Is there a role of depressive symptoms in the fear-avoidance model? A structural equation approach

Cognitive Symptoms Link Anxiety and Depression Within a Validation of the German State-Trait Inventory for Cognitive and Somatic Anxiety (STICSA)

Background

In the present study we aimed to develop a German version of the State-Trait Inventory for Cognitive and Somatic Anxiety (STICSA) and evaluate the psychometric properties. Associations of cognitive and somatic anxiety with other measures of anxiety, depression, and stress, elucidating possible underlying functional connections, were also examined, as symptoms of anxiety, depression and stress often overlap.

Method

Two samples (n1 = 301; n2 = 303) were collected online and in the lab, respectively. Dynamic connections between somatic and cognitive anxiety, other measures of anxiety, depression, and stress, were analyzed using a network approach. Psychometric analyses were conducted using exploratory and confirmatory factor analyses.

Results

We replicated and validated the two-factorial structure of the STICSA with the German translation. Network analyses revealed cognitive trait anxiety as the most central node, bridging anxiety and depression. Somatic trait anxiety exhibited the highest discriminant validity for distinguishing anxiety from depression.

Conclusion

The central role of cognitive symptoms in these dynamic interactions suggests an overlap of these symptoms between anxiety and depression and that differential diagnostics should focus more on anxious somatic symptoms than on cognitive symptoms. The STICSA could therefore be useful in delineating differences between anxiety and depression and for differential assessment of mood and anxiety symptoms. Additional understanding of both cognitive and somatic aspects of anxiety might prove useful for therapeutic interventions.

Validity and reliability of the Turkish version of breathlessness beliefs questionnaire

BACKGROUND

Dyspnea is often the main symptom that limits exercise; however, the vicious cycle of dyspnea limiting exercise participation is also an important contributor to the reduced exercise capacity.

OBJECTIVE

The aim of our study was to investigate the reliability and validity of Turkish Breathlessness Beliefs Questionnaire (BBQ) in patients with Chronic Obstructive Pulmonary Diseases (COPD).

METHODS

Seventy-seven COPD patients were included in the study. Sociodemographic and physical characteristics were recorded. Turkish version of BBQ, Saint George Respiratory Questionnaire (SGRQ) and Hospital Anxiety and Depression Scale (HADS) were applied. Second evaluation of BBQ was conducted via telephone calls with no drop-outs. Reliability of the questionnaire was explored by calculating the internal consistency and test-retest analysis. Construct validity was assessed calculating correlation coefficients of BBQ with HADS and SGRQ scores. Known group validity was also explored.

RESULTS

Cronbach alpha coefficients for total score of BBQ were 0.78, indicating that the questionnaire has 'good' internal consistency. Initial and test-retest BBQ total scores were 41.42 ± 6.47 and 41.18 ± 6.24, respectively. Intra-class correlation coefficients (ICC_2,1) values of BBQ and its sub-scales varied between 0.973 and 0.983, indicating strong test-retest reliability. Correlation coefficient between BBQ total and SGRQ-Activity (0.619) was highest among the variables of interest, followed by BBQ total and SGRQ total (0.611). There was a significant correlation between BBQ total and HADS (0.390). One-way analysis of variance revealed that BBQ total and BBQ-Activity Avoidance scores were significantly differ in disease stages.

CONCLUSION

Turkish version of BBQ was found to be a valid and reliable tool for measuring dysfunctional beliefs related to the dyspnea in patients with COPD.

Kinesiophobia And Related Factors In Adult Patients With Familial Mediterranean Fever

Objective Kinesiophobia is a common problem in patients with rheumatic diseases and can cause physical inactivity, social isolation, disability, and poor quality of life. This study aimed to evaluate kinesiophobia and associated factors in patients with familial Mediterranean fever (FMF).

Methods A total of 38 patients diagnosed with FMF volunteered to participate in the study. All patients were assessed using the Tampa Kinesiophobia Scale (TKS), the International Physical Activity Questionnaire (IPAQ), the Fatigue Severity Scale (FSS), and the Hospital Anxiety and Depression Scale (HADS).

Results Thirty-three (86.8%) of the patients had TKS scores over 37, indicating high levels of kinesiophobia. The TKS score was positively correlated with the HADS depression score (r=0.530; p=0.001) and the FSS score (r=0.340; p=0.035) but was not significantly associated with age (r=0.102; p=0.543), disease duration (r=–0.110; p=0.511), body mass index (r=0.283; p=0.085), the HADS anxiety score (r=0.306; p=0.061), or the IPAQ score (r=–0.097; p=0.563).

Conclusions Our sample of adult FMF patients showed high levels of kinesiophobia associated with fatigue and depression. Treatments focusing on kinesiophobia in FMF patients could help to increase the effectiveness of rehabilitation.

Modeling compliance with COVID-19 prevention guidelines: the critical role of trust in science

The coronavirus pandemic is one of the biggest health crises of our time. In response to this global problem, various institutions around the world had soon issued evidence-based prevention guidelines. However, these guidelines, which were designed to slow the spread of COVID-19 and contribute to public well-being, are (deliberately) disregarded by some individuals. In the present study, we aimed to develop and test a multivariate model that could help us identify individual characteristics that make a person more/less likely to comply with COVID-19 prevention guidelines. A total of 525 attentive participants completed the online survey. The results of structural equation modeling (SEM) show that COVID-19 risk perception and trust in science both independently predict compliance with COVID-19 prevention guidelines, while the remaining variables in the model (political conservatism, religious orthodoxy, conspiracy ideation and intellectual curiosity) do so via the mediating role of trust in science. The described model exhibited an acceptable fit (χ²(1611) = 2485.84, p < .001, CFI = .91, RMSEA = .032, SRMR = .055). These findings thus provide empirical support for the proposed multivariate model and underline the importance of trust in science in explaining the different levels of compliance with COVID-19 prevention guidelines.

Impact of Different Illness Perceptions and Emotions Associated with Chronic Back Pain on Anxiety and Depression in Patients Qualified for Surgery

BACKGROUND

Anxiety and depression are known comorbidities of chronic back pain. Their psychological predictors are not well established in patients with chronic back pain qualified for neurosurgery.

AIMS

The purpose of this study was to determine the psychological predictors of depression and anxiety in patients with chronic back pain qualified for surgery.

DESIGN

This was a cross-sectional study.

SETTINGS

A neurosurgical ward in Gdańsk, Poland.

PARTICIPANTS/SUBJECTS

All patients who were admitted to the neurosurgical ward and met the inclusion criteria were recruited for the study. Finally, 83 patients with chronic back pain waiting for surgery were recruited.

METHODS

A battery of questionnaires, including Illness Perceptions Questionnaire-Revised, Multidimensional Health Locus of Control Scale, Hospital Anxiety and Depression Scale, and Brief Pain Inventory, was used in 83 spinal surgery candidates.

RESULTS

Higher anxiety was predicted by stronger beliefs about negative consequences of illness (β = .205, p < .05), worse illness coherence (β = .204, p < .05), negative emotional representations of illness (β = .216, p < .05), and depression (β = .686, p < .001). Higher depression was predicted by anxiety (β = .601, p < .001), pain interference (β = .323, p < .01), lower personal control over pain (β = -.160, p < .05), and lower external control of health (β = -.161, p < .05) but, surprisingly, higher internal control of health (β = .208, p < .01).

CONCLUSIONS

Anxiety and depression commonly coexist in chronic back pain sufferers qualified for spine surgery but are derived from dissimilar beliefs. The results highlight the usefulness of advising about the disease and treatment in comprehensive care for this group of patients.

A Network Analysis of the Links Between Chronic Pain Symptoms and Affective Disorder Symptoms

BACKGROUND

A range of psychological constructs, including perceived pain, self-efficacy, and pain avoidance, have been proposed to account for the comorbidity of chronic pain and affective disorder symptoms. Despite the likely inter-relation among these constructs, few studies have explored these predictors simultaneously. As such, the relative contributions of these psychological influences remain an open question.

PURPOSE

The present study uses a novel, network model approach to help to identify the key psychological contributors to the pain-affective disorder link.

METHOD

A cross-sectional design was implemented. The sample comprised 169 individuals with chronic pain (M_age 49.82; range 22-80 years; 58% female) admitted to a metropolitan chronic pain clinic in Victoria, Australia. Participants completed self-report measures of anxiety, depressive, and pain symptoms, pain self-efficacy, fear avoidance beliefs, perceived control, and pain-related disability.

RESULTS

Network analysis identified self-efficacy, fear avoidance, and perceived disability as key constructs in the relationship between pain and affective disorder symptoms, albeit in different ways. While self-efficacy appeared to have direct links to other constructs in the network model, fear avoidance and perceived disability seemed to function more as mediators, linking other constructs in the model. Perceived control and anxiety were found to be less influential in the model.

CONCLUSIONS

Present findings identify self-efficacy, fear avoidance, and perceived disability as plausible candidate variables to target to disrupt the link between pain experience and affective disorder symptoms. However, further testing with longitudinal designs is needed to confirm this.

Can muscle weakness and disability influence the relationship between pain catastrophizing and pain worsening in patients with knee osteoarthritis? A cross-sectional study

OBJECTIVE

To verify if the relationship between pain catastrophizing and pain worsening would be mediated by muscle weakness and disability in patients with symptomatic knee osteoarthritis.

METHODS

This was a cross-sectional study in a hospital out-patient setting. Convenience sampling was used with a total of 50 participants with symptomatic knee osteoarthritis. Pain and the activities of daily livings (ADL) were assessed using the Knee Injury and Osteoarthritis Outcome Score (KOOS) subscale. Pain catastrophizing was assessed using the Coping Strategy Questionnaire (CSQ) subscale. Muscle strength of knee extension and 30-s chair stand test (30CST) were also assessed. Path analysis was performed to test the hypothetical model. Goodness of fit of models were assessed by using statistical parameters such as the chi-square value, goodness of fit index (GFI), adjusted goodness of fit index (AGFI), comparative fit index (CFI), and root mean square error of approximation (RMSEA).

RESULTS

The chi-square values were not significant (chi-square=0.283, p=0.594), and the indices of goodness of fit were high, implying a valid model (GFI=1.000; AGFI=0.997; CFI=1.000; RMSEA=0.000). Pain was influenced significantly by muscle strength and ADL; muscle strength was influenced significantly by ADL via 30CST; ADL was influenced by pain catastrophizing.

CONCLUSION

The relationship between pain catastrophizing with pain worsening are mediated by muscle weakness and disability.

The associations between psychological distress and healthcare use in patients with non-cardiac chest pain: does a history of cardiac disease matter?

BACKGROUND

Psychological distress such as somatization, fear of body sensations, cardiac anxiety and depressive symptoms is common among patients with non-cardiac chest pain, and this may lead to increased healthcare use. However, the relationships between the psychological distress variables and healthcare use, and the differences in relation to history of cardiac disease in these patients has not been studied earlier. Therefore, our aim was to explore and model the associations between different variables of psychological distress (i.e. somatization, fear of body sensations, cardiac anxiety, and depressive symptoms) and healthcare use in patients with non-cardiac chest pain in relation to history of cardiac disease.

METHODS

In total, 552 patients with non-cardiac chest pain (mean age 64 years, 51% women) responded to the Patient Health Questionnaire-15, Body Sensations Questionnaire, Cardiac Anxiety Questionnaire, Patient Health Questionnaire-9 and one question regarding number of healthcare visits. The relationships between the psychological distress variables and healthcare visits were analysed using Structural Equation Modeling in two models representing patients with or without history of cardiac disease.

RESULTS

A total of 34% of the patients had previous cardiac disease. These patients were older, more males, and reported more comorbidities, psychological distress and healthcare visits. In both models, no direct association between depressive symptoms and healthcare use was found. However, depressive symptoms had an indirect effect on healthcare use, which was mediated by somatization, fear of body sensations, and cardiac anxiety, and this effect was significantly stronger in patients with history of cardiac disease. Additionally, all the direct and indirect effects between depressive symptoms, somatization, fear of body sensations, cardiac anxiety, and healthcare use were significantly stronger in patients with history of cardiac disease.

CONCLUSIONS

In patients with non-cardiac chest pain, in particular those with history of cardiac disease, psychological mechanisms play an important role for seeking healthcare. Development of interventions targeting psychological distress in these patients is warranted. Furthermore, there is also a need of more research to clarify as to whether such interventions should be tailored with regard to history of cardiac disease or not.

Relationship of depression in participants with nonspecific acute or subacute low back pain and no-pain by age distribution

BACKGROUND AND PURPOSE

Nonspecific low back pain (LBP) is the most prevalent musculoskeletal condition in various age ranges and is associated with depression. The aim of this study was to determine the Beck Depression Inventory (BDI) scores in participants with nonspecific LBP and no-pain by age distribution.

METHODS

A case-control study was carried out following the Strengthening the Reporting of Observational Studies in Epidemiology criteria. A sample of 332 participants, divided into the following age categories: 19-24 (n=11), 25-39 (n=66), 40-64 (n=90), 65-79 (n=124), and ≥80 (n=41) years was recruited from domiciliary visits and an outpatient clinic. The BDI scores were self-reported in participants with nonspecific acute or subacute (≤3 months) LBP (n=166) and no-pain (n=166).

RESULTS

The BDI scores, mean ± standard deviation, showed statistically significant differences (p<0.001) between participants with nonspecific acute or subacute LBP (9.590±6.370) and no-pain (5.825±5.113). Significantly higher BDI scores were obtained from participants with nonspecific acute and subacute LBP in those aged 40-64 years (p<0.001; 9.140±6.074 vs 4.700±3.777) and 65-79 years (p<0.001; 10.672±6.126 vs 6.210±5.052). Differences were not significant in younger patients aged 19-24 (p=0.494; 5.000±2.646 vs 8.250±7.498), 25-39 (p=0.138; 5.440±5.245 vs 3.634±4.397), and in those aged ≥80 years (p=0.094; 13.625±6.1331 vs 10.440±5.591).

CONCLUSION

Participants with nonspecific acute and subacute LBP present higher BDI depression scores, influenced by age distribution. Specifically, patients in the age range from 40 to 80 years with LBP could require more psychological care in addition to any medical or physical therapy. Nevertheless, physical factors, different outcomes, and larger sample size should be considered in future studies.

Avoidance behavior associated with depressive symptoms in patients with implantable cardioverter defibrillators

Objective: Many patients with implantable cardioverter defibrillators experience depressive symptoms. In addition, avoidance behavior is a common problem among patients with implantable cardioverter defibrillators. We examined the association between avoidance behaviors and depressive symptoms in patients with implantable cardioverter defibrillators. Method: We conducted a single-center, cross-sectional study with self-completed questionnaires between May 2010 and March 2011. We measured avoidance behaviors (avoidance of places, avoidance of objects, and avoidance of situations) and depressive symptoms (using the Beck Depression Inventory, Version II) in 119 participants. An avoidance behaviors instrument was developed for this study and we confirmed its internal consistency reliability. Results: Ninety-two (77.3%) patients were aged older than 50 years, and 86 (72.3%) were men. Fifty-one (42.9%) patients reported "avoidance of places", 34 (28.6%) reported "avoidance of objects", and 63 (52.9%) reported "avoidance of activity". Avoidance behavior was associated with increased odds for the presence of depressive symptoms (OR 1.31; 95% CI 1.06-1.62). Conclusions: This was the first study to identify the relationship between avoidance behavior and depressive symptoms among patients with implantable cardioverter defibrillators; however, there are a few methodological limitations.