Comorbid generalized anxiety disorder and its association with quality of life in patients with major depressive disorder

Academic self-efficacy and cognitive strategy use in college students with and without depression or anxiety

OBJECTIVE

This study examined whether college students with and without depression or anxiety differed in subjective cognitive concerns, academic self-efficacy, and cognitive strategy use.

PARTICIPANTS

Participants included 582 college students (M = 19.0 ± 1.0 years-old, 79.4% women, 81.9% White).

METHODS

Participants completed online self-report questionnaires on subjective cognitive functioning, academic self-efficacy, cognitive strategy use, and depression and anxiety symptoms, which were used to categorize participants as having anxiety or depression based on established clinical cutoffs.

RESULTS

Participants with anxiety or depression reported greater subjective cognitive concerns and lower academic self-efficacy compared to participants without anxiety or depression, but these groups differed only modestly in cognitive strategy use.

CONCLUSIONS

Despite greater cognitive concerns, participants with anxiety or depression reported only modestly greater cognitive strategy use. Future research should evaluate interventions to increase strategy use among college students with anxiety or depression, tailoring these interventions for modern students by incorporating telehealth approaches and smartphone use.

Prevalence of the generalized anxiety disorder in Tunisia: A study of 707 primary care outpatients

OBJECTIVE

This study examined the prevalence and correlates of generalized anxiety disorder (GAD) among primary care outpatients.

METHOD

A multicenter, cross-sectional study was conducted that included 707 primary care outpatients being seen at 20 primary healthcare centers in Tunis and Sfax, Tunisia. The Mini International Neuropsychiatric Interview was used to identify a diagnosis of GAD. The Beck Depression Inventory was used to assess depressive symptom severity, and the Sheehan Disability Scale (SDS) was used to measure functional impairment.

RESULTS

The prevalence of GAD was 11%. GAD was positively correlated with female gender (P = .005), family history of psychiatric disorder (P < .001), personal history of suicide attempt (P = .019), and depressive symptoms (P < .001). Based on the SDS, severe to very severe functional limitations were reported at work, in social life, and family life (56.4%, 60.2%, and 73.1%, respectively) among GAD patients.

CONCLUSION

This study indicated a relatively high prevalence of GAD among primary care patients in Tunisia. Risk factors were also determined that may help to identify these patients. This information may help primary care physicians recognize this diagnosis and provide timely referrals to mental health professionals to prevent complications and preserve quality of life.

The influence of depression and anxiety on cognition in people with multiple sclerosis: a cross-sectional analysis

There are conflicting findings about the relationships between depression, anxiety, and cognitive dysfunction in people with multiple sclerosis (MS), and a paucity of research has examined the cumulative influence on cognition of depression plus anxiety. This study aimed to determine whether elevated symptoms of depression and anxiety alone or in combination are associated with worse cognition in people with MS. In this cross-sectional analysis, people with MS consecutively seen at a tertiary neuropsychiatry clinic completed the Hospital Anxiety and Depression Scale for symptoms of depression (HADS-D) and anxiety (HADS-A), and the Minimal Assessment of Cognitive Function in MS for cognitive indices. Accounting for covariates, regression models predicted cognitive indices from scores for HADS-D, HADS-A, and the interaction. Of 831 people with MS, 72% were female, mean age was 43.2 years, and median Expanded Disability Status Scale score was 2.0. Depressive symptoms were independently predictive of lower verbal fluency (Controlled Oral Word Association Test, p < 0.01), verbal learning (California Verbal Learning Test-II (CVLT-II) total learning, p = 0.02), verbal delayed recall (CVLT-II delayed recall, p < 0.01), and processing speed (Symbol Digit Modalities Test, p < 0.01; three-second Paced Auditory Serial Addition Test (PASAT), p = 0.05; two-second PASAT, p = 0.01). Anxiety in people with depression predicted decreased visuospatial function (Judgment of Line Orientation, p = 0.05), verbal learning (p < 0.01), verbal delayed recall (p < 0.01), visuospatial recall (Brief Visuospatial Memory Test-Revised, p = 0.02), and executive function (Delis-Kaplan Executive Function System, p < 0.01). Anxiety alone was not independently predictive of cognition. In conclusion, depression, especially with comorbid anxiety, is associated with cognitive dysfunction in people with MS.

Projecting the 10-year costs of care and mortality burden of depression until 2032: a Markov modelling study developed from real-world data

Background

Based on real-world data, we developed a 10-year prediction model to estimate the burden among patients with depression from the public healthcare system payer's perspective to inform early resource planning in Hong Kong.

Methods

We developed a Markov cohort model with yearly cycles specifically capturing the pathway of treatment-resistant depression (TRD) and comorbidity development along the disease course. Projected from 2023 to 2032, primary outcomes included costs of all-cause and psychiatric care, and secondary outcomes were all-cause deaths, years of life lived, and quality-adjusted life-years. Using the territory-wide electronic medical records, we identified 25,190 patients aged ≥10 years with newly diagnosed depression from 2014 to 2016 with follow-up until 2020 to observe the real-world time-to-event pattern, based on which costs and time-varying transition inputs were derived using negative binomial modelling and parametric survival analysis. We applied the model as both closed cohort, which studied a fixed cohort of incident patients in 2023, and open cohort, which introduced incident patients by year from 2014 to 2032. Utilities and annual new patients were from published sources.

Findings

With 9217 new patients in 2023, our closed cohort model projected the 10-year cumulative costs of all-cause and psychiatric care to reach US$309.0 million and US$58.3 million, respectively, with 899 deaths (case fatality rate: 9.8%) by 2032. In our open cohort model, 55,849-57,896 active prevalent cases would cost more than US$322.3 million and US$60.7 million, respectively, with more than 943 deaths annually from 2023 to 2032. Fewer than 20% of cases would live with TRD or comorbidities but contribute 31-54% of the costs. The greatest collective burden would occur in women aged above 40, but men aged above 65 and below 25 with medical history would have the highest costs per patient-year. The key cost drivers were relevant to the early disease stages.

Interpretation

A limited proportion of patients would develop TRD and comorbidities but contribute to a high proportion of costs, which necessitates appropriate attention and resource allocation. Our projection also demonstrates the application of real-world data to model long-term costs and mortality, which aid policymakers anticipate foreseeable burden and undertake budget planning to prepare for the care need in alternative scenarios.

Funding

Research Impact Fund from the University Grants Committee, Research Grants Council with matching fund from the Hong Kong Association of Pharmaceutical Industry (R7007-22).

Association between anxiety, depression and quality of life in male and female German students during the COVID-19 pandemic

BACKGROUND

Studies show that three-quarters of mental disorders appear during young adulthood, which makes students a risk group. Especially people with anxiety and depression experience lower Quality of Life (QoL) compared to healthy persons. Furthermore, previous research found that there was a wide range of negative mental consequences triggered by the COVID-19 pandemic. This study aimed to examine the association between anxiety, depression and QoL in male and female students at the time of the COVID-19 pandemic.

METHODS

297 German students (121 men, age spanmen: 18-41 years; 176 women, age spanwomen: 18-52 years) filled in the following questionnaires: World Health Organization Quality of Life Brief Version, Hospital Anxiety and Depression Scale and the Symptom-Checklist-90-R. Men and women did not differ significantly in their physical, psychological, environmental and global QoL.

RESULTS

While women showed higher raw anxiety scores, groups did not differ in terms of their raw depression scores. Furthermore, we found main effects of anxiety and depression on the four QoL subscales. Students´ QoL was highest if they were not affected by anxiety and depression, independently of gender. Psychological and social QoL was worst if the students reported marginal and particularly clinically significant levels of anxiety and depression. Men experienced worse psychological and social QoL than women for clinically significant anxiety levels.

CONCLUSIONS

Interventions should target especially the psychological and the social subscales of QoL, as these areas are most affected by anxiety and depression. Possible interventions could be psychoeducational programs or participation in sports because it offers an opportunity for social interaction and goal-directed activity.

Evaluating Machine Learning Stability in Predicting Depression and Anxiety Amidst Subjective Response Errors

Major Depressive Disorder (MDD) and Generalized Anxiety Disorder (GAD) pose significant burdens on individuals and society, necessitating accurate prediction methods. Machine learning (ML) algorithms utilizing electronic health records and survey data offer promising tools for forecasting these conditions. However, potential bias and inaccuracies inherent in subjective survey responses can undermine the precision of such predictions. This research investigates the reliability of five prominent ML algorithms-a Convolutional Neural Network (CNN), Random Forest, XGBoost, Logistic Regression, and Naive Bayes-in predicting MDD and GAD. A dataset rich in biomedical, demographic, and self-reported survey information is used to assess the algorithms' performance under different levels of subjective response inaccuracies. These inaccuracies simulate scenarios with potential memory recall bias and subjective interpretations. While all algorithms demonstrate commendable accuracy with high-quality survey data, their performance diverges significantly when encountering erroneous or biased responses. Notably, the CNN exhibits superior resilience in this context, maintaining performance and even achieving enhanced accuracy, Cohen's kappa score, and positive precision for both MDD and GAD. This highlights the CNN's superior ability to handle data unreliability, making it a potentially advantageous choice for predicting mental health conditions based on self-reported data. These findings underscore the critical importance of algorithmic resilience in mental health prediction, particularly when relying on subjective data. They emphasize the need for careful algorithm selection in such contexts, with the CNN emerging as a promising candidate due to its robustness and improved performance under data uncertainties.

Associations between anxiety, depression, and personal mastery in community-dwelling older adults: a network-based analysis

BACKGROUND

In China, about 18.70% of the population aged 60 years and older are at risk of low personal mastery as well as anxiety and depression for a variety of reasons. The purpose of this study was to construct a symptom network model of the relationship between anxiety, depression, and personal mastery in community-dwelling older adults and to identify central and bridge symptoms in this network.

METHODS

Depression, anxiety, and personal mastery were measured using the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder Scale (GAD-7), and Personal Mastery Scale (PMS), respectively. A total of 501 older adults in 16 communities in Changzhou and Zhenjiang, Jiangsu Province, China, were surveyed by using a combination of stratified sampling and convenience sampling methods. The R language was used to construct the network.

RESULTS

(1) The network structure of anxiety-depression-personal mastery was stable, with "Nervousness" (node GAD1, strength = 1.38), "Sad mood" (node PHQ2, strength = 1.22), " Inability to change" (node PMS2, strength = 1.01) and "Involuntarily" (node PMS3, strength = 0.95) as the central symptoms. (2) "Irritability" (node GAD6, bridge strength = 0.743), "Sad mood" (node PHQ2, bridge strength = 0.655), and "Trouble relaxing" (node GAD4, bridge strength = 0.550) were the bridge symptoms connecting anxiety, depressive symptoms, and personal mastery. (3) In the network comparison test (NCT), residence, somatic chronic comorbidity and gender had no significant effect on network structure.

CONCLUSIONS

The construction of the anxiety-depression-personal mastery network structure opens up new possibilities for mechanisms of action and intervention formulation for psychological disorders in community-dwelling older adults. The identification of central symptoms (e.g., nervousness, sad mood, inability to change, involuntarily) and bridge symptoms (e.g., irritability, sad mood, trouble relaxing) in community-dwelling older adults with anxiety, depression, and low sense of mastery can provide a scientific basis for the development of precise interventions.

Gender differences in prevalence and clinical correlates of anxiety in first-episode and drug-naïve patients with major depressive disorder comorbid with metabolic syndrome

BACKGROUND

Although gender differences in major depressive disorder (MDD) have been widely reported, there has not been much focus on gender differences in comorbidity. In patients with MDD and comorbid metabolic syndrome (Mets), the goal of this study was to investigate potential gender differences in the prevalence and clinical correlates of concomitant anxiety.

METHODS

Seven hundred and ninety-four first-episode and drug-naïve patients (FEDN) patients with MDD and comorbid Mets were recruited. For each patient, sociodemographic data, thyroid function indicators, and Mets parameters were acquired. Each participant completed the 14-item Hamilton Assessment Scale for Anxiety (HAMA) and the 17-item Hamilton Assessment Scale for Depression (HAMD).

RESULTS

There were no gender differences in the prevalence of anxiety in patients with MDD and comorbid Mets. Female patients with MDD had a shorter duration of illness. Correlation analysis showed that HAMD score, TSH, TgAb, and TPOAb were associated with anxiety prevalence in female patients, whereas anxiety onset in male patients was only associated with TSH, TgAb, and TPOAb levels. In addition, multiple logistic regression analysis showed that TSH and TgAb predicted anxiety in male patients, whereas HAMD score and age of onset significantly predicted anxiety in female patients.

LIMITATIONS

Cross-sectional design and no control for anxiety-related factors.

CONCLUSIONS

Our study showed no gender differences in the prevalence of anxiety in patients with MDD and comorbid Mets. HAMD score was associated with anxiety in female patients, whereas TSH, TgAb, and TPOAb were associated with anxiety in male patients.

Psychodynamic profiles of major depressive disorder and generalized anxiety disorder in China

Traditional clinical diagnoses relying on symptoms may overlook latent factors that illuminate mechanisms and potentially guide treatment. The Operationalized Psychodynamic Diagnosis (OPD) system may compensate for symptom-based diagnosis by measuring psychodynamic profiles underlying mental disorders through conflicts and structure axes. However, OPD has not been widely adopted in China, and it remains unclear whether OPD can be used as an effective approach to distinguish between depression and anxiety. The current study aims to adopt the OPD system to investigate the psychodynamic profiles of major depressive disorder (MDD) and generalized anxiety disorder (GAD) in China, targeting patients with "pure" symptoms without comorbidity. We recruited 42 MDD patients, 32 GAD patients, and 31 healthy controls (HC), and assessed their self-report depression and anxiety symptoms, along with their underlying psychodynamic profiles through OPD interviews. Overall, both MDD and GAD patients showed more prominent conflict issues and lower levels of structure than HC. The MDD and GAD groups yielded different conflict profiles and conflict processing modes when processing their second conflicts. Importantly, the multi-dimensional psychodynamic profiles achieved machine learning classification of clinical groups with an accuracy of 0.84, supporting successful distinction of MDD and GAD patients. In conclusion, the OPD demonstrated sensitivity in revealing distinct psychodynamic profiles underlying "pure" depression and anxiety clinical populations in China. This work calls for future incorporation of OPD as a tool to investigate psychodynamic formulations underlying mental disorders, compensating for traditional symptom-based diagnostic approaches to guide precise individualized interventions.

Review of the Assessment and Management of Perinatal Mood and Anxiety Disorders

Perinatal mood and anxiety disorders (PMADs) are the most common complication of childbirth. When poorly controlled, they are associated with worse obstetric outcomes, such as higher rates of preterm birth and unplanned cesarean delivery. They are also associated with suicide, a leading cause of perinatal maternal death. This article provides an overview of evidence-based recommendations for screening, assessment, and management of PMADs, including suicide risk assessment and management and pharmacological and nonpharmacological treatment options compatible with pregnancy and lactation. Although specialized reproductive psychiatrists can provide expert guidance for the management of PMADs, their scarcity means that most patients will not have access to this expert care and instead will seek guidance from general psychiatrists. This article provides a clinical guide for generalists that is based on the best current evidence, including recently released treatment guidelines.

Impaired eating behaviors but intact metabolic hormone levels in individuals with major depressive disorder and generalized anxiety disorder

BACKGROUND

Major depressive disorder (MDD) and generalized anxiety disorder (GAD) contribute significantly to global health burdens. Identifying disease markers for these comorbid disorders can increase understanding of pathogenesis and improve screening and intervention strategies. This study examined the association of physical health factors with MDD and MDD + GAD, across sexes.

METHODS

Two samples of participants from the Tulsa-1000 study (exploratory cohort: N = 136; confirmatory cohort: N = 185) completed body composition measurements, eating behavior (Three Factor Eating Questionnaire [TFEQ], Eating Disorder Diagnostic Scale [EDDS]), exercise questionnaires, and a blood draw. Metabolic hormone concentrations (leptin, insulin, and adiponectin) were analyzed from blood samples. Within each cohort, a two-way analysis of variance compared three groups (MDD, MDD + GAD, and healthy controls [HC]), sex, and their interaction on dependent variables. Hedges g was calculated to reflect effect size magnitude.

RESULTS

Medium-to-large group main effects across cohorts indicated that compared to HC: (1) MDD (g = 1.71/0.57) and MDD + GAD (g = 0.93/0.69) reported higher TFEQ Disinhibition scores; (2) MDD endorsed higher TFEQ Hunger scores (g = 0.66/0.48); and (3) MDD (g = 1.60/1.30) and MDD + GAD (g = 0.92/1.72) reported greater EDDS scores. Large sex main effects across cohorts indicated that females exhibited higher levels than males for percent body fat (g = 1.07/1.17), leptin (g = 1.27/1.12), and adiponectin (g=0.82/0.88).

LIMITATIONS

The power to detect group*sex interactions was limited due to a greater number of females (than males) in the study, and over half of clinical participants were taking medications.

CONCLUSIONS

Individuals with MDD and MDD + GAD demonstrate difficulties in regulating eating behaviors, potentially contributing to functional impairment and increased disease burden.

The genetic contribution to the comorbidity of depression and anxiety: a multi-site electronic health records study of almost 178 000 people

BACKGROUND

Depression and anxiety are common and highly comorbid, and their comorbidity is associated with poorer outcomes posing clinical and public health concerns. We evaluated the polygenic contribution to comorbid depression and anxiety, and to each in isolation.

METHODS

Diagnostic codes were extracted from electronic health records for four biobanks [N = 177 865 including 138 632 European (77.9%), 25 612 African (14.4%), and 13 621 Hispanic (7.7%) ancestry participants]. The outcome was a four-level variable representing the depression/anxiety diagnosis group: neither, depression-only, anxiety-only, and comorbid. Multinomial regression was used to test for association of depression and anxiety polygenic risk scores (PRSs) with the outcome while adjusting for principal components of ancestry.

RESULTS

In total, 132 960 patients had neither diagnosis (74.8%), 16 092 depression-only (9.0%), 13 098 anxiety-only (7.4%), and 16 584 comorbid (9.3%). In the European meta-analysis across biobanks, both PRSs were higher in each diagnosis group compared to controls. Notably, depression-PRS (OR 1.20 per s.d. increase in PRS; 95% CI 1.18-1.23) and anxiety-PRS (OR 1.07; 95% CI 1.05-1.09) had the largest effect when the comorbid group was compared with controls. Furthermore, the depression-PRS was significantly higher in the comorbid group than the depression-only group (OR 1.09; 95% CI 1.06-1.12) and the anxiety-only group (OR 1.15; 95% CI 1.11-1.19) and was significantly higher in the depression-only group than the anxiety-only group (OR 1.06; 95% CI 1.02-1.09), showing a genetic risk gradient across the conditions and the comorbidity.

CONCLUSIONS

This study suggests that depression and anxiety have partially independent genetic liabilities and the genetic vulnerabilities to depression and anxiety make distinct contributions to comorbid depression and anxiety.

Profiles of quality of life among patients using emergency departments for mental health reasons

BACKGROUND

This study identified profiles associated with quality of life (QoL) and sociodemographic and clinical characteristics of patients using emergency departments (ED) for mental health reasons and associated these profiles with patient service use.

METHODS

Recruited in four Quebec (Canada) ED networks, 299 patients with mental disorders (MD) were surveyed from March 1st, 2021, to May 13th, 2022. Data from medical records were collected and merged with survey data. Cluster analysis was conducted to identify QoL profiles, and comparison analyses used to assess differences between them.

RESULTS

Four QoL profiles were identified: (1) Unemployed or retired men with low QoL, education and household income, mostly having substance-related disorders and bad perceived mental/physical health conditions; (2) Men who are employed or students, have good QoL, high education and household income, the least personality disorders, and fair perceived mental/physical health conditions; (3) Women with low QoL, multiple mental health problems, and very bad perceived mental/physical health conditions; (4) Mostly women with very good QoL, serious MD, and very good perceived mental/physical health conditions.

CONCLUSION

The profiles with the highest QoL (4 and 2) had better overall social characteristics and perceived their health conditions as superior. Profile 4 reported the highest level of satisfaction with services used. To improve QoL programs like permanent supportive housing, individual placement and support might be better implemented, and satisfaction with care more routinely assessed in response to patient needs - especially for Profiles 1 and 3, that show complex health and social conditions.

Practical pathway for the management of depression in the workplace: a Canadian perspective

Major depressive disorder (MDD) and other mental health issues pose a substantial burden on the workforce. Approximately half a million Canadians will not be at work in any week because of a mental health disorder, and more than twice that number will work at a reduced level of productivity (presenteeism). Although it is important to determine whether work plays a role in a mental health condition, at initial presentation, patients should be diagnosed and treated per appropriate clinical guidelines. However, it is also important for patient care to determine the various causes or triggers including work-related factors. Clearly identifying the stressors associated with the mental health disorder can help clinicians to assess functional limitations, develop an appropriate care plan, and interact more effectively with worker's compensation and disability programs, as well as employers. There is currently no widely accepted tool to definitively identify MDD as work-related, but the presence of certain patient and work characteristics may help. This paper seeks to review the evidence specific to depression in the workplace, and provide practical tips to help clinicians to identify and treat work-related MDD, as well as navigate disability issues.

A Comprehensive Review of the Generalized Anxiety Disorder

Excessive, uncontrollable, and usually unjustified worry about certain things is a sign of the mental and behavioral disease known as generalized anxiety disorder (GAD). Genetic research suggests that numerous genes are likely implicated in the development of GAD, even if much is yet unclear about this. As a result, if someone in a family has GAD, there is a high likelihood that someone else will also suffer from the illness, as well as another anxiety disorder. Individuals with GAD are frequently overly bothered about workaday affairs like health, assets, demise, family, accord issues, or effort challenges. Worry frequently interferes with daily functioning. Excessive concern, restlessness, difficulty sleeping, tiredness, irritability, sweating, and trembling are a few symptoms that may be present. For a formal diagnosis of GAD, symptoms must be persistent for at least six months and consistent. Conversion in the amygdala's utilitarian congruence and how it processes fear and anxiety have been linked to generalized anxiety disorder. Neurotransmitters, and particularly the gamma-aminobutyric acid (GABA) variant, have long been known to cause GAD through dysregulating amygdala activity in the brain. Anxiety, concern, or physical symptoms must significantly hinder social, academic, or occupational functioning in order to qualify for a GAD diagnosis. The Diagnostic and Statistical Manual of Mental Disorders-V (DSM-V) provides explicit ethos to aid doctors in identifying this disorder. Psychological therapy based on cognitive behavioral therapy (CBT) principles is effective in reducing anxiety symptoms for short-term treatment of GAD. In this, the patient's thinking ability and methods are focused. The main principle behind CBT is that your thought patterns affect your feelings, which in turn can affect your behavior. Drugs like antidepressants, buspirone, benzodiazepines, and can all be worn to goody GAD. Outside of therapy, patients with anxiety can learn to manage it by practicing relaxation methods, reframing unfavorable ideas, and adopting stress-relieving adjustments. Being socially active and setting aside time for proper self-care are crucial components of managing generalized anxiety disorder.

The impact of psychological treatment on intolerance of uncertainty in generalized anxiety disorder: A systematic review and meta-analysis

Research has demonstrated a strong link between intolerance of uncertainty and generalized anxiety disorder (GAD). The current systematic review and meta-analysis aimed to evaluate how effective evidence-based psychological treatments are at reducing intolerance of uncertainty for adults with GAD. An extensive literature search identified 26 eligible studies, with a total of 1199 participants with GAD. Psychological treatments (k = 32 treatment groups) yielded large significant within-group effect size from pre- to post-treatment and pre-treatment to follow-up for intolerance of uncertainty (g = 0.88; g = 1.05), as well as related symptoms including worry (g = 1.32; g = 1.45), anxiety (g = 0.94; g = 1.04) and depression (g = 0.96; g = 1.00). Psychological treatment also yielded a large significant between-group effect on intolerance of uncertainty (g = 1.35). Subgroups analysis found that CBT that directly targeted intolerance of uncertainty (CBT-IU) throughout treatment was significantly more effective than general CBT at reducing intolerance of uncertainty (p < 0.01) and worry (p < 0.01) from pre- to post treatment, however, this result was not maintained at follow-up. Meta-regression analyses supported this finding as increases in the amount of time spent directly targeting intolerance of uncertainty, significantly increased the effect size for both intolerance of uncertainty (z = 2.01, p < 0.01) and worry (z = 2.23, p < 0.01). Overall, these findings indicate that psychological treatments are effective at reducing IU, and related symptom measures of GAD.

Vortioxetine in patients with major depressive disorder and high levels of anxiety symptoms: An updated analysis of efficacy and tolerability

BACKGROUND

Patients with major depressive disorder (MDD) often experience comorbid anxiety symptoms. Vortioxetine has demonstrated efficacy in treating anxiety symptoms in patients with MDD; however, efficacy and tolerability have not been assessed across the entire approved dosage range.

METHODS

The efficacy and tolerability of vortioxetine 5-20 mg/day were assessed in patients with MDD and high levels of anxiety symptoms (Hamilton Anxiety Rating Scale [HAM-A] total score ≥ 20) using pooled data from four randomized, fixed-dose, placebo-controlled studies (n = 842). Data from a randomized, double-blind study of vortioxetine 10-20 mg/day versus agomelatine 25-50 mg/day in patients with an inadequate response to prior therapy (n = 299) were analyzed separately. Mean changes from baseline in Montgomery-Åsberg Depression Rating Scale (MADRS), HAM-A, and Sheehan Disability Scale (SDS) total scores were analyzed by vortioxetine dosage.

RESULTS

The pooled analysis of fixed-dose studies demonstrated a clear dose-response relationship for vortioxetine 5-20 mg/day for improvements in MADRS, HAM-A, and SDS total scores. Vortioxetine 20 mg/day demonstrated significant effects versus placebo from week 4 onwards. In the post-hoc analysis of the active-controlled study in patients with an inadequate response to prior therapy, vortioxetine 10-20 mg/day was superior to agomelatine across all outcome measures from week 4 onwards. Up-titration of vortioxetine to 20 mg/day was not associated with an increase in adverse events.

LIMITATIONS

Short-term trials.

CONCLUSIONS

Vortioxetine is efficacious and well tolerated in patients with MDD and high levels of anxiety symptoms, including those with an inadequate response to prior therapy. The greatest therapeutic benefits were observed with vortioxetine 20 mg/day.

TRIAL REGISTRATION

NCT01140906, NCT01153009, NCT01163266, NCT01255787, NCT01488071.

Symptoms of Depression and Anxiety and Subsequent Use of Nicotine and THC in Electronic Cigarettes

BACKGROUND

This study examines whether symptoms of depression, anxiety, or comorbid depression and anxiety are associated with future use of nicotine or THC in e-cigarettes.

METHODS

Data were from an online survey of youth and young adults in urban areas of Texas with complete data (n = 2,307) in spring 2019 (baseline) and spring 2020 (12-month follow-up). Multivariable logistic regression models examined associations between self-reported symptoms of depression, anxiety, or comorbid depression and anxiety at baseline and past 30-day e-cigarette use with nicotine or THC at 12-month follow-up. Analyses adjusted for baseline demographics and baseline past 30-day e-cigarette, combustible tobacco, marijuana, and alcohol use and stratified by race/ethnicity, gender, grade level, and SES.

RESULTS

Participants were 16-23 years old, 58.1% female and 37.9% Hispanic. At baseline, 14.7% reported symptoms of comorbid depression and anxiety, 7.9% depression, and 4.7% anxiety. Prevalence of past 30-day e-cigarette use at 12-month follow-up was 10.4% with nicotine and 10.3% with THC. Symptoms of depression and comorbid depression and anxiety at baseline were significantly associated with both nicotine and THC use in e-cigarettes 12 months later. Symptoms of anxiety were associated with nicotine use in e-cigarettes 12 months later.

CONCLUSIONS

Symptoms of anxiety and depression may be important indicators of future nicotine and THC vaping among young people. Clinicians should be aware of groups most at risk who may benefit from substance use counseling and intervention.

The Contribution of Psychological Inflexibility and Metacognitive Processes to Emotional Distress

Process-based cognitive behavior therapy (PB-CBT) may be informed by identifying shared mechanisms of disorder linked to shared processes of therapeutic change. Repetitive negative thinking (RNT) is a molar pathogenic process common to both generalized anxiety disorder and depression. Acceptance and commitment therapy (ACT) and metacognitive therapy (MCT) offer separate models of the relationship between RNT and emotional distress. In a pair of related studies, the relative degree to which processes specific to the two models accounted for variability in levels of generalized anxiety and depression in college student samples was evaluated. Across both studies, processes of cognitive fusion and obstructed valued living within the ACT model and beliefs about the negative consequences of RNT within the MCT model were most predictive of variability in levels of emotional distress. Limitations of this project as well as implications for further research and practice of PB-CBT for disorders of emotional distress are discussed.

Nonpharmacologic and Pharmacologic Treatments of Adults in the Acute Phase of Major Depressive Disorder: A Living Clinical Guideline From the American College of Physicians

DESCRIPTION

The purpose of this guideline from the American College of Physicians (ACP) is to present updated clinical recommendations on nonpharmacologic and pharmacologic interventions as initial and second-line treatments during the acute phase of a major depressive disorder (MDD) episode, based on the best available evidence on the comparative benefits and harms, consideration of patient values and preferences, and cost.

METHODS

The ACP Clinical Guidelines Committee based these recommendations on an updated systematic review of the evidence.

AUDIENCE AND PATIENT POPULATION

The audience for this guideline includes clinicians caring for adult patients in the acute phase of MDD in ambulatory care. The patient population includes adults in the acute phase of MDD.

RECOMMENDATION 1A

ACP recommends monotherapy with either cognitive behavioral therapy or a second-generation antidepressant as initial treatment in patients in the acute phase of moderate to severe major depressive disorder (strong recommendation; moderate-certainty evidence).

RECOMMENDATION 1B

ACP suggests combination therapy with cognitive behavioral therapy and a second-generation antidepressant as initial treatment in patients in the acute phase of moderate to severe major depressive disorder (conditional recommendation; low-certainty evidence). The informed decision on the options of monotherapy with cognitive behavioral therapy versus second-generation antidepressants or combination therapy should be personalized and based on discussion of potential treatment benefits, harms, adverse effect profiles, cost, feasibility, patients' specific symptoms (such as insomnia, hypersomnia, or fluctuation in appetite), comorbidities, concomitant medication use, and patient preferences.

RECOMMENDATION 2

ACP suggests monotherapy with cognitive behavioral therapy as initial treatment in patients in the acute phase of mild major depressive disorder (conditional recommendation; low-certainty evidence).

RECOMMENDATION 3

ACP suggests one of the following options for patients in the acute phase of moderate to severe major depressive disorder who did not respond to initial treatment with an adequate dose of a second-generation antidepressant: • Switching to or augmenting with cognitive behavioral therapy (conditional recommendation; low-certainty evidence) • Switching to a different second-generation antidepressant or augmenting with a second pharmacologic treatment (see Clinical Considerations) (conditional recommendation; low-certainty evidence) The informed decision on the options should be personalized and based on discussion of potential treatment benefits, harms, adverse effect profiles, cost, feasibility, patients' specific symptoms (such as insomnia, hypersomnia, or fluctuation in appetite), comorbidities, concomitant medication use, and patient preferences.

Differential co-expression networks of the gut microbiota are associated with depression and anxiety treatment resistance among psychiatric inpatients

BACKGROUND

Comorbid anxiety and depression are common and are associated with greater disease burden than either alone. Our recent efforts have identified an association between gut microbiota dysfunction and severity of anxiety and depression. In this follow-up, we applied Differential Co-Expression Analysis (DiffCoEx) to identify potential gut microbiota biomarker(s) candidates of treatment resistance among psychiatric inpatients.

METHODS

In a sample of convenience, 100 psychiatric inpatients provided clinical data at admission and discharge; fecal samples were collected early during the hospitalization. Whole genome shotgun sequencing methods were used to process samples. DiffCoEx was used to identify clusters of microbial features significantly different based on treatment resistance status. Once overlapping features were identified, a knowledge-mining tool was used to review the literature using a list of microbial species/pathways and a select number of medical subject headlines (MeSH) terms relevant for depression, anxiety, and brain-gut-axis dysregulation. Network analysis used overlapping features to identify microbial interactions that could impact treatment resistance.

RESULTS

DiffCoEx analyzed 10,403 bacterial features: 43/44 microbial features associated with depression treatment resistance overlapped with 43/114 microbial features associated with anxiety treatment resistance. Network analysis resulted in 8 biological interactions between 16 bacterial species. Clostridium perfringens evidenced the highest connection strength (0.95). Erysipelotrichaceae bacterium 6_1_45 has been most widely examined, is associated with inflammation and dysbiosis, but has not been associated with depression or anxiety.

CONCLUSION

DiffCoEx potentially identified gut bacteria biomarker candidates of depression and anxiety treatment-resistance. Future efforts in psychiatric microbiology should examine the mechanistic relationship of identified pro-inflammatory species, potentially contributing to a biomarker-based algorithm for treatment resistance.

Association between physical activity and comorbid anxiety/depression in 46 low- and middle-income countries

BACKGROUND

Evidence on the association of low physical activity (PA) with depression or anxiety is well established. Yet, evidence on the association between PA and comorbid anxiety/depression remains scarce, especially in low- and middle-income countries (LMICs). Thus, this study explored this relationship among adults aged ≥18 years from 46 LMICs.

METHODS

Cross-sectional, community-based data were analyzed from the World Health Survey (WHS). Multivariable multinomial logistic regression analysis was conducted to examine the association between low PA and comorbid anxiety/depression with no anxiety or depression as the base category.

RESULTS

237,023 participants [mean (SD) age = 38.4 (16.0) years; 50.8 % female] were included in the analysis. Low PA was significantly associated with depression alone (OR = 1.33; 95%CI = 1.12-1.57) and anxiety alone (OR = 1.37; 95%CI = 1.23-1.53), while the OR was highest among those with comorbid anxiety/depression (OR = 1.75; 95%CI = 1.52-2.01).

CONCLUSION

Low PA is associated with particularly increased odds for comorbid anxiety/depression. Increasing PA may have a beneficial effect on the prevention of comorbid anxiety/depression. However, future longitudinal research establishing the direction of this relationship is warranted.

Sex differences in amygdalohippocampal oscillations and neuronal activation in a rodent anxiety model and in response to infralimbic deep brain stimulation

Introduction

Depression and anxiety are highly comorbid mental disorders with marked sex differences. Both disorders show altered activity in the amygdala, hippocampus, and prefrontal cortex. Infralimbic deep brain stimulation (DBS-IL) has anxiolytic and antidepressant effects, but the underlying mechanisms remain unclear. We aimed to contribute to understanding sex differences in the neurobiology of these disorders.

Methods

In male and female rats, we recorded neural oscillations along the dorsoventral axis of the hippocampus and the amygdala in response to an anxiogenic drug, FG-7142. Following this, we applied DBS-IL.

Results

Surprisingly, in females, the anxiogenic drug failed to induce most of the changes observed in males. We found sex differences in slow, delta, theta, and beta oscillations, and the amygdalo-hippocampal communication in response to FG-7142, with modest changes in females. Females had a more prominent basal gamma, and the drug altered this band only in males. We also analyzed c-Fos expression in both sexes in stress-related structures in response to FG-7142, DBS-IL, and combined interventions. With the anxiogenic drug, females showed reduced expression in the nucleus incertus, amygdala, septohippocampal network, and neocortical levels. In both experiments, the DBS-IL reversed FG-7142-induced effects, with a more substantial effect in males than females.

Discussion

Here, we show a reduced response in female rats which contrasts with the higher prevalence of anxiety in women but is consistent with other studies in rodents. Our results open compelling questions about sex differences in the neurobiology of anxiety and depression and their study in animal models.

Relationship between self-management of patients with anxiety disorders and their anxiety level and quality of life: A cross-sectional study

PURPOSE

To explore the correlation between self-management and anxiety and quality of life in patients with anxiety disorders and to understand whether self-management can influence the relationship between anxiety and quality of life and provide a basis for improving their anxiety and quality of life.

METHODS

A cross-sectional survey of 245 patients with anxiety disorders in West China Hospital of Sichuan University was conducted using the Self-Management of Anxiety Disorders Scale, Self-rating anxiety scale (SAS), and World Health Organization Quality of Life-BBREF. The data were then analyzed using descriptive tests and Pearson correlation in SPSS 25. Bootstrap mediated effects tests were used to test the effect relationship between anxiety, quality of life and self-management scores in patients with anxiety disorders and Amos was used to establish the structural equation model.

RESULTS

The results of the correlation analysis showed that the total self-management score was positively correlated with the total quality of life score (r = 0.695, P <0.001), physical domain score (r = 0.552, P <0.001), psychological domain score (r = 0.661, P <0.001), social relations domain score (r = 0.542, P <0.001), and environmental domain score (r = 0.614, P <0.001). Additionally, it was negatively correlated with SAS score (r = -0.470, P <0.001). Self-management partially mediates the relationship between anxiety and quality of life, and the direct effect value of anxiety on quality of life was -0.44. The indirect effect value of self-management was -0.27, accounting for 38% of the total effect value.

CONCLUSION

Self-management of patients with anxiety disorders was negatively correlated with anxiety and positively correlated with quality of life. It played a partially mediating effect between anxiety and quality of life. We recommend that healthcare providers pay attention to self-management interventions for patients with anxiety disorders to further improve their quality of life.

Distinct Effects of Anxiety and Depression on Updating Emotional Information in Working Memory

Anxiety and depression have been shown to negatively influence the processing of emotional information in working memory. However, most studies have examined anxiety-related or depression-related working memory deficits independently, without considering their high co-morbidity. We tested the effects of emotional valence on working memory performance among healthy young adults with varying levels of anxiety and depressive symptoms. Ninety young adults aged between 18-24 (51 female) completed an emotional 2-back task in which positive, negative, and neutral images were presented. Multi-level modeling was used to examine anxiety and depressive symptoms as predictors of response accuracy and latency across the three emotional valence conditions. The results showed that participants responded to negative images with the highest accuracy and to positive images with the lowest accuracy. Both negative and positive images elicited slower responses than neutral images. Importantly, we found that more severe anxiety symptoms predicted a smaller difference in response accuracy between negative and neutral stimuli, whereas more severe depressive symptoms predicted a larger updating reaction time difference between positive and neutral stimuli. These findings demonstrated the uniquely anxiety-related deficits in processing negative contents and the uniquely depression-related deficits in updating positive contents in working memory, thus highlighting the necessity of novel cognitive bias modification interventions targeting the anxiety-specific and depression-specific deficits in working memory.

The Dynamic Interplay of Anxious and Depressive Symptoms in a Sample of Undergraduate Students

The network perspective on psychopathology suggests that mental disorders can be regarded as networks of elements that influence each other. In this study, we used network analysis to explore the temporal interactions of anxiety and depression symptoms at the level of day-to-day experiences and find potential explanatory pathways for their comorbidity. We collected intensive longitudinal data from a sample of undergraduate students and fitted a Multilevel Vector Autoregressive model on GAD and MDD DSM-5 symptoms. “Sad mood” and “Concentration difficulties” were responsible for the most connections between anxiety and depression symptoms and were also among the most central symptoms. It is possible that anxio-depressive comorbidity can be explained by the presence of “Sad mood” and “Concentration difficulties” and targeting these two symptoms in therapy can lead to beneficial effects in comorbid cases.

Effectiveness of vortioxetine in patients with major depressive disorder and co-morbid generalized anxiety disorder in routine clinical practice: A subgroup analysis of the RELIEVE study

BACKGROUND

Generalized anxiety disorder (GAD) is commonly co-morbid with major depressive disorder (MDD) and is associated with greater functional impairment and poorer treatment outcomes than MDD alone. However, studies on treatment with drugs for depression in patients with MDD and co-morbid GAD are limited.

AIMS

To examine the effectiveness of vortioxetine treatment in patients with MDD and co-morbid GAD in a subgroup analysis of the real-world RELIEVE study.

METHODS

The analysis included outpatients diagnosed with MDD and co-morbid GAD who initiated vortioxetine treatment at their physician's discretion in the 24-week, observational RELIEVE study. Primary outcome was patient functioning (Sheehan Disability Scale (SDS)) after 12 and 24 weeks of vortioxetine treatment; secondary outcomes included depression severity (9-item Patient Health Questionnaire (PHQ-9)), cognitive symptoms (5-item Perceived Deficits Questionnaire - Depression (PDQ-D-5)) and cognitive performance (Digit Symbol Substitution Test (DSST)).

RESULTS

Overall, 180 patients with MDD and co-morbid GAD were included in the analysis. Following vortioxetine initiation, clinically significant improvements in patient functioning (SDS total score) were observed at week 12 (least-squares (LS) mean reduction from baseline, 7.5 points), sustained through week 24 (9.2 points) (both p < 0.0001). LS mean PHQ-9, PDQ-D-5 and DSST scores improved by 7.9, 4.8 and 7.4 points at week 24, respectively (all p < 0.0001 vs baseline). Adverse events were reported by 33.9% of patients (most commonly nausea, 13.3%).

CONCLUSIONS

In routine clinical practice, vortioxetine was associated with clinically meaningful, sustained improvements in functioning, and depressive and cognitive symptoms, in patients with MDD and co-morbid GAD.

CLINICAL TRIALS REGISTRY NAME AND IDENTIFIER

Real-life Effectiveness of Vortioxetine in Depression (RELIEVE) (NCT03555136) https://clinicaltrials.gov/ct2/show/NCT03555136.

Network analysis of comorbid depression and anxiety and their associations with quality of life among clinicians in public hospitals during the late stage of the COVID-19 pandemic in China

BACKGROUND

Mental health problems are common among clinicians working in public hospitals even in the late stage of the COVID-19 pandemic. Network analysis is a novel approach to explore interactions between mental health problems at the symptom level. This study examined the network structure of comorbid depression and anxiety and their associations with quality of life (QOL) among hospital clinicians in China during the late stage of the COVID-19 pandemic.

METHODS

A total of 4931 participants were recruited from October 13 to 22, 2020. The nine-item Patient Health Questionnaire (PHQ-9), seven-item Generalized Anxiety Disorder Scale (GAD-7), and the World Health Organization Quality of Life Questionnaire-Brief Version (WHOQOL-BREF) were used to measure depressive and anxiety symptoms, and QOL, respectively. Central and bridge symptoms were identified with centrality and bridge centrality indices, respectively. Network stability was examined using the case-dropping procedure.

RESULTS

The prevalence of depression (defined as PHQ-9 total score ≥ 5) was 35.1 % [95 % confidence interval (CI) = 33.73-36.41 %)], the prevalence of anxiety (GAD-7 total score ≥ 5) was 32.5 % (95 % CI = 31.20-33.84 %), while the prevalence of comorbid depression and anxiety was 26.9 % (95 % CI = 25.7-28.2 %). "Impaired motor skills", "Trouble relaxing" and "Uncontrollable worry" were the central symptoms in the whole depression-anxiety network. "Irritability", "Feeling afraid" and "Sad mood" were the most key bridge symptoms linking depression and anxiety. Three symptoms ("Fatigue", "Trouble relaxing" and "Nervousness") were the most strongly and negatively associated with QOL. Neither gender nor the experiences of caring for COVID-19 patients was associated with network global strength, distribution of edge weights or individual edge weights.

LIMITATIONS

The causality between variables could not be established. Depressive and anxiety symptoms were assessed by self-report measures, which may result in recall bias and limitations in capturing clinical phenomena.

CONCLUSIONS

Both the central (i.e., "Impaired motor skills", "Trouble relaxing" and "Uncontrollable worry") and bridge symptoms (i.e., "Irritability", "Feeling afraid" and "Sad mood") identified in this network analysis should be targeted in specific treatment and preventive measures for comorbid depressive and anxiety symptoms among clinicians in the late stage of the pandemic. Furthermore, "Fatigue", "Trouble relaxing" and "Nervousness" are key symptoms to address to improve clinicians' QOL.

Depression and work productivity: insights from a longitudinal cohort study on digital care programs for Musculoskeletal conditions

BACKGROUND

Comorbidity between musculoskeletal (MSK) pain and depression is highly common and associated with greater symptom burden and greater loss of work productivity. Multimodal care programs tackling both physical and mental health components may maximize productivity recovery and return to work. Digital delivery of such programs can facilitate access, ensure continuity of care, and enhance patient engagement.

OBJECTIVE

Assess the impact of a completely remote multimodal digital care program (DCP) for MSK pain on mental health and work-related outcomes stratified by baseline depression levels.

METHODS

The present study is an ad-hoc analysis of an interventional, single-arm, cohort study of individuals with MSK pain undergoing a DCP. Three subgroups with different baseline depression severity levels were created based on the Patient Health Questionnaire (PHQ-9): cluster 1 (<5: minimal depression); cluster 2 (5-10: mild depression) and cluster 3 (≥10: moderate depression). The mean change between baseline and end-of-program (8-12 weeks) on depression, anxiety, fear-avoidance beliefs, work productivity and activity impairment and adherence was assessed across subgroups. Outcome changes were analyzed by latent growth curve analysis.

RESULTS

From a total of 7785 eligible participants, 6137 (78.8%) were included in Cluster 1, 1158 (14.9%) in cluster 2 and 490 (6.3%) in cluster 3. Significant improvements in depression and anxiety scores were observed in clusters 2 and 3 but not cluster 1, with average end-of-the program scores in clusters 2 and 3 below the initially defined cluster thresholds (5 and 10 for clusters 2 and 3, respectively). All clusters reported significant improvements in productivity impairment scores (mean changes from -16.82, 95%CI -20.32 to -13.42 in cluster 1 to -20.10, 95%CI -32.64 to -7.57 in cluster 3). Higher adherence was associated with higher improvements in depression in clusters 2 and 3, and with greater recovery in activities of daily living in cluster 3. Overall patient satisfaction was 8.59/10.0 (SD 1.74).

CONCLUSIONS

A multimodal DCP was able to promote improvements in productivity impairment scores comparable to those previously reported in the literature, even in participants with comorbid depression and anxiety. These results reinforce the need to follow a biopsychosocial framework to optimize outcomes in patients with MSK pain.

CLINICALTRIAL

ClinicalTrials.gov NCT04092946; https://clinicaltrials.gov/ct2/show/NCT04092946.

Anxiolytic and antidepressant-like effects of monoterpene tetrahydrolinalool and in silico approach of new potential targets

INTRODUCTION- The drugs currently available for treatment of anxiety and depression act through modulation of the neurotransmission systems involved in the neurobiology of the disorder, yet they of-ten present side effects, which can impair patient adherence to treatment. METHOD- This, has driven the search for new molecules with anxiolytic and antidepressant potential. Aromatic plants are rich in essential oils, and their chemical constituents, such as monoterpenes, are be-ing studied for these disorders. This study aims to evaluate the anxiolytic and antidepressant-like poten-tial of the monoterpene tetrahydrolinalool in in vivo animal models, and review pharmacological targets with validation through molecular docking. Male Swiss mice (Mus musculus) were treated with THL (37.5-600 mg kg-1 p.o.) and submitted to the elevated plus maze, open field, rota rod, and forced swim tests. In the elevated plus-maze, THL at doses of 37.5 and 75 mg kg-1 induced a significant increase in the percentage of entries (72.7 and 64.3% respectively), and lengths of stay (80.3 and 76.8% respective-ly) in the open arms tests. RESULT- These doses did not compromise locomotor activity or motor coordination in the animals. In the open field, rota rod tests, and the forced swimming model, treatment with THL significantly reduced immobility times at doses of 150, 300, and 600 mg kg-1, and by respective percentages of 69.3, 60.9 and 68.7%. CONCLUSION- In molecular docking assay, which investigated potential targets, THL presented sat-isfactory energy values for: nNOs, SGC, IL-6, 5-HT1A, NMDAr, and D1. These demonstrate the po-tential of THL (a derivative of natural origin) in in vivo and in silico models, making it a drug candidate.

Effectiveness of vortioxetine in patients with major depressive disorder comorbid with generalized anxiety disorder: Results of the RECONNECT study

BACKGROUND

Major depressive disorder (MDD) and generalized anxiety disorder (GAD) are frequently comorbid.

AIMS

To assess the effectiveness of vortioxetine in patients with MDD and comorbid GAD.

METHODS

Open-label, 8-week study (NCT04220996) in 100 adult outpatients with severe MDD and severe comorbid GAD receiving vortioxetine as first treatment for the current depressive episode or switching to vortioxetine due to inadequate response to another drug for depression. Vortioxetine starting dosage was 10 mg/day, with forced up-titration to 20 mg/day after 1 week. Response was defined as ⩾50% decrease in Montgomery-Åsberg Depression Rating Scale (MADRS) and/or Hamilton Anxiety Rating Scale (HAM-A) total score from baseline; remission defined as MADRS and/or HAM-A total score ⩽10.

RESULTS

Clinically meaningful and statistically significant improvements from baseline in symptoms of depression and anxiety, and overall functioning and health-related quality of life, were observed after 8 weeks' vortioxetine treatment (all changes p < 0.0001 vs baseline). At week 8, rates of MADRS response and remission were 61% and 35%, respectively. Corresponding rates of HAM-A response and remission were 55% and 42%. Response on both the MADRS and HAM-A scales was achieved by 52% of patients; 31% achieved remission on both scales. Vortioxetine dose up-titration was well tolerated; no unexpected adverse events were reported.

CONCLUSION

Vortioxetine demonstrates effectiveness in significantly reducing symptoms of both depression and anxiety in patients with severe MDD comorbid with severe GAD. Findings support increasing vortioxetine dosage to 20 mg/day early in the course of therapy, and show that this may be achieved without compromising tolerability.

Untangling the tingle: Investigating the association between the Autonomous Sensory Meridian Response (ASMR), neuroticism, and trait & state anxiety

The Autonomous Sensory Meridian Response (ASMR) is an intensely pleasant tingling sensation originating in the scalp and neck and is elicited by a range of online video-induced triggers. Many individuals now regularly watch ASMR videos to relax, and alleviate symptoms of stress and insomnia, all which are indicative of elevated levels of anxiety. Emerging literature suggests that ASMR-capable individuals are characterised by high trait neuroticism, which is associated with a tendency to experience negative emotional states such as anxiety. To date however no literature has empirically linked these personality constructs and watching ASMR videos on the effect of reducing anxiety. In the current study, 36 ASMR-experiencers and 28 non-experiencers watched an ASMR video, and completed assessments of neuroticism, trait anxiety, and pre- / post-video state anxiety. MANCOVA with Group as the independent measures factor showed that ASMR-experiencers had significantly greater scores for neuroticism, trait anxiety, and video engagement than non-experiencers. Pre-video state anxiety was also significantly greater in the ASMR-experiencers and was significantly attenuated on exposure to the ASMR video, whereas non-experiencers reported no difference in state anxiety pre- and post-video. Thus, watching ASMR alleviated state anxiety but only in those who experienced ASMR. Subsequent mediation analyses identified the importance of pre-existing group differences in neuroticism, trait and (pre-video) state anxiety in accounting for the group difference in the reduction of state anxiety. The mediation analysis further lends support for watching ASMR videos as an intervention for the reduction of acute state anxiety. Future areas for research are discussed.

COVID-19 anxiety and quality of life among Iranian nurses

BACKGROUND

The Coronavirus Disease 2019 (COVID-19) pandemic has exposed nurses, who are a very important group involved in the care of these patients, to many stresses that may affect their quality of life. This study aimed to determine the relationship between COVID-19 anxiety and the quality of life among Iranian nurses.

METHOD

This online cross-sectional study enrolled 1,131 of Iranian nurses working at the time of the COVID-19 outbreak in treatment centers in different parts of Iran from April to May 2020. The convenience sampling strategy was used. Data were collected using a demographic questionnaire, the 36-Item Short-Form Health Survey (SF-36), and Corona Disease Anxiety Scale (CDAS). The stepwise multiple linear regression models were used to examine the relationships among self-reported anxiety concerning COVID-19 and SF-36 quality of life, its components, and subscales. Partial r was used as an estimate of effect size.

RESULT

The mean SF-36 score was 65.2 (SD=17.6). The mean score of the mental component summary (MCS) (M=56.8, SD=22.3) was lower than the mean score of the physical component summary (PCS) (M=71.6, SD=17.5). The mean score of COVID-19 anxiety was 17.8 (SD=10.5). Of the participants, 378 (33.4%; 95% CI [30.7%, 36.3%]), and 152 (13.4%; 95% CI [11.5%, 15.6%]) reported moderate and severe anxiety, respectively. According to the results of stepwise multiple linear regression model, after adjusting for possible confounding variables, the SF-36 quality of life was still significantly negatively associated with COVID-19 anxiety, with a large effect size (The partial r = -0.515, p < 0.001). The relationship between the SF-36 components and COVID-19 anxiety were also significant, and moderate to large effect sizes were observed (The partial r for (PCS; COVID-19 anxiety) = -0.404; p < 0.001, and for (MCS; COVID-19 anxiety) = -0.521; p < 0.001). In addition, significant correlation coefficients for every subscale of the SF-36 were found for COVID-19 anxiety and its two components, with small to large effect sizes (The partial correlations= -0.211 to -0.524, all ps< 0.001).

CONCLUSIONS

The results showed that higher COVID-19 anxiety in nurses decreases their quality of life. In order to increase nurses' quality of life during the COVID-19 pandemic, it is recommended to design and implement programs to reduce their COVID-19 anxiety.

Understanding the Complex Interactions between Coffee, Tea Intake and Neurologically Relevant Tissues Proteins in the Development of Anxiety and Depression

OBJECTIVES

Coffee and tea intake might be associated with psychiatry diseases. However, it is unclear whether the effect of coffee/tea on anxiety and depression depending on the different types of proteins.

DESIGN

This was a cross-sectional study.

SETTING

Our datasets were downloaded from online.

PARTICIPANTS

Phenotypic and genotypic data for coffee intake(N=376,196) and tea intake (N=376,078) were derived from UK Biobank. GWAS data of proteins (N=1,537) from neurologically relevant tissues (brain, cerebrospinal fluid (CSF) and plasma) were obtained from a recently published study.

MEASUREMENTS

Multivariate linear analysis was then used to evaluate the potential interaction effect between coffee/tea intake and proteins polygenetic risk score (PRS) on the risks of anxiety and depression controlling for age, sex, Townsend deprivation index (TDI), smoke, drinking and education level.

RESULTS

34 coffee intake-proteins interactions and 15 tea intake-proteins interactions were observed in anxiety individuals, such as coffee intake-c-Jun interaction (β=0.0169, P=4.131×10-3), coffee intake-Fas interaction (β=-0.0190, P=8.132×10-4), tea intake-sL-Selectin interaction (β=0.0112, P=5.412×10-3) and tea intake-IL-1F6 (β=0.0083, P=4.471×10-2). 25 coffee intake-proteins and 14 tea intake-proteins interactions were observed in depression individuals, including coffee intake- IL-1 sRI (β=0.0171, P=4.888×10-3) and coffee intake-NXPH1 interaction (β=0.0156, P=9.819×10-3), tea intake-COLEC12 interaction (β=0.0127, P=3.280×10-3), and tea intake-Layilin interaction (β=0.0117, P=7.926×10-3).

CONCLUSIONS

Our results suggested the important role of multiple proteins in neurologically relevant tissues in the associations between coffee/tea intake and psychiatry diseases, providing entry points to explore the mechanisms underlying anxiety and depression.

Validation of the intolerance of uncertainty scale as a screening tool for perinatal anxiety

Background

To date, there is a significant lack of research validating clinical tools for early and accurate detection of anxiety disorders in perinatal populations. Intolerance of uncertainty was recently identified as a significant risk factor for postpartum anxiety symptoms and is a key trait of non-perinatal anxiety disorders. The present study aimed to validate the Intolerance of Uncertainty Scale (IUS) in a perinatal population and evaluate its use as a screening tool for anxiety disorders.

Methods

Psychiatric diagnoses were assessed in a sample of perinatal women (n = 198), in addition to completing a self-report battery of questionnaires. Psychometric properties including internal consistency and convergent and discriminant validity were assessed. Determination of an optimal clinical cut-off score was measured through a ROC analysis in which the area under the curve, sensitivity, specificity, as well as positive and negative predictive values were calculated.

Results

The IUS demonstrated excellent internal consistency (α = 0.95) and an optimal clinical cut-off score of 64 or greater was established, yielding a sensitivity of 89%. The IUS also demonstrated very good positive (79%) and negative (80%) predictive values.

Conclusions

These findings suggest that the IUS represents a clinically useful screening tool to be used as an aid for the early and accurate detection of perinatal anxiety.

Interpersonal Counseling for College Students: Pilot Feasibility and Acceptability Study

OBJECTIVE

University counseling centers struggle to meet the growing demand for mental health treatment by students in distress. More acutely distressed students typically receive priority, whereas those with mild to moderate depression often face longer wait times and fewer available therapy sessions. For this reason, interpersonal counseling for college students (IPC-C) was created as a brief manualized psychotherapy, suitable for students with mild to moderate depression, that maintains the core components of interpersonal counseling and integrates components from interpersonal psychotherapy for adolescents and other developmentally appropriate techniques. This article describes a pilot trial of IPC-C.

METHODS

IPC-C is delivered in three to six psychotherapy sessions focused on alleviating depressive symptoms and increasing social support. Ten participants from two university counseling centers were recruited to receive IPC-C. The inclusion criterion was a Patient Health Questionnaire-9 (PHQ-9) score of 5-14, indicating mild to moderate depression. Participants completed the PHQ-9 at each session, the College Adjustment Test at baseline and termination, and the IPC Satisfaction Scale at termination.

RESULTS

Nine of the 10 participants completed the study, attending an average of five therapy sessions each. Participants agreed that the number of sessions was appropriate and indicated satisfaction with the IPC-C intervention. Participants exhibited significantly reduced depression severity (Cohen's d=2.45) and significantly improved college adjustment (d=0.92).

CONCLUSIONS

In this pilot trial, IPC-C was found to be a feasible and acceptable intervention for university-based treatment of young adults with mild to moderate depressive symptoms. IPC-C holds promise as a potentially effective intervention for this population and warrants further study in a randomized trial.

Gender differences in prevalence and clinical correlates of anxiety symptoms in first-episode and drug-naïve patients with major depressive disorder

AIM

Gender differences in major depressive disorder (MDD) are commonly reported; however, gender differences in first-episode and drug-naïve (FEDN) patients with major depressive disorder remain unclear. This study aimed to examine potential gender differences in the prevalence and clinical correlates of comorbid anxiety in FEDN patients with MDD.

METHODS

A cross-sectional study was conducted with1718 FEDN patients with MDD. Patients' demographic and clinical data were collected and analyzed using standardized clinical evaluation forms. The Hamilton depression scale (HAMD), Hamilton anxiety scale (HAMA) and Positive and Negative Syndrome Scale (PANSS) were used to evaluate depression, anxiety and psychotic symptoms, respectively.

RESULTS

There were no gender-based differences in the comorbidity rates of MDD and anxiety disorders (male: 10.2% vs. female:12.7%, P = 0.123). The prevalence of MDD with severe anxiety symptoms in male patients was similar to that of female patients (80.8%vs. 80.1%, P = 0.749). Male MDD patients were younger, had earlier age of onset, and were less likely to be married. In both the male and female groups, HAMD scores, HAMA scores, suicide attempts, and psychotic symptoms in patients with severe anxiety symptoms were higher than those patients without severe anxiety symptoms (all p ≤ 0.001). Furthermore, binary logistic regression analysis showed that psychotic symptoms and suicide attempts significantly predicted severe anxiety symptoms in both male and female patients with MDD, while body mass index(BMI)significantly predicted severe anxiety symptoms in MDD females only.

CONCLUSION

Our study showed that there were no gender differences in the prevalence of comorbid anxiety in FEDN patients with MDD. Suicide attempts and psychiatric symptoms were associated with severe anxiety symptoms in both men and women with MDD, whereas BMI was only correlated with severe anxiety symptoms in women.

Revisiting Treatment Options for Depressed Patients with Generalised Anxiety Disorder

Symptoms of anxiety and depression often coexist, and evidence suggests that this has a genetic basis, among other possible causes. However, the current classification of comorbid generalised anxiety disorder (GAD) and depression (anxious depression) in the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition; DSM-5) does not fully reflect the high prevalence of anxiety symptoms in people with depression and the International Classification of Diseases (10th and 11th revisions) has tended to identify anxious depression with minor disorders seen in primary care. As a result, few dedicated therapeutic trials have been conducted in patients with anxious depression, and specific treatment guidelines and recommendations are lacking. Fortunately, there is considerable therapeutic overlap between anxiety and depression, such that many agents with antidepressant efficacy are also effective for symptoms of GAD. The initial treatment of a patient with depression and symptoms of anxiety should be with an agent that is approved for both major depressive disorder and GAD, such as a selective serotonin reuptake inhibitor. There is an obvious need for greater recognition of anxious depression in order to boost the volume of high-quality clinical data, which should translate over time into better, more specific treatment recommendations and improved outcomes.

An International Pilot Study of Self-Reported Quality of Life in Outpatient and Inpatient Mental Health Settings

Introduction: Measuring quality of life (QoL) is essential to understand how clients perceive their care. In practice, many instruments are in place to identify mental health diagnoses and measure treatment outcomes, but there are fewer standardized instruments to routinely collect information about self-reported QoL, especially across different mental health settings. Moreover, existing tools have been criticized for being built from the perspective of care professionals rather than the users' perspective. The 23-item Self-Reported interRAI-QoL Survey for Mental Health and Addictions (interRAI SQoL-MHA) tackles these issues, as it is based on self-reported measures and has proven validity across settings and countries. Objective: The aim of this study is to assess and compare QoL across settings and explore associations between dimensions of self-reported QoL and some items from the interRAI SQoL-MHA in a multinational sample. Settings: Inpatient and community mental health services. Methods: Data were collected from organizations in Belgium, Finland, Russia, Brazil, Rwanda, Canada and Hong Kong. Logistic regression models were constructed using each domain scale of the interRAI SQoL-MHA (relationship, support, hope, activities and relationship with staff) as dependent variables. Results: A total of 2,474 people (51.2% female, 56.7% of age 45 or older) were included in the study. A benchmark analysis showed the samples that performed above the benchmark line or below. The models yielded significant odds ratios among the domain scales, as well as for the items of the interRAI SQoL-MHA, with positive associations for the items "work and education opportunities" and "satisfied with services", and inverse associations for the items "financial difficulties" and for the inpatient setting. Conclusion: The analysis of associations between the determinants offers relevant information to improve mental health care and clients' perceived quality of life. Information about the determinants can help policymakers to design interventions to improve care outcomes, as well as provide more possibilities for integration into the community. The interRAI SQoL-MHA is innovative, as it can be linked to the third generation interRAI MH and Community MH-instruments, to be used in different mental health care settings, combining the objective and subjective QoL domains.

Uptake and impact of journaling program on wellbeing of NICU parents

OBJECTIVE

This pilot study evaluated a brief parent journaling program in the neonatal intensive care unit (NICU).

STUDY DESIGN

Hundred NICU parents were randomized to a control group (no journal) or an intervention group (journal provided). Parents reported pre- and post-intervention anxiety and depression symptoms using the hospital anxiety and depression scale (HADS) and qualitative journal use data. The analysis included Student's paired two-tailed t-test and two-way ANOVA. This study was registered with clinicaltrials.gov on April 1, 2020, NCT04331925.

RESULT

At baseline, clinically significant anxiety was more prevalent than depression (66% vs. 23%). Post-intervention scores were best predicted by baseline scores. Relative to controls, intervention group parents experienced a decrease in anxiety from baseline (t = -1.983, p = 0.056). The same effect was not seen for depression. Most intervention group parents used the journal and provided positive feedback.

CONCLUSION

Journal use rates and positive feedback support the acceptability of a NICU journaling program.

Minocycline as adjunctive treatment for major depressive disorder: Pooled data from two randomized controlled trials

BACKGROUND

Randomized controlled clinical trials that have investigated minocycline as an adjunctive treatment for major depressive disorder have proved promising. Data from two studies were pooled to evaluate more definitively whether the addition of minocycline to standard treatment for major depressive disorder leads to an improvement of depressive symptoms when compared with placebo.

METHODS

Both studies were multi-site, double-blinded, placebo-controlled trials of minocycline 200 mg/day added to treatment as usual during a 12-week period. The primary outcome measure was change in depressive symptoms (Montgomery-Asberg Depression Rating Scale in Dean et al. and Hamilton Depression Rating Scale in Husain et al.). Secondary outcomes were change in depression severity (Montgomery-Asberg Depression Rating Scale for Dean et al. and 9-item Patient Health Questionnaire in Husain et al.), anxiety severity (Hamilton Anxiety Rating Scale in Dean et al. and Generalized Anxiety Disorder 7-item scale in Husain et al.) and functional status, which were also evaluated as potential mediators on the primary outcome.

RESULTS

A total of 112 participants were included in the pooled data (Dean et al., n = 71; Husain et al., n = 41). A significant change from baseline to week 12 was noted in depressive symptoms - differential change (Placebo vs Minocycline): 9.0, 95% confidence interval = [4.2, 13.9], Cohen's D (95% confidence interval): 0.71 [0.29, 1.14], p < 0.001 - anxiety severity - differential change (Placebo vs Minocycline): 0.38, confidence interval = [0.00, 0.75], Cohen's D (95% confidence interval): 0.41 [0.00, 0.82], p = 0.050) and functional status - differential change (Placebo vs Minocycline): 1.0, 95% confidence interval = [0.4, 1.5], Cohen's D (95% confidence interval): 0.76 [0.34, 1.19], p = 0.001). Duration of illness, current use of benzodiazepine and pain medication were identified as moderators, whereas functional status as a mediator/predictor.

CONCLUSION

The improvement of depressive symptoms, anxiety severity and functional status is promising and suggests that minocycline has potential as an adjunctive treatment for major depressive disorder. However, further studies are warranted to confirm therapeutic effects of minocycline in major depressive disorder.

TRIAL REGISTRATIONS

NCT02263872, registered October 2014, and ACTRN12612000283875, registered March 2012.

The Oscillatory Profile Induced by the Anxiogenic Drug FG-7142 in the Amygdala-Hippocampal Network Is Reversed by Infralimbic Deep Brain Stimulation: Relevance for Mood Disorders

Anxiety and depression exhibit high comorbidity and share the alteration of the amygdala–hippocampal–prefrontal network, playing different roles in the ventral and dorsal hippocampi. Deep brain stimulation of the infralimbic cortex in rodents or the human equivalent—the subgenual cingulate cortex—constitutes a fast antidepressant treatment. The aim of this work was: (1) to describe the oscillatory profile in a rodent model of anxiety, and (2) to deepen the therapeutic basis of infralimbic deep brain stimulation in mood disorders. First, the anxiogenic drug FG-7142 was administered to anaesthetized rats to characterize neural oscillations within the amygdala and the dorsoventral axis of the hippocampus. Next, deep brain stimulation was applied. FG-7142 administration drastically reduced the slow waves, increasing delta, low theta, and beta oscillations in the network. Moreover, FG-7142 altered communication in these bands in selective subnetworks. Deep brain stimulation of the infralimbic cortex reversed most of these FG-7142 effects. Cross-frequency coupling was also inversely modified by FG-7142 and by deep brain stimulation. Our study demonstrates that the hyperactivated amygdala–hippocampal network associated with the anxiogenic drug exhibits an oscillatory fingerprint. The study contributes to comprehending the neurobiological basis of anxiety and the effects of infralimbic deep brain stimulation.

Interpersonal Counseling for College Students: Pilot Feasibility and Acceptability Study

OBJECTIVE

University counseling centers struggle to meet the growing demand for mental health treatment by students in distress. More acutely distressed students typically receive priority, whereas those with mild to moderate depression often face longer wait times and fewer available therapy sessions. For this reason, interpersonal counseling for college students (IPC-C) was created as a brief manualized psychotherapy, suitable for students with mild to moderate depression, that maintains the core components of interpersonal counseling and integrates components from interpersonal psychotherapy for adolescents and other developmentally appropriate techniques. This article describes a pilot trial of IPC-C.

METHODS

IPC-C is delivered in three to six psychotherapy sessions focused on alleviating depressive symptoms and increasing social support. Ten participants from two university counseling centers were recruited to receive IPC-C. The inclusion criterion was a Patient Health Questionnaire-9 (PHQ-9) score of 5-14, indicating mild to moderate depression. Participants completed the PHQ-9 at each session, the College Adjustment Test at baseline and termination, and the IPC Satisfaction Scale at termination.

RESULTS

Nine of the 10 participants completed the study, attending an average of five therapy sessions each. Participants agreed that the number of sessions was appropriate and indicated satisfaction with the IPC-C intervention. Participants exhibited significantly reduced depression severity (Cohen's d=2.45) and significantly improved college adjustment (d=0.92).

CONCLUSIONS

In this pilot trial, IPC-C was found to be a feasible and acceptable intervention for university-based treatment of young adults with mild to moderate depressive symptoms. IPC-C holds promise as a potentially effective intervention for this population and warrants further study in a randomized trial.

Predictors and moderators of quality of life in patients with major depressive disorder: An AGTs-MDD study report

Effective and targeted interventions for improving quality of life (QOL) in addition to achieving 'clinical remission' are imperatives for patients with major depressive disorder (MDD). This study aimed to examine potential predictors and moderators of QOL in depression. Data were obtained from the Algorithm Guided Treatment Strategies for Major Depressive Disorder (AGTs-MDD) study, a multisite, randomized controlled trial composed of 980 depressed patients. Mixed Model Repeated Measures (MMRM) analyses were conducted to identify baseline characteristics associated with QOL overall (predictors) and their interaction effects (moderators). Severe core depressive, anxiety and pain symptoms were found to be independently associated with poor QOL over the 12-week acute phase treatment. Severe depression, severe anxiety or pain symptoms, or severe suicidal ideation predicted a larger improvement of QOL during acute phase treatment, whereas males showed less improvement. None of the putative moderators were identified except for the educational level. Patients with lower educational level showed a larger improvement of QOL in the AGT started with escitalopram (AGT-E) group and AGT started with mirtazapine (AGT-M) group compared to the treatment as usual (TAU) group. These findings may help to instruct informed decision-making for heterogeneous patients with MDD in the view of full recovery.

[Comorbidity of depression and anxiety in clinical practice]

OBJECTIVE

The study was the comparative characterization of depressed patients depending on the presence of comorbid anxiety.

MATERIAL AND METHODS

Thirty patients of the Clinic of neuroses named after acad. I.P. Pavlov Clinic of Neuroses. Comparison groups included 15 patients with comorbid anxiety and depressive disorders and 15 patients with depressive disorder without comorbid anxiety. The groups were comparable by sex and age. Clinical-catamnestic, clinical-therapeutic, and clinical-scale methods, including the Hamilton Depression and Anxiety Scales, were used during the study.

RESULTS

The structure of clinically diagnosed comorbid anxiety and depressive disorders was shown to be characterized by high representation of somato-vegetative symptoms and higher level of depression in comparison to depressive disorder without comorbid anxiety. According to psychometric assessment results, the level of anxiety did not differ in comparison groups, while clinically, according to ICD-10 criteria, anxiety was not diagnosed, indicating a discrepancy between clinical and scale assessments of anxiety and depressive disorders and greater accuracy of clinical and scale assessment of the condition. The effectiveness of combined treatment, including psychotropic therapy and psychotherapy, was lower in patients with comorbidity of anxiety and depression according to parameters of the degree of reduction of psychopathological symptoms, duration of treatment, and quality of remission. The structure of incomplete remission was similar in patients with comorbid anxiety and depressive disorders and depression.

CONCLUSION

The obtained data suggest the expediency of continuous systematization of affective disorders and the need to improve the diagnostic criteria of comorbid anxiety and depressive disorders on the basis of combined clinical and scale assessment.

Economic and Humanistic Burden Associated with Depression and Anxiety Among Adults with Non-Communicable Chronic Diseases (NCCDs) in the United States

INTRODUCTION

Patients with both major depressive disorder (MDD) and generalized anxiety disorder (GAD) in addition to one or multiple comorbid non-communicable chronic diseases (NCCDs) face unique challenges. However, few studies have characterized how the burden of co-occurring MDD and GAD differs from that of only MDD or only GAD among patients with NCCDs.

METHODS

In this study, we used Medical Expenditures Panel Survey data from 2010-2017 to understand how the economic and humanistic burden of co-occurring MDD and GAD differs from that of MDD or GAD alone among patients with NCCDs. We used generalized linear models to investigate this relationship and controlled for patient sociodemographics and clinical characteristics.

RESULTS

Co-occurring MDD and GAD was associated with increases in mean annual per patient inpatient visits, office visits, emergency department visits, annual drug costs, and total medical costs. Among patients with 3+ NCCDs, MDD or GAD only was associated with lower odds ratios (ORs) of limitations in activities of daily living (ADLs; 0.532 and 0.508, respectively) and social (0.503, 0.526) and physical limitations (0.613, 0.613) compared to co-occurring MDD and GAD. Compared to patients with co-occurring MDD and GAD, having MDD only or GAD only was associated with significantly lower odds of cognitive limitations (0.659 and 0.461, respectively) in patients with 1-2 NCCDs and patients with 3+ NCCDs (0.511, 0.416).

DISCUSSION

Comorbid MDD and GAD was associated with higher economic burden, lower quality of life, and greater limitations in daily living compared to MDD or GAD alone. Health-related economic and humanistic burden increased with number of NCCDs.

Validation of an 8-item Recovery Assessment Scale (RAS-8) for people with schizophrenia in China

Background

The 24-item Recovery Assessment Scale (RAS) is the most widely-used and well-validated tool for measuring recovery for people with mental illness. The current study aims to assess the reliability and validity of an 8-item short form of RAS (RAS-8) among a Chinese sample of people living with schizophrenia.

Methods

A sample of 400 people living with schizophrenia were recruited for scale validation. Internal consistency was tested by calculating Cronbach's α. Test–retest reliability was calculated using the intraclass correlation coefficient (ICC) for the total score and weighted kappa for each item. Factor structure was tested with confirmatory factor analysis, and concurrent validity was examined by investigating the correlation of the RAS-8 with patient symptoms, disability, depression, anxiety, patient functioning, quality of life and general health.

Results

The RAS-8 full scale and subscales showed good internal consistency with Cronbach’s alpha ranging from 0.87 to 0.92. ICC of 0.99 and weighted kappa ranged from 0.62 to 0.88, which generally indicates good test–retest reliability. The findings supported an a priori two-factor structure, χ²/df = 2.93, CFI = 0.98, TLI = 0.98, RMSEA = 0.07, SRMR = 0.035. Concurrent validity of the RAS-8 was further supported by its significant negative correlations with patient symptoms (r =  −0.24, p < 0.01), disability (r =  −0.30, p < 0.01), depression (r =  −0.16, p < 0.05), and anxiety (r =  −0.14, p < 0.05), and its significant positive relationships with patient functioning (r = 0.26, p < 0.01), quality of life (r = 0.39, p < 0.01) and general health (r = 0.34, p < 0.01).

Conclusions

This study confirmed the reliability and validity of an 8-item short-form RAS for people living with schizophrenia in Chinese communities. The validation of the RAS-8 allows for its use as an alternative for the full RAS as a rapid assessment tool in clinical and research settings. The findings are discussed for their implications for application and validation with other populations and in other countries.

The Relationship between Achievement Motivation and Job Performance among Chinese Physicians: A Conditional Process Analysis

Background

To explore the relationship between achievement motivation and job performance among physicians, this study investigated the impacts of different personality traits on job performance among the physicians.

Methods

This cross-sectional study was conducted in 2017 and 1,523 physicians from eight tertiary grade A hospitals in Harbin, China. The type of data collected included the achievement motivation of the physicians, job performance, organizational commitment, personality traits, and other demographic variables. To assess and compare the demographic data, independent t-test and ANOVA were applied. Further, Pearson correlation coefficients were used to evaluate the correlation among the variables. Moderated mediation analysis was performed to test the correlation among the job performance, achievement motivation, organizational commitment, neuroticism, extraversion, openness, agreeableness, and conscientiousness.

Results

Achievement motivation directly influences job performance and organizational commitment partially mediates the direct effects of achievement motivation on job performance. Additionally, our findings demonstrated that agreeableness and conscientiousness moderate the strength of the relationships between achievement motivation and job performance mediated by organizational commitment.

Conclusion

We propose that hospital managers should pay attention to the personal growth of the physicians and improve their organizational commitment via creating a positive working climate and training for career planning and education. Moreover, managers should identify conscientiousness and agreeableness individuals and increase their responsibilities geared towards improving the performance of the organization.

Preliminary evidence of acylated ghrelin association with depression severity in postmenopausal women

We have previously shown increased depression and anxiety scores in postmenopausal overweight women, when compared to overweight premenopausal women. The mechanisms responsible for these alterations are not understood. Although ghrelin involvement in mood modulation has been suggested, its role is still ambiguous and has not been evaluated in postmenopause. Here we investigated the association of ghrelin with depression and anxiety symptoms in postmenopausal women. Fifty-five postmenopausal women with depression symptoms, who were not in use of hormones or antidepressants, were included in the study. Depression symptoms were evaluated by Beck's Depression Inventory (BDI) and Patient Health Questionnaire-9 (PHQ-9) and anxiety symptoms were evaluated by Beck's Anxiety Inventory (BAI). Women were allocated into three groups, according to BDI classification of mild, moderate, or severe depression symptoms. Anthropometric, biochemical and hormonal parameters were analyzed. Total and acylated ghrelin levels were higher in the severe depression than in the mild depression group. Multivariate regression analyses showed positive associations of BDI scores with acylated ghrelin and BMI, and of PHQ-9 scores with acylated ghrelin and homeostasis model assessment of insulin resistance (HOMA-IR). BAI scores associated positively with waist-to-hip ratio. To the best of our knowledge, this is the first demonstration of an association between acylated ghrelin and the severity of depression symptoms in postmenopausal women. This association may reflect either a physiological response aimed at fighting against depression symptoms or a causal factor of this mental disorder.