
- Department of Psychology, University of Pennsylvania, Philadelphia, PA United States
| | - Jun J Mao
- Bendheim Center for Integrative Medicine, Memorial Sloan-Kettering Cancer Center, 1429 First Avenue, New York, NY 10021 United States.
| | - Irene Soeller
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA United States
| | - Qing S Li
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA United States
| | - Jay D Amsterdam
- Depression Research Unit, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA United States
| |
Collapse
|
26
|
Wanmaker S, Geraerts E, Franken IHA. A working memory training to decrease rumination in depressed and anxious individuals: a double-blind randomized controlled trial. J Affect Disord 2015; 175:310-9. [PMID: 25661397 DOI: 10.1016/j.jad.2014.12.027] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 12/06/2014] [Accepted: 12/09/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Rumination is one of the hallmark characteristics of both anxiety disorders and depression, and has been linked to deficient executive functioning, particularly working memory (WM). Previous findings show that working memory capacity can be increased through training. METHODS The current study explored whether an adaptive stand-alone WM training could increase WMC and consequently reduce rumination, anxiety and depression by means of a double-blind randomized controlled trial in a sample of 98 patients with symptoms of anxiety and/or depression. RESULTS No positive effect of training on WMC was found. In addition, the results show that a WM training was not associated with a reduction of rumination, depression, nor anxiety. LIMITATIONS The high drop-out rate in both groups (20.11% from pre- to post-training) and the overrepresentation of men and use of anti-depressants in the placebo group might have influenced the results. Furthermore, expectations and perceptions about the training might have interacted with performance on WM tasks. CONCLUSIONS Overall, results show that a stand-alone WM training in patients with symptoms of anxiety and/or depression does not result in reduced rumination nor in reduced symptoms of depression and anxiety. We discuss potential explanations for these findings.
Collapse
Affiliation(s)
- Sabine Wanmaker
- Institute of Psychology, Erasmus University Rotterdam, The Netherlands.
| | - Elke Geraerts
- Institute of Psychology, Erasmus University Rotterdam, The Netherlands
| | | |
Collapse
|
27
|
Katzman MA, Bleau P, Blier P, Chokka P, Kjernisted K, Van Ameringen M. Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders. BMC Psychiatry 2014; 14 Suppl 1:S1. [PMID: 25081580 PMCID: PMC4120194 DOI: 10.1186/1471-244x-14-s1-s1] [Citation(s) in RCA: 437] [Impact Index Per Article: 43.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Anxiety and related disorders are among the most common mental disorders, with lifetime prevalence reportedly as high as 31%. Unfortunately, anxiety disorders are under-diagnosed and under-treated. METHODS These guidelines were developed by Canadian experts in anxiety and related disorders through a consensus process. Data on the epidemiology, diagnosis, and treatment (psychological and pharmacological) were obtained through MEDLINE, PsycINFO, and manual searches (1980-2012). Treatment strategies were rated on strength of evidence, and a clinical recommendation for each intervention was made, based on global impression of efficacy, effectiveness, and side effects, using a modified version of the periodic health examination guidelines. RESULTS These guidelines are presented in 10 sections, including an introduction, principles of diagnosis and management, six sections (Sections 3 through 8) on the specific anxiety-related disorders (panic disorder, agoraphobia, specific phobia, social anxiety disorder, generalized anxiety disorder, obsessive-compulsive disorder, and posttraumatic stress disorder), and two additional sections on special populations (children/adolescents, pregnant/lactating women, and the elderly) and clinical issues in patients with comorbid conditions. CONCLUSIONS Anxiety and related disorders are very common in clinical practice, and frequently comorbid with other psychiatric and medical conditions. Optimal management requires a good understanding of the efficacy and side effect profiles of pharmacological and psychological treatments.
Collapse
Affiliation(s)
- Martin A Katzman
- Department of Psychiatry, University of Toronto, Toronto, ON, M5S 1A1, Canada
| | - Pierre Bleau
- Department of Psychiatry, McGill University, Montreal, QC, H3A 1A1, Canada
| | - Pierre Blier
- Department of Psychiatry and Cellular/Molecular Medicines, University of Ottawa, Ottawa, ON, K1Z 7K4, Canada
| | - Pratap Chokka
- Department of Psychiatry, University of Alberta, Edmonton, AB, T6G 2R7, Canada
| | - Kevin Kjernisted
- Department of Psychiatry, University of British Columbia, Vancouver, BC, V6T 2A1, Canada
| | - Michael Van Ameringen
- Department of Psychiatry and Behavioural Neuroscience, McMaster University, Hamilton, ON, L8N 3K7, Canada
| | | |
Collapse
|
28
|
Naragon-Gainey K, Gallagher MW, Brown TA. A longitudinal examination of psychosocial impairment across the anxiety disorders. Psychol Med 2014; 44:1691-1700. [PMID: 23942055 DOI: 10.1017/s0033291713001967] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Anxiety disorders are highly prevalent disorders associated with substantial psychosocial impairment, but few studies have examined impairment within specific anxiety disorders. Furthermore, it is unclear how change in different types of anxiety has an impact on change in impairment, particularly given high rates of co-morbidity. The current study assessed the temporal associations of impairment and symptoms of three common anxiety disorders in a large, diagnostically heterogeneous clinical sample. METHOD Data were collected from 606 treatment-seeking individuals at an anxiety clinic, most of whom subsequently enrolled in cognitive-behavioral therapy. Symptoms of panic, social anxiety and generalized anxiety disorder (GAD), as well as levels of impairment, were assessed three times over 2 years. In addition to examining levels of impairment across diagnostic groups, latent growth modeling was used to evaluate the longitudinal associations of anxiety symptoms and impairment. RESULTS Those with a principal diagnosis of GAD reported higher levels of impairment in some domains at baseline; however, at follow-up assessments individuals with social anxiety disorder reported greater impairment than those with panic disorder. Anxiety symptoms and impairment both declined over time. Change in all three anxiety symptoms was closely associated with change in impairment, but only GAD remained a significant (positive) predictor of change in impairment after accounting for co-morbidity. CONCLUSIONS Impairment and all three anxiety disorders were closely associated, both cross-sectionally and longitudinally. Because change in GAD was most specifically related to change in impairment, treatment for those with multiple anxiety disorders could focus on treating GAD symptoms first or treating transdiagnostic processes.
Collapse
Affiliation(s)
- K Naragon-Gainey
- Center for Anxiety and Related Disorders, Boston University, Boston, MA, USA
| | - M W Gallagher
- Center for Anxiety and Related Disorders, Boston University, Boston, MA, USA
| | - T A Brown
- Center for Anxiety and Related Disorders, Boston University, Boston, MA, USA
| |
Collapse
|
29
|
Baldwin DS, Anderson IM, Nutt DJ, Allgulander C, Bandelow B, den Boer JA, Christmas DM, Davies S, Fineberg N, Lidbetter N, Malizia A, McCrone P, Nabarro D, O'Neill C, Scott J, van der Wee N, Wittchen HU. Evidence-based pharmacological treatment of anxiety disorders, post-traumatic stress disorder and obsessive-compulsive disorder: a revision of the 2005 guidelines from the British Association for Psychopharmacology. J Psychopharmacol 2014; 28:403-39. [PMID: 24713617 DOI: 10.1177/0269881114525674] [Citation(s) in RCA: 369] [Impact Index Per Article: 36.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
This revision of the 2005 British Association for Psychopharmacology guidelines for the evidence-based pharmacological treatment of anxiety disorders provides an update on key steps in diagnosis and clinical management, including recognition, acute treatment, longer-term treatment, combination treatment, and further approaches for patients who have not responded to first-line interventions. A consensus meeting involving international experts in anxiety disorders reviewed the main subject areas and considered the strength of supporting evidence and its clinical implications. The guidelines are based on available evidence, were constructed after extensive feedback from participants, and are presented as recommendations to aid clinical decision-making in primary, secondary and tertiary medical care. They may also serve as a source of information for patients, their carers, and medicines management and formulary committees.
Collapse
Affiliation(s)
- David S Baldwin
- 1Faculty of Medicine, University of Southampton, Southampton, UK
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Shang J, Fu Y, Ren Z, Zhang T, Du M, Gong Q, Lui S, Zhang W. The common traits of the ACC and PFC in anxiety disorders in the DSM-5: meta-analysis of voxel-based morphometry studies. PLoS One 2014; 9:e93432. [PMID: 24676455 PMCID: PMC3968149 DOI: 10.1371/journal.pone.0093432] [Citation(s) in RCA: 108] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Accepted: 03/04/2014] [Indexed: 02/05/2023] Open
Abstract
Background The core domains of social anxiety disorder (SAD), generalized anxiety disorder (GAD), panic disorder (PD) with and without agoraphobia (GA), and specific phobia (SP) are cognitive and physical symptoms that are related to the experience of fear and anxiety. It remains unclear whether these highly comorbid conditions that constitute the anxiety disorder subgroups of the Diagnostic and Statistical Manual for Mental Disorders – Fifth Edition (DSM-5) represent distinct disorders or alternative presentations of a single underlying pathology. Methods A systematic search of voxel-based morphometry (VBM) studies of SAD, GAD, PD, GA, and SP was performed with an effect-size signed differential mapping (ES-SDM) meta-analysis to estimate the clusters of significant gray matter differences between patients and controls. Results Twenty-four studies were eligible for inclusion in the meta-analysis. Reductions in the right anterior cingulate gyrus and the left inferior frontal gyrus gray matter volumes (GMVs) were noted in patients with anxiety disorders when potential confounders, such as comorbid major depressive disorder (MDD), age, and antidepressant use were controlled for. We also demonstrated increased GMVs in the right dorsolateral prefrontal cortex (DLPFC) in comorbid depression-anxiety (CDA), drug-naïve and adult patients. Furthermore, we identified a reduced left middle temporal gyrus and right precentral gyrus in anxiety patients without comorbid MDD. Conclusion Our findings indicate that a reduced volume of the right ventral anterior cingulate gyrus and left inferior frontal gyrus is common in anxiety disorders and is independent of comorbid depression, medication use, and age. This generic effect supports the notion that the four types of anxiety disorders have a clear degree of overlap that may reflect shared etiological mechanisms. The results are consistent with neuroanatomical DLPFC models of physiological responses, such as worry and fear, and the importance of the ventral anterior cingulate (ACC)/medial prefrontal cortex (mPFC) in mediating anxiety symptoms.
Collapse
Affiliation(s)
- Jing Shang
- Mental Health Center, Department of Psychiatry, West China Hospital of Sichuan University, Chengdu, People's Republic of China
| | - Yuchuan Fu
- Radiology Department of the Second Affiliated Hospital, Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Zhengjia Ren
- Mental Health Center, Department of Psychiatry, West China Hospital of Sichuan University, Chengdu, People's Republic of China
| | - Tao Zhang
- West China School of Public Health, Sichuan University, Chengdu, People's Republic of China
| | - Mingying Du
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, People's Republic of China
| | - Qiyong Gong
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, People's Republic of China
| | - Su Lui
- Radiology Department of the Second Affiliated Hospital, Wenzhou Medical University, Wenzhou, People's Republic of China
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, People's Republic of China
- * E-mail: (WZ); (SL)
| | - Wei Zhang
- Mental Health Center, Department of Psychiatry, West China Hospital of Sichuan University, Chengdu, People's Republic of China
- * E-mail: (WZ); (SL)
| |
Collapse
|
31
|
Schat A, van Noorden MS, Noom MJ, Giltay EJ, van der Wee NJA, Vermeiren RRJM, Zitman FG. Predictors of outcome in outpatients with anxiety disorders: the Leiden routine outcome monitoring study. J Psychiatr Res 2013; 47:1876-85. [PMID: 24074517 DOI: 10.1016/j.jpsychires.2013.09.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Revised: 09/04/2013] [Accepted: 09/09/2013] [Indexed: 12/01/2022]
Abstract
Little is known about the predictors of outcome in anxiety disorders in naturalistic outpatient settings. We analyzed 2-year follow-up data collected through Routine Outcome Monitoring (ROM) in a naturalistic sample of 917 outpatients in psychiatric specialty care in order to identify factors predicting outcome. We included patients with panic disorder with or without agoraphobia, agoraphobia without panic, social phobia, or generalized anxiety disorder. Main findings from Cox regression analyses demonstrated that several socio-demographic variables (having a non-Dutch ethnicity [HR = 0.71)], not having a daily occupation [HR = 0.76]) and clinical factors (having a diagnosis of agoraphobia [HR = 0.67], high affective lability [HR = 0.80] and behavior problems [HR = 0.84]) decreased chances of response (defined as 50% reduction of anxiety severity) over the period of two years. Living with family had a protective predictive value [HR = 1.41]. These results may imply that factors that could be thought to limit societal participation, are associated with elevated risk of poor outcome. A comprehensive ROM screening process at intake may aid clinicians in the identification of patients at risk of chronicity.
Collapse
Affiliation(s)
- A Schat
- Leiden University Medical Centre, Department of Psychiatry, P.O. Box 7500, 2300 RC Leiden, The Netherlands.
| | | | | | | | | | | | | |
Collapse
|
32
|
Newman MG, Llera SJ, Erickson TM, Przeworski A, Castonguay LG. Worry and generalized anxiety disorder: a review and theoretical synthesis of evidence on nature, etiology, mechanisms, and treatment. Annu Rev Clin Psychol 2013; 9:275-97. [PMID: 23537486 DOI: 10.1146/annurev-clinpsy-050212-185544] [Citation(s) in RCA: 218] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Generalized anxiety disorder (GAD) is associated with substantial personal and societal cost yet is the least successfully treated of the anxiety disorders. In this review, research on clinical features, boundary issues, and naturalistic course, as well as risk factors and maintaining mechanisms (cognitive, biological, neural, interpersonal, and developmental), are presented. A synthesis of these data points to a central role of emotional hyperreactivity, sensitivity to contrasting emotions, and dysfunctional attempts to cope with strong emotional shifts via worry. Consistent with the Contrast Avoidance model, evidence shows that worry evokes and sustains negative affect, thereby precluding sharp increases in negative emotion. We also review current treatment paradigms and suggest how the Contrast Avoidance model may help to target key fears and avoidance tendencies that serve to maintain pathology in GAD.
Collapse
Affiliation(s)
- Michelle G Newman
- Department of Psychology, The Pennsylvania State University, University Park, Pennsylvania 16802-3106, USA.
| | | | | | | | | |
Collapse
|
33
|
Sibrava NJ, Beard C, Bjornsson AS, Moitra E, Weisberg RB, Keller MB. Two-year course of generalized anxiety disorder, social anxiety disorder, and panic disorder in a longitudinal sample of African American adults. J Consult Clin Psychol 2013; 81:1052-62. [PMID: 24041233 DOI: 10.1037/a0034382] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Anxiety disorders are the most common group of psychiatric disorders in adults. In addition to high prevalence, anxiety disorders are associated with significant functional impairment, and published research has consistently found them to have a chronic course. To date, very little research has explored the clinical characteristics and prospective course of anxiety disorders in racial and ethnic minority samples. The aims of this article are to present clinical and demographic characteristics at intake and prospective 2-year course findings in a sample of African American adults. METHOD Data are presented from 152 African Americans diagnosed with generalized anxiety disorder (GAD, n = 94), social anxiety disorder (SAD, n = 85), and panic disorder with agoraphobia (PDA, n = 77) who are participating in the Harvard/Brown Anxiety Research Project-Phase II (HARP-II). HARP-II is an observational, prospective, longitudinal study of the course of anxiety disorders. Participants were interviewed at intake and annually for 2 years of follow-up. Probabilities of recovery over 2 years of follow-up were calculated using standard survival analysis methods. RESULTS AND CONCLUSIONS Survival analyses revealed a chronic course for all anxiety disorders, with rates of recovery of 0.23, 0.07, and 0.00 over 2 years for GAD, SAD, and PDA, respectively. These rates of recovery were lower than those reported in predominantly non-Latino White longitudinal samples, especially for SAD and PDA, suggesting that anxiety disorders may have a more chronic course for African Americans, with increased psychosocial impairment and high rates of comorbid Axis-I disorders. Clinical implications of these findings are discussed.
Collapse
Affiliation(s)
- Nicholas J Sibrava
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University
| | | | | | | | | | | |
Collapse
|
34
|
Abbo C, Kinyanda E, Kizza RB, Levin J, Ndyanabangi S, Stein DJ. Prevalence, comorbidity and predictors of anxiety disorders in children and adolescents in rural north-eastern Uganda. Child Adolesc Psychiatry Ment Health 2013; 7:21. [PMID: 23841918 PMCID: PMC3710504 DOI: 10.1186/1753-2000-7-21] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2013] [Accepted: 07/08/2013] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Child and adolescent anxiety disorders are the most prevalent form of childhood psychopathology. Research on child and adolescent anxiety disorders has predominantly been done in westernized societies. There is a paucity of data on the prevalence, comorbidity, and predictors of anxiety disorders in children and adolescents in non-western societies including those in sub-Saharan Africa. This paper investigates the prevalence, comorbidity, and predictors of anxiety disorders in children and adolescents in north-eastern Uganda. OBJECTIVE To determine the prevalence of DSM-IV anxiety disorders, as well as comorbidity patterns and predictors in children and adolescents aged 3 to 19 years in north-eastern Uganda. METHODS Four districts (Lira, Tororo, Kaberamaido and Gulu) in rural north-eastern Uganda participated in this study. Using a multi-stage sampling procedure, a sample of 420 households with children aged 3-19 years from each district was enrolled into the study. The MINI International Neuropsychiatric Interview for children and adolescents (MINI KID) was used to assess for psychiatric disorders in 1587 of 1680 respondents. RESULTS The prevalence of anxiety disorders was 26.6%, with rates higher in females (29.7%) than in males (23.1%). The most common disorders in both males and females were specific phobia (15.8%), posttraumatic stress disorder (PTSD) (6.6%) and separation anxiety disorder (5.8%). Children below 5 years of age were significantly more likely to have separation anxiety disorder and specific phobias, while those aged between 14-19 were significantly more likely to have PTSD. Anxiety disorders were more prevalent among respondents with other psychiatric disorders; in respondents with two or more co-morbid psychiatric disorders the prevalence of anxiety disorders was 62.1%. Predictors of anxiety disorders were experience of war trauma (OR = 1.93, p < 0.001) and a higher score on the emotional symptom scale of the SDQ (OR = 2.58, p < 0.001). Significant socio-demograghic associations of anxiety disorders were found for female gender, guardian unemployment, living in permanent housing, living without parents, and having parents without education. CONCLUSION The prevalence of anxiety disorders in children and adolescents in rural north-eastern Uganda is high, but consistent in terms of gender ratio and progression over time with a range of prior work in other contexts. Patterns of comorbidity and predictors of anxiety disorders in this setting are also broadly consistent with previous findings from western community studies. Both psychosocial stressors and exposure to war trauma are significant predictors of anxiety disorders.Prevention and treatment strategies need to be put in place to address the high prevalence rates of anxiety disorders in children and adolescents in Uganda.
Collapse
Affiliation(s)
- Catherine Abbo
- Department of Psychiatry, College of Health Sciences, Makerere University, P.O.BOX 7072, Kampala, Uganda
- Division of Child and Adolescent Psychiatry, Red Cross War Memorial Hospital and University of Cape Town, 7700 Rondebosch, Cape Town, South Africa
| | - Eugene Kinyanda
- MRC/UVRI Uganda Reseach Unit on AIDS, P.O.BOX 49, Entebbe, Uganda
| | - Ruth B Kizza
- North Stockholm’s Psychiatric Clinic, Stockholm, Sweden
| | - Jonathan Levin
- MRC/UVRI Uganda Reseach Unit on AIDS, P.O.BOX 49, Entebbe, Uganda
| | | | - Dan J Stein
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| |
Collapse
|
35
|
Joutsenniemi K, Laaksonen MA, Knekt P, Haaramo P, Lindfors O. Prediction of the outcome of short- and long-term psychotherapy based on socio-demographic factors. J Affect Disord 2012; 141:331-42. [PMID: 22520738 DOI: 10.1016/j.jad.2012.03.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2011] [Revised: 03/14/2012] [Accepted: 03/14/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Socio-demographic factors predict the outcome of short-term psychotherapy (STT) in the treatment of mood and anxiety disorders, but information on the prediction for long long-term therapy (LPP) is lacking. We aimed to compare the prediction of changes in psychiatric symptoms afforded by socio-demographic factors across two treatment conditions, short- versus long-term psychotherapy. METHODS In the Helsinki Psychotherapy Study, 326 outpatients with mood or anxiety disorders, aged 20-46 years, were randomly assigned to STT or LPP. Socio-demographic factors (i.e. age, gender, education, employment status, marital status, and living arrangement) were self-reported. Psychiatric symptoms were measured by the Symptom Check List, Global Severity Index (SCL-90-GSI) and Anxiety scale (SCL-90-Anx), and the Beck Depression Inventory (BDI) at baseline and seven times during a three-year follow-up period. RESULTS Socio-demographic factors were found to predict symptom development during follow-up irrespective of the baseline symptom level. Patients in a relatively good position, i.e. married and highly educated patients benefited from STT, whereas patients in less advantaged positions, i.e. homemakers, lone parents, and divorced patients needed LPP or did not benefit from either therapy. In several categories of socio-demographic factors, the extent to which a patient's background predicted the outcome of the psychotherapy varied according to whether general, anxiety or depressive symptoms were studied. LIMITATIONS We were unable to assess widows and pensioners. For ethical reasons, a no-treatment control group with a long follow-up could not be included in the study design. CONCLUSIONS Socio-demographic factors may need to be considered in the selection of patients for short- and long-term therapy.
Collapse
Affiliation(s)
- K Joutsenniemi
- National Institute for Health and Welfare (THL), Finland.
| | | | | | | | | |
Collapse
|
36
|
Gutiérrez F, Vall G, Peri JM, Baillés E, Ferraz L, Gárriz M, Caseras X. Personality disorder features through the life course. J Pers Disord 2012; 26:763-74. [PMID: 23013344 DOI: 10.1521/pedi.2012.26.5.763] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Personality Disorders have proved to be more fluid through the life course than previously thought. However, because analyses have usually been undertaken at the level of diagnostic categories, relevant findings may be obscured. An examination at the criteria level could bypass arbitrary aggregations of heterogeneous traits and thus offer more accurate information. To this end, we administered the Personality Diagnostic Questionnaire-4+ (PDQ-4+) to 1,477 patients aged 15 to 82. Nine of 12 disorders declined to some extent over the lifespan, but the evolution of individual criteria diverged within categories. At this level, 45 of 93 criteria showed age-related decreases, whereas only seven presented increases. A clearer picture is offered of the PD traits that change and those that remain stable. Thus, pathological features are not only more fluid, but developmentally more heterogeneous than previously believed.
Collapse
Affiliation(s)
- Fernando Gutiérrez
- Servei Psicologia Clínica, Institut Clínic Neurociències, Hospital Clínic de Barcelona, Villarroel 170, 08036 Barcelona, Spain.
| | | | | | | | | | | | | |
Collapse
|
37
|
Woodward AT, Taylor RJ, Bullard KM, Aranda MP, Lincoln KD, Chatters LM. Prevalence of lifetime DSM-IV affective disorders among older African Americans, Black Caribbeans, Latinos, Asians and non-Hispanic White people. Int J Geriatr Psychiatry 2012; 27:816-27. [PMID: 21987438 PMCID: PMC3391316 DOI: 10.1002/gps.2790] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2010] [Accepted: 07/27/2011] [Indexed: 11/12/2022]
Abstract
OBJECTIVES The purpose of this study is to estimate lifetime prevalence of seven psychiatric affective disorders for older non-Hispanic White people, African Americans, Caribbean Black people, Latinos, and Asian Americans and examine demographic, socioeconomic, and immigration correlates of those disorders. DESIGN Data are taken from the older sub-sample of the Collaborative Psychiatric Epidemiology Surveys. Selected measures of lifetime DSM-IV psychiatric disorders were examined (i.e., panic disorder, agoraphobia, social phobia, generalized anxiety disorder, post-traumatic stress disorder, major depressive disorder, and dysthymia). SETTING Community epidemiologic survey. PARTICIPANTS Nationally representative sample of adults 55 years and older (n = 3046). MEASUREMENTS Disorders were assessed using the DSM-IV World Mental Health Composite International Diagnostic Interview. RESULTS Major depressive disorder and social phobia were the two most prevalent disorders among the seven psychiatric conditions. Overall, non-Hispanic White people and Latinos consistently had higher prevalence rates of disorders, African Americans had lower prevalence of major depression and dysthymia, and Asian Americans were typically less likely to report affective disorders than those of their counterparts. There is variation across groups in the association of demographic, socioeconomic, and immigration variables with disorders. CONCLUSIONS This study furthers our understanding of the racial and ethnic differences in the prevalence of DSM-IV disorders among older adults and the correlates of those disorders. It highlights the importance of examining both between-group and within-group differences in disorders and the complexity of the mechanisms associated with differences across groups. Findings from this study underscore the need for future research that more clearly delineates subgroup differences and similarities.
Collapse
|
38
|
A review on predictors of treatment outcome in social anxiety disorder. BRAZILIAN JOURNAL OF PSYCHIATRY 2012. [DOI: 10.1016/s1516-4446(12)70016-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
|
39
|
Mululo SCC, de Menezes GB, Vigne P, Fontenelle LF. A review on predictors of treatment outcome in social anxiety disorder. BRAZILIAN JOURNAL OF PSYCHIATRY 2012; 34:92-100. [DOI: 10.1590/s1516-44462012000100016] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2011] [Accepted: 09/03/2011] [Indexed: 12/16/2022]
|
40
|
Reliability and discriminant validity of an Arabic translation of the Children’s Automatic Thought Scale. MIDDLE EAST CURRENT PSYCHIATRY 2012. [DOI: 10.1097/01.xme.0000407828.74392.d6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
41
|
Penninx BWJH, Nolen WA, Lamers F, Zitman FG, Smit JH, Spinhoven P, Cuijpers P, de Jong PJ, van Marwijk HWJ, van der Meer K, Verhaak P, Laurant MGH, de Graaf R, Hoogendijk WJ, van der Wee N, Ormel J, van Dyck R, Beekman ATF. Two-year course of depressive and anxiety disorders: results from the Netherlands Study of Depression and Anxiety (NESDA). J Affect Disord 2011; 133:76-85. [PMID: 21496929 DOI: 10.1016/j.jad.2011.03.027] [Citation(s) in RCA: 238] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2010] [Revised: 03/12/2011] [Accepted: 03/12/2011] [Indexed: 12/11/2022]
Abstract
BACKGROUND Whether course trajectories of depressive and anxiety disorders are different, remains an important question for clinical practice and informs future psychiatric nosology. This longitudinal study compares depressive and anxiety disorders in terms of diagnostic and symptom course trajectories, and examines clinical prognostic factors. METHODS Data are from 1209 depressive and/or anxiety patients residing in primary and specialized care settings, participating in the Netherlands Study of Depression and Anxiety. Diagnostic and Life Chart Interviews provided 2-year course information. RESULTS Course was more favorable for pure depression (n=267, median episode duration = 6 months, 24.5% chronic) than for pure anxiety (n=487, median duration = 16 months, 41.9% chronic). Worst course was observed in the comorbid depression-anxiety group (n=455, median duration > 24 months, 56.8% chronic). Independent predictors of poor diagnostic and symptom trajectory outcomes were severity and duration of index episode, comorbid depression-anxiety, earlier onset age and older age. With only these factors a reasonable discriminative ability (C-statistic 0.72-0.77) was reached in predicting 2-year prognosis. LIMITATION Depression and anxiety cases concern prevalent - not incident - cases. This, however, reflects the actual patient population in primary and specialized care settings. CONCLUSIONS Their differential course trajectory justifies separate consideration of pure depression, pure anxiety and comorbid anxiety-depression in clinical practice and psychiatric nosology.
Collapse
Affiliation(s)
- Brenda W J H Penninx
- Department of Psychiatry/EMGO Institute for Health and Care Research/Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Ramsawh HJ, Weisberg RB, Dyck I, Stout R, Keller MB. Age of onset, clinical characteristics, and 15-year course of anxiety disorders in a prospective, longitudinal, observational study. J Affect Disord 2011; 132:260-4. [PMID: 21295858 PMCID: PMC3109118 DOI: 10.1016/j.jad.2011.01.006] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2010] [Revised: 01/03/2011] [Accepted: 01/13/2011] [Indexed: 11/29/2022]
Abstract
BACKGROUND Age of onset is rarely studied in the anxiety disorders literature. The current study examined age of onset as it relates to clinical characteristics and course of anxiety disorders using a prospective, longitudinal, observational design. METHODS Fifteen-year follow-up data were examined for participants with panic disorder with (PDA) or without (PD) agoraphobia, social phobia (SP), and/or generalized anxiety disorder (GAD) at baseline. Logistic regression analyses were conducted to determine whether age of onset was associated with demographic or clinical variables at baseline. Cox regression analyses were conducted to examine longitudinal course (time to recurrence and recovery, respectively) for each diagnostic group. RESULTS At baseline, PD participants with early onset (i.e., < age 20) were more likely to have comorbid MDD, GAD, and SP relative to late-onset participants (≥ age 20). For PDA, early-onset participants were less likely to be married, and more likely to have both GAD and SP at baseline. With respect to longitudinal course, earlier onset was associated with an increased likelihood of recurrence in participants with PDA. No other models reached significance. LIMITATIONS The sample sizes for some disorders were comparatively small in relation to PDA, and all participants were treatment-seeking, which may limit generalizability. CONCLUSIONS For some anxiety disorders, earlier age of onset appears to be associated with greater severity and worse course, as evidenced by increased risk of recurrence over 15years of follow-up. Early interventions focused on children and adolescents may alleviate some of the public health burden associated with anxiety disorders.
Collapse
Affiliation(s)
- Holly J. Ramsawh
- Department of Psychiatry, School of Medicine, University of California San Diego
| | - Risa B. Weisberg
- Department of Psychiatry & Human Behavior, Warren Alpert Medical School, Brown University,Department of Family Medicine, Warren Alpert Medical School, Brown University Providence, RI 02912
| | - Ingrid Dyck
- Department of Psychiatry & Human Behavior, Warren Alpert Medical School, Brown University
| | - Robert Stout
- Department of Psychiatry & Human Behavior, Warren Alpert Medical School, Brown University
| | - Martin B. Keller
- Department of Psychiatry & Human Behavior, Warren Alpert Medical School, Brown University
| |
Collapse
|
43
|
Prevalence and correlates of generalized anxiety disorder among older adults in the Australian National Survey of Mental Health and Well-Being. J Affect Disord 2011; 132:223-30. [PMID: 21429587 DOI: 10.1016/j.jad.2011.02.023] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2010] [Revised: 02/23/2011] [Accepted: 02/23/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND Generalized anxiety disorder (GAD) occurs commonly, with widespread consequences including decreased functioning and wellbeing, and increased consumption of health resources. Notwithstanding its prevalence and impact, knowledge about GAD in older adults is still scarce. Accordingly, the main goals of this study were to estimate the prevalence and analyze the correlates of 12-month DSM-IV GAD in older community-residing adults. METHODS The sample was drawn from the 2007 Australian National Survey of Mental Health and Well-Being and consisted of 3035 participants aged between 55 and 85years, assessed by lay interviewers with the fully-structured Composite International Diagnostic Interview. RESULTS Eighty-four participants were diagnosed with GAD, equivalent to a weighted 12-month population prevalence of 2.8% (95% CI: 2.0, 3.7). In a multivariate logistic regression model older age (OR=0.24, p=0.006), functional limitations (OR=1.07, p=0.001), lifetime depression comorbidity (OR=5.31, p<0.001), concerns about having a serious illness despite doctor's reassurance (OR=2.29, p=0.021), and family history of anxiety or depression (OR=2.41, p=0.007) were the most significant predictors of 12-month GAD in older adults. LIMITATIONS This was a cross sectional study, limiting causal inferences. CONCLUSIONS In community-residing older adults GAD is highly prevalent and strongly associated with functional limitations, psychiatric comorbidity and increased medication intake. These findings suggest the need for greater clinical awareness of GAD among older adults.
Collapse
|
44
|
Abstract
OBJECTIVES The objectives of this study are to provide current estimates of the prevalence and correlates of generalized anxiety disorder (GAD). METHODS The authors used Wave 2 data from the National Epidemiologic Survey on Alcohol and Related Conditions, which included 12,312 adults 55+ and older. In addition to examining the prevalence of GAD in the past year, this study explored psychiatric and medical comorbidity, health-related quality of life, and rates of help-seeking and self-medication. RESULTS The past-year prevalence of GAD in this sample was 2.80%, although only 0.53% had GAD without Axis I or II comorbidity. The majority of individuals with GAD had mood or other anxiety disorders, and approximately one quarter had a personality disorder. Individuals with GAD were also more likely to have various chronic health problems although these associations disappeared after controlling for psychiatric comorbidity. Health-related quality of life was reduced among older adults with GAD, even after controlling for health conditions and comorbid major depression. Finally, only 18% of those without and 28.3% with comorbid Axis I disorders sought professional help for GAD in the past year. Self-medication for symptom relief was rare (7.2%). CONCLUSIONS GAD is a common and disabling disorder in later life that is highly comorbid with mood, anxiety, and personality disorders; psychiatric comorbidity is associated with an increased risk of medical conditions in this population. Considering that late-life GAD is associated with impaired quality of life but low levels of professional help-seeking increased effort is needed to help individuals with this disorder to access effective treatments.
Collapse
|
45
|
Ramsawh HJ, Chavira DA, Stein MB. Burden of anxiety disorders in pediatric medical settings: prevalence, phenomenology, and a research agenda. ACTA ACUST UNITED AC 2010; 164:965-72. [PMID: 20921356 DOI: 10.1001/archpediatrics.2010.170] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The current review describes the phenomenology of several common anxiety disorders in children and adolescents as they present in medical settings. Anxiety disorders and associated features in children are described, along with epidemiology, functional impairment, common somatic complaints, medical comorbidity, health care utilization, and presentation in general and in specialty pediatric medical settings. Recommendations for clinical management in pediatric settings are presented, and evidence-based interventions and emerging treatments for pediatric anxiety disorders are described. The review concludes with a discussion of future research directions that may lead to increased recognition and improved management of anxiety disorders in pediatric medical settings.
Collapse
Affiliation(s)
- Holly J Ramsawh
- Department of Psychiatry, University of California, San Diego, La Jolla, CA 92093-0855, USA.
| | | | | |
Collapse
|
46
|
Abstract
This article presents the current evidence base for pharmacotherapy of generalized anxiety disorder (GAD) and an update on the phenomenology of GAD and its association with other psychiatric and somatic conditions. It discusses nosological issues and suggests ways to improve recognition, treatment, and care for patients who have GAD.
Collapse
Affiliation(s)
- Christer Allgulander
- Department of Clinical Neuroscience, Karolinska Institutet, Section of Psychiatry at Karolinska University Hospital, SE14186 Huddinge, Sweden.
| |
Collapse
|