Cognitive Vulnerabilities for Depression and Anxiety in Childhood: Specificity of Anxiety Sensitivity and Rumination

Pre-pandemic socio-emotional vulnerability, internalizing and externalizing symptoms predict changes in hair cortisol concentrations in reaction to the COVID-19 pandemic in children

The COVID-19 pandemic led to increased distress in many children, particularly in girls. Socio-emotional vulnerability, as well as psychiatric symptomatology prior to or during the initial stages of the pandemic, have been identified as important predictors of this distress. Still, it is unclear whether the pandemic also had physiological repercussions in children. If so, it remains to be determined whether these same predictors could provide insight into inter-individual variability. This longitudinal study aimed to investigate the effects of socio-emotional vulnerability, as well as pre-pandemic internalizing and externalizing symptoms, on hair cortisol concentrations (HCC) in response to the COVID-19 pandemic in healthy youth. In June 2020 (T1), 69 healthy children (M = 11.57 y/o) who visited the laboratory between 2017 and 2019 (T0) provided a 6 cm hair sample. This technique allowed us to quantify cortisol secretion during the three months preceding the COVID-19 pandemic (Segment A) and during the first three months of the first wave of the pandemic in Quebec, Canada (Segment B). At T0, participants completed the Dominic Interactive to assess pre-pandemic internalizing and externalizing symptoms. A socio-emotional composite score (SECS) was derived using a weighted z-score with the following constructs: anxiety sensitivity (Childhood Anxiety Sensitivity Index) measured at T0, trait anxiety (Trait subscale of the State-Trait Anxiety Inventory for Children (STAI-C)), intolerance of uncertainty (Intolerance of Uncertainty Scale for Children), and trait rumination (Children's Response Style Scale) measured at T1. A linear regression was conducted using the percent change in HCC across Segment A and B as the dependent variable, where SECS, pre-pandemic internalizing and externalizing symptoms, and sex were used as predictors. We found a main effect of sex, with girls presenting increased HCC reactivity compared to boys. We also found that SECS and internalizing symptoms negatively predicted HCC, whereas the opposite relationship was found between externalizing symptoms and HCC reactivity. For healthy children, our results suggest that previous psychiatric symptoms and socio-emotional vulnerability may be risk factors for the presentation of diverging cortisol response patterns in response to an adverse life event (such as the COVID-19 pandemic).

The reciprocal relationships between Chinese children’s perception of interparental conflict, negative thinking, and depression symptoms: A cross-lagged study

The present longitudinal study used the traditional cross-lagged panel model (CLPM) and autoregressive latent trajectory model with structured residuals (ALT-SR) to examine the relationships between perceived interparental conflict (IPC), negative thinking (NT), and depression symptoms in Chinese children. Changes in these three variables over time were also examined, as well as the trait and state aspects of the relationships between them. A sample of 516 third-grade primary students completed questionnaires about IPC, NT, and depression three times over a period of 1 year, at 6-month intervals. The CLPM findings indicated that, assuming that stability of each variable across time was controlled, Chinese children’s perception of IPC significantly affected their level of depression through the mediating path of NT. After taking trait factors into account, among all the significant autoregressive and cross-lagged paths originally found in the CLPM, only one third remained significant in the ALT-SR model. More specifically, the ALT-SR model, revealed a driving effect of children’s NT on perceived IPC and depression symptoms. The CLPM model although elucidated the interplay among three variables, the ALT-SR model showed little evidence of their interrelated growth across time. Taken together, these results indicate that children’s perceived IPC in the long term are a stable trait, with few state-level fluctuations, and is not a significant within-person predictor of subsequent children’s internalization problems. These perceptions appear to contribute more to children’s general psychological tendency than do changes over time. The research is the first to test the reciprocal relationships between Chinese children’s perceived IPC, NT, and depression symptoms. The findings demonstrate that previously proposed theories about the bidirectional relation between IPC and children’s social adjustment, to some extent, may reflect a correlation at a trait level. Put another way, it is IPC’s central tendency to be sensitive in the long term as a stable trait that is associated with their children’s general tendency to show well adjustment. The study contributes to our understanding of that extend previous results and have implications for complementary theoretical and practical interventions. The complementary techniques of CLPM and ALT-SR models offer different insights into children’s internalization problems, and hold promise for supporting the building of more comprehensive children’s developmental theories that acknowledge the interconnectedness of different domains of mental health.

The efficacy of transdiagnostic cognitive behavioural therapy on reducing negative affect, anxiety sensitivity and improving perceived control in children with emotional disorders - a randomized controlled trial

In response to the high rate of comorbidity among different types of emotional disorders in children, Transdiagnostic Unified Protocol of Emotional disorder in children (UP-C) was developed to address common underlying mechanisms in the development and maintenance of emotional disorders using empirically supported cognitive and behavioural strategies. Although, studies supported the effectiveness of this protocol in the treatment of wide range of emotional disorders, further studies are needed to examine its effect on transdiagnostic factors. The present study aimed to investigate the efficacy of the UP-C on negative affect, anxiety sensitivity and perceived control in children with emotional disorders. During this randomized controlled trial, 34 children aged 7 to 13 with emotional disorders were randomly assigned to treatment (n=18) and control (n=16) groups. The treatment group and their parents received 15 sessions of UP-C. Negative Affect Schedule for Children (PANASNA- C), Children’s Anxiety Sensitivity Index (CASI), Anxiety Control Questionnaire-Children (ACQ-C) were carried out in all phases (pre-treatment, post-treatment, 3 and 8 months follow- up). The results showed that following UP-C, negative affect (hedges’g=2.01) and anxiety sensitivity (hedges’g=1.05) were significantly reduced, and perceived control (hedges’g= –2.36) was significantly improved. The results remained relatively constant during the follow-ups. Findings provide evidence that the UP-C has significant effect on negative affect, anxiety sensitivity and perceived control as roots of emotional disorders.

Relations between anxiety sensitivity's cognitive concerns and anxiety severity: brooding and reflection as serial multiple mediators

The outbreak of COVID-19 has caused a major impact on productivity and life functioning, and also led to adverse emotional reactions. In the face of this public health event, increased anxiety is one of the most common emotional reactions. Previous studies have shown that anxiety sensitivity, rumination and anxiety are closely related. Various dimensions of anxiety sensitivity have different effects on anxiety. Also, rumination can be divided into brooding and reflection. To explore the relationships among anxiety sensitivity’s cognitive concerns, anxiety and different types of rumination, we conducted an online survey during the outbreak of coronavirus (February 17–25, 2020), using the Anxiety Sensitivity Scale-3 (ASI-3), Ruminative Responses Scale (RSS), and Depression Anxiety Stress Scale-21 (DASS-21). The results showed significant positive correlations among anxiety sensitivity’s cognitive concerns, anxiety, brooding and reflection. Furthermore, brooding and reflection had a chain mediation effect between cognitive concerns and anxiety, and the mediation effect of reflection was even stronger. Results suggest that anxiety sensitivity’s cognitive concerns may not only affect anxiety directly, but also affect anxiety through rumination, especially reflection.

Cognitive vulnerabilities to anxiety symptoms among Chinese adolescents: A 3-year longitudinal study

OBJECTIVE

This study established cognitive vulnerability of anxiety symptoms among high school students.

METHOD

A total of 72 grade 9-11 students completed measures on levels of anxiety sensitivity (AS), selective attentional processing, and anxiety symptoms annually between 2016 and 2018.

RESULTS

Latent class growth analysis (unconditional model) showed a four-class model: High (stable) (6.94%), low (stable) (11.11%), medium (decreasing) (61.11%), and medium (increasing) (20.83%). The conditioned model controlling for the physical-concerns dimension of AS and negative attentional bias demonstrated that a two-class model consisted of a low anxiety class (n = 59, 81.9%) and a high anxiety class (n = 13, 18.1%) provided the best fit for the data. Negative attentional bias is a significant factor related to the development of anxiety trajectories.

CONCLUSION

Attentional bias modification to disengage from negative stimuli may serve as a potential target of intervention to reduce chronic anxiety among high school students.

Predictors of posttraumatic stress symptoms and perceived health after an acute coronary syndrome: the role of experiential avoidance, anxiety sensitivity, and depressive symptoms

Objectives: The identification of psychological markers of the posttraumatic stress reaction after a cardiac event is relevant in the management of cardiovascular risk factors. The aim of the study to test the contribution of experiential avoidance, anxiety sensitivity, and depressive symptoms to acute coronary syndrome posttraumatic stress symptoms and perceived health (both measured 6 months later), and to determine whether the associations between experiential avoidance, anxiety sensitivity, and depressive symptoms with perceived health were mediated by the posttraumatic stress symptoms.Design: 180 patients with acute coronary syndrome completed a survey over a 6-month period.Results: Anxiety sensitivity and depressive symptoms but not experiential avoidance contributed significantly to posttraumatic stress symptoms. Depressive symptoms and posttraumatic symptoms but neither anxiety sensitivity nor experiential avoidance had a significant association on perceived health. Acute coronary syndrome posttraumatic symptoms significantly mediated the association of depressive symptoms with perceived health. That is, increased depressive symptoms was significantly associated with higher levels of posttraumatic symptoms, which in turn predicted lower levels of perceived health.Conclusions: Understanding the psychological factors that are associated with post-acute coronary syndrome posttraumatic stress symptoms may help to identify patients at risk in order to refer them to the appropriate psychological care service.

Cognitive factors associated with depression and anxiety in adolescents: A two-year longitudinal study

Background/Objective: To examine the roles of anxiety sensitivity and attentional bias in the development of anxiety and depression symptoms among adolescents. Method: 214 grade 7 to grade 10 Hong Kong Chinese students completed a package of psychometric inventories to measure levels of anxiety sensitivity, selective attentional processing, and anxiety and depressive symptoms in 2016 and then again in 2017. Results: Girls, when compared with boys, exhibited more anxiety symptoms and anxiety sensitivity in 2016. They also reported a significant increase in mean depression level from 2016 to 2017. Regression analyses revealed that the physical-concerns dimension of anxiety sensitivity, positive attentional bias, and to a lesser extent negative attentional bias were related to the development of both anxiety and depression symptoms one year later. Fear of mental incapacity could predict depression one year later but not anxiety symptoms. Conclusions: Intervention through anxiety sensitivity training to reduce somatic concerns and attentional bias modification to increase habitual attention to positive stimuli and to disengage from negative stimuli can reduce anxiety and depression symptoms among high school students.

The effect of panic disorder versus anxiety sensitivity on event-related potentials during anticipation of threat

Attention-related abnormalities are key components of the abnormal defensive responding observed in panic disorder (PD). Although behavioral studies have found aberrant attentional biases towards threat in PD, psychophysiological studies have been mixed. Predictability of threat, an important feature of threat processing, may have contributed to these mixed findings. Additionally, anxiety sensitivity, a dimensional trait associated with PD, may yield stronger associations with cognitive processes than categorical diagnoses of PD. In this study, 171 participants with PD and/or depression and healthy controls completed a task that differentiated anticipation of predictable vs. unpredictable shocks, while startle eyeblink and event-related potentials (ERPs [N100, P300]) were recorded. In all participants, relative to the control condition, probe N100 was enhanced to both predictable and unpredictable threat, whereas P300 suppression was unique to predictable threat. Probe N100, but not P300, was associated with startle eyeblink during both threatening conditions, and was strongest for unpredictable threat. PD was not associated with ERPs, but anxiety sensitivity (physical concerns) was positively associated with probe N100 (indicating reduced responding) in the unpredictable condition independent of PD diagnosis. Vulnerability to panic-related psychopathology may be characterized by aberrant early processing of threat, which may be especially evident during anticipation of unpredictable threats.

The effect of positive and negative memory bias on anxiety and depression symptoms among adolescents

OBJECTIVE

To examine the interaction effect of anxiety and depression on the intentional forgetting of positive and negative valence words.

METHODS

One hundred fifty-five grade 7 to grade 10 students participated in the study. The item-method directed forgetting paradigm was used to examine the intentional forgetting of positive-valence, negative-valence, and neutral-valence words.

RESULTS

Negative-valence words were recognized better than either positive-valence or neutral-valence words. The results revealed an anxiety main effect (p = .01, LLCI = -.09, and ULCI = -.01) and a depression main effect (p = .04, LLCI = .00, and ULCI = .24). The anxiety score was negative, whereas the depression score was positively related to the directed forgetting of negative-valence words. Regression-based moderation analysis revealed a significant anxiety × depression interaction effect on the directed forgetting of positive-valence words (p = .02, LLCI = .00, and ULCI = .01). Greater anxiety was associated with more directed forgetting of positive-valance words only among participants with high depression scores. With negative-valence words, the anxiety × depression interaction effect was not significant (p = .15, LLCI = - .00, and ULCI = .01).

CONCLUSION

Therapeutic strategies to increase positive memory bias may reduce anxiety symptoms only among those with high depression scores. Interventions to reduce negative memory bias may reduce anxiety symptoms irrespective of levels of depression.

Lower-order anxiety sensitivity and intolerance of uncertainty dimensions operate as specific vulnerabilities for social anxiety and depression within a hierarchical model

Within a hierarchical framework for depressive and anxiety disorders, negative affect (NA) is posited to be indirectly related to social anxiety and depression through cognitive vulnerabilities, including intolerance of uncertainty (IU) and anxiety sensitivity (AS). However, few prior studies have considered whether the lower-order dimensions of IU (i.e., prospective and inhibitory IU) and AS (i.e., physical, cognitive, and social concerns) better explain the indirect relation between NA and social anxiety and depression. The indirect relations between NA and social anxiety and depression through these cognitive vulnerabilities were examined using structural equation modeling in a clinical sample (N=298). NA and social anxiety symptoms were indirectly related through AS social concerns and inhibitory IU, although a direct effect of NA was also found. Only AS social concerns explained the relation between NA and a social anxiety disorder diagnosis. AS cognitive concerns was the only cognitive vulnerability factor to indirectly explain the relation between NA and depressive symptoms, although a direct effect of NA was also found. These findings suggest that the lower-order dimensions of AS and IU demonstrate more specific and less transdiagnostic associations with social anxiety and depression.

The role of emotions in depression and aggression

Background

Depression is a broad and heterogeneous diagnostic grouping, central to which is depressed mood or inability to enjoy most activities. Depressive symptoms are frequently accompanied by conduct problems stemming from anger. It is very important to know the interrelation of these emotions very well to be able to help adolescents to manage them more easily. The main aim of this article is to present the problem of interaction between negative affects (emotional instability, anger state and trait, physical and verbal aggression and depression) analyzing the different relationship through the time in spanish sample.

Material and Methods

The sample included 470 adolescents (192 boys and 225 girls) in a three-wave longitudinal study in Valencia (Spain). The mean age was 14.70 in the first wave. Structural equations modelling was employed to explore two longitudinal models.

Results

The results show differences based on sex, and that an internalised variable, like emotional instability, is relevant to prevent the appearance of depression directly in girls and also the later appearance of aggression as long as anger mediates, in both boys and girls, so the control of anger becomes an important goal to control the rest of the negative affects.

Conclusions

This results has consequences in the preparation of all programmes that try to establish an emotional control on adolescents, as not only has to be taken into account as a direct goal the control of externalised emotions like anger, but internalised emotions like emotional instability have to be taken into account also. Furthermore, it is also made apparent that not only the punctual explosions and externalisation of anger have to be worked on, but the temperamental aspects which are the base of anger trait have to be worked on too.

Key words:Emotional instability, anger, depression, aggression, negative emotions, adolescence.