Recurrence of anxiety disorders and its predictors in the general population

Risk factors of chronic course of anxiety and depressive disorders: a 3-year longitudinal study in the general population

BACKGROUND

Risk factors of a chronic course of anxiety and depressive disorders were previously studied using a limited definition of recovery, i.e. remission of the index disorder. However, frequently, other mental disorders are present at follow-up. Thus, the course of anxiety and depressive disorders was represented too rosy and the identified determinants may not apply when using a broader, more realistic definition. Additionally, physical health risk factors have often been ignored.

METHODS

Data were used from two waves of the Netherlands Mental Health Survey and Incidence Study-2 including 509 respondents with 12-month anxiety disorder (panic disorder, social phobia, agoraphobia or generalized anxiety disorder) or/and major depressive disorder at baseline. Chronic course was defined as (1) presence of index disorder; and (2) presence of any anxiety, mood or substance use disorder (overall course) during the subsequent three years. Regression models were built with sociodemographic, clinical, and lifestyle/physical health indicators. Predictive accuracy was evaluated with area under the curve (AUC).

RESULTS

Chronic course of the index disorder was present among 24.8% of cases, whereas 38.7% had a chronic overall course. The accuracy of prediction of chronic course of the index disorder was suboptimal (AUC = 0.68) compared to prediction of overall course (AUC = 0.75). The main risk factors were baseline number of mental disorders, neuroticism, childhood abuse, parental psychopathology and alcohol use. Lifestyle and physical health indicators were marginally relevant.

CONCLUSION

Transdiagnostic risk factors are important in predicting overall course of anxiety and depressive disorders but cannot accurately predict chronic course of the index disorder.

Incidence Rates and Predictors of Recurrent Long-Term Mental Sickness Absence Due to Common Mental Disorders

PURPOSE

Several predictors have been identified for mental sickness absence, but those for recurrences are not well-understood. This study assesses recurrence rates for long-term mental sickness absence (LTMSA) within subgroups of common mental disorders (CMDs) and identifies predictors of recurrent LTMSA.

METHODS

This historical prospective cohort study used routinely collected data from 16,310 employees obtained from a nationally operating Dutch occupational health service (ArboNed). Total follow-up duration was 23,334 person-years. Overall recurrence rates were assessed using Kaplan-Meier estimators. Recurrence rates within subgroups of CMDs were calculated using person-years. Univariable and multivariable Cox proportional hazards models were used to identify predictors.

RESULTS

15.6% of employees experienced a recurrent LTMSA episode within three years after fully returning to work after a previous LTMSA episode. Highest recurrence rates for LTMSA were observed after a previous LTMSA episode due to mood or anxiety disorders. Mood or anxiety disorders and shorter previous episode duration were predictors of recurrent LTMSA. No associations were found for age, gender, company size, full-time equivalent and job tenure.

CONCLUSION

Employees should be monitored adequately after they fully returned to work after LTMSA. It is recommended to monitor high-risk employees (i.e. employees with mood or anxiety disorders and short LTMSA episode) more intensively, also beyond full return to work. Moreover, diagnosis of anxiety and depressive symptoms should be given a higher priority in occupational healthcare.

Neuroticism/negative emotionality is associated with increased reactivity to uncertain threat in the bed nucleus of the stria terminalis, not the amygdala

Neuroticism/Negative Emotionality (N/NE)-the tendency to experience anxiety, fear, and other negative emotions-is a fundamental dimension of temperament with profound consequences for health, wealth, and wellbeing. Elevated N/NE is associated with a panoply of adverse outcomes, from reduced socioeconomic attainment to psychiatric illness. Animal research suggests that N/NE reflects heightened reactivity to uncertain threat in the bed nucleus of the stria terminalis (BST) and central nucleus of the amygdala (Ce), but the relevance of these discoveries to humans has remained unclear. Here we used a novel combination of psychometric, psychophysiological, and neuroimaging approaches to rigorously test this hypothesis in an ethnoracially diverse, sex-balanced sample of 220 emerging adults selectively recruited to encompass a broad spectrum of N/NE. Cross-validated robust-regression analyses demonstrated that N/NE is preferentially associated with heightened BST activation during the uncertain anticipation of a genuinely distressing threat (aversive multimodal stimulation), whereas N/NE was unrelated to BST activation during certain-threat anticipation, Ce activation during either type of threat anticipation, or BST/Ce reactivity to threat-related faces. It is often assumed that different threat paradigms are interchangeable assays of individual differences in brain function, yet this has rarely been tested. Our results revealed negligible associations between BST/Ce reactivity to the anticipation of threat and the presentation of threat-related faces, indicating that the two tasks are non-fungible. These observations provide a framework for conceptualizing emotional traits and disorders; for guiding the design and interpretation of biobank and other neuroimaging studies of psychiatric risk, disease, and treatment; and for informing mechanistic research.

Association between gut microbiota and anxiety disorders: a bidirectional two-sample mendelian randomization study

BACKGROUND

There are many articles reporting that the component of intestinal microbiota implies a link to anxiety disorders (AD), and the brain-gut axis is also a hot topic in current research. However, the specific relevance between gut microbiota and AD is uncertain. We aimed to investigate causal relationship between gut microbiota and AD by using bidirectional Mendelian randomization (MR).

METHODS

Genetic instrumental variable (IV) for the gut microbiota were obtained from a genome-wide association study (GWAS) involving 18,340 participants. Summary data for AD were derived from the GWAS and included 158,565 cases and 300,995 controls. We applied the inverse variance weighted (IVW) method as the main analysis. Cochran's Q values was computed to evaluate the heterogeneity among IVs. Sensitivity analyses including intercept of MR-Egger method and MR-PRESSO analysis were used to test the horizontal pleiotropy.

RESULT

We discovered 9 potential connections between bacterial traits on genus level and AD. Utilizing the IVW method, we identified 5 bacterial genera that exhibited a direct correlation with the risk of AD: genus Eubacteriumbrachygroup, genus Coprococcus3, genus Enterorhabdus, genus Oxalobacter, genus Ruminiclostridium6. Additionally, we found 4 bacterial genera that exhibited a negative association with AD: genus Blautia, genus Butyricicoccus, genus Erysipelotrichaceae-UCG003 and genus Parasutterella. The associations were confirmed by the sensitivity analyses.

CONCLUSION

Our study found a causal relation between parts of the gut microbiota and AD. Further randomized controlled trials are crucial to elucidate the positive effects of probiotics on AD and their particular protection systems.

Not just emotion regulation, but cognition: An experience sampling study testing the relations of ecological interpretation biases and use of emotion regulation strategies with momentary affective states during daily life functioning

BACKGROUND

Current research is moving from studying cognitive biases and maladaptive emotion regulation (ER) as relatively stable phenomena contributing to affective disturbances, adopting ecological methodologies, such as Experience Sampling Methods (ESM). However, there is still limited ESM evidence on the interactions between stress and ER strategies' use, and negative interpretation biases, regarding their relations with momentary affective states. In this study, we used a new ESM design to disentangle the contextual, regulatory and cognitive processes implicated in daily affective experiences.

METHOD

A sample of 103 participants completed an ESM study (3 times a day for 10 days) that included self-reports of momentary affect, stress intensity, ER strategies' use and a cognitive task measuring momentary negative interpretation biases.

RESULTS

Multilevel analyses supported significant interactions of both rumination and worry with stress intensity, to account for momentary higher negative and lower positive affect levels. Furthermore, higher state negative interpretation bias levels uniquely predicted both higher negative and lower positive momentary affect levels.

CONCLUSION

This study implemented a novel online cognitive task within an ESM procedure, which helped to disentangle how contextual ER strategies' use and momentary cognitive biases uniquely relate to affective experiences in daily life.

Communicating the benefits of quitting smoking on mental health increases motivation to quit in people with anxiety and/or depression

BACKGROUND

Although smoking rates have declined over time, this decline has not been observed among those with mental health concerns. It is therefore important to develop effective messaging to support quitting in this population.

METHODS

We conducted an online experiment with 419 adults who smoke cigarettes daily. Participants with, or without a lifetime history of anxiety and/or depression were randomized to view a message focused on the benefits of quitting smoking on mental or physical health. Participants then reported motivation to quit smoking, mental health concerns about quitting, and perceived effectiveness of the message.

RESULTS

Participants with a lifetime history of anxiety and/or depression who saw the message focused on the benefits of quitting smoking on mental health reported greater motivation to quit than when they saw a message focused on the benefits to physical health. This was not replicated when examining current symptoms instead of lifetime history. Pre-existing beliefs that smoking improves one's mood were greater in those experiencing current symptoms and in those with a lifetime history of anxiety and/or depression. There was no main or interaction (message type X mental health status) effect of message type received on mental health related concerns about quitting.

CONCLUSIONS

This study is one of the first to evaluate a smoking cessation message with content specifically targeted to those with mental health concerns about quitting smoking. Additional work is needed to determine how to best target those with mental health concerns with messages focused on the benefits of quitting on mental health.

A preliminary study of the effects of an antimuscarinic agent on anxious behaviors and white matter microarchitecture in nonhuman primates

Myelination subserves efficient neuronal communication, and alterations in white matter (WM) microstructure have been implicated in numerous psychiatric disorders, including pathological anxiety. Recent work in rodents suggests that muscarinic antagonists may enhance myelination with behavioral benefits; however, the neural and behavioral effects of muscarinic antagonists have yet to be explored in non-human primates (NHP). Here, as a potentially translatable therapeutic strategy for human pathological anxiety, we present data from a first-in-primate study exploring the effects of the muscarinic receptor antagonist solifenacin on anxious behaviors and WM microstructure. 12 preadolescent rhesus macaques (6 vehicle control, 6 experimental; 8F, 4M) were included in a pre-test/post-test between-group study design. The experimental group received solifenacin succinate for ~60 days. Subjects underwent pre- and post-assessments of: 1) anxious temperament (AT)-related behaviors in the potentially threatening no-eye-contact (NEC) paradigm (30-min); and 2) WM and regional brain metabolism imaging metrics, including diffusion tensor imaging (DTI), quantitative relaxometry (QR), and FDG-PET. In relation to anxiety-related behaviors expressed during the NEC, significant Group (vehicle control vs. solifenacin) by Session (pre vs. post) interactions were found for freezing, cooing, and locomotion. Compared to vehicle controls, solifenacin-treated subjects exhibited effects consistent with reduced anxiety, specifically decreased freezing duration, increased locomotion duration, and increased cooing frequency. Furthermore, the Group-by-Session-by-Sex interaction indicated that these effects occurred predominantly in the males. Exploratory whole-brain voxelwise analyses of post-minus-pre differences in DTI, QR, and FDG-PET metrics revealed some solifenacin-related changes in WM microstructure and brain metabolism. These findings in NHPs support the further investigation of the utility of antimuscarinic agents in targeting WM microstructure as a means to treat pathological anxiety.

Status after Hospital Discharge: An Observational Study of the Progression of Patients' Mental Health Symptoms Six Weeks after Hospital Discharge

(1) Background: Transitioning from mental health inpatient care to community care is often a vulnerable time in the treatment process where additional risks and anxiety may arise. We collected data for this study as part of a pragmatic cluster-randomized, longitudinal approach in Alberta. As the first phase of the ongoing innovative supportive program, this paper assessed the progression of mental health symptoms in patients six weeks after hospital discharge. Factors that may contribute to the presence or absence of anxiety and depression symptoms, as well as well-being, following return to the community were investigated. This provides evidence and baseline data for future phases of the project. (2) Methods: An observational study design was adopted for this study. Data on a variety of sociodemographic and clinical factors were collected at discharge and six weeks after via REDCap. Anxiety, depression, and well-being symptoms were assessed using the Generalized Anxiety Disorder (GAD-7) questionnaire, the Patient Health Questionnaire-9 (PHQ-9), and the World Health Organization-Five Well-Being Index (WHO-5), respectively. Descriptive, chi-square, independent t-tests, and multivariate regression analyses were conducted. (3) Result: The survey was completed by 88 out of 306 participants (28.8% response rate). The chi-square/Fisher exact test and independent t-test revealed no significant change in the mental health conditions from baseline to six weeks after discharge. It was found that the only significant factor predicting symptoms six weeks after discharge from inpatient treatment was the baseline symptoms in all three logistic regression models. It was four times more likely for those who experienced anxiety and depression at baseline to experience anxiety and depression symptoms six weeks after discharge (OR = 4.27; 95% CI: 1.38-13.20) (OR = 4.04; 95% CI: 1.25-13.05). Those with poor baseline well-being were almost 12 times more likely to experience poor well-being six weeks after discharge (OR = 11.75; 95% CI: 3.21-42.99). (4) Conclusions: Study results found no significant change in mental health conditions in the short term following hospital discharge. It is essential that researchers and policymakers collaborate in order to implement effective interventions to support and maintain the mental health conditions of patients following discharge.

Association between high levels of comorbid anxiety and depressive symptoms and decreased likelihood of birth without intervention: A longitudinal prospective cohort study

OBJECTIVE

To assess the association between trajectories of comorbid anxiety and depressive (CAD) symptoms assessed in each pregnancy trimester and physiological birth.

DESIGN

Large longitudinal prospective cohort study with recruitment between January 2013 and September 2014.

SETTING

Primary care, in the Netherlands.

POPULATION

Dutch-speaking pregnant women with gestational age at birth ≥37 weeks, and without multiple pregnancy, severe psychiatric disorder or chronic disease history.

METHODS

Pregnancy-specific anxiety and depressive symptoms were measured prospectively in each trimester of pregnancy using the negative affect subscale of the Tilburg Pregnancy Distress Scale and Edinburgh (Postnatal) Depression Scale. Data on physiological birth were obtained from obstetric records. Multivariate growth mixture modelling was performed in MPLUS to determine longitudinal trajectories of CAD symptoms. Multiple logistic regression analysis was used to examine the association between trajectories and physiological birth.

MAIN OUTCOME MEASURES

Trajectories of CAD symptoms and physiological birth.

RESULTS

Seven trajectories (classes) of CAD symptoms were identified in 1682 women and subsequently merged into three groups: group 1-persistently low levels of symptoms (reference class 1; 79.0%), group 2-intermittently high levels of symptoms (classes 3, 6 and 7; 11.2%), and group 3-persistently high levels of symptoms (classes 2, 4 and 5; 9.8%). Persistently high levels of CAD symptoms (group 3) were associated with a lower likelihood of physiological birth (odds ratio 0.67, 95% confidence interval 0.47-0.95, P = 0.027) compared with the reference group (persistently low levels of symptoms), after adjusting for confounders.

CONCLUSIONS

This study is the first showing evidence that persistently high CAD levels, assessed in each pregnancy trimester, are associated with a lower likelihood of physiological birth.

The Netherlands Mental Health Survey and Incidence Study-3 (NEMESIS-3): Objectives, methods and baseline characteristics of the sample

OBJECTIVES

NEMESIS-3 (Netherlands Mental Health Survey and Incidence Study-3) is a psychiatric epidemiological cohort study of the Dutch general population that replicates and expands on two previous NEMESIS-studies conducted in 1996-1999 and 2007-2018 respectively. The main aims of NEMESIS-3 are to provide up-to-date information on the prevalence, incidence, course and consequences of mental disorders, their risk indicators, and to study the relevant time trends. This paper gives an overview of the objectives and methods of NEMESIS-3, especially of the recently completed first wave, and describes the sample characteristics.

METHODS

NEMESIS-3 is based on a multistage, stratified random sampling of individuals aged 18-75 years. Face-to-face interviews were laptop computer-assisted and held at the respondent's home. A slightly modified Composite International Diagnostic Interview (CIDI) version 3.0 was used to assess both Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) and DSM-5 mental disorders. Two follow-up waves are planned three and six years after baseline.

RESULTS

In the first wave, performed from November 2019 to March 2022, 6194 individuals were interviewed: 1576 respondents before and 4618 respondents during the COVID-19 pandemic. The average interview duration was 91 min and the response rate was 54.6%. The sample consisted of 50.4% women and had a mean age of 47.9 years. The sample was reasonable nationally representative, although some sociodemographic groups were somewhat underrepresented.

CONCLUSIONS

Despite the COVID-19 restrictions, we were able to build a large and comprehensive dataset of good quality, permitting us to investigate the latest trends in mental health status, various new topics related to mental health, and the extent to which the pandemic has had an effect on the population's mental health.

The gold-standard treatment for social anxiety disorder: A roadmap for the future

Exposure therapy (ET), which follows the Pavlovian extinction model, is regarded as the gold-standard treatment for social anxiety disorder (SAD). The prospect of virtual reality in lieu of a traditional laboratory setting for the treatment of SAD has not been rigorously explored. The aim of the review was to summarize, find gaps in the current literature, and formulate future research direction by identifying two broad research questions: the comparative efficacy between in vivo ET and virtual reality exposure therapy (VRET) and the effectiveness of the Pavlovian extinction model in treating SAD. The criteria for effectiveness were effect size, relapse prevention, attrition rate and ecological validity. A literature search on recent randomized controlled trials yielded a total of 6 original studies (N=358), excluding duplication and overlapping participants. All studies supported that VRET was as effective as in vivo ET. Behavioral therapy that follows classical conditioning principles has a high attrition and relapse rate. Comparisons were drawn between the efficacy of the Pavlovian extinction model and other existing models, including third-wave approaches. The neural markers are suggested to be included as efficacy measures in treating SAD. The gold-standard treatment for SAD requires a paradigm shift through rigorous longitudinal comparative studies.

HDAC1-mediated regulation of GABA signaling within the lateral septum facilitates long-lasting social fear extinction in male mice

Social anxiety disorder (SAD) is caused by traumatic social experiences. It is characterized by intense fear and avoidance of social contexts, which can be robustly mimicked by the social fear conditioning (SFC) paradigm. The extinction phase of the SFC paradigm is akin to exposure therapy for SAD and requires learning to disassociate the trauma with the social context. Learning-induced acetylation of histones is critical for extinction memory formation and its endurance. Although class I histone deacetylases (HDACs) regulate the abovementioned learning process, there is a lack of clarity in isoforms and spatial specificity in HDAC function in social learning. Utilizing the SFC paradigm, we functionally characterized the role of HDAC1, specifically in the lateral septum (LS), in regulating the formation of long-term social fear extinction memory. We measured a local increase in activity-inducing HDAC1 phosphorylation at serine residues of social fear-conditioned (SFC⁺) mice in response to the extinction of social fear. We also found that LS-HDAC1 function negatively correlates with acute social fear extinction learning using pharmacological and viral approaches. Further, inhibition of LS-HDAC1 enhanced the expression of the GABA-A receptor β1 subunit (Gabrb1) in SFC⁺ mice, and activation of GABA-A receptors facilitated acute extinction learning. Finally, the facilitation of extinction learning by HDAC1 inhibition or GABA-A receptor activation within the LS led to the formation of long-lasting extinction memory, which persisted even 30 days after extinction. Our results show that HDAC1-mediated regulation of GABA signaling in the LS is crucial for the formation of long-lasting social fear extinction memory.

Translating Big Data to Clinical Outcomes in Anxiety: Potential for Multimodal Integration

PURPOSE OF THE REVIEW

This review describes approaches to research on anxiety that attempt to link neural correlates to treatment response and novel therapies. The review emphasizes pediatric anxiety disorders since most anxiety disorders begin before adulthood.

RECENT FINDINGS

Recent literature illustrates how current treatments for anxiety manifest diverse relations with a range of neural markers. While some studies demonstrate post-treatment normalization of markers in anxious individuals, others find persistence of group differences. For other markers, which show no pretreatment association with anxiety, the markers nevertheless distinguish treatment-responders from non-responders. Heightened error related negativity represents the risk marker discussed in the most depth; however, limitations in measures related to error responding necessitate multimodal and big-data approaches. Single risk markers show limits as correlates of treatment response. Large-scale, multimodal data analyzed with predictive models may illuminate additional risk markers related to anxiety disorder treatment outcomes. Such work may identify novel targets and eventually guide improvements in treatment response/outcomes.

How chronic are depressive and anxiety disorders? 9-year general population study using narrow and broad course outcomes

BACKGROUND

Existing studies on disease course usually apply relatively short follow-up periods and narrow definitions of disease course resulting in too optimistic views on disease prognosis. This study explores the relevance of using a longer and broader (cross-disorder) perspective.

METHODS

Respondents with a 12-month disorder at baseline and available at 3-, 6- and 9-year follow-up were selected (major depressive disorder, MDD: n = 208; anxiety disorder: n = 220) from a general population study (N = 6646). DSM-IV disorders were assessed with the Composite International Diagnostic Interview. Disease course was described using a short and narrow perspective (i.e., 3-year follow-up, and considering presence of the index disorder only) and a long and broad perspective (9-year follow-up, and considering presence of any mood, anxiety or substance use disorder as outcome).

RESULTS

The recovery rates of both MDD and anxiety disorder reduced by half when the perspective switched from short and narrow (MDD: 74.0 %; anxiety disorder: 79.5 %) to long and broad (35.6 % and 40.0 % respectively). At 9-year follow-up, the rates of a persistent disorder (a disorder at each follow-up assessment) tripled when the perspective switched from narrow to broad (MDD: from 4.8 % to 13.9 %; anxiety disorder: from 4.5 % to 15.5 %).

LIMITATIONS

The findings are not generalizable to the most severe depressed and anxious patients.

CONCLUSIONS

Most people with MDD or anxiety disorder in the general population have a rather favourable prognosis when a narrow perspective is applied, but an unfavourable prognosis when a long-term and broad perspective is applied. Consequently, MDD and anxiety disorder should not merely be perceived as episodic disorders, and require longer-term disease monitoring and management.

Reliability and validity of the Mental Health Self-management Questionnaire among Chinese patients with mood and anxiety disorders

BACKGROUND

Self-management plays an important role in promoting and restoring mental health for individuals with mental health issues. However, there is no valid and reliable Chinese tool assessing the self-management behaviors of people with mood and anxiety disorders. This study aimed to develop a Chinese version of the Mental Health Self-management Questionnaire (MHSQ-C) and to verify its psychometric properties.

METHODS

A total of 440 potential participants were recruited by convenience sampling from June to August 2020. Item analysis and analyses of internal consistency, test-retest reliability, content validity, construct validity and criterion validity were performed.

RESULTS

Data from 326 participants were used. Three factors obtained via principal component analysis and varimax rotation explained 53.68% of the total variance. The average content validity index was 0.99. The Cronbach's α coefficient (total: 0.874, clinical: 0.706, empowerment: 0.818, vitality: 0.830) and test-retest reliability (ICC: total: 0.783, 95% confidence interval (CI) [0.616, 0.882], clinical: 0.525, 95% CI [0.240, 0.725], empowerment: 0.786, 95% CI [0.622, 0.884], vitality: 0.748, 95% CI [0.564, 0.862]) were good. The MHSQ-C was well correlated with the Partners in Health scale and showed no floor or ceiling effect.

DISCUSSION

The MHSQ-C is a reliable and valid tool to evaluate the self-management strategies of patients with mood and anxiety disorders.