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Chen L, Lu J, Li Q, Shi Y, Liu S, He Y, Zheng G, Xiang Y, Xiao Y. Childhood maltreatment, parenting style and anxiety in Chinese youths: A case-control study. CHILD ABUSE & NEGLECT 2024; 153:106807. [PMID: 38677178 DOI: 10.1016/j.chiabu.2024.106807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 04/11/2024] [Accepted: 04/17/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND Although evidence in supporting the associations between childhood maltreatment (CM), parenting style and anxiety in children and adolescents exists, few high-quality analytical epidemiological studies which focusing on clinically diagnosed anxiety disorders (AD) had been published. OBJECTIVE The aim of this study was to further corroborate the associations between CM, parenting style, and AD in a large representative sample of Chinese children and adolescents. PARTICIPANTS AND SETTING Study subjects were derived from the Mental Health Survey for Children and Adolescents in Yunnan (MHSCAY), a population-based cross-sectional program. METHODS Individually matched case-control study design was adopted. Univariate and multivariate conditional binary logistic regression models were used to estimate the associations between CM, parenting style and AD. Dose-response trends were estimated using the Cochran-Armitage Chi-square test. A series of stratified analyses were conducted to explore effect modification on exposure-outcome association by some important features. RESULTS Totally we screened out 202 cases and 404 matched controls, with an age mean of 14.43 years. Conditional logistic regression models revealed that EA and a higher level of parental over-protection were significantly associated with increased risk of AD, with adjusted ORs of 3.39 (95 % CI: 2.07-5.56) and 1.93 (95 % CI: 1.28-2.90). Stratified analysis identified noticeable effect modification by sex, age, and whether the only child in the family. CONCLUSIONS Major findings of this study suggested that children and adolescents who had experienced EA or raised up by over-protective parents are at increased risk of AD. Targeted intervention measures should be developed and implemented for these high-risk youths.
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Affiliation(s)
- Lin Chen
- NHC Key Laboratory of Drug Addiction Medicine, Division of Epidemiology and Health Statistics, School of Public Health, Kunming Medical University, Kunming, Yunnan, China
| | - Jin Lu
- Psychiatry Department, The First Affiliated Hospital, Kunming Medical University, Kunming, Yunnan, China; Mental Health Institute of Yunnan, The First Affiliated Hospital, Kunming Medical University, Kunming, Yunnan, China; Yunnan Clinical Research Center for Mental Health, Kunming, Yunnan, China
| | - Qiongxian Li
- NHC Key Laboratory of Drug Addiction Medicine, Division of Epidemiology and Health Statistics, School of Public Health, Kunming Medical University, Kunming, Yunnan, China
| | - Yuanyu Shi
- NHC Key Laboratory of Drug Addiction Medicine, Division of Epidemiology and Health Statistics, School of Public Health, Kunming Medical University, Kunming, Yunnan, China
| | - Shuqing Liu
- NHC Key Laboratory of Drug Addiction Medicine, Division of Epidemiology and Health Statistics, School of Public Health, Kunming Medical University, Kunming, Yunnan, China
| | - Yandie He
- NHC Key Laboratory of Drug Addiction Medicine, Division of Epidemiology and Health Statistics, School of Public Health, Kunming Medical University, Kunming, Yunnan, China
| | - Guiqing Zheng
- NHC Key Laboratory of Drug Addiction Medicine, Division of Epidemiology and Health Statistics, School of Public Health, Kunming Medical University, Kunming, Yunnan, China
| | - Yi Xiang
- NHC Key Laboratory of Drug Addiction Medicine, Division of Epidemiology and Health Statistics, School of Public Health, Kunming Medical University, Kunming, Yunnan, China
| | - Yuanyuan Xiao
- NHC Key Laboratory of Drug Addiction Medicine, Division of Epidemiology and Health Statistics, School of Public Health, Kunming Medical University, Kunming, Yunnan, China; Key Library in Public Health and Disease Prevention and Control, Yunnan Provincial Department of Education, China.
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Bazo Perez M, Hayes TB, Frazier LD. Beyond generalized anxiety: the association of anxiety sensitivity with disordered eating. J Eat Disord 2023; 11:173. [PMID: 37784155 PMCID: PMC10544544 DOI: 10.1186/s40337-023-00890-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 09/12/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND Anxiety and eating disorders (EDs) are rising at alarming rates. These mental health disorders are often comorbid, yet the factors associated with their comorbidity are not well understood. The present study examined a theoretical model of the pathways and relative associations of anxiety sensitivity (AS) with different dimensions of ED risk, controlling for generalized anxiety. METHODS Participants (N = 795) were undergraduate students with an average age of 21 (SD = 4.02), predominantly female (71%), and Hispanic (71.8%). Participants completed an online survey with established measures of AS (i.e., Anxiety Sensitivity Index-3; ASI-3), general anxiety (i.e., Beck Anxiety Inventory; BAI), and eating behaviors (i.e., Eating Attitudes Test-26; EAT-26). RESULTS The results of our structural equation models indicated that AS subscales were significantly associated with dimensions of the EAT-26, even when controlling for generalized anxiety. Specifically, the ASI-3 factors reflecting cognitive and social concerns provided the most consistent significant associations with EDs. Whereas reporting higher cognitive concerns was associated with higher ED symptoms (e.g., reporting the urge to vomit after a meal), reporting higher social concerns was associated with fewer ED symptoms. These differential results may suggest risk and resilience pathways and potential protective or buffering effects of social concerns on ED risk. DISCUSSION Findings advance understanding of the role of AS in the comorbidity of anxiety and EDs, demonstrating the strong association of AS with ED pathology. These findings provide cognitive indicators for transdiagnostic therapeutic intervention in order to reduce the risk of EDs.
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Affiliation(s)
- Maria Bazo Perez
- Department of Psychology, Florida International University, 11200 SW 8th Street, Miami, FL, 33199, USA.
| | - Timothy B Hayes
- Department of Psychology, Florida International University, 11200 SW 8th Street, Miami, FL, 33199, USA
| | - Leslie D Frazier
- Department of Psychology, Florida International University, 11200 SW 8th Street, Miami, FL, 33199, USA
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3
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Garey L, Senger AR, Smit T, Nizio P, Matoska CT, Kauffman B, Businelle MS, Gallagher MW, Zvolensky MJ. Anxiety sensitivity and reasons for smoking among Black smokers. Addict Behav 2023; 139:107593. [PMID: 36563479 PMCID: PMC9897199 DOI: 10.1016/j.addbeh.2022.107593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 11/15/2022] [Accepted: 12/16/2022] [Indexed: 12/23/2022]
Abstract
Black smokers demonstrate higher nicotine dependence and experience higher rates of smoking-related diseases and mortality relative to European American/White smokers. A potential factor relevant to race-specific smoking health disparities may be smoking motives (i.e., motivational basis of smoking). Yet, little research has been conducted to understand psychological factors that may be associated with specific smoking motives among Black smokers. To address this gap in the literature, the current study explored the association between anxiety sensitivity and smoking motives within a subset sample of Black smokers who were interested in participating in a smoking cessation trial (N = 105; 70.5 % male; Mage = 44.8 years, SD = 11.6 years). Hierarchical regression analyses indicated anxiety sensitivity was associated with smoking motives related to habit (β = 0.39, p <.001), negative affect reduction (β = 0.32, p <.001), stimulation (β = 0.31, p <.001), and sensorimotor manipulation (β = 0.26, p =.008). Limited support was found for the effect of motives on past quit attempt engagement. These results may broaden understanding of the psychological mechanisms related to smoking motivation among Black smokers and may inform future intervention efforts to reduce smoking motivation among this health disparities population.
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Affiliation(s)
- Lorra Garey
- Department of Psychology, University of Houston, Houston, TX, USA; HEALTH Institute, University of Houston, Houston, TX, USA.
| | - Amy R Senger
- Department of Psychology, University of Houston, Houston, TX, USA; Texas Institute for Measurement, Evaluation, and Statistics University of Houston, Houston, TX USA.
| | - Tanya Smit
- Department of Psychology, University of Houston, Houston, TX, USA.
| | - Pamella Nizio
- Department of Psychology, University of Houston, Houston, TX, USA.
| | | | - Brooke Kauffman
- Department of Psychology, University of Houston, Houston, TX, USA.
| | - Michael S Businelle
- HEALTH Institute, University of Houston, Houston, TX, USA; Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA; TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
| | - Matthew W Gallagher
- Department of Psychology, University of Houston, Houston, TX, USA; Texas Institute for Measurement, Evaluation, and Statistics University of Houston, Houston, TX USA; HEALTH Institute, University of Houston, Houston, TX, USA.
| | - Michael J Zvolensky
- Department of Psychology, University of Houston, Houston, TX, USA; HEALTH Institute, University of Houston, Houston, TX, USA; Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, US.
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4
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Chorot P, Valiente RM, Sandín B. The Spanish Version of the Childhood Anxiety Sensitivity Index: Factorial Dimensions and Invariance across Gender in a Sample of Adolescents. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3045. [PMID: 36833740 PMCID: PMC9958708 DOI: 10.3390/ijerph20043045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 01/28/2023] [Accepted: 02/05/2023] [Indexed: 06/18/2023]
Abstract
Anxiety sensitivity is a transdiagnostic construct that has been associated with the etiology of emotional disorders, especially panic and other anxiety disorders. Although it is well known that, for the adult population, the factor structure of anxiety sensitivity includes three separate facets (physical, cognitive, and social concerns), the facets of anxiety sensitivity for adolescents have not yet been established. The main goal of the present study was to examine the factor structure of the Spanish version of the Childhood Anxiety Sensitivity Index (CASI). A large sample of nonclinical adolescents completed the Spanish version of the CASI in school settings (N = 1655; aged 11-17 years; 800 boys and 855 girls). Exploratory and confirmatory factor analyses of the full scale (CASI-18) indicate that a three first-order factor solution represents appropriately the three anxiety sensitivity facets previously defined for the adult population. The 3-factor structure had a better fit and was more parsimonious than a 4-factor solution. Results also indicate that the 3-factor structure remains invariant across genders. Girls scored significantly higher than boys on the total scale and on all three dimensions of anxiety sensitivity. In addition, the present study provides information concerning normative data for the scale. The CASI holds promise as a useful tool for assessing general and specific facets of anxiety sensitivity. It could be helpful for the assessment of this construct in clinical and preventive settings. The limitations of the study and suggestions for further research are outlined.
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Affiliation(s)
| | | | - Bonifacio Sandín
- Facultad de Psicología, Universidad Nacional de Educación a Distancia (UNED), 28040 Madrid, Spain
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Terin H, Açıkel SB, Yılmaz MM, Şenel S. The effects of anxiety about their parents getting COVID-19 infection on children's mental health. Eur J Pediatr 2023; 182:165-171. [PMID: 36264340 PMCID: PMC9582391 DOI: 10.1007/s00431-022-04660-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 10/06/2022] [Accepted: 10/12/2022] [Indexed: 01/21/2023]
Abstract
UNLABELLED Although the effects of COVID-19 on children's physical health are relatively less serious, it is known that pandemic has serious effects on children's mental health. Anxiety and related symptoms increase among children during this period. The main purpose of this study is to measure children's anxiety about their parents and themselves with structured scales. Children who applied to the pediatric outpatient clinic were included in the study. Participants were asked questions about their parents' and their own concerns about getting COVID-19. Psychiatric symptoms of the participants were evaluated with the Revised Child Anxiety and Depression Scale, the Coronavirus Anxiety Scale, and Anxiety Sensitivity Index for Children. Increased social phobia, separation anxiety, generalized anxiety, total anxiety, total internalizing disorder scores, increased anxiety sensitivity, and increased coronavirus anxiety were detected among children who have increased subjective anxiety for themselves about getting COVID-19. In addition, increased social phobia, depression, separation anxiety, generalized anxiety, total anxiety, total internalizing disorder scores, and anxiety sensitivity were also detected among children who have increased subjective anxiety for their parents about getting COVID-19. In logistic regression, panic, separation anxiety, and generalized anxiety scores significantly predicted children's anxiety for their parents, and separation anxiety and generalized anxiety were shown to predict anxiety for themselves. CONCLUSION Children who have increased subjective anxiety about their parents and themselves also have increased anxiety, anxiety sensitivity, and coronavirus anxiety scores. This is the first study which determines that children who are worried about their parents and themselves have higher levels of anxiety, depression symptoms, and anxiety sensitivity. WHAT IS KNOWN • Although COVID19 pandemic's negative effects on the mental health of children and adolescents has been investigated and consistently demonstrated, the children's anxiety about their parents getting infection were less researched. WHAT IS NEW • Children's anxiety about their parents getting SARS-Cov-2 infection was investigated with the questionnaires. • The scale scores of the children who expressed their anxiety with open-ended questions were statistically significantly higher.
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Affiliation(s)
- Harun Terin
- Department of Pediatrics, Dr. Sami Ulus Maternity and Children’s Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Sadettin Burak Açıkel
- Department of Child and Adolescent Psychiatry, Ankara University School of Medicine, Ankara, Turkey.
| | - Mehmet Mustafa Yılmaz
- Department of Pediatrics, Dr. Sami Ulus Maternity and Children’s Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Saliha Şenel
- Department of Pediatrics, Dr. Sami Ulus Maternity and Children’s Health and Diseases Training and Research Hospital, Ankara, Turkey ,Department of Pediatrics, Yıldırım Beyazıt University, School of Medicine, Ankara, Turkey
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6
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Businelle MS, Garey L, Gallagher MW, Hébert ET, Vujanovic A, Alexander A, Kezbers K, Matoska C, Robison J, Montgomery A, Zvolensky MJ. An Integrated mHealth App for Smoking Cessation in Black Smokers With Anxiety: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2022; 11:e38905. [PMID: 35635746 PMCID: PMC9153912 DOI: 10.2196/38905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 04/24/2022] [Accepted: 04/28/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Black smokers have greater difficulty in quitting and higher rates of smoking-related diseases and disabilities than the general population. The smoking disparities experienced by this group are, in part, a consequence of multiple chronic life stressors (eg, racial discrimination) that engender increased exposure to interoceptive stress symptoms (eg, anxiety), which can ultimately lead to smoking as a means of immediate emotion regulation. OBJECTIVE This study aimed to culturally adapt and initially test a novel mobile intervention (ie, Mobile Anxiety Sensitivity Program for Smoking [MASP]) that targets anxiety sensitivity (AS; a proxy for difficulty and responsivity to interoceptive stress) among Black smokers. The MASP intervention is culturally informed to address interoceptive stress management difficulties among Black smokers and is thus hypothesized to facilitate smoking cessation. METHODS In phase 1, a total of 25 Black smokers with elevated AS will be administered MASP for 6 weeks. Following the completion of phase 1, we will further refine the MASP based on qualitative and quantitative data from participants to produce the final MASP iteration. In phase 2, a total of 200 Black smokers with elevated AS will be enrolled and randomly assigned to receive nicotine replacement therapy and either the smartphone-based National Cancer Institute QuitGuide app for standard mobile smoking cessation treatment or the MASP intervention. All participants in phases 1 and 2 will be enrolled remotely and will complete a web-based study screener; smartphone-based baseline assessment; daily smartphone-based ecological momentary assessments for 6 weeks; phone-based end-of-treatment qualitative interviews; and smartphone-based follow-up assessments at postbaseline weeks 1, 2 (quit date), 3, 4, 5, 6, 28, and 54 (weeks 28 and 54 follow-ups will be completed by phase 2 participants only). The MASP intervention is intended to offset barriers to treatment and encourage treatment engagement via smartphones. RESULTS This project was funded in September 2020. Phase 1 data collection began in January 2022. Phase 2 data collection is scheduled to begin in July 2022. CONCLUSIONS If successful, data from this study will support culturally informed treatment approaches for Black smokers and, pending findings of efficacy, provide an evidence-based mobile intervention for smoking cessation that is ready for dissemination and implementation. TRIAL REGISTRATION ClinicalTrials.gov NCT04838236; https://clinicaltrials.gov/ct2/show/NCT04838236. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/38905.
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Affiliation(s)
- Michael S Businelle
- TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
- Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
- HEALTH Institute, University of Houston, Houston, TX, United States
| | - Lorra Garey
- HEALTH Institute, University of Houston, Houston, TX, United States
- Department of Psychology, University of Houston, Houston, TX, United States
| | - Matthew W Gallagher
- HEALTH Institute, University of Houston, Houston, TX, United States
- Department of Psychology, University of Houston, Houston, TX, United States
- Texas Institute for Measurement, Evaluation, and Statistics, University of Houston, Houston, TX, United States
| | - Emily T Hébert
- Department of Health Promotion and Behavioral Sciences, UTHealth School of Public Health, Austin, TX, United States
| | - Anka Vujanovic
- HEALTH Institute, University of Houston, Houston, TX, United States
- Department of Psychology, University of Houston, Houston, TX, United States
| | - Adam Alexander
- TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
- Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Krista Kezbers
- TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Cameron Matoska
- HEALTH Institute, University of Houston, Houston, TX, United States
- Department of Psychology, University of Houston, Houston, TX, United States
| | - Jillian Robison
- TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Audrey Montgomery
- TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Michael J Zvolensky
- HEALTH Institute, University of Houston, Houston, TX, United States
- Department of Psychology, University of Houston, Houston, TX, United States
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The Relationship Between Anxiety Sensitivity and PTSD Symptom Severity Among Trauma-Exposed Inpatient Adolescents. COGNITIVE THERAPY AND RESEARCH 2022. [DOI: 10.1007/s10608-022-10294-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Olbrecht VA, O'Conor KT, Williams SE, Boehmer CO, Marchant GW, Glynn SM, Geisler KJ, Ding L, Yang G, King CD. Guided Relaxation-Based Virtual Reality for Acute Postoperative Pain and Anxiety in a Pediatric Population: Pilot Observational Study. J Med Internet Res 2021; 23:e26328. [PMID: 34048358 PMCID: PMC8314162 DOI: 10.2196/26328] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 02/02/2021] [Accepted: 05/04/2021] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Distraction-based therapies, such as virtual reality (VR), have been used to reduce pain during acutely painful procedures. However, distraction alone cannot produce prolonged pain reduction to manage sustained postoperative pain. Therefore, the integration of VR with other pain-reducing therapies, like guided relaxation, may enhance its clinical impact. OBJECTIVE The goal of this pilot study was to assess the impact of a single guided relaxation-based VR (VR-GR) session on postoperative pain and anxiety reduction in children. We also explored the influence of pain catastrophizing and anxiety sensitivity on this association. METHODS A total of 51 children and adolescents (7-21 years) with postoperative pain and followed by the Acute Pain Service at Cincinnati Children's Hospital were recruited over an 8-month period to undergo a single VR-GR session. Prior to VR, the patients completed 2 questionnaires: Pain Catastrophizing Scale for Children (PCS-C) and the Child Anxiety Sensitivity Index (CASI). The primary outcome was a change in pain intensity following the VR-GR session (immediately, 15 minutes, and 30 minutes). The secondary outcomes included changes in pain unpleasantness and anxiety. RESULTS The VR-GR decreased pain intensity immediately (P<.001) and at 30 minutes (P=.04) after the VR session, but not at 15 minutes (P=.16) postsession. Reductions in pain unpleasantness were observed at all time intervals (P<.001 at all intervals). Anxiety was reduced immediately (P=.02) but not at 15 minutes (P=.08) or 30 minutes (P=.30) following VR-GR. Patients with higher CASI scores reported greater reductions in pain intensity (P=.04) and unpleasantness (P=.01) following VR-GR. Pain catastrophizing was not associated with changes in pain and anxiety. CONCLUSIONS A single, short VR-GR session showed transient reductions in pain intensity, pain unpleasantness, and anxiety in children and adolescents with acute postoperative pain. The results call for a future randomized controlled trial to assess the efficacy of VR-GR. TRIAL REGISTRATION ClinicalTrials.gov NCT04556747; https://clinicaltrials.gov/ct2/show/NCT04556747.
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Affiliation(s)
- Vanessa A Olbrecht
- Center for Understanding Pediatric Pain, Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Keith T O'Conor
- Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Sara E Williams
- Center for Understanding Pediatric Pain, Division of Behavioral Medicine and Clinical Psychology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Chloe O Boehmer
- Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Gilbert W Marchant
- Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Susan M Glynn
- Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Kristie J Geisler
- Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Lili Ding
- Division of Biostatistics and Epidemiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Gang Yang
- Division of Biostatistics and Epidemiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Christopher D King
- Center for Understanding Pediatric Pain, Division of Behavioral Medicine and Clinical Psychology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
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9
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Paulus DJ, Gallagher MW, Zvolensky MJ, Leventhal AM. Reciprocal longitudinal associations between anxiety sensitivity and alcohol consumption/problems across adolescence: Examining anxiety as a mediator and race/ethnicity as a moderator. Behav Res Ther 2021; 142:103861. [PMID: 34049078 PMCID: PMC8542277 DOI: 10.1016/j.brat.2021.103861] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 03/16/2021] [Accepted: 04/06/2021] [Indexed: 11/26/2022]
Abstract
The conditions and populations for which anxiety sensitivity (AS; i.e., the tendency to interpret unpleasant physiological sensations as dangerous) relates to adolescent alcohol use is unclear. This study tested latent-variable cross-lagged panel modeling of AS-alcohol relations in a racially/ethnically heterogenous longitudinal youth cohort (N = 3396; 53.4% female, 45.8% Latinx) assessed annually across high school. Anxiety and race/ethnicity were tested as mediators and moderators, respectively, of AS-alcohol associations. AS prospectively predicted alcohol problems (β's = 0.05-0.07) but not alcohol consumption (β's = 0.02-0.04) across high school. Alcohol problems predicted AS at the end (β = 0.09) but not beginning (β's = 0.01-0.03) of high school and alcohol consumption predicted lower AS at the beginning (β = -0.06) but not end (β's = -0.02-0.01) of high school. Anxiety mediated AS's predictive effects on alcohol problems (βindirect's = 0.01, 95% CI [0.003, 0.03]) across high school. Race/ethnicity did not moderate interrelations of AS, anxiety, and alcohol outcomes. These findings lend support to the risk factor model of AS on alcohol problems (but not consumption) through anxiety and the scar/complication model whereby alcohol problems may exacerbate AS later in adolescence. Addressing reciprocal risk processes between AS, anxiety, and alcohol problems warrant consideration in adolescent behavioral health promotion for various racial/ethnic populations.
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Affiliation(s)
- Daniel J Paulus
- University of Pittsburgh, Department of Psychiatry, Pittsburgh, PA, United States.
| | - Matthew W Gallagher
- University of Houston, Department of Psychology, Houston, TX, United States; University of Houston, Texas Institute for Measurement, Evaluation, and Statistics, Houston, TX, United States
| | - Michael J Zvolensky
- University of Houston, Department of Psychology, Houston, TX, United States; The University of Texas MD Anderson Cancer Center, Department of Behavioral Science, Houston, TX, United States; Health Institute, University of Houston, Houston, TX, United States
| | - Adam M Leventhal
- University of Southern California Keck School of Medicine, Department of Preventative Medicine, Los Angeles, CA, United States; University of Southern California, Department of Psychology, Los Angeles, CA, United States
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10
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Olbrecht VA, O'Conor KT, Williams SE, Boehmer CO, Marchant GW, Glynn SM, Geisler KJ, Pickerill HM, Ding L, Yang G, King CD. Transient Reductions in Postoperative Pain and Anxiety using Virtual Reality in Children. PAIN MEDICINE 2021; 22:2426-2435. [PMID: 34175959 DOI: 10.1093/pm/pnab209] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Virtual reality (VR) is a promising method to manage pain. Distraction-based VR (VR-D) is thought to reduce pain by redirecting attention. While VR-D can reduce pain associated with acutely painful procedures, it is unclear if VR-D can reduce pain after surgery. We assessed the ability of a single VR-D session to decrease postoperative pain and anxiety and explored if pain catastrophizing and anxiety sensitivity influenced these outcomes in children following surgery. DESIGN Single-center, prospective, pilot study. SETTING Cincinnati Children's Hospital Medical Center (CCHMC). SUBJECTS 50 children (7-21 years) with postoperative pain followed by the Acute Pain Service. METHODS Patients received one VR-D session following surgery. Prior to the session, patients completed pain catastrophizing (PCS-C) and anxiety sensitivity (CASI) questionnaires. Primary outcome consisted of changes in pain intensity following VR-D (immediately, 15, and 30 minutes). Secondary outcomes included changes in pain unpleasantness and anxiety. RESULTS VR-D use was associated with a decrease in pain intensity immediately and 15-minutes after VR-D. Reductions in pain unpleasantness were observed up to 30 minutes following VR-D. VR-D was also associated with a reduction in anxiety immediately and at 15-minutes. While patients with higher pain catastrophizing had higher baseline pain intensity and unpleasantness, they did not show larger pain reductions following VR-D compared to those with lower pain catastrophizing. CONCLUSIONS VR-D may be beneficial in transiently reducing pain intensity, unpleasantness, and anxiety in children with postoperative pain. This study informs design of larger, randomized, controlled study assessing VR-D for acute postoperative pain and anxiety management.
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Affiliation(s)
- Vanessa A Olbrecht
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH.,University of Cincinnati College of Medicine, Cincinnati, OH
| | - Keith T O'Conor
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH.,University of Cincinnati College of Medicine, Cincinnati, OH
| | - Sara E Williams
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Chloe O Boehmer
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Gilbert W Marchant
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH.,University of Cincinnati College of Medicine, Cincinnati, OH
| | - Susan M Glynn
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | | | | | - Lili Ding
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH.,University of Cincinnati College of Medicine, Cincinnati, OH
| | - Gang Yang
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH
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11
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Shaw AM, Halliday ER, Tonarely NA, Ehrenreich-May J. Relationship of affect intolerance with anxiety, depressive, and obsessive-compulsive symptoms in youth. J Affect Disord 2021; 280:34-44. [PMID: 33202336 DOI: 10.1016/j.jad.2020.10.048] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 09/11/2020] [Accepted: 10/25/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Structural research on the construct of affect intolerance (an overarching latent construct indicated by distress tolerance and anxiety sensitivity) has only been conducted in adults. Given that a self-report measure of distress tolerance was recently validated for youth and affect intolerance may be a core mechanism of transdiagnostic interventions for internalizing disorders, we examined how affect intolerance relates to internalizing symptoms in youth. We predicted that a latent affect intolerance factor (indicated by distress tolerance and anxiety sensitivity) would be associated with self and parent-reports of youth anxiety, depressive, and obsessive-compulsive symptoms, controlling for age and gender. METHODS At a pre-treatment evaluation, youth with a primary depressive, anxiety, or obsessive-compulsive spectrum disorder (N=277) aged 8-17, and their parent, completed questionnaires. RESULTS Greater levels of the affect intolerance factor predicted greater youth- and parent-reported youth anxiety, depression, and obsessive-compulsive symptoms, controlling for age. LIMITATIONS Future research should replicate findings in a sample with a greater proportion of depressed youth and utilize experimental or longitudinal methods. CONCLUSIONS Importantly, distress tolerance and anxiety sensitivity are core transdiagnostic processes that can be targeted in cognitive-behavioral interventions. Future research should examine how transdiagnostic interventions for youth with internalizing disorders can target these cross-cutting emotional vulnerabilities.
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Affiliation(s)
- Ashley M Shaw
- Florida International University, 11200 SW 8th St., AHC 1, Miami, Florida 33199.
| | | | - Niza A Tonarely
- University of Miami, 5665 Ponce de Leon Blvd., Coral Gables, FL 33146, USA.
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12
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Predatu R, David OA, Ovidiu David D, Maffei A. Emotion regulation abilities as a predictor of anxiety, positive emotions, heart rate, and alpha asymmetry during an impromptu speech task. ANXIETY STRESS AND COPING 2020; 34:719-733. [PMID: 33380225 DOI: 10.1080/10615806.2020.1867717] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND OBJECTIVES Recent approaches suggest that emotion regulation (ER) abilities represent potential predictors of emotional response among youths navigating stressful situations. To test this, we investigated whether ER abilities predicted the subjective and physiological emotional response experienced by youths during a stressful situation. DESIGN A cross-sectional design was employed. METHOD One hundred and thirty-four youths completed measures of ER abilities (emotional awareness, anxiety sensitivity, emotional control) and were asked to deliver a speech while their anxiety, positive emotions, heart rate, and alpha asymmetry were collected at four time points: baseline, anticipation, speech, and post-recovery. RESULTS Pearson r correlations showed that poor emotional control and awareness, as well as high anxiety sensitivity were related to greater anxiety and lower positive emotions experienced during the speech. Hierarchical multiple regressions also revealed that emotional control and emotional awareness predicted greater speech anxiety and lower positive emotions. Moreover, anxiety sensitivity was related to and predicted an increased heart rate experienced during speech. CONCLUSIONS Findings suggest that difficulties in emotional awareness, anxiety sensitivity, and emotional control predict the emotional response experienced by youths during a stressful situation. Interventions delivered by clinicians/teachers that target ER difficulties may be effective in improving emotional functioning when navigating stressful situations.
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Affiliation(s)
- Răzvan Predatu
- Doctoral School "Evidence-based Assessment and Psychological Interventions", Babeș-Bolyai University, Cluj-Napoca, Romania.,International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Babeş-Bolyai University, Cluj-Napoca, Romania
| | - Oana Alexandra David
- International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Babeş-Bolyai University, Cluj-Napoca, Romania.,Department of Clinical Psychology and Psychotherapy, Babeş-Bolyai University, Cluj-Napoca, Romania
| | - Daniel Ovidiu David
- International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Babeş-Bolyai University, Cluj-Napoca, Romania.,Department of Clinical Psychology and Psychotherapy, Babeş-Bolyai University, Cluj-Napoca, Romania.,Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Antonio Maffei
- Department of General Psychology, University of Padova, Padova, Italy
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13
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Chow CHT, Schmidt LA, Buckley DN. The role of anxiety and related states in pediatric postsurgical pain. Can J Pain 2020; 4:26-36. [PMID: 33987517 PMCID: PMC7942768 DOI: 10.1080/24740527.2020.1847600] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 10/25/2020] [Accepted: 11/04/2020] [Indexed: 11/22/2022]
Abstract
Background: Nearly 20% of children and adolescents have pain with disability 1 year after surgery, and they experience poor sleep, school absence, and decreased activities. Negative clinical, psychological, and developmental effects include greater pain medication use, longer recovery, and fear of future medical care. Research has found psychological and family influences (i.e., child and parental anxiety) on pediatric chronic postsurgical pain (CPSP), but a better understanding of the role of perioperative anxiety and its related states in predicting pediatric postsurgical pain is needed. The poor understanding of the causes of child CPSP can lead to misdiagnosis and inadequate treatment, with significant short- and long-term effects. Objectives: The aim of this review was to summarize the literature on children's perioperative anxiety and parental anxiety in relation to acute postsurgical pain, CPSP, and pain trajectories. We also examined other related psychological factors (i.e., anxiety sensitivity, catastrophizing, pain anxiety, and fear of pain) in relation to pediatric acute and chronic postsurgical pain. Lastly, we discuss the interventions that may be effective in reducing children's and parents' preoperative anxiety. Conclusions: Our findings may improve the understanding of the causes of CPSP and highlight the gaps in research and need for further study.
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Affiliation(s)
- Cheryl H. T. Chow
- Department of Psychology, Neuroscience & Behavior, McMaster University, Hamilton, Ontario, Canada
| | - Louis A. Schmidt
- Department of Psychology, Neuroscience & Behavior, McMaster University, Hamilton, Ontario, Canada
| | - D. Norman Buckley
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
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14
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Olbrecht VA, Williams SE, O'Conor KT, Boehmer CO, Marchant GW, Glynn SM, Geisler KJ, Ding L, Yang G, King CD. Guided relaxation-based virtual reality versus distraction-based virtual reality or passive control for postoperative pain management in children and adolescents undergoing Nuss repair of pectus excavatum: protocol for a prospective, randomised, controlled trial (FOREVR Peds trial). BMJ Open 2020; 10:e040295. [PMID: 33380482 PMCID: PMC7780540 DOI: 10.1136/bmjopen-2020-040295] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Virtual reality (VR) offers an innovative method to deliver non-pharmacological pain management. Distraction-based VR (VR-D) using immersive games to redirect attention has shown short-term pain reductions in various settings. To create lasting pain reduction, VR-based strategies must go beyond distraction. Guided relaxation-based VR (VR-GR) integrates pain-relieving mind-body based guided relaxation with VR, a novel therapy delivery mechanism. The primary aim of this study is to assess the impact of daily VR-GR, VR-D and 360 video (passive control) on pain intensity. We will also assess the impact of these interventions on pain unpleasantness, anxiety and opioid and benzodiazepine consumption. The secondary aim of this study will assess the impact of psychological factors (anxiety sensitivity and pain catastrophising) on pain following VR. METHODS AND ANALYSIS This is a single centre, prospective, randomised, clinical trial. Ninety children/adolescents, aged 8-18 years, presenting for Nuss repair of pectus excavatum will be randomised to 1 of 3 study arms (VR-GR, VR-D and 360 video). Patients will use the Starlight Xperience (Google Daydream) VR suite for 10 min. Patients randomised to VR-GR (n=30) will engage in guided relaxation/mindfulness with the Aurora application. Patients randomised to VR-D (n=30) will play 1 of 3 distraction-based games, and those randomised to the 360 video (n=30) will watch the Aurora application without audio instructions or sound. Primary outcome is pain intensity. Secondary outcomes include pain unpleasantness, anxiety and opioid and benzodiazepine consumption. ETHICS AND DISSEMINATION This study follows Standard Protocol Items: Recommendations for Interventional Trials guidelines. The protocol was approved by the Cincinnati Children's Hospital Medical Center's institutional review board. Patient recruitment began in July 2020. Written informed consent will be obtained for all participants. All information acquired will be disseminated via scientific meetings and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT04351776.
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Affiliation(s)
- Vanessa A Olbrecht
- Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Sara E Williams
- Division of Behavioral Medicine and Clinical Psychology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Keith T O'Conor
- Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Chloe O Boehmer
- Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Gilbert W Marchant
- Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Susan M Glynn
- Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Kristie J Geisler
- Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Lili Ding
- Divsion of Biostatistics and Epidemiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Gang Yang
- Divsion of Biostatistics and Epidemiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Christopher D King
- Division of Behavioral Medicine and Clinical Psychology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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15
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Howlett M, Chorney J. The MRI Self-Efficacy Scale for Children: Development and Preliminary Psychometrics. J Pediatr Psychol 2020; 45:736-748. [PMID: 32632443 DOI: 10.1093/jpepsy/jsaa045] [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: 11/18/2019] [Revised: 05/11/2020] [Accepted: 05/19/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Magnetic resonance imaging (MRI) is a common procedure that can be distressing for children. Although not yet studied in the context of pediatric medical procedures, self-efficacy may be a good predictor of procedural stress and a clinically feasible target for behavioral intervention. The objectives of this study were to develop the MRI Self-Efficacy Scale for Children (MRI-SEC) and assess the preliminary psychometric properties. METHODS Development of the MRI-SEC was informed by literature searches and feedback from healthcare providers. Twenty child-parent dyads naïve to MRI and 10 child-parent dyads with MRI experience completed the MRI-SEC to assess the comprehensibility and ease of use, and to inform item and scale refinement. The final version includes four practice items and 12 items directly assessing MRI self-efficacy. To evaluate the psychometric properties, 127 children (ages 6-12) and parents naïve to MRI completed the MRI-SEC, and a series of measures to assess construct validity. To evaluate test-retest reliability 27 children completed the MRI-SEC a second time. RESULTS The MRI-SEC demonstrated acceptable internal consistency, test-retest reliability, and convergent validity. CONCLUSION Development of the MRI-SEC provides an opportunity to better understand the role of self-efficacy as a predictor of procedural stress and cooperation with MRI, informing reliable prediction of children who may benefit from additional support for MRI and the development of tailored behavioral interventions.
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Affiliation(s)
- Melissa Howlett
- Department of Psychology & Neuroscience, Dalhousie University.,Centre for Pediatric Pain Research, IWK Health Centre
| | - Jill Chorney
- Department of Psychology & Neuroscience, Dalhousie University.,Centre for Pediatric Pain Research, IWK Health Centre.,Department of Psychiatry, Dalhousie University
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16
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Estimating the stability of heartbeat counting in middle childhood: A twin study. Biol Psychol 2019; 148:107764. [DOI: 10.1016/j.biopsycho.2019.107764] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 08/05/2019] [Accepted: 09/03/2019] [Indexed: 12/30/2022]
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17
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Davidson CA, Willner CJ, van Noordt SJR, Banz BC, Wu J, Kenney JG, Johannesen JK, Crowley MJ. One-Month Stability of Cyberball Post-Exclusion Ostracism Distress in Adolescents. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2019; 41:400-408. [PMID: 32042218 PMCID: PMC7010318 DOI: 10.1007/s10862-019-09723-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
We examined one-month reliability, internal consistency, and validity of ostracism distress (Need Threat Scale) to simulated social exclusion during Cyberball. Thirty adolescents (13-18 yrs.) completed the Cyberball task, ostracism distress ratings, and measures of related clinical symptoms, repeated over one month. Need Threat Scale ratings of ostracism distress showed adequate test-retest reliability and internal consistency at both occasions. Construct validity was demonstrated via relationships with closely related constructs of anxiety, anxiety sensitivity, and emotion dysregulation, and weaker associations with more distal constructs of state paranoia and subclinical psychosis-like experiences. While ratings of ostracism distress and anxiety were significantly attenuated at retest, most participants continued to experience post-Cyberball ostracism distress at one-month follow-up, which indicates that the social exclusion induction of Cyberball persisted despite participants' familiarity with the paradigm. Overall, results suggest that the primary construct of ostracism distress is preserved over repeated administration of Cyberball, with reliability sufficient for usage in longitudinal research. These findings have important implications for translating this laboratory simulation of social distress into developmental and clinical intervention studies.
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Affiliation(s)
- Charlie A. Davidson
- Department of Clinical Psychology, Mercer University College of Health Professions, 2930 Flowers Rd. S., Rm. 466, Atlanta, GA 30341, USA
| | - Cynthia J. Willner
- Yale Child Study Center, Yale University School of Medicine, New Haven, CT, USA
| | | | - Barbara C. Banz
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Jia Wu
- Yale Child Study Center, Yale University School of Medicine, New Haven, CT, USA
| | - Joshua G. Kenney
- Psychology Service, VA Connecticut Healthcare System, 116-B, 950 Campbell Ave, West Haven, CT 06516, USA
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Jason K. Johannesen
- Psychology Service, VA Connecticut Healthcare System, 116-B, 950 Campbell Ave, West Haven, CT 06516, USA
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Michael J. Crowley
- Yale Child Study Center, Yale University School of Medicine, New Haven, CT, USA
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18
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Chidambaran V, Zhang X, Geisler K, Stubbeman BL, Chen X, Weirauch MT, Meller J, Ji H. Enrichment of Genomic Pathways Based on Differential DNA Methylation Associated With Chronic Postsurgical Pain and Anxiety in Children: A Prospective, Pilot Study. THE JOURNAL OF PAIN 2019; 20:771-785. [PMID: 30639570 PMCID: PMC6616015 DOI: 10.1016/j.jpain.2018.12.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 10/23/2018] [Accepted: 12/14/2018] [Indexed: 12/13/2022]
Abstract
We have reported child anxiety sensitivity (Child Anxiety Sensitivity Index [CASI]) predicts chronic postsurgical pain (CPSP). Herein, we evaluated DNA methylation profiles to understand the gene-environment interactions underlying CPSP and CASI, to identify shared, enriched, genomic pathways. In 73 prospectively recruited adolescents undergoing spine fusion, preoperative CASI and pain data over 12 months after surgery were collected. DNA from the peripheral blood of evaluable subjects with (n = 16) and without CPSP (n = 40) were analyzed using MethylationEPIC arrays. We identified 637 and 2,445 differentially DNA methylated positions (DMPs) associated with CPSP and CASI, respectively (P ≤ .05). Ingenuity pathway analysis of 39 genes with DMPs for both CPSP and CASI revealed enrichment of several canonical pathways, including GABA receptor (P = .00016 for CPSP; P =.0008 for CASI) and dopamine-DARPP32 feedback in cyclic adenosine monophosphate (P = .004 for CPSP and P =.00003 for CASI) signaling. Gene-gene interaction network enrichment analysis revealed participation of pathways in cell signaling, molecular transport, metabolism, and neurologic diseases (P < 10-8). Bioinformatic approaches to identify histone marks and transcription factor (TF) binding events underlying DMPs, showed their location in active regulatory regions in pain pathway relevant brain cells. Using Enrichr/Pinet enrichment and Library of Integrated Network-Based Cellular Signatures knockdown signatures, we identified TFs regulating genes with DMPs in association with CPSP and CASI. In conclusion, we identified epigenetically enriched pathways associated with CPSP and anxiety sensitivity in children undergoing surgery. Our findings support GABA hypofunction and the roles of the dopamine-DARPP32 pathway in emotion/reward and pain. This pilot study provides new epigenetic insights into the pathophysiology of CPSP and a basis for future studies in biomarker development and targetable interventions. PERSPECTIVE: Differential DNA methylation in regulatory genomic regions enriching shared neural pathways were associated with CPSP and CASI in adolescents undergoing spine surgery. Our findings support GABA hypofunction and the roles of the dopamine-DARPP32 pathway in emotion/reward contributing to behavioral maintenance of pain 10 to 12 months after surgery.
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Affiliation(s)
- Vidya Chidambaran
- Department of Anesthesiology, Cincinnati Children's Hospital, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.
| | - Xue Zhang
- Pyrosequencing core for genomic and epigenomic research, Cincinnati Children's Hospital, Cincinnati, Ohio
| | - Kristie Geisler
- Department of Anesthesiology, Cincinnati Children's Hospital, Cincinnati, Ohio
| | - Bobbie L Stubbeman
- Department of Anesthesiology, Cincinnati Children's Hospital, Cincinnati, Ohio
| | - Xiaoting Chen
- Center for Autoimmune Genomics and Etiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Matthew T Weirauch
- Center for Autoimmune Genomics and Etiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Divisions of Biomedical Informatics and Developmental Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Jarek Meller
- Divisions of Biomedical Informatics and Developmental Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Hong Ji
- Department of Environmental Health, University of Cincinnati; Division of Asthma Research, Cincinnati Children's Hospital, Cincinnati, Ohio
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19
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A Psychometric Evaluation of the Revised Childhood Anxiety Sensitivity Index (CASI-R) in a Child and Adolescent Sample. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2019. [DOI: 10.1007/s10862-019-09745-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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20
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Francis SE, Noël VA, Ryan SL. A Systematic Review of the Factor Structure of Anxiety Sensitivity Among Children: Current Status and Recommendations for Future Directions. CHILD & YOUTH CARE FORUM 2019. [DOI: 10.1007/s10566-019-09502-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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21
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Shiah Y, Hwang K. Socialized reflexivity and self‐exertion: Mandala Model of Self and its role in mental health. ASIAN JOURNAL OF SOCIAL PSYCHOLOGY 2019. [DOI: 10.1111/ajsp.12344] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Yung‐Jong Shiah
- Graduate Institute of Counseling Psychology and Rehabilitation Counseling National Kaohsiung Normal University Kaohsiung Taiwan
| | - Kwang‐Kuo Hwang
- Department of Psychology Kaohsiung Medical University Kaohsiung Taiwan
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22
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Do Youth with Separation Anxiety Disorder Differ in Anxiety Sensitivity From Youth with Other Anxiety Disorders? Child Psychiatry Hum Dev 2018; 49:888-896. [PMID: 29666976 DOI: 10.1007/s10578-018-0805-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Studies on the relationship between separation anxiety disorder (SAD) in childhood and panic disorder (PD) in adolescence and adulthood have yielded results which suggest a common underlying vulnerability for both disorders. In this study, we examined whether one such possible vulnerability-anxiety sensitivity-differed for youth diagnosed with SAD versus other anxiety disorders. Anxiety sensitivity was assessed using the Childhood Anxiety Sensitivity Index (CASI) in 315 clinic-referred youth (ages 6-17, 113 girls). 145 children (46%) were diagnosed with one or more primary anxiety disorder, including SAD (n = 22), generalized anxiety (GAD) (n = 79), social anxiety (SocA) (n = 55), and specific phobia (SP) (n = 45). Children with SAD reported higher levels of anxiety sensitivity and fears of physical symptoms than children with SP and SocA, but not children with GAD. We speculate that children who have SAD and GAD and high anxiety sensitivity may be more vulnerable to develop PD.
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23
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The Role of Anxiety Sensitivity in the Relationship Between Emotion Dysregulation and Internalizing Psychopathology Among Trauma-Exposed Inpatient Adolescents. COGNITIVE THERAPY AND RESEARCH 2018. [DOI: 10.1007/s10608-018-9943-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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24
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The Associations of Parents’ and Children’s Anxiety Sensitivity with Child Anxiety and Somatic-Hypochondriac Symptoms. CHILD & YOUTH CARE FORUM 2018. [DOI: 10.1007/s10566-018-9464-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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25
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Papachristou H, Theodorou M, Neophytou K, Panayiotou G. Community sample evidence on the relations among behavioural inhibition system, anxiety sensitivity, experiential avoidance, and social anxiety in adolescents. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2018. [DOI: 10.1016/j.jcbs.2018.03.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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26
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Mathews BL, Koehn AJ, Abtahi MM, Kerns KA. Emotional Competence and Anxiety in Childhood and Adolescence: A Meta-Analytic Review. Clin Child Fam Psychol Rev 2017; 19:162-84. [PMID: 27072682 DOI: 10.1007/s10567-016-0204-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Anxiety is conceptualized as a state of negative emotional arousal that is accompanied by concern about future threat. The purpose of this meta-analytic review was to evaluate the evidence of associations between emotional competence and anxiety by examining how specific emotional competence domains (emotion recognition, emotion expression, emotion awareness, emotion understanding, acceptance of emotion, emotional self-efficacy, sympathetic/empathic responses to others' emotions, recognition of how emotion communication and self-presentation affect relationships, and emotion regulatory processes) relate to anxiety in childhood and adolescence. A total of 185 studies were included in a series of meta-analyses (N's ranged from 573 to 25,711). Results showed that anxious youth are less effective at expressing (r = -0.15) and understanding emotions (r = -0.20), less aware of (r = -0.28) and less accepting of their own emotions (r = -0.49), and report less emotional self-efficacy (r = -0.36). More anxious children use more support-seeking coping strategies (r = 0.07) and are more likely to use less adaptive coping strategies including avoidant coping (r = 0.18), externalizing (r = 0.18), and maladaptive cognitive coping (r = 0.34). Emotion acceptance and awareness, emotional self-efficacy, and maladaptive cognitive coping yielded the largest effect sizes. Some effects varied with children's age. The findings inform intervention and treatment programs of anxiety in youth and identify several areas for future research.
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Affiliation(s)
| | - Amanda J Koehn
- Kent State University, 600 Hilltop Dr., Kent Hall, Kent, OH, 4424, USA
| | | | - Kathryn A Kerns
- Kent State University, 600 Hilltop Dr., Kent Hall, Kent, OH, 4424, USA
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27
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Rappaport LM, Sheerin C, Savage JE, Hettema JM, Roberson-Nay R. Clinical characteristics of latent classes of CO 2 hypersensitivity in adolescents and young adults. Behav Res Ther 2017; 93:95-103. [PMID: 28395158 DOI: 10.1016/j.brat.2017.03.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Revised: 02/22/2017] [Accepted: 03/28/2017] [Indexed: 10/19/2022]
Abstract
Although breathing CO2-enriched air reliably increases anxiety, there is debate concerning the nature and specificity of CO2 hypersensitivity to panic risk and panic disorder versus anxiety disorders and related traits broadly, particularly among adolescents and emerging adults. The present study sought to clarify the association of CO2 hypersensitivity with internalizing conditions and symptoms among adolescents and young adults. Participants (N = 628) self-reported anxiety levels every 2 min while breathing air enriched to 7.5% CO2 for 8 min. Growth mixture models were used to examine the structure of anxiety trajectories during the task and the association of each trajectory with dimensional and diagnostic assessments of internalizing disorders. Three distinct trajectories emerged: overall low (low), overall high (high), and acutely increased anxiety (acute). Compared to the low class, the acute class reported elevated neuroticism, anxiety sensitivity, and stress whereas the high class reported elevated anxiety symptoms, depression symptoms, neuroticism, anxiety sensitivity, and increased likelihood of an anxiety disorder diagnosis. Moreover, the acute and high classes reported experiencing a panic-like event at a higher rate than the low class while participants in the high class terminated the task prematurely at a higher rate. The present study clarifies the nature of response to CO2 challenge. Three distinct response profiles emerged, which clarifies the manifestation of CO2 hypersensitivity in anxiety disorders with strong, though not unique, associations with panic-relevant traits.
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Affiliation(s)
- Lance M Rappaport
- Virginia Institute for Psychiatric and Behavioral Genetics, Department of Psychiatry, Virginia Commonwealth University, 800 E Leigh Street, Suite 101, Richmond, VA, USA.
| | - Christina Sheerin
- Virginia Institute for Psychiatric and Behavioral Genetics, Department of Psychiatry, Virginia Commonwealth University, 800 E Leigh Street, Suite 101, Richmond, VA, USA.
| | - Jeanne E Savage
- Virginia Institute for Psychiatric and Behavioral Genetics, Department of Psychiatry, Virginia Commonwealth University, 800 E Leigh Street, Suite 101, Richmond, VA, USA.
| | - John M Hettema
- Virginia Institute for Psychiatric and Behavioral Genetics, Department of Psychiatry, Virginia Commonwealth University, 800 E Leigh Street, Suite 101, Richmond, VA, USA.
| | - Roxann Roberson-Nay
- Virginia Institute for Psychiatric and Behavioral Genetics, Department of Psychiatry, Virginia Commonwealth University, 800 E Leigh Street, Suite 101, Richmond, VA, USA.
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28
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Chidambaran V, Ding L, Moore DL, Spruance K, Cudilo EM, Pilipenko V, Hossain M, Sturm P, Kashikar-Zuck S, Martin LJ, Sadhasivam S. Predicting the pain continuum after adolescent idiopathic scoliosis surgery: A prospective cohort study. Eur J Pain 2017; 21:1252-1265. [PMID: 28346762 DOI: 10.1002/ejp.1025] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2017] [Indexed: 11/09/2022]
Abstract
BACKGROUND Chronic postsurgical pain (CPSP) affects half a million children annually in the United States, with dire socioeconomic consequences, including long-term disability into adulthood. The few studies of CPSP in children are limited by sample size, follow-up duration, non-homogeneity of surgical procedure and factors evaluated. METHODS In a prospective study of 144 adolescents undergoing a single major surgery (spine fusion), we evaluated demographic, perioperative, surgical and psychosocial factors as predictors of a continuum of postsurgical pain: immediate, pain maintenance at 2-3 months (chronic pain/CP) and persistence of pain a year (persistent pain/PP) after surgery. RESULTS We found an incidence of 37.8% and 41.8% for CP and PP. CP and acute pain were both significant predictors for developing PP (p-value <0.001 and 0.003). Preoperative pain and higher postoperative opioid requirement was significantly associated with CP (p = 0.015, p = 0.002), while Childhood Anxiety Sensitivity Index (p = 0.002) and surgical duration (p = 0.014) predicted PP. The final regression models had reasonable predictive accuracy (c-statistic of 0.73 and 0.83 for CP and PP, respectively). Anxiety scores and catastrophizing for child and parent were found to be significantly correlated (p = 0.005, p = 0.013 respectively). Pain trajectories revealed that 65% of patients who developed PP reported CP and high pain trends; however, 33% of those who developed PP could not be identified using solely pain criteria. CONCLUSION Persistent postsurgical pain in children is a significant problem. It can be predicted in part by combinations of psychological and clinical variables, which may provide evidence-based measures to prevent development of CPSP in the future. SIGNIFICANCE In a homogeneous cohort of adolescents undergoing spine fusion, we report a high incidence of persistent postsurgical pain (41.8%) predicted by child anxiety, perioperative pain, and surgical duration. Our results stress timely preventive and therapeutic strategies.
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Affiliation(s)
- V Chidambaran
- Department of Anesthesia, Cincinnati Children's Hospital Medical Center, USA.,Department of Pediatrics, Cincinnati Children's Hospital Medical Center, USA
| | - L Ding
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, USA.,Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, USA
| | - D L Moore
- Department of Anesthesia, Cincinnati Children's Hospital Medical Center, USA.,Department of Pediatrics, Cincinnati Children's Hospital Medical Center, USA
| | - K Spruance
- Department of Anesthesia, Cincinnati Children's Hospital Medical Center, USA
| | - E M Cudilo
- Pediatric Anesthesia Associates Medical Group Fresno, CA
| | - V Pilipenko
- Division of Human Genetics, Cincinnati Children's Hospital, USA
| | - M Hossain
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, USA
| | - P Sturm
- Division of Orthopedic Surgery, Cincinnati Children's Hospital Medical Center, USA
| | - S Kashikar-Zuck
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, USA
| | - L J Martin
- Division of Human Genetics, Cincinnati Children's Hospital, USA
| | - S Sadhasivam
- Department of Anesthesia, Cincinnati Children's Hospital Medical Center, USA.,Department of Pediatrics, Cincinnati Children's Hospital Medical Center, USA
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Wright KD, Lebell MANA, Carleton RN. Intolerance of uncertainty, anxiety sensitivity, health anxiety, and anxiety disorder symptoms in youth. J Anxiety Disord 2016; 41:35-42. [PMID: 27302203 DOI: 10.1016/j.janxdis.2016.04.011] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 04/19/2016] [Accepted: 04/22/2016] [Indexed: 12/30/2022]
Abstract
Intolerance of uncertainty (IU) - difficulty coping with uncertainty and its implications - is traditionally studied in adult populations, but more recently has been explored in children and adolescents. To date, the association between IU and health anxiety has not been explored in a child or adolescent sample. Further, it is unknown whether the relationship between IU and health anxiety may be mediated by anxiety sensitivity (i.e., fear of anxiety-related sensations) in this population. We sought to extend the existing research and expand our understanding of IU as a transdiagnostic construct by exploring the association between IU and health anxiety, anxiety sensitivity, and DSM-IV anxiety disorder symptom categories in 128 youth (M age=12.7years, SD=0.82, range 11-17 years). Participants completed measures of IU, health anxiety, anxiety sensitivity, and anxiety disorder symptom categories. Results demonstrated significant positive associations between IU and all measures. Mediation analyses supported the direct and indirect importance of each IU subscale on health anxiety. Future directions and implications are discussed.
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Affiliation(s)
- Kristi D Wright
- Department of Psychology, University of Regina, 3737 Wascana Parkway, Regina, SK, Canada.
| | - Megan A N Adams Lebell
- Department of Educational Psychology and Special Education, University of Saskatchewan, Saskatoon, SK, Canada
| | - R Nicholas Carleton
- Department of Psychology, University of Regina, 3737 Wascana Parkway, Regina, SK, Canada
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Möller EL, Nikolić M, Majdandžić M, Bögels SM. Associations between maternal and paternal parenting behaviors, anxiety and its precursors in early childhood: A meta-analysis. Clin Psychol Rev 2016; 45:17-33. [DOI: 10.1016/j.cpr.2016.03.002] [Citation(s) in RCA: 103] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 12/04/2015] [Accepted: 03/02/2016] [Indexed: 12/01/2022]
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Ghisi M, Bottesi G, Altoè G, Razzetti E, Melli G, Sica C. Factor Structure and Psychometric Properties of the Anxiety Sensitivity Index-3 in an Italian Community Sample. Front Psychol 2016; 7:160. [PMID: 26909057 PMCID: PMC4754426 DOI: 10.3389/fpsyg.2016.00160] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 01/28/2016] [Indexed: 11/30/2022] Open
Abstract
Anxiety Sensitivity (AS) is defined as the fear of anxiety and of arousal-related bodily sensations, arising from erroneous beliefs that these sensations will have adverse consequences. AS plays a key role both in the onset and in the maintenance of several disorders, particularly anxiety disorders. To date, only two studies on American samples have examined the bifactor structure of the Anxiety Sensitivity Index-3 (ASI-3); therefore, findings on different cultures are needed. The main purpose of the present study was to assess the factor structure and psychometric properties of the ASI-3 in an Italian community sample. Participants were recruited from the general population (N = 1507). The results of a series of confirmatory factor analyses indicated that the bifactor structure fitted the data better than the most commonly accepted structure for the measure and that it was invariant across gender. Moreover, the current study provided evidence regarding the ASI-3’s reliability and its convergent and divergent validity. Lastly, results pertaining incremental validity of the ASI-3 Physical and Cognitive Concerns subscales above and beyond the total showed that the former was not associated with a measure of physiological anxiety, whereas the latter was weakly associated with a measure of worry. Findings suggest that the ASI-3 is comprised of a dominant general factor and three specific independent factors; given the dominance of the general factor, the use of the ASI-3 total score as a measure of the general fear of anxiety is recommended in both clinical and research settings.
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Affiliation(s)
- Marta Ghisi
- Department of General Psychology, University of Padova Padova, Italy
| | - Gioia Bottesi
- Department of General Psychology, University of Padova Padova, Italy
| | - Gianmarco Altoè
- Department of Developmental and Social Psychology, University of Padova Padova, Italy
| | - Enrico Razzetti
- Department of General Psychology, University of Padova Padova, Italy
| | - Gabriele Melli
- Institute of Behavioral and Cognitive Psychology and Psychotherapy (IPSICO) Firenze, Italy
| | - Claudio Sica
- Department of Health Sciences, University of Florence Firenze, Italy
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32
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Martin L, Kidd M, Seedat S. Anxiety Sensitivity in School Attending Youth: Exploratory and Confirmatory Factor Analysis of the 18-Item CASI in a Multicultural South African Sample. Front Psychol 2016; 6:1996. [PMID: 26779098 PMCID: PMC4703811 DOI: 10.3389/fpsyg.2015.01996] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 12/14/2015] [Indexed: 11/17/2022] Open
Abstract
Anxiety sensitivity (AS) is a risk factor for the development of anxiety disorders in youth. To date, the applicability of the Childhood Anxiety Sensitivity Index (CASI) in youth from a low or middle income country (LMIC) setting on the African continent has not been assessed. A representative sample of 1149 secondary school learners from 29 schools in Cape Town, South Africa, participated in the study. Participants completed the CASI on a single occasion. One-, two-, and four-factor models of the CASI were assessed. A one-factor solution that comprised items predominantly represented by physical concerns appeared to provide the best fit to our data, however, relatively low variance (26%) was explained. Subsequent item deletion resulted in a 9-item ‘physical concerns’ factor that showed good construct reliability (0.83) but also explained a low amount of variance (35%). In terms of gender, a one-factor model provided the best fit, however, low variance was explained (i.e., 25%). Configural, metric and scalar invariance of the CASI by gender was determined. Our results suggest that the 18-item CASI is not applicable to our target population and may require adaptation in this population; however, replication of this study in other multicultural adolescent samples in South Africa is first needed to further assess the validity of the AS construct as measured by the CASI.
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Affiliation(s)
- Lindi Martin
- Department of Psychiatry, Stellenbosch University Cape Town, South Africa
| | - Martin Kidd
- Centre for Statistical Consultation, Department of Statistics and Actuarial Sciences, Stellenbosch University Cape Town, South Africa
| | - Soraya Seedat
- Department of Psychiatry, Stellenbosch University Cape Town, South Africa
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Lebowitz ER, Shic F, Campbell D, Basile K, Silverman WK. Anxiety sensitivity moderates behavioral avoidance in anxious youth. Behav Res Ther 2015; 74:11-7. [PMID: 26348546 PMCID: PMC4895193 DOI: 10.1016/j.brat.2015.08.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 08/14/2015] [Accepted: 08/26/2015] [Indexed: 11/26/2022]
Abstract
Individuals who are high in anxiety sensitivity (AS) are motivated to avoid sensations of anxiety. Consequently, AS is hypothesized to contribute to overall avoidance of any feared stimuli. No studies have yet examined whether fear of a stimulus is a stronger predictor of behavioral avoidance in individuals who are high in AS compared to individuals who are low in AS. We examined whether AS moderates the association between fear of spiders and behavioral avoidance of spider stimuli in 50 clinically anxious youth. Fear of spiders significantly predicted avoidance of spider stimuli in youth high in AS but not in youth low in AS. These results provide support for the role of AS in avoidant behavior and help to explain the link between AS and the anxiety disorders. The results have implications for exposure-based anxiety treatments and highlight the importance of increasing anxious patients' ability to tolerate sensations of anxiety.
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Affiliation(s)
- Eli R Lebowitz
- Yale University Child Study Center, 230 S. Frontage Rd., New Haven, CT 06519, USA.
| | - Frederick Shic
- Yale University Child Study Center, 230 S. Frontage Rd., New Haven, CT 06519, USA
| | - Daniel Campbell
- Yale University Child Study Center, 230 S. Frontage Rd., New Haven, CT 06519, USA
| | - Krista Basile
- Yale University Child Study Center, 230 S. Frontage Rd., New Haven, CT 06519, USA
| | - Wendy K Silverman
- Yale University Child Study Center, 230 S. Frontage Rd., New Haven, CT 06519, USA
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Experiential Avoidance and Anxiety Sensitivity: Independent and Specific Associations with Children’s Depression, Anxiety, and Social Anxiety Symptoms. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2015. [DOI: 10.1007/s10862-015-9502-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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35
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Rozenman M, Johnson OE, Chang SW, Woods DW, Walkup JT, Wilhelm S, Peterson A, Scahill L, Piacentini J. Relationships between Premonitory Urge and Anxiety in Youth with Chronic Tic Disorders. CHILDRENS HEALTH CARE 2015; 44:235-248. [PMID: 27110050 PMCID: PMC4840885 DOI: 10.1080/02739615.2014.986328] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Tourette's Disorder and other chronic tic disorders are common neurodevelopmental conditions. One characteristic of tic disorders is the premonitory urge, an aversive or unpleasant sensory phenomenon that may precede tics. Initial examination of premonitory urge in pediatric tic disorders suggests that awareness and experience of sensations preceding tics may be related to anxiety and OCD. However, it may be possible that specific anxiety-related symptoms, such as anxious physiologic arousal, are particularly relevant to the experience of premonitory urge. The current study examines relationships between tic-related premonitory urge and anxiety-related symptom clusters in treatment-seeking youths with a primary diagnoses of Tourette's or other chronic tic disorder. The sample consisted of 124 youth, ages 9 to 17, who participated in the multi-site Comprehensive Behavioral Intervention for Tics randomized controlled trial (CBIT; Piacentini et al., 2010). Specific anxiety-related subtypes, including generalized worry, separation, social, and panic/somatic symptoms, as well as severity of obsessions and compulsions, were assessed as potential correlates of premonitory urge. Findings indicated that age, global tic-related impairment, and specific panic/somatic symptoms accounted for a substantial proportion of variance in youth report of premonitory urge. These findings provide information about the characteristics of premonitory urge in pediatric tic disorders, and have implications for the treatment of pediatric tic syndromes.
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Affiliation(s)
| | | | | | | | | | | | - Alan Peterson
- University of Texas Health Science Center at San Antonio
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Allan NP, Capron DW, Lejuez CW, Reynolds EK, MacPherson L, Schmidt NB. Developmental trajectories of anxiety symptoms in early adolescence: the influence of anxiety sensitivity. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2014; 42:589-600. [PMID: 24062146 DOI: 10.1007/s10802-013-9806-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Children and adolescents seem to suffer from anxiety disorders at rates similar to adults. Interestingly, anxiety symptoms appear to generally decline over time within children as evidenced by lower rates in early and middle adolescence. There is some evidence that there may be heterogeneous subpopulations of adolescent children with different trajectories of anxiety symptoms, including a class of adolescents with elevated levels of anxiety that do not dissipate over time. Anxiety sensitivity has been identified as an important risk factor in the development of anxiety psychopathology. This study prospectively examined the development of anxiety symptoms in a sample of 277 adolescents (M age = 11.52; 44 % female, 56 % male) over a 3 year period including the influence of anxiety sensitivity on this development. Further, this study investigated whether there were distinct classes of adolescents based on their anxiety symptom trajectories and including anxiety sensitivity as a predictor. Consistent with other reports, findings indicated an overall decline in anxiety symptoms over time in the sample. However, three classes of adolescents were found with distinct anxiety symptom trajectories and anxiety sensitivity was an important predictor of class membership. Adolescents with elevated anxiety sensitivity scores were more likely to be classified as having high and increasing anxiety symptoms over time versus having moderate to low and decreasing anxiety symptoms over time. There are important implications for identification of adolescents and children who are at risk for the development of an anxiety disorder.
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Affiliation(s)
- Nicholas P Allan
- Department of Psychology, Florida State University, P.O. Box 3064301, Tallahasssee, FL, 32306-4301, USA
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Allan NP, MacPherson L, Young KC, Lejuez CW, Schmidt NB. Examining the latent structure of anxiety sensitivity in adolescents using factor mixture modeling. Psychol Assess 2014; 26:741-51. [PMID: 24749756 DOI: 10.1037/a0036744] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Anxiety sensitivity has been implicated as an important risk factor, generalizable to most anxiety disorders. In adults, factor mixture modeling has been used to demonstrate that anxiety sensitivity is best conceptualized as categorical between individuals. That is, whereas most adults appear to possess normative levels of anxiety sensitivity, a small subset of the population appears to possess abnormally high levels of anxiety sensitivity. Further, those in the high anxiety sensitivity group are at increased risk of having high levels of anxiety and of having an anxiety disorder. This study was designed to determine whether these findings extend to adolescents. Factor mixture modeling was used to examine the best fitting model of anxiety sensitivity in a sample of 277 adolescents (M age = 11.0 years, SD = 0.81). Consistent with research in adults, the best fitting model consisted of 2 classes, 1 containing adolescents with high levels of anxiety sensitivity (n = 25) and another containing adolescents with normative levels of anxiety sensitivity (n = 252). Examination of anxiety sensitivity subscales revealed that the social concerns subscale was not important for classification of individuals. Convergent and discriminant validity of anxiety sensitivity classes were found in that membership in the high anxiety sensitivity class was associated with higher mean levels of anxiety symptoms, controlling for depression and externalizing problems, and was not associated with higher mean levels of depression or externalizing symptoms controlling for anxiety problems.
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Affiliation(s)
| | - Laura MacPherson
- Center for Addictions, Personality, and Emotion Research, University of Maryland
| | - Kevin C Young
- Center for Addictions, Personality, and Emotion Research, University of Maryland
| | - Carl W Lejuez
- Center for Addictions, Personality, and Emotion Research, University of Maryland
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A French Translation of the Childhood Anxiety Sensitivity Index (CASI): Factor Structure, Reliability and Validity of This Scale in a Nonclinical Sample of Children. Psychol Belg 2014. [DOI: 10.5334/pb.an] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Capron DW, Allan NP, Norr AM, Zvolensky MJ, Schmidt NB. The effect of successful and unsuccessful smoking cessation on short-term anxiety, depression, and suicidality. Addict Behav 2014; 39:782-8. [PMID: 24457901 DOI: 10.1016/j.addbeh.2013.12.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 12/14/2013] [Accepted: 12/18/2013] [Indexed: 11/26/2022]
Abstract
Research on the mental health effects of quitting smoking is limited. Smokers with mental illness appear to be at a higher risk of unsuccessful smoking cessation. Recent work suggests they are at elevated risk for post-cessation increases in anxiety, depression and suicidal ideation. The current study tested the effects of successful and unsuccessful smoking cessation on short-term psychopathology in 192 community participants. Smoking cessation outcomes were classified using expired carbon monoxide levels that were taken at quit week, 1 and 2 week follow-up and 1 month follow-up. We found no psychopathology increases in participants who successfully quit smoking. For individuals struggling to quit our results partially supported a recently proposed struggling quitters hypothesis. However, the vast majority of individuals posited to be vulnerable by the struggling quitters hypothesis did not experience clinically significant increases in psychopathology. These findings have implications for clinicians whose clients are interested in smoking cessation.
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Stevanovic DS, Silverman WK, Nichols-Lopez KA, Popovic-Deusic SD, Pejovic-Milovancevic MM. Facets of the childhood anxiety sensitivity index among Serbian youth. Cogn Behav Ther 2013; 42:342-6. [PMID: 23952679 DOI: 10.1080/16506073.2013.773060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Data from factor analytic studies using the Child Anxiety Sensitivity Index (CASI) suggest that global anxiety sensitivity (AS) is best represented by three or four underlying factors or facets. The aim of this study was to identify facets best representing the CASI structure in its Serbian version. Confirmatory factor analysis was used on data collected from 456 non-referred children in Serbia. A 13-item version of the CASI provided a better fit to the data than the original 18-item version. The four-factor model of the CASI-13 with disease, unsteady, mental incapacitation, and social concerns facets provided the best fits for the data and it was found to be fully invariant (configural, metric, and scalar invariance) across gender and age. Among Serbian children, hierarchical structure was found for a 13-item CASI version with a single higher-order factor of global AS represented by four underlying facets. Future research will consider these AS facets and their role in the development, maintenance, and exacerbation of anxiety symptoms in children.
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Bernstein A, Stickle TR, Schmidt NB. Factor mixture model of anxiety sensitivity and anxiety psychopathology vulnerability. J Affect Disord 2013; 149:406-17. [PMID: 23261139 DOI: 10.1016/j.jad.2012.11.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Accepted: 11/06/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND The purpose of the present study was to shed light on the latent structure and nature of individual differences in anxiety sensitivity (AS) and related risk for psychopathology. METHODS The present study evaluated the latent structure of AS using factor mixture modeling (FMM; Lubke and Muthén, 2005) and tested the relations between the observed FMM-based model of AS and psychopathology in a large, diverse adult clinical research sample (N=481; 57.6% women; M(SD)(age)=36.6(15.0) years). RESULTS Findings showed that a two-class three-factor partially invariant model of AS demonstrated significantly better fit than a one-class dimensional model and more complex multi-class models. As predicted, risk conferred by AS taxonicity was specific to anxiety psychopathology, and not to other forms of psychopathology. LIMITATIONS The sample was not epidemiologic, self-report and psychiatric interview data were used to index AS and psychopathology, and a cross-sectional design limited inference regarding the directionality of observed relations between AS and anxiety psychopathology. CONCLUSIONS Findings are discussed with respect to the nature of AS and related anxiety psychopathology vulnerability specifically, as well as the implications of factor mixture modeling for advancing taxonomy of vulnerability and psychopathology more broadly.
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Affiliation(s)
- Amit Bernstein
- University of Haifa, Department of Psychology, Haifa, Israel.
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Knapp AA, Frala J, Blumenthal H, Badour CL, Leen-Feldner EW. Anxiety Sensitivity and Childhood Learning Experiences: Impacts on Panic Symptoms Among Adolescents. COGNITIVE THERAPY AND RESEARCH 2013. [DOI: 10.1007/s10608-013-9558-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Abstract
BACKGROUND Mood disorders are expressed in many heterogeneous forms, varying from anxiety to severe major clinical depression. The disorders are expressed in individual variety through manifestations governed by co-morbidities, symptom frequency, severity, and duration, and the effects of genes on phenotypes. The underlying etiologies of mood disorders consist of complex interactive operations of genetic and environmental factors. The notion of endophenotypes, which encompasses the markers of several underlying liabilities to the disorders, may facilitate efforts to detect and define, through staging, the genetic risks inherent to the extreme complexity of disease state. AIMS This review evaluates the role of genetic biomarkers in assisting clinical diagnosis, identification of risk factors, and treatment of mood disorders. METHODS Through a systematic assessment of studies investigating the epigenetic basis for mood disorders, the present review examines the interaction of genes and environment underlying the pathophysiology of these disorders. RESULTS The majority of research findings suggest that the notion of endophenotypes, which encompasses the markers of several underlying liabilities to the disorders, may facilitate efforts to detect and define, through staging, the genetic risks inherent to the extreme complexity of the disease states. Several strategies under development and refinement show the propensity for derivation of essential elements in the etiopathogenesis of the disorders affecting drug-efficacy, drug metabolism, and drug adverse effects, e.g., with regard to selective serotonin reuptake inhibitors. These include: transporter gene expression and genes encoding receptor systems, hypothalamic-pituitary-adrenal axis factors, neurotrophic factors, and inflammatory factors affecting neuroimmune function. Nevertheless, procedural considerations of pharmacogenetics presume the parallel investment of policies and regulations to withstand eventual attempts at misuse, thereby ensuring patient integrity. CONCLUSIONS Identification of genetic biomarkers facilitates choice of treatment, prediction of response, and prognosis of outcome over a wide spectrum of symptoms associated with affective states, thereby optimizing clinical practice procedures. Epigenetic regulation of primary brain signaling, e.g., serotonin and hypothalamic-pituitary-adrenal function, and factors governing their metabolism are necessary considerations. The participation of neurotrophic factors remains indispensable for neurogenesis, survival, and functional maintenance of brain systems.
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Affiliation(s)
- T Archer
- Department of Psychology, University of Gothenburg, Box 500, SE-40530 Gothenburg, Sweden
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Phenotypic and genetic structure of anxiety sensitivity in adolescence and early adulthood. J Anxiety Disord 2012; 26:680-8. [PMID: 22721752 DOI: 10.1016/j.janxdis.2012.05.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Revised: 04/16/2012] [Accepted: 05/03/2012] [Indexed: 11/22/2022]
Abstract
Anxiety sensitivity is a risk factor for emotional disorders. The structure of anxiety sensitivity was examined using phenotypic and genetic analyses. Self-reported anxiety sensitivity was measured at three time points from adolescence into young adulthood by 2651 individuals from the G1219 twin study. Confirmatory factor analyses revealed comparable statistical support for anxiety sensitivity models consisting of three or four dimensions across all time points. The three-factor model depicting Physical, Social and Mental anxiety-related concerns was favoured due to greater interpretability and parsimony. Multivariate quantitative genetic analyses supported a hierarchical structure with general genetic (.09-.61) and non-shared environmental (.39-.72) influences acting via a higher-order factor as well as dimension-specific genetic (.09-.21) and non-shared environmental (.23-.68) influences. The findings provide further evidence for a hierarchical structure underlying different dimensions of anxiety sensitivity.
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Childhood depression and anxiety disorders in Serbia: a psychometric study of four screening questionnaires. Epidemiol Psychiatr Sci 2012; 21:111-6. [PMID: 22670418 DOI: 10.1017/s2045796011000655] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Isolan L, Salum G, Flores SM, Carvalho HWD, Manfro GG. Reliability and convergent validity of the Childhood Anxiety Sensitivity Index in children and adolescents. JORNAL BRASILEIRO DE PSIQUIATRIA 2012. [DOI: 10.1590/s0047-20852012000400001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE: The purpose of this study was to examine the reliability and the convergent validity of the Children Anxiety Sensitivity Index (CASI) with DSM-IV anxiety disorder symptoms, by comparison with the Screen for Child Anxiety Related Emotional Disorders (SCARED), in a community sample of Brazilian children and adolescents. METHODS: Children and adolescents from five schools were selected from a larger study that aimed to assess different aspects of childhood anxiety disorders. All participants completed the CASI and the SCARED. RESULTS: This study supported the reliability of the CASI total score. Girls reported higher total anxiety sensitivity scores than boys and there were no differences in total anxiety sensitivity scores between children and adolescents. This study showed moderate to high correlations between the CASI scores with SCARED scores, all correlations coefficients being positive and significant. CONCLUSIONS: Our findings demonstrate an appropriate reliability and evidence of convergent validity in the CASI in a sample of Brazilian children and adolescents.
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Affiliation(s)
- Luciano Isolan
- Hospital de Clínicas de Porto Alegre, Brazil; Universidade Federal do Rio Grande do Sul, Brazil
| | - Giovanni Salum
- Hospital de Clínicas de Porto Alegre, Brazil; Universidade Federal do Rio Grande do Sul, Brazil; Institute of Developmental Psychiatry for Children and Adolescent
| | | | | | - Gisele Gus Manfro
- Hospital de Clínicas de Porto Alegre, Brazil; Universidade Federal do Rio Grande do Sul, Brazil; Institute of Developmental Psychiatry for Children and Adolescent
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Jokić-Begić N, Jurin T, Lauri Korajlija A. Factor Structure and Psychometric Properties of the Modified Childhood Anxiety Sensitivity Index in a Sample of Croatian Children and Adolescents. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2011. [DOI: 10.1007/s10862-011-9244-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Bernstein A, Cárdenas SJ, Coy PEC, Zvolensky MJ. Test of a Factor Mixture-Based Taxonic-Dimensional Model of Anxiety Sensitivity and Panic Attack Vulnerability among University and Clinical Samples in Mexico City. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2011. [DOI: 10.1007/s10862-011-9235-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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A Meta-analytic Review of the Role of Child Anxiety Sensitivity in Child Anxiety. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2011; 39:721-33. [DOI: 10.1007/s10802-011-9489-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Francis SE, Noël V. Parental contributions to child anxiety sensitivity: a review and recommendations for future directions. Child Psychiatry Hum Dev 2010; 41:595-613. [PMID: 20499157 DOI: 10.1007/s10578-010-0190-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Anxiety sensitivity (AS) is defined as the fear of anxiety-related symptoms (e.g., a fast beating heart) and the consequences that may follow from these symptoms (e.g., a heart attack). Recently, child AS has been examined in relation to parental AS and parental anxiety to elucidate potential parental contributions. Given inconsistent findings to date, this review was intended to identify parental factors that are significant contributors to child AS. Two key findings from this review included the absence of a significant relationship between parental anxiety and child AS and the determination that the parent-child AS association is conditional upon the child reporter, the parent reporter, and the specific dimensions of AS being tested. Recommendations for future directions include examining specific facets of AS, studying parental contributions amongst anxiety-disordered youth, and employing sufficiently large samples to allow for between child group comparisons.
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Affiliation(s)
- Sarah E Francis
- Department of Psychology, Memorial University of Newfoundland, St. John's, NL, A1B 3X9, Canada.
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